TY 2014 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)	(F) Estimated amount of other compensation from the organization and related organizations
(1) JOHN S GRUBE........................................................................ CHAIR	1.00 .......................7.00	X	X		0	0
(2) STEVE LACKEY........................................................................ SECRETARY	1.00 .......................0.00	X	X		0	0
(3) MIKE ALDREDGE........................................................................ MEMBER	1.00 .......................0.00	X			0	0
(4) SR LOIS ANNE PALKERT OSF........................................................................ MEMBER	2.00 .......................0.00	X			0	0
(5) ODETTE BOLANO........................................................................ PRES/CEO, EX-OFFICIO TRUSTEE, PART YR	1.00 .......................48.00	X	X		457,998	0
(6) JAMES P SCHUESSLER........................................................................ INTERIM PRES/CEO, EX-OFFICIO TRUSTEE STARTING 9/9/	1.00 .......................48.00	X	X		106,000	0
(7) KATHLEEN KRUSIE........................................................................ COO	1.00 .......................48.00	X	X		380,185	28,372
(8) JEFFERY BARNHART........................................................................ ADMINISTRATOR THRU 02/14	40.00 .......................0.00	X	X		28,745	577
(9) MICHAEL ZILM........................................................................ ADMINISTRATOR THRU 05/14	40.00 .......................0.00	X	X		77,785	0
(10) MARK RIGGINS........................................................................ ADMINISTRATOR STARTING 05/14	40.00 .......................0.00	X	X		136,325	22,366
(11) DANIEL GOGGIN........................................................................ CFO	1.00 .......................48.00		X		373,307	28,371
(12) HERMAN BLANTON........................................................................ CHIEF MEDICAL OFFICER	1.00 .......................48.00			X	186,685	11,721
(13) MICHAEL RUSSO........................................................................ VP/INFORMATION SERVICES	1.00 .......................48.00			X	250,010	28,109
(14) MICHAEL COSTA........................................................................ VP/HUMAN RESOURCES	1.00 .......................48.00			X	244,613	27,503
(15) STEVE CRICHTON........................................................................ VP/SUPPORT SERVICES	1.00 .......................48.00			X	200,310	19,140
(16) DONOVAN FRENCH........................................................................ VP STRATEGY & SERVICE LINES	1.00 .......................48.00			X	176,646	15,552
(17) RICARDO DIAZ........................................................................ VP/CLINICAL SUPPORT	1.00 .......................48.00			X	230,876	22,008

(A) Name and business address	(B) Description of services	(C) Compensation
BRAZOS VALLEY EMERGENCY PHYSICIANS PA 6300 LA CALMA DR STE 200 AUSTIN,TX78752	PHYSICIAN SERVICES	372,274
CONCORD MEDICAL GROUP PO BOX 489 MULESHOE,TX79347	PHYSICIAN SERVICES	319,938
DMS IMAGING INC 415 LOCKHAVEN DRIVE HOUSTON,TX77073	MRI SERVICES	105,480


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 3

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 domestic organizations and domestic governments. See Part IV, line 21 ....
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ....
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16 ............
4	Benefits paid to or for members ....
5	Compensation of current officers, directors, trustees, and key employees ....
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....
7	Other salaries and wages ....	4,384,903	3,806,137	578,766
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	126,259	109,594	16,665
9	Other employee benefits .......	648,507	562,910	85,597
10	Payroll taxes ...........	320,871	278,519	42,352
11	Fees for services (non-employees):
a	Management ......	375,257		375,257
b	Legal .........
c	Accounting ...........	40,878		40,878
d	Lobbying ...........	2,519		2,519
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ....	1,442,905	1,186,399	256,506
12	Advertising and promotion ....	42,700	1,806	40,894
13	Office expenses .......	604,844	519,410	85,434
14	Information technology ......	12,802	12,802
15	Royalties ..
16	Occupancy ...........	2,416,982	2,023,314	393,668
17	Travel ............	65,514	39,870	25,644
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	525	525
20	Interest ...........	16,376		16,376
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization .....	576,472	486,672	89,800
23	Insurance ..............	110,875		110,875
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	PROVISION FOR BAD DEBTS	1,755,835	1,755,835
b	MED SUPPLIES & DRUGS	848,604	847,378	1,226
c	LICENSE & FEES	32,258	24,985	7,273
d	DUES AND SUBSCRIPTIONS	19,185	5,925	13,260
e	All other expenses	16,841	7,781	9,060
25	Total functional expenses. Add lines 1 through 24e	13,861,912	11,669,862	2,192,050	0
26	Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here if following SOP 98-2 (ASC 958-720).

Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
	1	Cash–non-interest-bearing .............	93,431	1	796,162
2	Savings and temporary cash investments .........		2
3	Pledges and grants receivable, net ...........		3
4	Accounts receivable, net .............	3,148,033	4	6,407,824
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
			5
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
			6
7	Notes and loans receivable, net .............		7
8	Inventories for sale or use ..............	277,957	8	244,115
9	Prepaid expenses and deferred charges ..........	55,818	9	47,846
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,300,857
b	Less: accumulated depreciation .....	10b	103,396	2,147,306	10c	2,197,461
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....		12
13	Investments—program-related. See Part IV, line 11 .....	100	13
14	Intangible assets ...............		14	209,082
15	Other assets. See Part IV, line 11 ...........	198,578	15	1,606,946
16	Total assets. Add lines 1 through 15 (must equal line 34)......	5,921,223	16	11,509,436
	17	Accounts payable and accrued expenses .........	612,155	17	558,710
18	Grants payable .................		18
19	Deferred revenue ................		19	1,300,000
20	Tax-exempt bond liabilities .............		20
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..........		22
23	Secured mortgages and notes payable to unrelated third parties ..	1,800,000	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....................	1,424,442	25	1,313,061
26	Total liabilities. Add lines 17 through 25.........	3,836,597	26	3,171,771
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	2,084,526	27	6,937,521
28	Temporarily restricted net assets ...........	100	28	1,400,144
29	Permanently restricted net assets ...........		29
	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 ...........	2,084,626	33	8,337,665
34	Total liabilities and net assets/fund balances ........	5,921,223	34	11,509,436

- TIN:

SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service

Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section 4947(a)(1) nonexempt charitable trust.
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Attach to Form 990 or Form 990-EZ.
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Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization

BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

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 in lines 11a through 11d that describes the type of supporting organization and complete lines 11e, 11f, and 11g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations .............................

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

(i)Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i)Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

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

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.)..
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 section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2013 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2014. 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—2013. 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—2014. 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 VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2013. 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 VI 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) 2014

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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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) 2010	(b) 2011	(c) 2012	(d) 2013	(e) 2014	(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 VI.) ..
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 section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2014 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2013 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2014 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2013 Schedule A, Part III, line 17 .............

19a

33 1/3% support tests—2014. 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—2013. 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) 2014

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 11 of Part I. If you checked 11a of Part I, complete Sections A and B. If you checked 11b of Part I, complete Sections A and C. If you checked 11c of Part I, complete Sections A, D, and E. If you checked 11d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 11a or 11b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations....

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed, (ii) the reasons for each such action, (iii) the authority under the organization's organizing document authorizing such action, and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (a) its supported organizations; (b) individuals that are part of the charitable class benefited by one or more of its supported organizations; or (c) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in IRC 4958(c)(3)(C)), a family member of a substantial contributor, or a 35-percent controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part II of Schedule L (Form 990).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9(a)) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9(a)) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of IRC 4943 because of IRC 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Schedule A (Form 990 or 990-EZ) 2014

Page 5

Part IV

Supporting Organizations (continued)

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (1) a written notice describing the type and amount of support provided during the prior tax year, (2) a copy of the Form 990 that was most recently filed as of the date of notification, and (3) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2014

Page 6

Part V – Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

1. Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970. See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6
7	Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2014

Page 7

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2014 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2014	(iii) Distributable Amount for 2014
1 Distributable amount for 2014 from Section C, line 6
2 Underdistributions, if any, for years prior to 2014 (reasonable cause required--see instructions)
3 Excess distributions carryover, if any, to 2014:
a From 2009.......X
b From 2010.......X
c From 2011.......X
d From 2012.......X
e From 2013.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2014 distributable amount
i Carryover from 2009 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2014 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2014 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2014, if any. Subtract lines 3g and 4a from line 2 (if amount greater than zero, see instructions)
6 Remaining underdistributions for 2014. Subtract lines 3h and 4b from line 1 (if amount greater than zero, see instructions)
7 Excess distributions carryover to 2015. Add lines 3j and 4c.
8 Breakdown of line 7:
a From 2010.......X
b From 2011.......X
c From 2012.......X
d From 2013.......
e From 2014.......

Schedule A (Form 990 or 990-EZ) (2014)

Schedule A (Form 990 or 990-EZ) 2014

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

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

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

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

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

OMB No. 1545-0047

2014

Name of the organization

BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

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, contributions totaling $5,000 or more (in money or
property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) 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), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 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 an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled 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 totaling $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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 2

Name of organization BELLVILLE ST JOSEPH HEALTH CENTER

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	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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 3

Name of organization BELLVILLE ST JOSEPH HEALTH CENTER

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) (2014)

Schedule B (Form 990, 990-EZ, or 990-PF) (2014)

Page 4

Name of organization
BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

Part III

Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10)
that total more than $1,000 for the year from any one contributor. 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) (2014)

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Political Campaign and Lobbying Activities

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

Complete if the organization is described below. SchCMd Bullet

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

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

OMB No. 1545-0047

2014

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) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

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

Name of the organization

BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

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) 2014

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2011	(b) 2012	(c) 2013	(d) 2014	(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) 2014

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

2,519

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

2,519

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
PART II-B, LINE 1:	THE ORGANIZATION PAID DUES TO THE AMERICAN HOSPITAL ASSOCIATION, TEXAS HOSPITAL ASSOCIATION, AND TEXAS ORGANIZATION OF RURAL & COMMUNITY HOSPITALS, OF WHICH A PORTION OF THOSE DUES WERE USED FOR LOBBYING ACTIVITIES.

Schedule C (Form 990 or 990EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

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

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

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 value of contributions to (during year)
3	Aggregate value of 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)

Revenue 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:

Revenue 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) 2014

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, for escrow or custodial account liability?

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 .................
b	Buildings ................	2,988		2,988
c	Leasehold improvements ............	221,478		221,478
d	Equipment ................	1,880,810	103,396	1,777,414
e	Other .................	195,581		195,581
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				2,197,461

Schedule D (Form 990) 2014

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
(1) DUE FROM AFFILIATES- SHORT TERM				41,353
(2) DUE FROM AFFILIATES- LONG TERM				165,449
(3) INTEREST IN ASSETS OF THE FOUNDATION				1,400,144






Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				1,606,946

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
PAYABLE TO HEALTH INS. PROGRAMS		222,293
DUE TO AFFILIATES		165,449
PAYABLE TO RELATED PARTY		925,319






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		1,313,061
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) 2014

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 (losses) 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

PART X, LINE 2:

THE SYSTEM, THE HOSPITAL, THE FOUNDATION, SJM, BURLESON, BSJM, MADISON, BELLVILLE, SHP, ACO, AND SJPA ARE 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. ALLIANCE IS A FOR-PROFIT CORPORATION INCORPORATED UNDER THE TEXAS BUSINESS CORPORATION ACT. FEDERAL INCOME TAX RETURNS ARE FILED ON A SEPARATE-ENTITY BASIS. THERE ARE NO MATERIAL UNRECORDED TAX LIABILITIES AT DECEMBER 31, 2014 OR 2013.

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE H (Form 990)

Department of the TreasuryInternal Revenue Service

Hospitals

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

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 50000.0000000000 %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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? ......

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		(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) ..	48,976	35,807	13,169	0.110 %
b	Medicaid (from Worksheet 3, column a) ....	146,610	86,047	60,563	0.500 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	195,586	121,854	73,732	0.610 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4) ..
f	Health professions education (from Worksheet 5) ..
g	Subsidized health services (from Worksheet 6) ..
h	Research (from Worksheet 7)
i	Cash and in-kind contributions for community benefit (from Worksheet 8)
j	Total. Other Benefits ..
k	Total. Add lines 7d and 7j .	195,586	121,854	73,732	0.610 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2014

Schedule H (Form 990) 2014

Page

Part II

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

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

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. ......

1,755,835

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. ......

175,584

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).....

2,050,826

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

3,712,830

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

-1,662,004

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) 2014

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 (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	BELLVILLE ST JOSEPH HEALTH CENTER 44 NORTH CUMMINGS BELLVILLE,TX77418 WWW.ST-JOSEPH.ORG/BELLVILLE 100120	X	X	X

Schedule H (Form 990) 2014

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)

	BELLVILLE GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a State as a hospital facility in the current tax year or the immediately preceding tax year?.......................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C..........

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 12....................

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 significant 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 Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 14

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 Section C 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 Section C................................

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

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.ST-JOSEPH.ORG/WORKFILES/EXECUTIVEREPORT_AUSTINCOUNTY_FINAL.PDF

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. .............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 13

Is the hospital facility's most recently adopted implementation strategy posted on a website? ........

Yes

If "Yes" (list url): HTTP://WWW.ST-JOSEPH.ORG/WORKFILES/2013BELLVILLESJCBREPORT.PDF

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)? ...........................

12a

If "Yes" to line 12a, did the organization file Form 4720 to report the section 4959 excise tax? ......

12b

If "Yes" to line 12b, 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) 2014

Page

Part VFacility Information (continued)

	BELLVILLE GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Financial Assistance Policy (FAP)

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 200.000000000000%
and FPG family income limit for eligibility for discounted care of 500.000000000000%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application.

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application.

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process.

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications.

Other (describe in Section C)

Included measures to publicize the policy within the community served by the hospital facility?.......

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

The FAP application form was widely available on a website (list url):

A plain language summary of the FAP was widely available on a website (list url):

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Notice of availability of the FAP was conspicuously displayed throughout the hospital facility

Notified members of the community who are most likely to require financial assistance about availability of the FAP

Other (describe in Section C)

Billing and Collections

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 all of the actions the hospital facility or other authorized party may take upon non-payment?..................................

Yes

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:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Schedule H (Form 990) 2014

Page

Part VFacility Information (continued)

	BELLVILLE GENERAL HOSPITAL
Name of hospital facility or letter of facility reporting group

Yes

Did the hospital facility or other 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?.........

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 18. (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)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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 Section C)

Other (describe in Section C)

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 Section C)

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 Section C.

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 Section C.

Schedule H (Form 990) 2014

Page

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16i, 18d, 19d, 20e, 21c, 21d, 22d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
BELLVILLE GENERAL HOSPITAL	PART V, SECTION B, LINE 5: THE ASSESSMENT COVERED AUSTIN COUNTY. RESIDENTS OF THESE COUNTIES PARTICIPATED IN INTERVIEWS, HOUSEHOLD SURVEYS, AND COMMUNITY DISCUSSION GROUPS (CDG'S). A SECONDARY DATA ANALYSIS AND COMPILATION WAS ALSO COMPLETED BY THE CENTER FOR COMMUNITY HEALTH DEVELOPMENT. THE FULL CHNA CAN BE FOUND AT HTTP://WWW.ST-JOSEPH.ORG/WORKFILES/EXECUTIVEREPORT_AUSTINCOUNTY_FINAL.PDF.
BELLVILLE GENERAL HOSPITAL	PART V, SECTION B, LINE 11: ACCESS TO AVAILABLE HEALTH RESOURCES/OTHER COMMUNITY RESOURCES/LACK OF TRANSPORTATION/INCREASING RATES OF REPORTED CHRONIC DISEASE. BELLVILLE ST. JOSEPH IS ADDRESSING THE FOLLOWING SIGNIFICANT HEALTH NEEDS FOR THEIR SERVICE AREA: ESTABLISHING A HEALTH RESOURCE CENTER IN AUSTIN COUNTY THROUGH COLLABORATION WITH LOCAL BUSINESSES, CHURCHES, CIVIC GROUPS, AND OTHER ORGANIZATIONS. WILL OFFER HEALTH AND WELLNESS RESOURCES, HEALTH CARE MARKETPLACE OPTIONS FOR INSURANCE ENROLLMENT (TARGETING THE UNINSURED), JOB ASSISTANCE, TRANSPORTATION, AND EDUCATION ON A VARIETY OF HEALTH AND COMMUNITY TOPICS. ONGOING SIGNIFICANT ISSUES BEING ADDRESSED: HOST CHRONIC DISEASE MANAGEMENT EDUCATIONAL PROGRAMS FOR AREA RESIDENTS; OFFER PREVENTIVE AND SPECIALTY HEALTH SCREENINGS TO LOW-INCOME, UNINSURED, AND MEDICALLY UNDERSERVED RESIDENTS; OFFERING COMMUNITY INJURY PREVENTION PROGRAMS; PARTICIPATE IN COMMUNITY HEALTH FAIRS IN COLLABORATION WITH OTHER COMMUNITY STAKEHOLDERS; PROVIDE FREE MAMMOGRAMS AND EDUCATION TO UNINSURED/UNDERINSURED WOMEN IN AUSTIN COUNTY.A FULL COPY OF THE IMPLEMENTATION PLAN CAN BE LOCATED AT HTTP://WWW.ST-JOSEPH.ORG/WORKFILES/2013BELLVILLESJCBREPORT.PDF.
BELLVILLE GENERAL HOSPITAL	PART V, SECTION B, LINE 13H: A FINANCIALLY INDIGENT PATIENT IS A PERSON WHO IS UNINSURED OR UNDERINSURED AND IS ACCEPTED FOR CARE WITH NO OBLIGATION OR A DISCOUNTED OBLIGATION TO PAY FOR SERVICES RENDERED BASED ON THE HOSPITAL'S ELIGIBILITY CRITERIA. TO BE ELIGIBLE FOR CHARITY CARE AS A FINANCIALLY INDIGENT PATIENT, A PERSON'S GROSS ANNUAL INCOME SHALL BE AT OR BELOW 200 PERCENT OF THE FEDERAL POVERTY GUIDELINES AND HAVE NO ALTERNATIVE RESOURCES AVAILABLE. THE HOSPITAL MAY CONSIDER OTHER FINANCIAL ASSETS AND LIABILITIES OF THE PERSON WHEN DETERMINING ELIGIBILITY.A MEDICALLY INDIGENT PATIENT IS A PERSON WHO'S MEDICAL OR HOSPITAL BILLS AFTER PAYMENT BY THIRD-PARTY PAYORS EXCEED A SPECIFIC PERCENTAGE OF THE PERSON'S ANNUAL GROSS INCOME AND WHO IS UNABLE TO PAY THE REMAINING BILL. THE HOSPITAL MAY CONSIDER OTHER ASSETS AND LIABILITIES OF THE PERSON WHEN DETERMINING ABILITY TO PAY. TO BE ELIGIBLE FOR CHARITY CARE AS A MEDICALLY INDIGENT PATIENT, THE PATIENT'S GROSS ANNUAL INCOME MUST BE GREATER THAN 200 PERCENT BUT LESS THAN OR EQUAL TO 500 PERCENT OF THE FEDERAL POVERTY LEVEL AND THE AMOUNT OWED BY THE PATIENT ON THE HOSPITAL BILL AFTER PAYMENT BY THIRD PARTY PAYERS MUST EXCEED 10 PERCENT OF THE PATIENT'S GROSS ANNUAL INCOME. IN THESE INSTANCES, THE HOSPITAL MAY DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE GRANTED TO THESE PATIENTS AS SET FORTH IN THE HOSPITAL'S FINANCIAL ASSISTANCE ELIGIBILITY DISCOUNT GUIDELINES. TO QUALIFY AS CATASTROPHIC MEDICAL INDIGENCE, THE PATIENT'S REMAINING BILL MUST BE NO GREATER THAN 50 PERCENT OF THE PATIENT'S GROSS ANNUAL INCOME AND THE PATIENT'S INCOME MUST BE GREATER THAN 500 PERCENT OF THE FEDERAL POVERTY GUIDELINES. IN THESE INSTANCES, THE HOSPITAL MAY DETERMINE THE AMOUNT OF FINANCIAL ASSISTANCE GRANTED TO THESE PATIENTS IN ACCORDANCE WITH THE HOSPITAL'S FINANCIAL ASSISTANCE ELIGIBILITY DISCOUNT GUIDELINES. A DETERMINATION OF A PATIENT'S ABILITY TO PAY THE REMAINDER OF THE BILL WILL BE BASED ON WHETHER THE PATIENT CAN REASONABLY BE EXPECTED TO PAY THE ACCOUNT IN FULL OVER A TWO-YEAR PERIOD. IF A DETERMINATION IS MADE THAT A PATIENT HAS THE ABILITY TO PAY THE REMAINDER OF THE BILL, SUCH A DETERMINATION DOES NOT PREVENT A RE-ASSESSMENT OF THE PATIENT'S ABILITY TO PAY AT A LATER DATE.THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION OFFERING A CHARITY CARE PROGRAM. THE HOSPITAL WILL NOT DISCRIMINATE ON THE BASIS OF RACE, ANCESTRY, RELGION, NATIONAL ORIGIN, CITIZENSHIP STATUS, AGE, DISABILITY, OR GENDER IN ITS CONSIDERATION OF A PATIENT'S QUALIFICATION FOR CHARITY CARE. THE CLASSIFICATION OF A PATIENT AS BEING ELIGIBLE FOR CHARITY CARE SHALL OCCUR AT THE TIME SUFFICIENT INFORMATION HAS BEEN OBTAINED TO VERIFY THE PATIENT'S INABILITY TO PAY FOR NEEDED MEDICAL SERVICES, AND AS SOON AS POSSIBLE AFTER THE PATIENT FIRST PRESENTS FOR SERVICES OR INDICATES AN INABILITY TO PAY FOR SERVICES. THIS PATIENT'S IDENTIFICATION PROCESS INCLUDES PATIENTS WITH THIRD-PARTY COVERAGE (I.E., INSURANCE, MEDICARE, ETC.) WHERE THE PATIENT HAS A RESPONSIBILITY FOR PAYMENT AND HAS AN INABILITY TO PAY THE HOSPITAL. PERSONNEL SHALL ATTEMPT TO IDENTIFY ALL CASES THAT QUALIFY AS CHARITY PATIENTS AT THE TIME OF PRE-REGISTRATION OR ADMISSION. PATIENTS IDENTIFIED AS POSSIBLE CHARITY CARE PATIENTS WILL BE GIVEN AN APPLICATION AND POLICY GUIDELINES, TOGETHER WITH DIRECTIONS ON COMPLETING THE PAPERWORK AND ANY ADDITIONAL DOCUMENTATION NEEDED TD CONSIDER THE APPLICATION. THE PATIENT WILL ALSO BE GIVEN CONTACT INFORMATION FOR THE APPROPRIATE PERSONNEL TO WHOM THEY SHOULD RETURN THE APPLICATION. APPLICANTS MUST FULLY COOPERATE AND COMPLY WITH ELIGIBILITY REQUIREMENTS FOR ANY OTHER HEALTHCARE PROGRAM(S) FOR WHICH THEY MAY BE QUALIFIED PRIOR TO THEIR EVALUATION FOR CHARITY CARE. FEDERAL AND/OR STATE ASSISTANCE MAY BE AVAILABLE TO THOSE WHO MEET QUALIFICATIONS BEFORE CHARITY CARE IS CONSIDERED, ALL AVAILABLE AVENUES OF ASSISTANCE FROM THIRD-PARTY PAYORS MUST BE EXHAUSTED. ALL SERVICES MUST BE MEDICALLY NECESSARY IN ORDER TO QUALIFY FOR A CHARITY CARE DISCOUNT (E.G., ELECTIVE PROCEDURES SUCH AS COSMETIC SURGERY DO NOT QUALIFY FOR A CHARITY DESIGNATION). ELIGIBLE SERVICES WILL BE BASED ON THOSE SERVICES FOR WHICH MEDICARE PROVIDES COVERAGE. PATIENTS OR THE RESPONSIBLE PARTY MUST VERIFY THE INCOME REPORTED ON THE FINANCIAL ASSISTANCE APPLICATION IN ACCORDANCE WITH THE DOCUMENTATION REQUIREMENTS SET FORTH BELOW. IN ORDER TO BE CONSIDERED FOR CHARITY CARE, CREDIT REPORT AND INCOME INFORMATION MAY BE OBTAINED REGARDING THE PATIENT. THE HOSPITAL MAY OBTAIN A CREDIT REPORT ON PATIENTS TO CONFIRM THE INCOME DOCUMENTATION PATIENT PROVIDES ELIGIBILITY. DOCUMENTATION MUST BE MAINTAINED IN THE PATIENT'S FINANCIAL FILE. IN ADDITION TO THE CREDIT REPORT, THE HOSPITAL MAY OBTAIN, FOR EACH PATIENT, ONE OR MORE OF THE FOLLOWING DOCUMENTS IN ORDER TO DETERMINE INCOME AND ASSETS OF THE PATIENT: 1. IRS FORM W-2, 2. WAGE AND EARNINGS STATEMENT, 3. PAYCHECK REMITTANCE, 4. INDIVIDUAL TAX RETURNS, 5. UNEMPLOYMENT INSURANCE, 6. SOCIAL SECURITY AWARD LETTER, OR CO PAY OF SOCIAL SECURITY CHECK, 7. TELEPHONE VERIFICATION BY EMPLOYER OF THE PATIENTS INCOME, 8. VETERAN'S ADMINISTRATION LETTER, OR COPY OF VA CHECK, 9. PHYSICIAN DISABILITY STATEMENT LISTING TERM OF DISABILITY AND DOCUMENTATION OR PROOF OF THREE OR MORE MONTHS WITH NO INCOME FOR THE PERIOD OF DISABILITY, 10. BANK ACCOUNTS AND RECORDS, OR 11. OTHER APPROPRIATE INDICATORS OF YEARLY, MONTHLY, WEEKLY, OR HOURLY INCOME BY THE PROVISION OF DOCUMENTATION SHOWING CURRENT PARTICIPATION IN A PUBLIC BENEFIT PROGRAM SUCH AS WORKER'S COMPENSATION, MEDICAID, COUNTY INDIGENT HEALTH PROGRAM, TANF, WIC, TEXAS HEALTHY KIDS, CHILDREN'S HEALTH INSURANCE PROGRAM, UNEMPLOYMENT COMPENSATION DETERMINATION LETTER, UNEMPLOYMENT INSURANCE, OR OTHER SIMILAR INDIGENCY-RELATED PROGRAMS. PROOF OF PARTICIPATION IN ANY OF THE ABOVE PROGRAMS INDICATES THAT THE PATIENT HAS BEEN DEEMED FINANCIALLY INDIGENT AND THEREFORE, IS NOT REQUIRED TO PROVIDE HIS OR HER "GROSS MONTHLY INCOME" OF THE FINANCIAL ASSISTANCE APPLICATION, OR PROVIDE ANY OF THE INCOME DOCUMENTATION VERIFICATION LISTED ABOVE. THE HOSPITAL MAY ALSO USE THIRD-PARTY VERIFICATION OF A PATIENT'S PARTICIPATION IN A PUBLIC BENEFIT PROGRAM IF THE CHARITY CARE APPLICANT IS UNABLE TD PROVIDE THAT DOCUMENTATION.
BELLVILLE GENERAL HOSPITAL	PART V, SECTION B, LINE 22D: THE MAXIMUM AMOUNT THAT WILL BE CHARGED TO A PATIENT WHO HAS BEEN DEEMED ELIGIBLE FOR ST. JOSEPH'S FINANCIAL ASSISTANCE PROGRAM IS BASED UPON THEIR INCOME LEVEL. FOR PATIENTS WHOSE INCOME IS LESS THAN 200% OF THE FEDERAL POVERTY GUIDELINES, THE PATIENT WILL HAVE NO FINANCIAL OBLIGATION FOR THE SERVICES RECEIVED. FOR PATIENTS WHOSE INCOME IS GREATER THAN OR EQUAL TO 200% OF FPG BUT LESS THAN 250% OF FPG, THEIR OBLIGATION WILL BE 10% OF BILLED CHARGES, NOT TO EXCEED 20% OF THE PATIENT'S ANNUAL FAMILY INCOME. 10% OF BILLED CHARGES HAS BEEN DETERMINED TO BE WELL BELOW THE AVERAGE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES. FOR PATIENTS WHO QUALIFY FOR CATASTROPHIC FINANCIAL ASSISTANCE, THEIR OBLIGATION WILL BE 20% OF BILLED CHARGES, NOT TO EXCEED 20% OF THE PATIENT'S ANNUAL FAMILY INCOME. 20% OF BILLED CHARGES HAS BEEN DETERMINED TO BE WELL BELOW THE AVERAGE OF THE THREE LOWEST NEGOTIATED COMMERCIAL INSURANCE RATES.
PART V, SECTION B, LINE 16	FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY
BELLVILLE GENERAL HOSPITAL PART V, SECTION B, LINE 16A WEBSITE:	HTTP://WWW.ST-JOSEPH.ORG/FINANCIALASSISTANCEPOLICY
BELLVILLE GENERAL HOSPITAL PART V, SECTION B, LINE 16B WEBSITE:	HTTP://WWW.ST-JOSEPH.ORG/FINANCIALASSISTANCEPOLICY

Schedule H (Form 990) 2014

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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?1
Name and address		Type of Facility (describe)
1	MEDICAL CLINIC OF BELLVILLE 235 W PALM SUITE 108 BELLVILLE,TX77418	RURAL HEALTH CLINIC
2
3
4
5
6
7
8
9
10

Schedule H (Form 990) 2014

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
PART I, LINE 6A:	ST. JOSEPH REGIONAL HEALTH CENTER - EIN 74-1282696
PART I, LINE 7:	A COST-TO-CHARGE RATIO WAS USED TO COMPLETE THE CHARITY CARE (LINE 7A) PROGRAM. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2 THAT ACCOMPANIES THE INSTRUCTIONS TO THIS SCHEDULE. COST ACCOUNTING DATA AND GENERAL LEDGER AMOUNTS, LESS BAD DEBT AND COST OF CHARITY CARE, WERE USED TO COMPLETE THE OTHER MEANS TESTED GOVERNMENT PROGRAMS (LINE 7B & LINE 7C) LINES.
PART I, LN 7 COL(F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 24A - BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE SCHEDULE H, PART I, COLUMN F PERCENTAGE EQUALS $1,755,835.
PART III, LINE 2:	THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2, IS THE BAD DEBT EXPENSE REPORTED ON FORM 990, PART IX.
PART III, LINE 3:	THE BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY FINANCIAL ASSISTANCE IS ESTIMATED TO BE 10% OF TOTAL BAD DEBT EXPENSE THAT WOULD HAVE QUALIFIED FOR CHARITY CARE HAD APPLICATIONS BEEN COMPLETED.
PART III, LINE 4:	ACCOUNTS RECEIVABLE FINANCIAL STATEMENT FOOTNOTE:PATIENT RECEIVABLES CONSIST OF AMOUNTS DUE FROM THIRD-PARTY PAYORS, INCLUDING FEDERAL AND STATE INDEMNITY AND MANAGED CARE PROGRAMS, MANAGED CARE HEALTH PLANS AND COMMERCIAL INSURANCE COMPANIES, AND INDIVIDUAL PATIENTS FOR HEALTH CARE SERVICES RENDERED. THE SYSTEM DOES NOTREQUIRE COLLATERAL OR OTHER SECURITY ON ITS PATIENT RECEIVABLES. PATIENT ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR DOUBTFUL ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE SYSTEM ANALYZES ITS HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON SPECIFIC ACCOUNTS, HISTORICAL WRITE-OFF EXPERIENCE, AND CURRENT MARKET CONDITIONS. THE RESULTS OF THIS REVIEW THEN ARE USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR BAD DEBTS IN ORDER TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, WHICH INCLUDE BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLES AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL, THE SYSTEM RECORDS A PROVISION FOR BAD DEBTS ON THE BASIS OF ITS PAST EXPERIENCE. THE DIFFERENCE BETWEEN THE STANDARD RATES AND THE AMOUNT ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS.
PART III, LINE 8:	THE AMOUNTS REPORTED FOR MEDICARE ARE FROM THE MEDICARE COST REPORT - WHICH IS BASED ON THE METHODOLOGY REQUIRED FOR COMPLETING THE MEDICARE COST REPORT. LINE 7 SHOULD BE TREATED AS A COMMUNITY BENEFIT IN THAT THE HOSPITAL TREATS PATIENTS REGARDLESS OF THE REIMBURSEMENT BY MEDICARE.
PART III, LINE 9B:	IN ACCORDANCE WITH ST JOSEPH HEALTH SYSTEM POLICY #17: ST JOSEPH HEALTH SYSTEM HAS ESTABLISHED THE FOLLOWING PAYMENT OPTIONS TO ASSIST GUARANTORS OF PATIENT ACCOUNTS IN DISCHARGING THEIR FINANCIAL REPONSIBILITIES TO THE HOSPITAL. A COMPLETED FINANCIAL ASSISTANCE (UNCOMPENSATED SERVICES) APPLICATION ACCOMPANIED BY THE REQUIRED DOCUMENTATION WHICH ESTABLISHED THE QUALIFICATIONS FOR A FINANCIAL ASSISTANCE (CHARITY) DISCOUNT AT OR PRIOR TO THE DELIVERY OF HEALTH CARE SERVICES IF THE SERVICES ARE SCHEDULED. IF UNSCHEDULED SERVICES ARE PROVIDED, THE FINANCIAL ASSISTANCE APPLICATION AND DOCUMENTATION MUST BE COMPLETED AND PROVIDED TO A ST JOSEPH HEALTH SYSTEM TEAM MEMBER AT THE DATE DETERMINED BY THE ST JOSEPH HEALTH SYSTEM TEAM MEMBER. FINANCIAL ASSISTANCE COLLECTION PROCESS - UNTIL FINANCIAL ASSISTANCE APPLICATION (CHARITY CARE/UNCOMPENSATED CARE) HAS BEEN DETERMINED EITHER BY A COMPLETED AND APPROVED FINANCIAL ASSISTANCE APPLICATION OR BY THE PATIENT/RESPONSIBLE PARTY'S RESIDENCE BEING IN AN IMPOVERISHED ZIP CODE WHICH QUALIFIES FOR FINANCIAL ASSISTANCE PER THE SYSTEM FINANCIAL ASSISTANCE POLICY (SJHS #70), THE STANDARD COLLECTION PROCESS REQUIRING PAYMENT FOR THE ACCOUNT WILL BE ENFORCED. LASTLY, A PATIENT MAY QUALIFY AS UN UNINSURED PATIENT AND RECEIVE A DISCOUNT FROM BILLED CHARGES IF THEY ARE NOT CURRENTLY RECEIVING ASSISTANCE UNDER ST JOSEPH HEALTH SYSTEM'S FINANCIAL ASSISTANCE POLICY, AND EITHER THE PATIENT MUST NOT HAVE ANY HEALTH INSURANCE COVERAGE OR THE PROCEDURE TO THE PATIENT MUST NOT BE COVERED BY THE HEALTH INSURANCE BENEFITS, AS CONFIRMED BY THE HEALTH BENEFITS PLAN.
PART VI, LINE 2:	IN AUSTIN COUNTY, THE TEXAS AGRICULTURAL EXTENSION SERVICE CONDUCTED A COUNTY-WIDE NEEDS ASSESSMENT IN 2011. PRIORITY ISSUES IDENTIFIED IN THAT NEEDS ASSESSMENT INCLUDED FALL SAFETY FOR ELDERLY ADULTS, POSITIVE PARENTING, OVERWEIGHT/OBESITY, AND DOMESTIC VIOLENCE. THE BELLVILLE HOSPITAL DISTRICT IS PART OF THE REGIONAL HEALTHCARE PARTNERSHIP PLAN, REGION #3, WHICH INCLUDES AUSTIN COUNTY AND THE GREATER HARRIS COUNTY AREA. IN 2014, A COMMUNITY NEEDS ASSESSMENT FOR BELLVILLE AND AUSTIN COUNTY WILL BE COMPLETED AND USED FOR CREATING A NEW COMMUNITY BENEFIT PLAN AND GOALS FOR BELLVILLE ST. JOSEPH HEALTH CENTER.
PART VI, LINE 3:	INFORMATION CONCERNING FINANCIAL ASSISTANCE FOR PATIENTS IS COMMUNICATED VIA CONSENT FOR ADMISSION AND REGISTRATION COMPLETION, SIGNAGE POSTED IN EMERGENCY ROOMS AND OTHER CONSPICUOUS PATIENT TRAFFIC AREAS, FIANCIAL COUNSELORS, PATIENT COMMUNICATIONS, PATIENT BILLS AND ST JOSEPH HEALTH SYSTEM WEBSITE.
PART VI, LINE 4:	BELLVILLE ST. JOSEPH HEALTH CENTER SERVES BELLVILLE AND THE SURROUNDING COMMUNITIES IN AUSTIN COUNTY WHICH COVERS 656 SQUARE MILES OF WHICH 647 SQUARE MILES IS LAND AND 10 SQUARE MILES IS WATER. AUSTIN COUNTY WAS FOUNDED IN 1837 AND WAS NAMED FOR STEPHEN F. AUSTIN WHO IS KNOWN AS THE FATHER OF TEXAS. AUSTIN COUNTY IS ABOUT AN HOUR NORTHWEST OF THE HOUSTON METROPOLITAN AREA. IT IS SURROUNDED BY WASHINGTON COUNTY (NORTH), WALLER COUNTY (EAST), FORT BEND COUNTY (SOUTHEAST), WHARTON COUNTY (SOUTH), COLORADO COUNTY (WEST), AND FAYETTE COUNTY (NORTHWEST). AUSTIN COUNTY IS INCLUDED IN THE HOUSTON-THE WOODLANDS-SUGARLAND TEXAS METROPOLITAN AREA. BELLVILLE IS THE COUNTY SEAT. ACCORDING TO THE 2013 CENSUS ESTIMATES, THE POPULATION OF AUSTIN COUNTY IS 28,847 WITH 63.8% WHITE/CAUCASIAN, 9.6% BLACK/AFRICAN AMERICAN, 25.5% HISPANIC/LATINO, AND 1.1% OTHER. THE AGE DISTRIBUTION OF AUSTIN COUNTY IS 30.6% AGE 0-18, 52.1% AGE 19-64, AND 17.3% AGE 65 AND ABOVE. THE MEDIAN HOUSEHOLD INCOME FOR THE PERIOD 2008-2012 WAS $51,340. THE PERCENTAGE OF PERSONS BELOW POVERTY LEVEL, FOR THE PERIOD OF 2008-2012 WAS 9.1%. THE PERCENTAGE OF PERSONS AGE 25+, FOR THE PERIOD OF 2008-2012, WHO WERE HIGH SCHOOL GRADUATES OR HIGHER WAS 83.5%. THE PERCENTAGE OF PERSONS AGE 25+, FOR THE PERIOD OF 2008-2012, HAVING A BACHELORS DEGREE OR HIGHER WAS 18.6%. IN 2013 THERE WERE 12,907 HOUSING UNITS IN AUSTIN COUNTY. FOR THE PERIOD 2008-2012, THE HOMEOWNERSHIP RATE WAS 76.2%. THE MEDIAN VALUE OF OWNER-OCCUPIED HOUSING UNITS FOR THE PERIOD OF 2008-2012 WAS $153,000. THE PERCENTAGE OF MULTI-UNIT HOUSING STRUCTURES DURING THE PERIOD OF 2008-2012 WAS 7.8%.
PART VI, LINE 5:	BELLVILLE ST. JOSEPH HEALTH CENTER IS AN ACUTE CARE FACILITY LOCATED IN BELLVILLE WHICH PROVIDES INPATIENT, OUTPATIENT, AND EMERGENCY CARE SERVICES. PRIMARY CARE SERVICES ARE OFFERED TO AUSTIN COUNTY RESIDENTS THROUGH TWO CLINICS; THE MEDICAL CLINIC OF BELLVILLE, WHICH IS A DESIGNATED RURAL HEALTH CLINIC, AND BELLVILLE ST. JOSEPH INTERNAL MEDICINE CLINIC. EACH YEAR THE HOSPITAL PARTNERS WITH THE CITY OF BELLVILLE POLICE DEPARTMENT, THE VOLUNTEER FIRE DEPARTMENT, AND AUSTIN COUNTY EMS TO PROVIDE A DRUG AND SAFETY EDUCATION PROGRAM AT THE PRIMARY SCHOOL LEVEL. IN MAY 2013 OVER 350 CHILDREN FROM THE AUSTIN COUNTY AREA PARTICIPATED IN THE 6TH ANNUAL YOUTH AND SAFETY DAY. THIS EVENT IS A COLLABORATIVE EFFORT BETWEEN THE TEXAS A & M AGRILIFE EXTENSION SERVICES, THE DEPARTMENT OF STATE HEALTH SERVICES, COLORADO-AUSTIN-WALLER CHILD FATALITY REVIEW TEAM, AND BELLVILLE ST. JOSEPH HEALTH CENTER WHICH ALLOWS STUDENTS TO PARTICIPATE IN A VARIETY OF INTERACTIVE SAFETY EDUCATION PRESENTATIONS INCLUDING WATER SAFETY, SNAKE AWARENESS, FIREARM SAFETY, ELECTRICITY SAFETY, AND PASSENGER SAFETY. IN OCTOBER 2013 THE HOSPITAL WAS SELECTED AS ONE OF FIVE HOSPITALS ACROSS THE STATE OF TEXAS TO IMPLEMENT THE PILOT PROGRAM JUST DRIVE THAT FOCUSES ON DISTRACTED DRIVING HABITS AND STRESSES THE CONSEQUENCES OF TEXTING AND TELEPHONING WHILE DRIVING. THE PROGRAM WAS COORDINATED BY THE TEXAS EMS TRAUMA & ACUTE CARE FOUNDATION IN CONJUNCTION WITH THE COLLEGE OF MEDIA AND COMMUNICATIONS AT TEXAS TECH UNIVERSITY AND RUNS THROUGHOUT THE SCHOOL YEAR. IN 2013 BELLVILLE ST. JOSEPH HEALTH CENTER TEAM MEMBERS BEGAN WORKING ON STROKE CERTIFICATION FOR THE FACILITY AS PART OF THEIR COMMITMENT TO IMPROVE STROKE CARE IN THE COMMUNITY. EDUCATION PROGRAMS ARE ALSO A CONTINUING PART OF STROKE PREVENTION EDUCATION FOR ALL COMMUNITY RESIDENTS. THE HOSPITAL HAS A PATIENT EDUCATION PROCESS FOR ALL PATIENTS OFFERING COUNSELING AND LITERATURE ON TOBACCO CESSATION. HOSPITAL DIETITIANS PROVIDE THE NUTRITIONAL COMPONENT OF A FIVE-WEEK DO WELL, BE WELL WITH DIABETES EDUCATIONAL PROGRAM FOCUSING ON MANAGING DIABETES THROUGH PROPER MEAL PLANNING AND SELF-CARE MANAGEMENT. THE HOSPITAL SUPPORTS SPECIAL HEALTH AND WELLNESS EVENTS IN THE COMMUNITY SUCH AS THE ANNUAL BACK TO SCHOOL HEALTH FAIR, PINK EVENT, AND THE ANNUAL MOTHERS DAY MIRACLE RUN. THE HOSPITAL ALSO COLLABORATES WITH THE LOCAL LIONS CLUB EVERY SPRING TO HOST THE FIRST STOP ON THE ANNUAL MS 150 BIKE RIDE FROM HOUSTON TO AUSTIN, PROVIDING SUPPLIES AND PREPARING FOOD FOR THE RIDERS. THE HOSPITAL IS A REGISTERED SAFE SITTER SITE, WITH FIVE SAFE SITTER INSTRUCTORS WHO ARE REGISTERED NURSES FOR TRAINING 11 TO 13 YEAR OLDS TO BECOME BABY SITTERS.
PART VI, LINE 6:	- JOSEPH REGIONAL HEALTH CENTER (SJRHC) IS THE ANCHOR FACILITY FOR ST JOSEPH HEALTH SYSTEM, A HEALTH MINISTRY OF THE SISTERS OF ST FRANCIS OF SYLVANIA, OHIO. ESTABLISHED IN 1936, SJRHC IS A 255-BED HEALTH CARE CENTER OFFERING THE COMMUNITY'S LEAD LEVEL III TRAUMA CENTER, AN EXTENSIVE INPATIENT AND OUTPATIENT SURGERY PROGRAM, AND IS KNOWN THROUGHOUT THE REGION FOR ITS CARDIAC, CANCER, AND REHABILITATION PROGRAMS. - GRIMES ST JOSEPH HEALTH CENTER (GSJHC) IS A 25-BED CRITICAL ACCESS HOSPITAL IN NAVASOTA, TEXAS OFFERING A LEVEL IV TRAUMA CENTER, INPATIENT, OUTPATIENT, AND DAY SURGERY SERVICES. THE HOSPITAL WAS ESTABLISHED BY GRIMES COUNTY AND HAS BEEN AN INTEGRAL PART OF THE COMMUNITY SINCE ITS INCEPTION. IN 1996 IT BECAME PART OF ST. JOSEPH REGIONAL HEALTH CENTER. ST. JOSEPH HAS A LONG-TERM LEASE TO MANAGE AND OPERATE GSJHC, WHICH IS OWNED BY GRIMES COUNTY.THE OTHER FACILITIES IN THE ST JOSEPH HEALTH SYSTEM ARE AS FOLLOWS: - BURLESON ST JOSEPH HEALTH CENTER (BSJHC) IS A 25-BED CRITICAL ACCESS HOSPITAL IN CALDWELL, TEXAS OFFERING A LEVEL IV TRAUMA CENTER, INPATIENT AND OUTPATIENT SERVICES. THE HOSPITAL WAS ESTABLISHED BY BURLESON COUNTY AND HAS BEEN AN INTEGRAL PART OF THE COMMUNITY SINCE ITS INCEPTION. IT JOINED THE ST JOSEPH HEALTH SYSTEM IN 1995. ST JOSEPH HAS A LONG-TERM LEASE TO MANAGE AND OPERATE BURLESON ST JOSEPH HEALTH CENTER, WHICH IS OWNED BY THE BURLESON COUNTY HOSPITAL DISTRICT AND PROVIDES SERVICES TO AN UNDER-SERVED RURAL COMMUNITY. - MADISON ST. JOSEPH HEALTH CENTER (MSJHC) IS A 25-BED CRITICAL ACCESS HOSPITAL IN MADISONVILLE, TEXAS OFFERING A LEVEL IV TRAUMA CENTER, INPATIENT AND OUTPATIENT SERVICES. THE HOSPITAL WAS ESTABLISHED BY MADISON COUNTY AND HAS BEEN AN INTEGRAL PART OF THE COMMUNITY SINCE ITS INCEPTION. IT JOINED THE ST. JOSEPH HEALTH SYSTEM IN 1995. ST. JOSEPH OWNS AND OPERATES MSJHC, WHICH SERVES MADISON AND THE SURROUNDING COUNTIES.ALL THREE CRITICAL ACCESS HOSPITALS PROVIDE COMPREHENSIVE CARE IN A GENERAL ACUTE CARE HOSPITAL SETTING, OFFERING INPATIENT AS WELL AS OUTPATIENT SERVICES IN EMERGENCY CARE, THERAPY AND ATHLETIC INJURIES AND MORE. THEY OFFER IMAGING SERVICES DURING NORMAL BUSINESS HOURS AND INSOME CASES AFTER HOURS AND ON WEEKENDS. ALL THREE FACILITIES ARE ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTHCARE ORGANIZATIONS (JCAHO).OTHER ROLES:ST. JOSEPH REGIONAL EMERGENCY MEDICAL SERVICES (SJR EMS) SJREMS IS THE OLDEST PRIVATE PRE-HOSPITAL EMERGENCY MEDICAL SERVICE IN THE BRAZOS COUNTY AND OPERATES A FLEET OF 14 AMBULANCES, STAFFED BYEMERGENCY MEDICAL TECHNICIANS AND PARAMEDICS WHO RESPOND TO MORE THAN 15,000 SERVICE REQUESTS EACH YEAR. SJREMS IS A NETWORK OF AMBULANCE SERVICES THAT INCLUDES THE BRYAN-COLLEGE STATION AREA AS WELL AS BURLESON, GRIMES AND MADISON COUNTIES. COLLECTIVELY, THE GOAL OF SJR EMS IS TO OFFER HIGHQUALITY PRE-HOSPITAL MEDICINE WITH COMPASSION TO ALL WITHIN THE BRAZOS VALLEY.IN BRYAN-COLLEGE STATION, SJR EMS PROVIDES NON-EMERGENCY MEDICAL RESPONSE, CRITICAL GROUND AMBULANCE TRANSPORTATION, AND BACK-UP TO THE BRYAN AND COLLEGE STATION FIRE DEPARTMENTS, WHICH ARE THE PRIMARY 911 EMERGENCY MEDICAL RESPONDERS IN BRAZOS COUNTY. IN BURLESON AND GRIMES COUNTIES, ST.JOSEPH HOLDS THE 911 EMERGENCY RESPONSE CONTRACTS.SJR EMS CURRENTLY SERVES 12 MUNICIPALITIES WITH ADVANCED LIFE SUPPORT CARE FROM 8 UNITS LOCATED IN BEDIAS, NAVASOTA, SOMERVILLE, CALDWELL, STONEHAM, MADISONVILLE, BRYAN, AND COLLEGE STATION SERVING AS A GATEWAY FOR SURROUNDING FACILITIES WITH 150,000 SQUARE MILE SERVICE AREA. IN 2011,,SJR EMS RESPONDED TO A TOTAL OF 13,685 911 CALLS AND NON-EMERGENCY CALLS. THESE CALLS INCLUDED SERVICES TO RURAL RESIDENTS.THREE SJR EMS AMBULANCES ARE HOUSED IN GRIMES COUNTY, ONE OF WHICH IS LOCATED IN THE RURAL COMMUNITY OF STONEHAM. THIS LOCATION WAS CHOSEN AFTER RESEARCH OF THE POPULATION GROWTH BY THE EMS DIRECTOR, TASK FORCE AND 911 COORDINATOR, WITH A GOAL OF REDUCING AMBULANCE RESPONSE TIME. NOT ONLY ISRAPID RESPONSE CRITICAL WITH TRAUMA PATIENTS, BUT EARLY RECOGNITION AND TREATMENT FOR HEART ATTACK AND STROKE ARE ESSENTIAL TO SAVING LIVES. DEFIBRILLATION IS MOST BENEFICIAL WHEN PERFORMED AS SOON AS POSSIBLE AFTER SUDDEN CARDIAC ARREST. HAVING SJR EMS IN THIS RURAL LOCATION HELPSFULFILL SUCH A NEED IN RURAL GRIMES COUNTY.CERTIFIED CHEST PAIN CENTER AND LEVEL II STROKE FACILITY SJRHC, THE FIRST HOSPITAL IN THE REGION TO BECOME A CERTIFIED CHEST PAIN CENTER, ALSO RECEIVED A FIVE-STAR RATING FROM HEALTHGRADES FORCORONARY INTERVENTIONAL PROCEDURES, ONE OF THE MOST COMMON PROCEDURES DONE TO HELP IMPROVE BLOOD FLOW TO THE HEART. AN IMPORTANT PART OF GOOD CARDIAC OUTCOMES, ESPECIALLY FOR HEART ATTACK PATIENTS, IS RAPID DIAGNOSIS AND INTERVENTION. IN 2011 SJRHC WAS ABLE TO CLINICALLY INTERVENE IN 100% OF HEART ATTACK PATIENTS WITHIN 90 MINUTES OF ARRIVAL TO THE EMERGENCY ROOM. THAT LEVEL OF PERFORMANCE HAS BEEN SHOWN TO SAVE LIVES AND REQUIRES TREMENDOUS TEAMWORK AND DEDICATION. SJRHC IS THE ONLY FACILITY THAT IS BOTH A LEVEL II STATE CERTIFIED FACILITY AND IS ACCREDITED BY THE JOINT COMMISSION AS A CERTIFIED PRIMARY STROKE CENTER. THE DEPARTMENT OF STATE HEALTH SERVICES HAS DESIGNATEDSJRHC AS A STATE OF TEXAS PRIMARY (LEVEL II) STROKE FACILITY - THE FIRST SUCH DESIGNATION IN THE REGION. THIS DESIGNATION REPRESENTS THE COMMITMENT THAT SJRHC HAS TOWARDS TREATING PATIENTS WITH STROKE IN OUR COMMUNITY. THE STROKE CENTER IS COMPRISED OF A LARGE TEAM OF MEDICAL SPECIALISTS THAT ARE ABLE TO PROVIDE AROUND-THE-CLOCK CARE FOR PATIENTS SUFFERING FROM A STROKE. IN ORDER TO RECEIVE A LEVEL II STROKE FACILITY DESIGNATION, A HOSPITAL MUST BE ABLE TO PROVIDE STROKE TREATMENT 24 HOURSA DAY, 7 DAYS A WEEK AND MEET ALL THE REQUIREMENTS SET FORTH BY THE DEPARTMENT OF STATE HEALTH SERVICES. PATIENTS THAT PRESENT TO PRIMARY STROKE CENTERS FOR THEIR CARE HAVE IMPROVED OUTCOMES AS COMPARED TO PATIENTS THAT DO NOT, UNDERSCORING, THE NEED AND IMPORTANCE OF THIS FACILITY IN THE AREA. THE DESIGNATION OF PRIMARY STROKE FACILITY IS NEW AMONG HOSPITALS IN TEXAS. THERE ARE ONLY 21 SUCH FACILITIES IN THE STATE AND SJRHC IS CURRENTLY THE ONLY DESIGNATED FACILITY IT ITS REGION. THEBRAZOS VALLEY IS IN REGION 7, AS DEFINED BY THE DEPARTMENT OF STATE HEALTH SERVICES, WHICH INCLUDES 30 COUNTIES SURROUNDING THE REGIONAL HEADQUARTERS IN TEMPLE. THIS STATE DESIGNATION IS A REFLECTION OF INCREDIBLE TEAMWORK.RURAL HEALTH CLINICSST. JOSEPH'S IS COMMITTED TO RURAL HEALTH AND MEETING THE NEEDS OF RURAL COMMUNITIES. THE RURAL CLINICS ARE SET UP IN FURTHERANCE OF OUR MISSION TO PROVIDE EXCELLENT HEALTH CARE AND TO PROMOTE WELLNESS THROUGHOUT THE BRAZOS VALLEY. IN TOTAL, THE 5 RURAL HEALTH CLINICS HAD59,760 PATIENT VISITS ATTENDED TO BY 9 PROVIDERS AND 8 MID-LEVEL PROVIDERS.BURLESON COUNTYST. JOSEPH CALDWELL FAMILY MEDICINE CLINIC IS A FAMILY MEDICINE CLINIC PROVIDING HEALTH AND WELLNESS SERVICES TO ADULTS AND CHILDREN. THE CLINIC OFFERS A FULL RANGE OF PRIMARY CARE, INCLUDING MINOR EMERGENCIES AND OFFICE SURGERY, GENERAL FAMILY MEDICINE, COMPREHENSIVE AND ROUTINEPHYSICALS, WELL WOMAN EXAMS, IMMUNIZATIONS, ALLERGY INJECTIONS, MINOR SUTURING, LAB SERVICES, DIAGNOSIS AND TREATMENT OF ACUTE ILLNESS. SPECIALISTS VISIT ON A BI-WEEKLY BASIS.LEE COUNTYST. JOSEPH LEXINGTON FAMILY MEDICINE CLINIC IS A FAMILY MEDICINE CLINIC PROVIDING HEALTH AND WELLNESS SERVICES TO ADULTS AND CHILDREN. THE CLINIC'S FULL RANGE OF PRIMARY CARE SERVICES INCLUDES PATIENT EDUCATION, SUTURING, TREATMENT OF EYE AND EAR PROBLEMS, COMPREHENSIVE AND ROUTINEPHYSICALS, WELL WOMAN EXAMS, IMMUNIZATIONS, ALLERGY INJECTIONS, INITIAL MANAGEMENT OF PATIENTS AND SOCIAL SERVICES. THEY ALSO OFFER LAB TESTING, MINOR SURGICAL PROCEDURES, CHRONIC MEDICAL CONDITIONING, RADIOLOGY AND ADD TESTING. MADISON COUNTYST. JOSEPH NORMANGEE FAMILY HEALTH CENTER IS STAFFED WITH A FULL-TIME PHYSICIAN AND PHYSICIAN ASSISTANT. THE CLINIC OFFERS A VARIETY OF PRIMARY CARE SERVICES INCLUDING GENERAL FAMILY MEDICAL SERVICES, CARE FOR MINOR INJURIES AND TEXAS HEALTH STEP EXAM. THE CLINIC ALSO OFFERS BLOOD DRAWS,ROUTINE AND COMPREHENSIVE PHYSICALS, PREVENTATIVE HEALTH EXAMS, WELL WOMAN EXAMS, MANAGEMENT OF HIGH BLOOD PRESSURE, CHOLESTEROL, DIABETES, ADD/ADHD AND CARE FOR ACUTE MINOR ILLNESS AND INJURIES.
PART VI, LINE 7, REPORTS FILED WITH STATES	TX

Schedule H (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule J
(Form 990)

Department of the Treasury
Internal Revenue Service

Compensation Information

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

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

Attach to Form 990.
SchJMediumBullet

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

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? .........

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), 501(c)(4), and 501(c)(29) organizations 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) 2014

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 in column(B) 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)
1ODETTE BOLANOPRES/CEO, EX-OFFICIO TRUSTEE, PART Y	(i) (ii)	0 ............................... 457,998	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 0	0 ............................... 457,998	0 ............................... 0
2KATHLEEN KRUSIECOO	(i) (ii)	0 ............................... 331,743	0 ............................... 48,442	0 ............................... 0	0 ............................... 10,400	0 ............................... 17,972	0 ............................... 408,557	0 ............................... 0
3MARK RIGGINSADMINISTRATOR STARTING 05/14	(i) (ii)	0 ............................... 136,325	0 ............................... 0	0 ............................... 0	0 ............................... 4,945	0 ............................... 17,421	0 ............................... 158,691	0 ............................... 0
4DANIEL GOGGINCFO	(i) (ii)	0 ............................... 324,960	0 ............................... 48,347	0 ............................... 0	0 ............................... 10,400	0 ............................... 17,971	0 ............................... 401,678	0 ............................... 0
5HERMAN BLANTONCHIEF MEDICAL OFFICER	(i) (ii)	0 ............................... 186,685	0 ............................... 0	0 ............................... 0	0 ............................... 7,523	0 ............................... 4,198	0 ............................... 198,406	0 ............................... 0
6MICHAEL RUSSOVP/INFORMATION SERVICES	(i) (ii)	0 ............................... 218,647	0 ............................... 31,363	0 ............................... 0	0 ............................... 9,681	0 ............................... 18,428	0 ............................... 278,119	0 ............................... 0
7MICHAEL COSTAVP/HUMAN RESOURCES	(i) (ii)	0 ............................... 215,150	0 ............................... 29,463	0 ............................... 0	0 ............................... 9,879	0 ............................... 17,624	0 ............................... 272,116	0 ............................... 0
8STEVE CRICHTONVP/SUPPORT SERVICES	(i) (ii)	0 ............................... 174,730	0 ............................... 25,580	0 ............................... 0	0 ............................... 7,943	0 ............................... 11,197	0 ............................... 219,450	0 ............................... 0
9DONOVAN FRENCHVP STRATEGY & SERVICE LINES	(i) (ii)	0 ............................... 154,461	0 ............................... 22,185	0 ............................... 0	0 ............................... 4,561	0 ............................... 10,991	0 ............................... 192,198	0 ............................... 0
10RICARDO DIAZVP/CLINICAL SUPPORT	(i) (ii)	0 ............................... 202,569	0 ............................... 28,307	0 ............................... 0	0 ............................... 3,656	0 ............................... 18,352	0 ............................... 252,884	0 ............................... 0

Schedule J (Form 990) 2014

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

PART I, LINE 3

ANY COMPENSATED OFFICERS LISTED ARE EMPLOYEES OF ST. JOSEPH REGIONAL HEALTH CENTER (SJRHC) AND ALL COMPENSATION INFORMATION IS REPORT UNDER EIN 74-1282696. THE FILING ORGANIZATION RELIES ON SJRHC WHICH USES (A) COMPENSATION COMMITTEE,(B) INDEPENDENT COMPENSATION CONSULTANT, (C) COMPENSATION SURVEY OR STUDY, AND (D) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE COMPENSATION OF TOP MANAGEMENT OFFICIALS. COMPENSATION FOR ALL EMPLOYEES IS PAID BY ST. JOSEPH REGIONAL HEALTH CENTER AND ALL COMPENSATION INFORMATION IS REPORTED UNDER EIN 74-1282696. PART II, COMPENSATION OF SR. LOIS ANNE PALKERT: SISTER LOIS ANNE PALKERT, OSF, WORKS 40 HOURS A WEEK FOR SYLVANIA FRANCISCAN HEALTH BUT DOES NOT RECEIVE A W-2. ALL COMPENSATION EARNED WAS PAID TO THE SISTERS OF ST. FRANCIS OF SYLVANIA OHIO'S CONGREGATION IN ACCORDANCE WITH IRS REVENUE RULING 77-290. PART II, COMPENSATION OF ODETTE BOLANO: ODETTE BOLANO, PRESIDENT/CEO OF ST. JOSEPH REGIONAL HEALTH CENTER RECEIVED COMPENSATION FROM ASCENCION, AN UNRELATED ORGANIZATION. PART II, COMPENSATION OF JAMES SCHUESSLER: JAMES P. SCHUESSLER, INTERIM PRESIDENT/CEO OF ST. JOSEPH REGIONAL HEALTH CENTER RECEIVED COMPENSATION FROM B.E. SMITH, AN UNRELATED ORGANIZATION.

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or 990-EZ 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

2014

Open to Public
Inspection

Name of the organization

BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

Return Reference	Explanation
FORM 990, PART III, LINE 3	DISCONTINUED RURAL HEALTH CLINIC SERVICES 10/21/2014.
FORM 990, PART VI, SECTION A, LINE 4	EFFECTIVE NOVEMBER 1, 2014 THE ORGANIZATION'S PARENT CORPORATION WAS TRANSFERRED FROM SYLVANIA FRANCISCAN HEALTH TO CATHOLIC HEALTH INITIATIVES (CHI). AS A RESULT A PORTION OF THE BYLAWS WERE UPDATED TO REFLECT THIS CHANGE IN OWNERSHIP.
FORM 990, PART VI, SECTION A, LINE 6	THE MEMBERSHIP OF THE CORPORATION SHALL CONSIST OF ONE (1) CLASS AND THE ONLY MEMBER OF THE CORPORATION SHALL BE ST JOSEPH SERVICES CORPORATION, D/B/A ST JOSEPH SYSTEM, A TEXAS NONPROFIT CORPORATION (HEREINAFTER REFERRED TO AS "ST JOSEPH HEALTH SYSTEM" OR "SJHS" OR THE "MEMBER").
FORM 990, PART VI, SECTION A, LINE 7A	THE NUMBER OF VOTING DIRECTORS SHALL BE SEVEN PERSONS. FOUR OF THE SEVEN DIRECTOR POSITIONS SHALL BE APPOINTED BY THE MEMBER. AFFIRMATIVE ACTION OF THE MEMBER IS REQUIRED TO REMOVE THE FOUR MEMBER-APPOINTED DIRECTORS WITH OR WITHOUT CAUSE.
FORM 990, PART VI, SECTION A, LINE 7B	THE FOLLOWING MATTERS ARE RESERVED SOLELY TO THE MEMBER AND SHALL REQUIRE THE AFFIRMATIVE ACTION OF THE MEMBER TO BE EFFECTIVE: A) APPROVAL OF ANNUAL OPERATING AND CAPITAL BUDGETS OF THE CORPORATION AFTER THE CONSULTATION ON THE OPERATING AND CAPITAL BUDGETS WITH THE BOARD OF DIRECTORS; B) MERGER, SALE, ACQUISITION, CONSOLIDATION, OR DISSOLUTION OF THE CORPORATION, PROVIDED SUCH MERGER, SALE, ACQUISITION, CONSOLIDATION, OR DISSOLUTION OF THE CORPORATION HAS BEEN ADOPTED BY A VOTE OF AT LEAST TWO-THIRDS OF THE BOARD THEN IN OFFICE AT ANY REGULAR OR SPECIAL MEETING OF THE BOARD CALLED FOR SUCH PURPOSE; C) BORROWING OR LENDING OF MONEY, INCURRENCE OF DEBT, OR THE CREATION OF INDEBTEDNESS THROUGH THE GUARANTY OF ANOTHER'S DEBT OR SIMILAR ACTION; D) TO REMOVE THE (4) MEMBER-APPOINTED DIRECTORS WITH OR WITHOUT CAUSE AS PROVIDED IN ARTICLE V; E) MAKE A LEGAL COMMITMENT OR APPROVE AN EXPENDITURE OF MONEY THAT MATERIALLY DEVIATES FROM THE BUDGET OF THE CORPORATION; F) AMEND OR REPEAL THE AMENDED AND RESTATED CERTIFICATE OF FORMATION AND THE AMENDED AND RESTATED BYLAWS OF THE CORPORATION AS PROVIDED IN ARTICLE XVI; PROVIDED, HOWEVER THE PARENT CORPORATION SHALL AT TIMES RETAIN THE RIGHT AND POWER TO UNILATERALLY AMEND THESE BYLAWS; G) TO TAKE ANY ACTION NECESSARY TO CONFORM THE PURPOSES AND ACTIVITIES OF THE CORPORATION AND OF ORGANIZATIONS CONTROLLED BY THE CORPORATION WITH THE TRADITIONS, TEACHINGS AND CANON LAW OF THE ROMAN CATHOLIC CHURCH AS THEY MAY BE IN EFFECT FROM TIME TO TIME. EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S CERTIFICATE OF FORMATION, ELSEWHERE IN THESE BYLAWS, OR IN THE LAWS OF THE STATE OF TEXAS, THE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. THE RIGHTS OF THE MEMBER SHALL BE FURTHER SUBJECT TO THE POWERS RESERVED TO THE PARENT CORPORATION UNDER THE GOVERNANCE MATRIX. THE GOVERNANCE MATRIX MAY BE AMENDED FROM TIME TO TIME BY THE PARENT CORPORATION, AND SUCH AMENDMENTS SHALL BE DEEMED TO BE A PART OF THESE BYLAWS WITHOUT FURTHER ACTION. THE CORPORATION SHALL BE DEEMED A "SUBSIDIARY OF A SUBSIDIARY" FOR PURPOSES OF THE GOVERNANCE MATRIX. IN ADDITION TO THE RIGHTS RESERVED TO THE PARENT CORPORATION UNDER THE GOVERNANCE MATRIX, THE PARENT CORPORATION SHALL HAVE THE POWER TO TRANSFER ASSETS OF THE CORPORATION OR TO REQUIRE THE CORPORATION TO TRANSFER ASSETS TO THE PARENT CORPORATION, TO THE EXTENT NECESSARY TO ACCOMPLISH THE PARENT CORPORATION'S GOALS AND OBJECTIVES, AND TO PROVIDE FOR THE PAYMENT OF ALL INDEBTEDNESS OF THE PARENT CORPORATION OR AN ENTITY CONTROLLED BY, CONTROLLING, OR UNDER COMMON CONTROL WITH THE PARENT CORPORATION (FOR PURPOSES OF THIS SECTION, A "PARENT CORPORATION AFFILIATE"), ISSUED OR INCURRED BY OR ON BEHALF OF THE PARENT CORPORATION OR A PARENT CORPORATION AFFILIATE IN FURTHERANCE OF THE PARENT CORPORATION'S GOALS AND OBJECTIVES. THE CORPORATION SHALL NOT BE REQUIRED TO VIOLATE ITS CHARITABLE PURPOSES, THE TERMS OF ANY RESTRICTED GIFTS, OR THE COVENANTS OF ITS DEBT INSTRUMENTS AS A RESULT OF ANY ASSET TRANSFERS MADE OR DIRECTED BY THE PARENT CORPORATION. EXCEPT FOR TRANSFERS PREVIOUSLY APPROVED BY THE PARENT CORPORATION, EITHER INDIVIDUALLY OR AS PART OF THE CHI HEALTHCARE SYSTEM BUDGET PROCESS, AND EXCEPT FOR TRANSFERS TO AN AFFILIATE OR SUBSIDIARY OF THE CORPORATION, THE CORPORATION SHALL NOT TRANSFER ASSETS TO ENTITIES OTHER THAN THE PARENT CORPORATION OR PARENT CORPORATION AFFILIATES WITHOUT THE APPROVAL OF THE PARENT CORPORATION. THE MEMBERS OF THE BOARD OF DIRECTORS SHALL BE RELIEVED FROM LIABILITY FOR MANAGERIAL ACTS OR OMISSIONS IMPOSED UPON MEMBERS OF BOARDS OF DIRECTORS BY LAW, TO THE EXTENT THAT, AND AS LONG AS, ANY DISCRETIONARY POWER IN THE MANAGEMENT OF CORPORATE AFFAIRS IS EXERCISED BY THE MEMBER PURSUANT TO THIS SECTION AND THE CERTIFICATE OF FORMATION.
FORM 990, PART VI, SECTION B, LINE 11	THE FORM 990 AND ACCOMPANYING SCHEDULES WERE MADE AVAILABLE TO ALL TRUSTEES EITHER ELECTRONICALLY OR BY HARD COPY, DEPENDING UPON THE TRUSTEES PREFERENCE, BEFORE THE COMPANY FINALIZED AND SENT THE DOCUMENTS TO THE IRS. THIS DRAFT WAS ALSO AVAILABLE AT THE ADMINISTRATIVE OFFICES OF THE REPORTING ENTITY FOR TRUSTEES'S REVIEW BEFORE THE FINAL FORM 990 AND ACCOMPANYING SCHEDULES WERE FINALIZED AND SENT TO THE IRS. THE REVIEW WAS UNDER THE DIRECTION OF THE CFO AND/OR TAX RETURN PREPARERS, PLANTE & MORAN, PLLC, IF REQUESTED BY THE TRUSTEES.
FORM 990, PART VI, SECTION B, LINE 12C	DESCRIPTION OF PERSONS COVERED UNDER THE CONFLICT OF INTEREST POLICY IN ACCORDANCE WITH THE ST JOSEPH HEALTH SYSTEM POLICY NO 38, "CONFLICT OF INTEREST": ANY BOARD MEMBER, TRUSTEE, GOVERANCE COUNCIL MEMBER, BOARD COMMITTEE MEMBER, CORPORATE OFFICER, EXECUTIVE, MEDICAL STAFF MEMBER,LICENSED INDEPENDENT PRACTICTIONER (LIP), DEPARTMENT DIRECTOR, SUPERVISOR, OR OTHER INDIVIDUAL THAT HAS A FINANCIAL INTEREST. DESCRIPTION OF PROCESS TO MONITOR TRANSACTION FOR CONFLICTS OF INTEREST IN ACCORDANCE WITH THE ST JOSEPH HEALTH SYSTEM POLICY NO 38, "CONFLICT OF INTEREST", SECTION 6, DISCLOSURE STATEMENT: "A CONFLICT OF INTEREST SHALL BE RETAINED BY THE CORPORATION IN ITS ADMINISTRATIVE OFFICE. THIS STATEMENT SHALL BE RENEWED AT LEAST ANNUALLY AT THE REQUEST OF THE CORPORATION AND AT ANY TIME THAT A CONFLICT OF INTEREST MAY ARISE." TO HELP ENSURE THAT DISCLOSURE STATEMENTS ARE COMPLETED ANNUALLY BY ALL BOARD OF TRUSTEE MEMBERS, THE CEO'S OFFICE SUMMARIZES ALL CONFLICTS OF INTEREST DISCLOSED BY EACH ENTITY'S TRUSTEES. IN 2012, THE SUMMARY WAS PRESENTED AS AN AGENDA ITEM AT EACH ENTITY'S BOARD OF TRUSTEES MEETINGS HELD. IN APRIL 2012, THE AGENDA ITEM WAS TITLED, "CONFLICT OF INTEREST DISCLOSURE REVIEW" OR SIMILAR DESCRIPTION. THE REVIEW IS PERFORMED BY THE OFFICE OF THE CEO WHERE DISCLOSURE STATEMENTS ARE ALSO FILED FOR TRUSTEES. OTHER DESIGNATED PERSONS DISCLOSURE STATEMENTS ARE FILED IN INDIVIDUAL PERSONNEL FILES IF EMPLOYED BY ST JOSEPH REGIONAL HEALTH CENTER. WHEN A CONFLICT OF INTEREST IS IDENTIFIED, THE INTERESTED PERSON SHALL LEAVE THE MEETING AT WHICH THE DETERMINATION OF A CONFLICT OF INTEREST IS DISCUSSED AND VOTED UPON.
FORM 990, PART VI, SECTION C, LINE 19	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY & FINANCIAL STATEMENTS ARE NOT MADE AVAILABLE TO THE PUBLIC.
FORM 990, PART VI, LINES 13 AND 14:	THE ORGANIZATION FOLLOWS THE POLICIES OF THE ST JOSEPH HEALTH SYSTEM TO WHICH IT IS AN AFFILIATE. THE POLICY INCLUDES THE WHISTLEBLOWER POLICY AND THE DOCUMENT RETENTION POLICY, WHICH ARE DOCUMENTED AND APPROVED BY THE PRESIDENT AND CEO OF THE SYSTEM. THE BYLAWS OF ST JOSEPH STATE "THE PRESIDENT/CEO SHALL HAVE ALL AUTHORITY AND RESPONSIBILITY NECESSARY TO OPERATE THE CORPORATION IN ALL ITS ACTIVITIES AND DEPARTMENTS, SUBJECT ONLY TO SUCH POLICIES AS MAY BE ISSUED BY THE BOARD. THE PRESIDENT/CEO SHALL ACT AS A DULY AUTHORIZED REPRESENTATIVE OF THE BOARD AND OF THE CORPORATION IN ALL MATTERS IN WHICH IT HAS NOT DESIGNATED SOME OTHER PERSON TO ACT." THEREFORE, THE PRESIDENT/CEO, BY THE AUTHORITY GRANTED TO HIM IN THE ABOVE PARAGRAPH, APPROVES THE POLICIES. THE TWO POLICIES WERE APPROVED BY THE ST JOSEPH HEALTH SYSTEM BOARD AT THE LAST 2012 BOARD MEETING.
FORM 990, PART IX, LINE 11G	CONTRACT LABOR: PROGRAM SERVICE EXPENSES 374,021. MANAGEMENT AND GENERAL EXPENSES 88,875. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 462,896. AGENCY STAFF: PROGRAM SERVICE EXPENSES 50,400. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 50,400. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 715,530. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 715,530. CONSULTING FEES: PROGRAM SERVICE EXPENSES 1,470. MANAGEMENT AND GENERAL EXPENSES 68,557. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 70,027. MEDICAL DIRECTOR FEES: PROGRAM SERVICE EXPENSES 22,630. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,630. COLLECTION FEES: PROGRAM SERVICE EXPENSES 328. MANAGEMENT AND GENERAL EXPENSES 99,074. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 99,402. PACS TRANSACTION FEES: PROGRAM SERVICE EXPENSES 22,020. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 22,020.
FORM 990, PART XI, LINE 9:	REVALUATION OF BALANCE SHEET DUE TO CHI AQUISITION 394,730. BENEFICIAL INTEREST IN ASSETS OF FOUNDATION 1,400,044.
FORM 990, PART XII, LINE 2C:	THE COMMITTEE THAT ASSUMES RESPONSIBILITY FOR OVERSIGHT OF THE AUDIT AND SELECTION OF THE INDEPENDENT ACCOUNTANT HAS NOT CHANGED ITS OVERSIGHT PROCESS OR SELECTION PROCESS FROM THE PRIOR YEAR.

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

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

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

Attach to Form 990.
MediumBullet

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

OMB No. 1545-0047

2014

Open to Public Inspection

Name of the organization

BELLVILLE ST JOSEPH HEALTH CENTER

Employer identification number

27-4005511

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

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) ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA,NE68154 47-0765154	HEALTHCARE	NE	501(C)(3)	LINE 3	ACH	Yes
(2) ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA,NE68154 47-0757164	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(3) ALEGENT CREIGHTON HEALTH FOUNDATION 12809 W DODGE RD OMAHA,NE68154 47-0648586	FUNDRAISING	NE	501(C)(3)	LINE 7	ACH	Yes
(4) ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA,NE68124 47-0484764	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(5) ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY,IA51555 42-0776568	HEALTHCARE	IA	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(6) ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA,NE68122 47-0376615	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(7) ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER,NE68661 47-0399853	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(8) ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING,IA50841 42-0782518	HEALTHCARE	IA	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(9) ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS,MN56345 41-1351177	LTERM CARE	MN	501(C)(3)	LINE 9	CHI	Yes
(10) APPLETREE COURT 601 OAK ST BRECKENRIDGE,MN56520 41-1850500	SENIOR LIVING	MN	501(C)(3)	LINE 9	SFH	Yes
(11) BISHOP DRUMM RETIREMENT CENTER 1111 6TH AVE DES MOINES,IA50314 42-0725196	LTERM CARE	IA	501(C)(3)	LINE 9	CHI-IA CORP	Yes
(12) BORNEMANN HEALTHCARE CORPORATION 2500 BERNVILLE RD PO BOX 316 READING,PA19603 23-2187242	HEALTHCARE	PA	501(C)(3)	LINE 11	CHI	Yes
(13) CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON,ND58421 45-0227311	HEALTHCARE	ND	501(C)(3)	LINE 3	CHI	Yes
(14) CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 47-0617373	HEALTHCARE	CO	501(C)(3)	LINE 9	N/A	Yes
(15) CATHOLIC HEALTH INITIATIVES - COLORADO 188 INVERNESS DRIVE WEST STE 500 ENGLEWOOD,CO80112 84-0405257	HEALTHCARE	CO	501(C)(3)	LINE 3	CHI	Yes
(16) CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES,IA50314 42-0680448	HEALTHCARE	IA	501(C)(3)	LINE 3	CHI	Yes
(17) CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 6385 CORPORATE DR STE 301 COLORADO SPRINGS,CO80919 84-0902211	FUNDRAISING	CO	501(C)(3)	LINE 7	CHIC	Yes
(18) CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 6385 CORPORATE DR COLORADO SPRINGS,CO80919 27-0930004	FUNDRAISING	CO	501(C)(3)	LINE 11	CHI	Yes
(19) CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-0992796	HEALTHCARE	CO	501(C)(3)	LINE 11	CHINS	Yes
(20) CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG,OR97471 26-3946191	PHYSICIANS	OR	501(C)(3)	LINE 9	MMC	Yes
(21) CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND,KS67530 48-0543724	SURGERY CENTER	KS	501(C)(3)	LINE 3	CHI	Yes
(22) CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO,ND58104 27-1966847	HEALTHCARE	MN	501(C)(3)	LINE 9	CHI	Yes
(23) CHI INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 27-1050565	HEALTHCARE	CO	501(C)(3)	LINE 11	CHI	Yes
(24) CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER,KY41018 20-2741651	HEALTHCARE	KY	501(C)(3)	LINE 11	CHI	Yes
(25) CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 45-1261716	HEALTHCARE	CO	501(C)(3)	LINE 9	CHI NS	Yes
(26) CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 45-2532084	HEALTHCARE	CO	501(C)(3)	LINE 11	CHI	Yes
(27) CHI NEBRASKA 6940 O ST STE 200 LINCOLN,NE68510 36-3233121	HEALTHCARE	NE	501(C)(3)	LINE 11	CHI	Yes
(28) CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER 6624 FANNIN ST HOUSTON,TX77030 74-1161938	HEALTHCARE	TX	501(C)(3)	LINE 3	SLHS	Yes
(29) CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS,AR71913 71-0236913	HEALTHCARE	AR	501(C)(3)	LINE 3	CHISVHS	Yes
(30) CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS,AR71913 26-1125064	HOLDING CO	AR	501(C)(3)	LINE 11	SVIMC	Yes
(31) CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 1 MERCY LANE STE 201 HOT SPRINGS,AR71913 26-1125131	HEALTHCARE	AR	501(C)(3)	LINE 3	CHISVHS	Yes
(32) COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK ST ACCOUNTING-3 W CINCINNATI,OH45206 23-7419853	HOLDING CO	OH	501(C)(2)		GSH	Yes
(33) COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY,IA51555 42-1294399	FUNDRAISING	IA	501(C)(3)	LINE 11	AH-CMHMV	Yes
(34) CONTINUING CARE HOSPITAL 150 NORTH EAGLE CREEK DR LEXINGTON,KY40509 61-1400619	LT ACH	KY	501(C)(3)	LINE 3	SJHS	Yes
(35) COVENANT HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 23-2028429	HOME HEALTH	PA	501(C)(3)	LINE 11	CHI NHC	Yes
(36) ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1450 BATTERSBY AVE ENUMCLAW,WA98022 91-0715805	HEALTHCARE	WA	501(C)(3)	LINE 3	FHS	Yes
(37) FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN,KY40004 61-1345363	HEALTHCARE	KY	501(C)(3)	LINE 3	KOH	Yes
(38) FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN,KY40004 56-2351341	FUNDRAISING	KY	501(C)(3)	LINE 11	FH	Yes
(39) FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA,WA98405 91-1145592	FUNDRAISING	WA	501(C)(3)	LINE 9	FHS	Yes
(40) FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA,WA98405 91-0564491	HEALTHCARE	WA	501(C)(3)	LINE 3	CHI	Yes
(41) FRANCISCAN HEALTH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BROADWAY TACOMA,WA98402 43-1882377	PHYSICIANS	MO	501(C)(3)	LINE 9	CHI	Yes
(42) FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA,WA98402 91-1939739	HEALTHCARE	WA	501(C)(3)	LINE 9	FHS	Yes
(43) FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE,WI53172 39-1093829	HEALTHCARE	WI	501(C)(3)	LINE 9	CHI	Yes
(44) GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 20-1536108	MINISTRIES	CO	501(C)(3)	LINE 11	CHI	Yes
(45) GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK ST ACCOUNTING-3 W CINCINNATI,OH45206 31-1778403	EDUCATION	OH	501(C)(3)	LINE 2	GSH	Yes
(46) GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK ST ACCOUNTING-3 W CINCINNATI,OH45206 31-1206047	FUNDRAISING	OH	501(C)(3)	LINE 11	GSH	Yes
(47) GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY,NE68848 47-0379755	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(48) GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY,NE68847 47-0659443	FUNDRAISING	NE	501(C)(3)	LINE 7	GSH	Yes
(49) GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON 110 N MAIN ST STE 500 DAYTON,OH45402 23-7296923	FUNDRAISING	OH	501(C)(3)	LINE 7	SHP	Yes
(50) HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON,WA98310 91-0565546	HEALTHCARE	WA	501(C)(3)	LINE 3	FHS	Yes
(51) HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVE BREMERTON,WA98310 91-1197626	FUNDRAISING	WA	501(C)(3)	LINE 7	HMC	Yes
(52) HEALTH SET 2420 W 26TH AVE STE 460D DENVER,CO80211 84-1102943	LOW INC CARE	CO	501(C)(3)	LINE 7	CHIC	Yes
(53) HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 76-0761782	FUNDRAISING	MN	501(C)(3)	LINE 11	SFMC	Yes
(54) HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN,WA98166 91-0712166	HEALTHCARE	WA	501(C)(3)	LINE 3	FHS	Yes
(55) HOUSE OF MERCY 1111 6TH AVE DES MOINES,IA50314 42-1323808	SHELTER	IA	501(C)(3)	LINE 7	CHI-IA CORP	Yes
(56) JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 539 S 4TH ST LOUISVILLE,KY40202 61-1029768	HEALTHCARE	KY	501(C)(3)	LINE 3	KOH	Yes
(57) KENTUCKYONE HEALTH MEDICAL GROUP INC 539 S 4TH ST LOUISVILLE,KY40202 61-1352729	HEALTHCARE	KY	501(C)(3)	LINE 9	JHSMH	Yes
(58) KENTUCKYONE HEALTH INC 200 ABRAHAM FLEXNER WAY LOUISVILLE,KY40202 61-1029769	HEALTHCARE	KY	501(C)(3)	LINE 9	CHI	Yes
(59) LAKEWOOD HEALTH CENTER 600 MAIN AVE S BAUDETTE,MN56623 41-0758434	HEALTHCARE	MN	501(C)(3)	LINE 3	CHI	Yes
(60) LINUS OAKES INC 2700 STEWART PKWY ROSEBURG,OR97471 93-0821381	SENIOR LIVING	OR	501(C)(3)	LINE 9	MMC	Yes
(61) LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON,ND58054 82-0558836	HEALTHCARE	ND	501(C)(3)	LINE 3	CHI	Yes
(62) LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN,TX75901 82-0563768	PROPERTY MGMT	TX	501(C)(3)	LINE 11	MHSET	Yes
(63) MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA,TN37404 62-1839548	FUNDRAISING	TN	501(C)(3)	LINE 7	MHCS	Yes
(64) MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA,TN37404 62-0532345	HEALTHCARE	TN	501(C)(3)	LINE 3	CHI	Yes
(65) MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA,TN37411 03-0417049	HEALTHCARE	TN	501(C)(3)	LINE 9	MHCS	Yes
(66) MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN,TX75902 75-0755367	HEALTHCARE	TX	501(C)(3)	LINE 3	CHI	Yes
(67) MEMORIAL MEDICAL CENTER - LIVINGSTON PO BOX 1447 LUFKIN,TX75902 76-0436439	HEALTHCARE	TX	501(C)(3)	LINE 3	MHSET	Yes
(68) MEMORIAL MEDICAL CENTER - SAN AUGUSTINE PO BOX 1447 LUFKIN,TX75902 75-2663904	HEALTHCARE	TX	501(C)(3)	LINE 3	MHSET	Yes
(69) MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVE LUFKIN,TX95904 75-2721155	PHYSICIANS	TX	501(C)(3)	LINE 11	MHSET	Yes
(70) MEMORIAL SPECIALTY HOSPITAL PO BOX 1447 LUFKIN,TX95902 75-2492741	HEALTHCARE	TX	501(C)(3)	LINE 3	MHSET	Yes
(71) MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVE DES MOINES,IA50314 42-6076069	AUXILIARY	IA	501(C)(3)	LINE 11	MF-DM IA	Yes
(72) MERCY CLINICS INC 1111 6TH AVE DES MOINES,IA50314 42-1193699	PHYSICIANS	IA	501(C)(3)	LINE 9	CHI-IA CORP	Yes
(73) MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVE DES MOINES,IA50314 42-1511682	EDUCATION	IA	501(C)(3)	LINE 2	CHI-IA CORP	Yes
(74) MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES,IA50314 23-7358794	FUNDRAISING	IA	501(C)(3)	LINE 7	CHI-IA CORP	Yes
(75) MERCY FOUNDATION INC 2700 STEWART PKWY ROSEBURG,OR97471 93-6088946	FUNDRAISING	OR	501(C)(3)	LINE 7	MMC	Yes
(76) MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING,IA50841 42-1461064	FUNDRAISING	IA	501(C)(3)	LINE 11	AHMH-CORNING	Yes
(77) MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BLVD VALLEY CITY,ND58072 45-0435338	FUNDRAISING	ND	501(C)(3)	LINE 11	MHVC	Yes
(78) MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS,IA51503 42-1178204	FUNDRAISING	IA	501(C)(3)	LINE 11	AHBMHS	Yes
(79) MERCY HOSPITAL OF DEVILS LAKE 1031 7TH ST NE DEVILS LAKE,ND58301 45-0227012	HEALTHCARE	ND	501(C)(3)	LINE 3	CHI	Yes
(80) MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 7TH ST NE DEVILS LAKE,ND58301 35-2367360	FUNDRAISING	ND	501(C)(3)	LINE 7	MHDL	Yes
(81) MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BLVD VALLEY CITY,ND58072 45-0226553	HEALTHCARE	ND	501(C)(3)	LINE 3	CHI	Yes
(82) MERCY MEDICAL CENTER 1301 15TH AVE WEST WILLISTON,ND58801 45-0231183	HEALTHCARE	ND	501(C)(3)	LINE 3	CHI	Yes
(83) MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE,IA52544 42-0680308	HEALTHCARE	IA	501(C)(3)	LINE 3	CHI-IA CORP	Yes
(84) MERCY MEDICAL CENTER INC 2700 STEWART PKWY ROSEBURG,OR97471 93-0386868	HEALTHCARE	OR	501(C)(3)	LINE 3	CHI	Yes
(85) MERCY MEDICAL FOUNDATION 1301 15TH AVE WEST WILLISTON,ND58801 45-0381803	FUNDRAISING	ND	501(C)(3)	LINE 11	MMC	Yes
(86) MERCY PROFESSIONAL PRACTICE ASSOCIATES INC 1111 6TH AVE DES MOINES,IA50314 42-1470935	PHYSICIANS	IA	501(C)(3)	LINE 9	CHI-IA CORP	Yes
(87) NEBRASKA HEART HOSPITAL 7500 S 91ST ST LINCOLN,NE68526 39-2031968	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(88) OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES,ND58474 45-0231675	HEALTHCARE	ND	501(C)(3)	LINE 3	CHI	Yes
(89) OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH ST OAKES,ND58474 71-0966606	FUNDRAISING	ND	501(C)(3)	LINE 11	OCH	Yes
(90) PINEYWOODS MEDICAL DEVELOPMENT CORP PO BOX 1447 LUFKIN,TX75902 75-2493116	PROPERTY MGMT	TX	501(C)(3)	LINE 11	MHSET	Yes
(91) PUEBLO STEPUP 1925 E ORMAN AVE STE G52 PUEBLO,CO81004 84-1234295	COMMUNITY	CO	501(C)(3)	LINE 7	CHIC	Yes
(92) REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE 12844 MILITARY RD S TUKWILA,WA98168 91-1170040	HEALTHCARE	WA	501(C)(3)	LINE 3	FHS	Yes
(93) SET OF COLORADO SPRINGS INC 2864 S CIRCLE DR STE 450 COLORADO SPRINGS,CO80906 84-1183335	LTERM CARE	CO	501(C)(3)	LINE 7	CHIC	Yes
(94) SAINT CLARE'S COMMUNITY CARE INC 25 POCONO RD DENVILLE,NJ07834 22-2876836	HEALTHCARE	NJ	501(C)(3)	LINE 11	SCHS	Yes
(95) SAINT CLARE'S FOUNDATION INC 25 POCONO RD DENVILLE,NJ07834 22-2502997	FUNDRAISING	NJ	501(C)(3)	LINE 7	SCHS	Yes
(96) SAINT CLARE'S HEALTH SERVICES INC 25 POCONO RD DENVILLE,NJ07834 22-3639733	MANAGEMENT	NJ	501(C)(3)	LINE 11	CHI	Yes
(97) SAINT CLARE'S HOSPITAL INC 25 POCONO RD DENVILLE,NJ07834 22-3319886	HEALTHCARE	NJ	501(C)(3)	LINE 3	SCHS	Yes
(98) SAINT ELIZABETH FOUNDATION 555 S 70TH ST LINCOLN,NE68510 47-0625523	FUNDRAISING	NE	501(C)(3)	LINE 7	SERMC	Yes
(99) SAINT ELIZABETH HEALTH SERVICES 555 S 70TH ST LINCOLN,NE68510 36-3233120	HEALTHCARE	NE	501(C)(3)	LINE 3	SERMC	Yes
(100) SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 S 70TH ST LINCOLN,NE68510 47-0379836	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(101) SAINT FRANCIS MEDICAL CENTER 2620 W FAIDLEY GRAND ISLAND,NE68803 47-0376601	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(102) SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND,NE68802 47-0630267	FUNDRAISING	NE	501(C)(3)	LINE 7	SFMC	Yes
(103) SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL ST BEREA,KY40403 26-0152877	FUNDRAISING	KY	501(C)(3)	LINE 7	SJHS	Yes
(104) SAINT JOSEPH HEALTH SYSTEM INC 424 LEWIS HARGETT CIRCLE STE 160 LEXINGTON,KY40503 61-1334601	HEALTHCARE	KY	501(C)(3)	LINE 3	KOH	Yes
(105) SAINT JOSEPH HOSPITAL FOUNDATION INC ONE SAINT JOSEPH DRIVE LEXINGTON,KY40504 61-1159649	FUNDRAISING	KY	501(C)(3)	LINE 11	SJHS	Yes
(106) SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON,KY40741 26-0438748	FUNDRAISING	KY	501(C)(3)	LINE 7	SJHS	Yes
(107) SAINT JOSEPH MEDICAL FOUNDATION INC 200 ABRAHAM FLEXNER WAY LOUISVILLE,KY40202 31-1539059	PHYSICIANS	KY	501(C)(3)	LINE 3	SJHS	Yes
(108) SAINT JOSEPH MOUNT STERLING FOUNDATION INC 225 FALCON DR MOUNT STERLING,KY40353 27-2884584	FUNDRAISING	KY	501(C)(3)	LINE 7	SJHS	Yes
(109) SAINT JOSEPH'S HOSPITAL FOUNDATION 30 WEST 7TH ST DICKINSON,ND58601 36-3418207	FUNDRAISING	ND	501(C)(3)	LINE 11	SJHHC	Yes
(110) SAMARITAN BEHAVIORAL HEALTH INC 601 S EDWIN C MOSES BLVD DAYTON,OH45417 02-0633634	HEALTHCARE	OH	501(C)(3)	LINE 7	SHP	Yes
(111) SAMARITAN HEALTH PARTNERS 110 N MAIN ST STE 500 DAYTON,OH45402 31-1107411	HEALTHCARE	OH	501(C)(3)	LINE 11	CHI	Yes
(112) SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC 104 W 17TH ST SCHUYLER,NE68661 36-3630014	FUNDRAISING	NE	501(C)(3)	LINE 11	AHMHS	Yes
(113) SJRMC JOPLIN MISSOURI 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 44-0545809	HEALTHCARE	MO	501(C)(3)	LINE 3	CHI	Yes
(114) SL AUGUSTA CORP PO BOX 20269 HOUSTON,TX77225 76-0226623	TITLE HOLDING	TX	501(C)(2)		SLPC	Yes
(115) ST ANTHONY HOSPITAL 1601 SE COURT AVE PENDLETON,OR97801 93-0391614	HEALTHCARE	OR	501(C)(3)	LINE 3	CHI	Yes
(116) ST ANTHONY HOSPITAL FOUNDATION 1601 SE COURT AVE PENDLETON,OR97801 93-0992727	FUNDRAISING	OR	501(C)(3)	LINE 11	SAH	Yes
(117) ST ANTHONY'S HOSPITAL ASSOCIATION FOUR HOSPITAL DR MORRILTON,AR72110 71-0245507	HEALTHCARE	AR	501(C)(3)	LINE 3	SVIMC	Yes
(118) ST CATHERINE HOSPITAL 401 EAST SPRUCE ST GARDEN CITY,KS67846 48-0543721	HEALTHCARE	KS	501(C)(3)	LINE 3	CHI	Yes
(119) ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION 401 EAST SPRUCE ST GARDEN CITY,KS67846 20-0598702	FUNDRAISING	KS	501(C)(3)	LINE 11	SCH	Yes
(120) ST DOMINIC OF ONTARIO OREGON 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 93-0433692	HEALTHCARE	OR	501(C)(4)	#N/A	CHI	Yes
(121) ST FRANCIS HOME 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 41-0729978	LTERM CARE	MN	501(C)(3)	LINE 9	CHI	Yes
(122) ST FRANCIS LIFE CARE CORPORATION 19 POCONO RD DENVILLE,NJ07834 22-2536017	ELDERLY CARE	NJ	501(C)(3)	LINE 9	SCHS	Yes
(123) ST FRANCIS MEDICAL CENTER 2400 ST FRANCIS DR BRECKENRIDGE,MN56520 41-0695598	HEALTHCARE	MN	501(C)(3)	LINE 3	CHI	Yes
(124) ST FRANCIS OF BAKER CITY 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 93-0412495	HEALTHCARE	OR	501(C)(3)	LINE 3	CHI	Yes
(125) ST JOSEPH COMMUNITY HEALTH 1516 5TH ST NW ALBUQUERQUE,NM87102 71-0897107	COMMUNITY	NM	501(C)(3)	LINE 11	CHI	Yes
(126) ST JOSEPH HEALTH MINISTRIES 1929 LINCOLN HWY E STE 150 LANCASTER,PA17602 23-2342997	HEALTHCARE	PA	501(C)(3)	LINE 11	CHI	Yes
(127) ST JOSEPH MEDICAL CENTER FOUNDATION 2500 BERNVILLE RD PO BOX 316 READING,PA19603 23-2649362	FUNDRAISING	PA	501(C)(3)	LINE 11	SJRHN	Yes
(128) ST JOSEPH MEDICAL CENTER INC 201 INTERNATIONAL CIRCLE STE 212 HUNT VALLEY,MD21030 52-0591461	HEALTHCARE	MD	501(C)(3)	LINE 3	CHI	Yes
(129) ST JOSEPH MEDICAL GROUP 2500 BERNVILLE RD PO BOX 316 READING,PA19603 20-8544021	HEALTHCARE	PA	501(C)(3)	LINE 9	BHC	Yes
(130) ST JOSEPH PHYSICIAN ENTERPRISE INC 201 INTERNATIONAL CIRCLE STE 212 HUNT VALLEY,MD21030 52-1311775	PHYSICIANS	MD	501(C)(3)	LINE 11	SJMC	Yes
(131) ST JOSEPH REGIONAL HEALTH NETWORK 2500 BERNVILLE RD PO BOX 316 READING,PA19603 23-1352211	HEALTHCARE	PA	501(C)(3)	LINE 3	CHI	Yes
(132) ST JOSEPH'S AREA HEALTH SERVICES 600 PLEASANT AVE PARK RAPIDS,MN56470 41-0695603	HEALTHCARE	MN	501(C)(3)	LINE 3	CHI	Yes
(133) ST JOSEPH'S HOSPITAL AND HEALTH CENTER 30 WEST 7TH ST DICKINSON,ND58601 45-0226429	HEALTHCARE	ND	501(C)(3)	LINE 3	CHI	Yes
(134) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-0274448	MANAGEMENT	TX	501(C)(3)	LINE 11	SLHS	Yes
(135) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - PMC 6624 FANNIN ST STE 2505 HOUSTON,TX77030 27-3733278	HEALTHCARE	TX	501(C)(3)	LINE 3	SLCDC	Yes
(136) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-1947374	HEALTHCARE	TX	501(C)(3)	LINE 3	SLHS	Yes
(137) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-0335902	HEALTHCARE	TX	501(C)(3)	LINE 3	SLCDC	Yes
(138) ST LUKE'S COMMUNITY HEALTH SERVICES 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0536234	HEALTHCARE	TX	501(C)(3)	LINE 3	SLHS	Yes
(139) ST LUKE'S FOUNDATION 1213 HERMANN DRIVE STE 855 HOUSTON,TX77004 45-3811485	FUNDRAISING	TX	501(C)(3)	LINE 7	SLHS	Yes
(140) ST LUKE'S HEALTH SYSTEM CORPORATION 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0536232	MANAGEMENT	TX	501(C)(3)	LINE 11	CHI	Yes
(141) ST LUKE'S HEALTH SYSTEM FOUNDATION 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0127715	INVESTMENT MGMT	TX	501(C)(3)	LINE 11	SLHS	Yes
(142) ST LUKE'S HOSPITAL AT THE VINTAGE 6624 FANNIN ST STE 2505 HOUSTON,TX77030 26-3734606	HEALTHCARE	TX	501(C)(3)	LINE 3	SLHS	Yes
(143) ST LUKE'S MEDICAL GROUP 6624 FANNIN ST HOUSTON,TX77030 76-0458535	PHYSICIANS	TX	501(C)(3)	LINE 3	SLHS	Yes
(144) ST LUKE'S MEDICAL TOWER CORPORATION 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0531713	PROPERTY MGMT	TX	501(C)(3)	LINE 11	CHI-SLH	Yes
(145) ST LUKE'S PROPERTIES CORPORATION 6624 FANNIN ST STE 1100 HOUSTON,TX77030 76-0531716	PROPERTY MGMT	TX	501(C)(3)	LINE 11	SLHS	Yes
(146) ST LUKE'S SUGAR LAND PROPERTIES CORPORATION 6624 FANNIN ST STE 2505 HOUSTON,TX77030 45-4120549	PROPERTY MGMT	TX	501(C)(3)	LINE 11	SLCDC-SL	Yes
(147) ST MARY'S COMMUNITY HOSPITAL 1314 3RD AVE NEBRASKA CITY,NE68410 47-0443636	HEALTHCARE	NE	501(C)(3)	LINE 3	CHI NEBRASKA	Yes
(148) ST MARY'S HOSPITAL FOUNDATION 1314 3RD AVE NEBRASKA CITY,NE68410 47-0707604	FUNDRAISING	NE	501(C)(3)	LINE 7	SMCH	Yes
(149) ST VINCENT FOUNDATION TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 51-0169537	FUNDRAISING	AR	501(C)(3)	LINE 11	SVIMC	Yes
(150) ST VINCENT INFIRMARY MEDICAL CENTER TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 71-0236917	HEALTHCARE	AR	501(C)(3)	LINE 3	CHI	Yes
(151) ST VINCENT MEDICAL GROUP TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 71-0830696	HEALTHCARE	AR	501(C)(3)	LINE 9	SVIMC	Yes
(152) THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH 619 OAK ST ACCOUNTING-3 W CINCINNATI,OH45206 31-0537486	HEALTHCARE	OH	501(C)(3)	LINE 3	CHI	Yes
(153) THE PHYSICIAN NETWORK 2000 Q ST STE 500 LINCOLN,NE68503 47-0780857	PHYSICIANS	NE	501(C)(3)	LINE 11	CHI NEBRASKA	Yes
(154) TOTAL HEALTHCARE 188 INVERNESS DRIVE WEST STE 500 ENGLEWOOD,CO80112 84-0927232	HEALTHCARE	CO	501(C)(3)	LINE 3	CHIC	Yes
(155) UNITY FAMILY HEALTHCARE 815 SE 2ND ST LITTLE FALLS,MN56345 41-0721642	HEALTHCARE	MN	501(C)(3)	LINE 3	CHI	Yes
(156) VILLA NAZARETH INC 801 PAGE DR FARGO,ND58103 45-0226714	LTERM CARE	ND	501(C)(3)	LINE 9	CHI	Yes
(157) VISITING NURSE ASSOCIATION OF ST CLARE'S INC 191 WOODPORT RD SPARTA,NJ07871 22-1768334	HOME HEALTH	NJ	501(C)(3)	LINE 9	SCHS	Yes
(158) WOODLANDS DOCTOR GROUP 17200 ST LUKES WAY STE 170 THE WOODLANDS,TX77384 27-4499340	PHYSICIANS	TX	501(C)(3)	LINE 9	SLCHS	Yes
(159) ST JOSEPH SERVICES CORPORATION 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2455161	GOVERNANCE	TX	501(C)(3)	LINE 11A, I	SYLVANIA FRANCISCAN HEALTH	Yes
(160) ST JOSEPH REGIONAL HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-1282696	HEALTH CARE	TX	501(C)(3)	LINE 3	ST JOSEPH SERVICES CORPORATION	Yes
(161) BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2759890	HEALTH CARE	TX	501(C)(3)	LINE 3	ST JOSEPH SERVICES CORPORATION	Yes
(162) MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2761145	HEALTH CARE	TX	501(C)(3)	LINE 3	ST JOSEPH SERVICES CORPORATION	Yes
(163) ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2847594	NURSING CARE	TX	501(C)(3)	LINE 9	ST JOSEPH SERVICES CORPORATION	Yes
(164) BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2913931	NURSING CARE	TX	501(C)(3)	LINE 9	ST JOSEPH SERVICES CORPORATION	Yes
(165) ST JOSEPH FOUNDATION 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2351158	FUNDRAISING	TX	501(C)(3)	LINE 11A, I	ST JOSEPH SERVICES CORPORATION	Yes
(166) ST JOSEPH PHYSICIAN ASSOCIATES 2801 FRANCISCAN DRIVE BRYAN,TX77802 20-3159302	PHYSICIAN PRACTICE	TX	501(C)(3)	LINE 3	ST JOSEPH SERVICES CORPORATION	Yes
(167) SISTERS OF ST FRANCIS 6832 CONVENT BLVD SYLVANIA,OH43560 34-4450609	RELIGIOUS	OH	501(C)(3)	LINE 1			No
(168) SYLVANIA FRANCISCAN HEALTH 3231 CENTRAL PARK WEST SUITE 106 TOLEDO,OH43617 34-1412964	CHURCH ORG	OH	501(C)(3)	LINE 1			No
(169) FRANCISCAN LIVING COMMUNITIES 5942 RENAISSANCE PLACE SUITE A TOLEDO,OH43623 34-1892096	MANAGEMENT SUPPORT	OH	501(C)(3)	LINE 11A, I	SYLVANIA FRANCISCAN HEALTH	Yes
(170) ST LEONARD 8100 CLYO ROAD CENTERVILLE,OH45458 34-1940863	LONG TERM CARE FACILITY	OH	501(C)(3)	LINE 9	FRANCISCAN LIVING COMMUNITIES	Yes
(171) ST LEONARD FOUNDATION 8100 CLYO ROAD CENTERVILLE,OH45458 32-0102715	FUNDRAISING	OH	501(C)(3)	LINE 7	FRANCISCAN LIVING COMMUNITIES	Yes
(172) PROVIDENCE CARE CENTER 2025 HAYES AVE SANDUSKY,OH44870 34-1658625	LONG TERM CARE FACILITY	OH	501(C)(3)	LINE 9	FRANCISCAN LIVING COMMUNITIES	Yes
(173) THE COMMONS OF PROVIDENCE 5000 PROVIDENCE DRIVE SANDUSKY,OH44870 34-1826097	ASSISTED LIVING FACILITY	OH	501(C)(3)	LINE 9	FRANCISCAN LIVING COMMUNITIES	Yes
(174) PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY,OH44870 34-1896807	INDEPENDENT LIVING FACILITY	OH	501(C)(3)	LINE 9	FRANCISCAN LIVING COMMUNITIES	Yes
(175) PROVIDENCE CARE CENTERS 2025 HAYES AVE SANDUSKY,OH44870 34-1826099	FINANCIAL SUPPORT	OH	501(C)(3)	LINE 11B, II	FRANCISCAN LIVING COMMUNITIES	Yes
(176) FRANCISCAN CARE CENTER 4111 HOLLAND SYLVANIA ROAD TOLEDO,OH43623 34-1931806	LONG TERM CARE FACILITY	OH	501(C)(3)	LINE 9	FRANCISCAN LIVING COMMUNITIES	Yes
(177) ST CLARE COMMONS 12469 FIVE POINT ROAD PERRYSBURG,OH43551 27-0163752	LONG TERM CARE FACILITY	OH	501(C)(3)	LINE 7	FRANCISCAN LIVING COMMUNITIES	Yes
(178) TRINITY HOSPITAL TWIN CITY 819 NORTH FIRST STREET DENNISON,OH44621 27-5401105	HEALTH CARE	OH	501(C)(3)	LINE 3	SYLVANIA FRANCISCAN HEALTH	Yes
(179) SYLVANIA FRANCISCAN HEALTH FOUNDATION 3231 CENTRAL PARK WEST SUITE 106 TOLEDO,OH43617 45-5357161	FUNDRAISING	OH	501(C)(3)	LINE 11B, II	SYLVANIA FRANCISCAN HEALTH	Yes
(180) MADONNA MANOR 2344 AMSTERDAM ROAD VILLA HILLS,KY41017 61-0654635	LONG TERM CARE FACILITY	KY	501(C)(3)	LINE 1	FRANCISCAN LIVING COMMUNITIES	Yes
(181) ST JOSEPH REGIONAL HEALTH PARTNERS 2801 FRANCISCAN DRIVE BRYAN,TX77802 45-4088170	PHYSICIAN SUPPORT	TX	501(C)(3)	LINE 3	ST JOSEPH SERVICES CORPORATION	Yes
(182) ST JOSEPH REGIONAL HEALTH PARTNERS ACO 2801 FRANCISCAN DRIVE BRYAN,TX77802 46-3265423	HEALTH CARE	TX	501(C)(3)	LINE 3	ST JOSEPH SERVICES CORPORATION	Yes

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

Cat. No. 50135Y

Schedule R (Form 990) 2014

Page 2

Part III

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

(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	(h) Disproprtionate allocations?		(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	(j) General or managing partner?
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) ALEGENT HEALTH NORTHWEST IMAGING CENTER LLC 3606 N 156TH ST OMAHA,NE68116 06-1786985	OP DIAGNOSTICS	NE	N/A
(2) AUDUBON LAND COMPANY LLC 5390 N ACADEMY BLVD STE 300 COLORADO SPRINGS,CO80918 84-1513085	REAL ESTATE	CO	N/A
(3) AVANTAS LLC 11128 JOHN GALT BLVD STE 400 OMAHA,NE68137 39-2045003	STAFFING OF NURSES	NE	N/A
(4) BERGAN MERCY SURGERY CENTER LLC 7710 MERCY RD STE 200 OMAHA,NE68124 20-8671994	AMBUL SURG CTR	NE	N/A
(5) BERYWOOD OFFICE PROPERTIES LLC 400 BERYWOOD TRAIL CLEVELAND,TN37312 62-1875199	PHYS OFFICE	TN	N/A
(6) BLUEGRASS REGIONAL IMAGING CENTER 1218 SOUTH BRDWAY STE 310 LEXINGTON,KY40504 61-1386736	DIAGNOSTIC IMAGING	KY	N/A
(7) CATHOLIC HEALTH INITIATIVES PHYSICIAN SERVICES LLC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-2945938	PRACTICE MGMT SRVC	DE	N/A
(8) CENTRAL NEBRASKA HOME CARE SERVICES PO BOX 1146 4502 N SECOND AVE KEARNEY,NE68848 47-0692112	HEALTHCARE SRVC	NE	N/A
(9) CENTRAL NEBRASKA REHAB SERVICE 620 DIERS AVE STE 300 GRAND ISLAND,NE68803 81-0653461	PHYSICAL THERAPY	NE	N/A
(10) CHI OPERATING INVESTMENT PROGRAM LP 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 47-0727942	INVESTMENTS	CO	N/A
(11) CHICAMSURG SURGERY CENTERS LLC 188 INVERNESS DRIVE WEST 500 ENGLEWOOD,CO80112 46-5683027	SURGERY CENTER	CO	N/A
(12) HC SL VINTAGE I LLC 18000 W SARAH LANE STE 250 BROOKFIELD,WI53045 27-0453767	PROPERTY HOLDING	WI	N/A
(13) HEALTHCARE SUPPORT SERVICES PO BOX 9804 GRAND ISLAND,NE68802 72-1546196	LAUNDRY	NE	N/A
(14) HEARTLAND ONCOLOGY LLC 2337 E CRAWFORD ST SALINA,KS67401 46-4265403	ONCOLOGY	KS	N/A
(15) HIGHLINE IMAGING LLC 275 SW 160TH ST BURIEN,WA98166 20-0460005	DIAGNOSTIC IMAGING	WA	N/A
(16) LAKESIDE AMBULATORY SURGICAL CENTER LLC 17031 LAKESIDE HILLS DR OMAHA,NE68130 20-4267902	AMBUL SURG CTR	NE	N/A
(17) LAKESIDE ENDOSCOPY CENTER LLC 17001 LAKESIDE HILLS PLZ STE 201 OMAHA,NE68130 20-5544496	ENDOSCOPY SRVC	NE	N/A
(18) LINCOLN CK LEASING LLC 6003 OLD CHENEY RD LINCOLN,NE68516 26-2496856	REAL ESTATE	NE	N/A
(19) LOUISVILLE SC LTD 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM,AL35244 62-1179566	SURGERY CENTER	AL	N/A
(20) NEBRASKA SPINE HOSPITAL LLC 6901 N 72ND ST OMAHA,NE68122 27-0263191	SPINE HOSPITAL	NE	N/A
(21) NORTH RIVER SURGERY CENTER LLC 2209 WILDWOOD AVE SHERWOOD,AR72120 71-0799771	AMBUL SURG CTR	AR	N/A
(22) ORTHOCOLORADO LLC 11650 WEST 2ND PLACE LAKEWOOD,CO80255 37-1577105	ORTHO HOSPITAL	CO	N/A
(23) PENINSULA RADIATION ONCOLOGY LLC 315 MLK JR WAY STE 111 TACOMA,WA98405 87-0808610	HEALTHCARE SRVC	WA	N/A
(24) PENRAD IMAGING 1390 KELLY JOHNSON BLVD COLORADO SPRINGS,CO80920 84-1072619	MEDICAL IMAGING	CO	N/A
(25) PMC HOSPITAL LLC 4600 E SAM HOUSTON PKWY SOUTH PASADENA,TX77505 27-3280598	HOSPITAL	TX	N/A
(26) PRAIRIE HEALTH VENTURES LLC 421 S 9TH ST STE 102 LINCOLN,NE68508 20-4962103	TECH SRVC	NE	N/A
(27) PREMIER SURGERY CENTER OF LOUISVILLE LP 3000 RIVERCHASE GALLERIA STE 500 BIRMINGHAM,AL35244 72-1378216	SURGERY CENTER	AL	N/A
(28) PUEBLO AMBULATORY SURGERY CENTER LLC 188 INVERNESS DRIVE WEST 500 ENGLEWOOD,CO80112 62-1488737	SURGERY CENTER	CO	N/A
(29) SAINT JOSEPH - PAML LLC 424 LEWIS HARGETT CIRCLE STE 160 LEXINGTON,KY40503 45-2116736	MGMT SVCS	KY	N/A
(30) SAINT JOSEPH - SCA HOLDINGS LLC 1451 HARRODSBURG RD LEXINGTON,KY40503 45-3801157	OP SURGERY	DE	N/A
(31) SAINT JOSEPH-ANC HOME CARE SERVICES 1700 EDISON DR MILFORD,OH45150 26-3330545	HOME HEALTH	KY	N/A
(32) SCA PREMIER SURGERY CENTER OF LOUISVILLE LLC 200 ABRAHAM FLEXNER WAY LOUISVILLE,KY40202 72-1386840	SURGERY CENTER	KY	N/A
(33) ST FRANCIS LAND COMPANY 5390 N ACADEMY BLVD STE 300 COLORADO SPRINGS,CO80918 26-3134100	REAL ESTATE	CO	N/A
(34) ST FRANCIS MEDICAL CENTER ASSOCIATES 1717 SOUTH J ST TACOMA,WA98405 91-1352698	MED OFFICE	WA	N/A
(35) ST LUKE'S DIAGNOSTIC CATH LAB LLP 6620 MAIN ST STE 1520 HOUSTON,TX77030 71-0959365	DIAGNOSTICS	TX	N/A
(36) ST LUKE'S HOSPITAL AT THE VINTAGE LLC 6624 FANNIN STE 2505 HOUSTON,TX77030 26-3734516	HOSPITAL	TX	N/A
(37) ST LUKE'S LAKESIDE HOSPITAL LLC 6624 FANNIN STE 2505 HOUSTON,TX77030 30-0427437	HOSPITAL	TX	N/A
(38) ST LUKE'S THE WOODLANDS SLEEP CENTER LLC 6624 FANNIN STE 800 HOUSTON,TX77030 46-2795726	DIAGNOSTICS	TX	N/A
(39) SUPERIOR MEDICAL IMAGING LLC 5000 NORTH 26TH ST LINCOLN,NE68521 26-2884555	OP DIAGNOSTICS	NE	N/A
(40) SURGERY CENTER OF LEXINGTON LLC 424 LEWIS HARGETT CIRCLE STE 160 LEXINGTON,KY40503 62-1179539	SURGERY CENTER	DE	N/A
(41) SURGERY CENTER OF LOUISVILLE LLC 200 ABRAHAM FLEXNER WAY LOUISVILLE,KY40202 62-1179537	SURGERY CENTER	KY	N/A

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	(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) ALLIANCE HEALTH PROVIDERS OF BRAZOS VALLEY 2801 FRANCISCAN DRIVE BRYAN,TX77802 74-2466914	PHYSICIAN HOSPITAL ORGANIZATION	TX	N/A	C			Yes
(2) SFH ASSURANCE LTD SUITE 6 GRAND PAVILLION COMERCIAL GRAND CAYMAN KY1- CJ 98-1056892	INSURANCE	CJ	N/A	C			Yes
(3) ALEGENT HEALTHCREIGHTON ST JOSEPH MANAGED CARE SERVICES INC 12809 WEST DODGE RD OMAHA,NE68154 47-0802396	MANAGED CARE	NE	N/A	C			Yes
(4) ALL SAINTS INSURANCE COMPANY SPC LTD PO BOX 10073 APO GEORGETOWN,GRAND CAYMANKY1-1001 CJ	INSURANCE	CJ	N/A	C			Yes
(5) ALTERNATIVE INSURANCE MANAGEMENT SERVICE 3900 OLYMPIC BLVD STE 400 ERLANGER,KY41018 84-1112049	MANAGEMENT SERVICES	CO	N/A	C			Yes
(6) AMERICAN NURSING CARE INC 1700 EDISON DR MILFORD,OH45150 31-1085414	HOME HEALTH	OH	N/A	C			Yes
(7) AMERIMED INC 1700 EDISON DR MILFORD,OH45150 31-1158699	HOME HEALTH	OH	N/A	C			Yes
(8) BC HOLDING COMPANY INC 1850 BLUEGRASS AVE LOUISVILLE,KY40215 31-1542851	FITNESS CLUB	KY	N/A	C			Yes
(9) CADUCEUS MEDICAL ASSOCIATES INC 2525 DE SALES AVE CHATTANOOGA,TN37404 62-1570736	HEALTHCARE	TN	N/A	C			Yes
(10) CAPTIVE MANAGEMENT INITIATIVES LTD PO BOX 10073 APO GEORGETOWN,GRAND CAYMANKY1-1001 CJ 98-0663022	CAPTIVE MANAGEMENT	CJ	N/A	C			Yes
(11) CARMONA-DESOTO BUILDING HORIZONTAL PROPERTY REGIME INC 300 WERNER ST HOT SPRINGS,AR71913 71-0771076	HEALTHCARE	AR	N/A	C			Yes
(12) CATHOLIC HEALTH INITIATIVES CENTER FOR TRANSLATIONAL RESEARCH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 27-2269511	RESEARCH	CO	N/A	C			Yes
(13) CGH REALTY COMPANY INC 2500 BERNVILLE RD READING,PA19603 23-2326801	REAL ESTATE	PA	N/A	C			Yes
(14) CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER CONDOMINIUM 6624 FANNIN STE 2505 HOUSTON,TX77030 45-5079545	CONDO ASSOC	TX	N/A	C			Yes
(15) CLEARRIVER HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-4495960	INSURANCE	TN	N/A	C			Yes
(16) COMCARE SERVICES INC 5570 DTC PARKWAY ENGLEWOOD,CO80111 84-0904813	INACTIVE	CO	N/A	C			Yes
(17) CONSOLIDATED HEALTH SERVICES 1700 EDISON DR MILFORD,OH45150 31-1378212	HOME HEALTH	OH	N/A	C			Yes
(18) DES MOINES MEDICAL CENTER INC 1111 6TH AVE DES MOINES,IA50314 42-0837382	REAL ESTATE	IA	N/A	C			Yes
(19) EAST TEXAS CLINICAL SERVICES INC 2801 VIA FORTUNA 500 AUSTIN,TX78746 45-4736213	HEALTHCARE	TX	N/A	C			Yes
(20) FIRST INITIATIVES INSURANCE LTD PO BOX 10073 APO GEORGETOWN,GRAND CAYMANKY1-1001 CJ 98-0203038	INSURANCE	CJ	N/A	C			Yes
(21) FRANCISCAN SERVICES INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 23-2487967	HEALTHCARE	CO	N/A	C			Yes
(22) GOOD SAMARITAN OUTREACH SERVICES PO BOX 1990 KEARNEY,NE68848 47-0659440	MEDICAL CLINIC	NE	N/A	C			Yes
(23) HEALTH SYSTEMS ENTERPRISES INC PO BOX 1990 KEARNEY,NE68848 47-0664558	MGMT	NE	N/A	C			Yes
(24) HEALTHCARE MGMT SERVICES ORGANIZATION INC 1717 SOUTH J ST TACOMA,WA98405 91-1865474	HEALTH ORG.	WA	N/A	C			Yes
(25) HEARTLANDPLAINS HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-4368223	INSURANCE	NE	N/A	C			Yes
(26) HIGHLINE MEDICAL GROUP 15811 AMBAUM BLVD SW STE 170 BURIEN,WA98166 91-1586438	MEDICAL SERVICES	WA	N/A	C			Yes
(27) MEDQUEST 1602 WEST 11TH ST WILLISTON,ND58801 45-0392137	SALE OF DME	ND	N/A	C			Yes
(28) MERCY PARK APARTMENTS LTD 1111 6TH AVE DES MOINES,IA50314 42-1202422	HOUSING	IA	N/A	C			Yes
(29) MERCY SERVICES CORP 2700 STEWART PARKWAY ROSEBURG,OR97471 93-0824308	RETAIL SALES	OR	N/A	C			Yes
(30) MHI CLINICAL SERVICES 1201 W FRANK AVE LUFKIN,TX75904 46-1967952	HEALTHCARE	TX	N/A	C			Yes
(31) MOUNTAIN MANAGEMENT SERVICES INC 6028 SHALLOWFORD RD CHATTANOOGA,TN37421 62-1570739	MGMT SVC ORG	TN	N/A	C			Yes
(32) NAZARETH ASSURANCE COMPANY PO BOX 10073 APO GEORGETOWN,GRAND CAYMANKY1-1001 CJ 03-0304831	INSURANCE	CJ	N/A	C			Yes
(33) PATIENT TRANSPORT SERVICES INC 1700 EDISON DR MILFORD,OH45150 31-1100798	HOME HEALTH	OH	N/A	C			Yes
(34) PHYSICIANHEALTH SYSTEM NETWORK 1149 MARKET ST TACOMA,WA98402 91-1746721	HEALTH ORG.	WA	N/A	C			Yes
(35) PROMINENCE HEALTH PLAN SERVICES INC (FKA COLLABHEALTH PLAN SERVICES INC) 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-1224037	ADMIN SERVICES	CO	N/A	C			Yes
(36) PROMINENCE HEALTH INC (FKA COLLABHEALTH MANAGED SOLUTIONS INC) 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-1222808	HOLDING CO	CO	N/A	C			Yes
(37) QCA HEALTH PLAN INC 12615 CHENAL PARKWAY STE 300 LITTLE ROCK,AR72211 71-0794605	INSURANCE	AR	N/A	C			Yes
(38) QUALCHOICE HOLDINGS INC 12615 CHENAL PARKWAY STE 300 LITTLE ROCK,AR72211 27-4075520	HOLDING CO	AR	N/A	C			Yes
(39) QUALCHOICE LIFE AND HEALTH INSURANCE COMPANY INC 12615 CHENAL PARKWAY STE 300 LITTLE ROCK,AR72211 71-0386640	INSURANCE	AR	N/A	C			Yes
(40) RIVERLINK HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-4380824	INSURANCE	OH	N/A	C			Yes
(41) RIVERLINK HEALTH OF KENTUCKY INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-4828332	INSURANCE	KY	N/A	C			Yes
(42) SAINT CLARE'S PRIMARY CARE INC 66 FORD RD DENVILLE,NJ07834 22-2441202	BILLING SERVICES	NJ	N/A	C			Yes
(43) SAMARITAN FAMILY CARE INC 40 W FOURTH ST STE 1700 DAYTON,OH45402 31-1299450	HEALTHCARE	OH	N/A	C			Yes
(44) SJH SERVICES CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 23-2307408	HEALTHCARE	CO	N/A	C			Yes
(45) SJL PHYSICIAN MANAGEMENT SERVICES INC 424 LEWIS HARGETT CR STE 160 LEXINGTON,KY40503 27-0164198	MGMT	KY	N/A	C			Yes
(46) SLMT PARKING INC 6624 FANNIN STE 800 HOUSTON,TX77030 76-0637140	PARKING	TX	N/A	C			Yes
(47) SOUNDPATH HEALTH INC 32129 WEYERHAEUSER WAY S STE 201 FEDERAL WAY,WA98001 42-1720801	INSURANCE	WA	N/A	C			Yes
(48) ST ANTHONY DEVELOPMENT COMPANY 1415 SOUTHGATE PENDLETON,OR97801 93-1216943	ATHLETIC CLUB	OR	N/A	C			Yes
(49) ST JOSEPH DEVELOPMENT COMPANY INC 1717 SOUTH J ST TACOMA,WA98405 91-1480569	RENTAL	WA	N/A	C			Yes
(50) ST JOSEPH OFFICE PARK ASSOCIATION 1401 HARRODSBURG RD BLDG B70 LEXINGTON,KY40504 61-1079899	MGMT	KY	N/A	C			Yes
(51) ST LUKE'S 6620 MAIN CONDOMINIUM ASSOCIATION 6624 FANNIN STE 2505 HOUSTON,TX77030 30-0355517	CONDO ASSOC	TX	N/A	C			Yes
(52) ST LUKE'S ANESTHESIOLOGY ASSOCIATES 6624 FANNIN STE 1100 HOUSTON,TX77030 46-1517163	MEDICAL CLINIC	TX	N/A	C			Yes
(53) ST LUKE'S EPISCOPAL HOSPITAL PHYSICIAN HOSPITAL ORGANIZATION INC 6720 BERTNER MC4-262 HOUSTON,TX77030 76-0377932	PHO	TX	N/A	C			Yes
(54) ST LUKE'S HEALTH SYSTEM HOLDINGS INC (FKA SLEHS HOLDINGS INC) 6624 FANNIN STE 800 HOUSTON,TX77030 76-0637138	HOLDING CO	TX	N/A	C			Yes
(55) ST LUKE'S MEDICAL ARTS CENTER I CONDOMINIUM ASSOCIATION 6624 FANNIN STE 2505 HOUSTON,TX77030 30-0355518	CONDO ASSOC	TX	N/A	C			Yes
(56) ST LUKE'S MEDICAL TOWER CONDOMINIUM ASSOCIATION 6624 FANNIN STE 2505 HOUSTON,TX77030 76-0298751	CONDO ASSOC	TX	N/A	C			Yes
(57) ST VINCENT COMMUNITY HEALTH SERVICES INC TWO ST VINCENT CIRCLE LITTLE ROCK,AR72205 71-0710785	HEALTHCARE	AR	N/A	C			Yes
(58) STABLEVIEW HEALTH INC 198 INVERNESS DRIVE WEST ENGLEWOOD,CO80112 46-4373713	INSURANCE	KY	N/A	C			Yes
(59) SUGAR LAND DOCTOR GROUP 1317 LAKE POINTE PARKWAY SUGAR LAND,TX77478 45-4270163	MEDICAL CLINIC	TX	N/A	C			Yes
(60) THE TEXAS HEART INSTITUTE AT ST LUKE'S EPISCOPAL HOSPITAL DENTON A COOLEY B 6624 FANNIN STE 2505 HOUSTON,TX77030 90-0064009	CONDO ASSOC	TX	N/A	C			Yes
(61) TOWSON MANAGEMENT INC 7601 OSLER DR TOWSON,MD21204 52-1710750	MGMT SERVICES	MD	N/A	C			Yes

Schedule R (Form 990) 2014

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

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

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

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

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

Yes

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

Yes

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

Yes

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

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) ST JOSEPH REGIONAL HEALTH CENTER	C	3,770,868	ACTUAL AMOUNTS PAID
(2) SYLVANIA FRANCSICAN HEALTH	C	13,553	ACTUAL AMOUNTS PAID
(3) ST JOSEPH REGIONAL HEALTH CENTER	Q	1,830,000	ACTUAL AMOUNTS PAID
(4) ST JOSEPH REGIONAL HEALTH CENTER	P	3,732,955	ACTUAL AMOUNTS PAID
(5) ST JOSEPH SERVICE CORPORATIONS	P	375,257	CASH

Schedule R (Form 990) 2014

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) 2014

Page 5

Part VII

Supplemental Information

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

Return Reference	Explanation

Schedule R (Form 990) 2014

Additional Data

Software ID:
Software Version:

1	Briefly describe the organization’s mission or most significant activities: THE PRIMARY PURPOSE OF THE HOSPITAL IS TO SUPPORT ITS COMMUNITY IN PROVIDING FOR THE HEALTHCARE NEEDS OF ITS COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	7
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	3
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	0
6	Total number of volunteers (estimate if necessary) .............	6	33
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	0
b	Net unrelated business taxable income from Form 990-T, line 34 .........	7b	0

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	1,828,250	3,788,278
9	Program service revenue (Part VIII, line 2g) .........	13,064,737	14,183,952
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	3,148	8,308
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	287,988	339,639
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	15,184,123	18,320,177
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	0	0
14	Benefits paid to or for members (Part IX, column (A), line 4).....	0	0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	4,566,726	5,480,540
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)....	8,066,436	8,381,372
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	12,633,162	13,861,912
19	Revenue less expenses. Subtract line 18 from line 12.......	2,550,961	4,458,265
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	5,921,223	11,509,436
21	Total liabilities (Part X, line 26).............	3,836,597	3,171,771
22	Net assets or fund balances. Subtract line 21 from line 20.....	2,084,626	8,337,665

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 2,280,913 including grants of $ 0 ) (Revenue $ 2,791,784 )
	EMERGENCY SERVICES: PROVIDED EMERGENCY CARE TO 4,534 PATIENTS.

4b	(Code: ) (Expenses $ 1,477,769 including grants of $ 0 ) (Revenue $ 1,808,755 )
	DIAGNOSTIC SERVICES: PROVIDED IMAGING SERVICES TO 3,141 PATIENTS.

4c	(Code: ) (Expenses $ 1,411,479 including grants of $ 0 ) (Revenue $ 1,727,617 )
	LABORATORY SERVICES: PROVIDED 6,856 LABORATORY SERVICES TO PATIENTS.

	(Code: ) (Expenses $ 6,499,701 including grants of $ 0 ) (Revenue $ 7,955,481 )
	PROVIDED MEDICAL/SURGICAL, OPERATING ROOM, PHARMACY SERVICES, SERVICES AT MEDICAL CLINIC OF BELLVILLE, CARDIOVASCULAR SERVICES, AND THERAPY SERVICES TO PATIENTS.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ 6,499,701 including grants of $ 0 ) (Revenue $ 7,955,481 )
4e	Total program service expenses11,669,862

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	0	2,849,485	203,719

				(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		3,784,421
e	Government grants (contributions)1e

f	All other contributions, gifts, grants, and similar amounts not included above1f		3,857

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			3,788,278
			Business Code
2a	PATIENT SERVICES		622110	13,442,152	13,442,152
b	ELECTRONIC MEDICAL RECORDS		622110	741,800	741,800
c
d
e
f	All other program service revenue .
g	Total. Add lines 2a–2f........			14,183,952
3	Investment income (including dividends, interest, and other similar amounts).......			8,308			8,308
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	228,236
b	Less: rental expenses	0
c	Rental income or (loss)	228,236
d	Net rental income or (loss).......			228,236			228,236
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory
b	Less: cost or other basis and sales expenses
c	Gain or (loss)
d	Net gain or (loss)..........
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..
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...
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..
Miscellaneous Revenue			Business Code
11a	TRAUMA ADD-ON REVENUE		621110	35,807	35,807
b	LAB FEE REVENUE		621500	30,851	30,851
c	OTHER RELATED REVENUE		900099	19,584	19,584
d	All other revenue ....			25,161	13,443		11,718
e	Total. Add lines 11a–11d ......			111,403
12	Total revenue. See Instructions......			18,320,177	14,283,637	0	248,262


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			93,431	1	796,162
2	Savings and temporary cash investments .........				2
3	Pledges and grants receivable, net ...........				3
4	Accounts receivable, net .............			3,148,033	4	6,407,824
5	Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of Schedule L ..................
					5
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
					6
7	Notes and loans receivable, net .............				7
8	Inventories for sale or use ..............			277,957	8	244,115
9	Prepaid expenses and deferred charges ..........			55,818	9	47,846
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	2,300,857
b	Less: accumulated depreciation .....	10b	103,396	2,147,306	10c	2,197,461
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....				12
13	Investments—program-related. See Part IV, line 11 .....			100	13
14	Intangible assets ...............				14	209,082
15	Other assets. See Part IV, line 11 ...........			198,578	15	1,606,946
16	Total assets. Add lines 1 through 15 (must equal line 34)......			5,921,223	16	11,509,436
17	Accounts payable and accrued expenses .........			612,155	17	558,710
18	Grants payable .................				18
19	Deferred revenue ................				19	1,300,000
20	Tax-exempt bond liabilities .............				20
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..........				22
23	Secured mortgages and notes payable to unrelated third parties ..			1,800,000	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....................			1,424,442	25	1,313,061
26	Total liabilities. Add lines 17 through 25.........			3,836,597	26	3,171,771
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			2,084,526	27	6,937,521
28	Temporarily restricted net assets ...........			100	28	1,400,144
29	Permanently restricted net assets ...........				29
	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 ...........			2,084,626	33	8,337,665
34	Total liabilities and net assets/fund balances ........			5,921,223	34	11,509,436