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)
(1) GEORGE JOHNSON........................................................................ BOARD MEMBER	1.50 .......................	X			0	0
(2) SR VIRGINIA HONISH........................................................................ BOARD MEMBER	1.50 .......................1.00	X			0	0
(3) FRANK PROBST PHD........................................................................ BOARD MEMBER	1.50 .......................3.00	X			0	0
(4) SR JEANETTE CLARKE........................................................................ BOARD MEMBER	1.50 .......................	X			0	0
(5) DON SCHULTZ........................................................................ BOARD MEMBER	1.50 .......................	X			0	0
(6) ROB WALZ........................................................................ BOARD MEMBER	1.50 .......................	X			0	0
(7) DAVE GERFEN........................................................................ BOARD MEMBER	1.50 .......................	X			0	0
(8) FRED POSTHUMA........................................................................ CHAIRPERSON	3.00 .......................	X	X		0	0
(9) JUDY WARMUTH PHD........................................................................ BOARD MEMBER	1.50 .......................	X			0	0
(10) JUDY COLLINS........................................................................ VICE CHAIRPERSON	2.50 .......................	X	X		0	0
(11) JACK HARKINS........................................................................ TREASURER	2.50 .......................	X	X		0	0
(12) NANCY BEASLEY........................................................................ SECRETARY	2.50 .......................	X	X		0	0
(13) MICHAEL DECKER........................................................................ CEO	40.00 .......................		X		387,895	81,852
(14) MARLIN NELSON........................................................................ VP FINANCE	40.00 .......................		X		233,260	55,960
(15) JOSHUA POGORELEC MD........................................................................ PHYSICIAN	40.00 .......................			X	519,221	31,426
(16) DOUGLAS ARNOLD MD........................................................................ PHYSICIAN	40.00 .......................			X	488,621	31,426
(17) JAMES FOSKETT MD........................................................................ PHYSICIAN	40.00 .......................			X	857,451	29,280

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 ....	4,450	4,450
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 ....	790,068		790,068
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 ....	41,674,367	37,895,266	3,779,101
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	1,341,452	1,204,013	137,439
9	Other employee benefits .......	6,421,922	5,839,571	582,351
10	Payroll taxes ...........	2,720,327	2,441,736	278,591
11	Fees for services (non-employees):
a	Management ......
b	Legal .........	38,757		38,757
c	Accounting ...........	61,287		61,287
d	Lobbying ...........
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) ....	5,093,542	4,162,001	931,541
12	Advertising and promotion ....	365,354		365,354
13	Office expenses .......	527,805		527,805
14	Information technology ......	594,706		594,706
15	Royalties ..
16	Occupancy ...........	3,051,604	3,051,604
17	Travel ............	75,107	75,107
18	Payments of travel or entertainment expenses for any federal, state, or local public officials ......
19	Conferences, conventions, and meetings ....	190,712	142,374	48,338
20	Interest ...........
21	Payments to affiliates .......	437,922		437,922
22	Depreciation, depletion, and amortization .....	4,732,623	4,732,623
23	Insurance ..............	459,245	459,245
24	Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a	SUPPLIES	12,571,138	11,948,405	622,733
b	BAD DEBT EXPENSE	5,888,411	5,888,411
c	REPAIRS & MAINTENANCE	1,962,643	1,844,843	117,800
d	HOSPITAL ASSESSMENT	1,570,252	1,570,252
e	All other expenses
25	Total functional expenses. Add lines 1 through 24e	90,573,694	81,259,901	9,313,793	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 .............	2,107,502	1	1,811,118
2	Savings and temporary cash investments .........	9,947,240	2	14,531,033
3	Pledges and grants receivable, net ...........	68,603	3	196,629
4	Accounts receivable, net .............	12,047,521	4	15,139,165
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 .............	929,980	7	931,191
8	Inventories for sale or use ..............	1,638,484	8	1,518,675
9	Prepaid expenses and deferred charges ..........	2,157,218	9	2,145,681
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	105,016,729
b	Less: accumulated depreciation .....	10b	48,011,392	51,158,721	10c	57,005,337
11	Investments—publicly traded securities ..........		11
12	Investments—other securities. See Part IV, line 11 .....	42,079,296	12	42,138,471
13	Investments—program-related. See Part IV, line 11 .....		13
14	Intangible assets ...............		14
15	Other assets. See Part IV, line 11 ...........	1,664,671	15	2,438,491
16	Total assets. Add lines 1 through 15 (must equal line 34)......	123,799,236	16	137,855,791
	17	Accounts payable and accrued expenses .........	7,089,642	17	7,888,335
18	Grants payable .................		18
19	Deferred revenue ................		19
20	Tax-exempt bond liabilities .............	45,249,238	20	53,144,013
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 ..		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....................	1,959,120	25	2,941,178
26	Total liabilities. Add lines 17 through 25.........	54,298,000	26	63,973,526
		Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............	69,277,149	27	73,617,657
28	Temporarily restricted net assets ...........	224,087	28	264,608
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 ...........	69,501,236	33	73,882,265
34	Total liabilities and net assets/fund balances ........	123,799,236	34	137,855,791

- 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

DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

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

DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

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 DIVINE SAVIOR HEALTHCARE INC

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 DIVINE SAVIOR HEALTHCARE INC

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
DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

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

DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

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

5,247

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

5,247

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:	DIVINE SAVIOR HEALTHCARE, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE WHA HAS NOTIFIED DIVINE SAVIOR HEALTHCARE, INC. THAT APPROXIMATELY $2,350 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. DIVINE SAVIOR HEALTHCARE, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, DIVINE SAVIOR HEALTHCARE, INC. PAYS MEMBERSHIP FEES TO THE RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. RWHC DETERMINED THAT APPROXIMATELY $2,897 OF THE FEES PAID BY DIVINE SAVIOR HEALTHCARE IN FISCAL YEAR 2015 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN.

Return Reference

Explanation

PART II-B, LINE 1:

DIVINE SAVIOR HEALTHCARE, INC. PAYS ANNUAL ASSOCIATION MEMBERSHIP DUES TO THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THESE DUES ARE PRIMARILY TO ACCESS EDUCATIONAL MATERIALS AND FOR STAFF TRAINING AND MATERIALS. THE WHA HAS NOTIFIED DIVINE SAVIOR HEALTHCARE, INC. THAT APPROXIMATELY $2,350 OF THE ANNUAL DUES WERE USED IN CONJUNCTION WITH LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE OVERALL HEALTHCARE ENVIRONMENT. DIVINE SAVIOR HEALTHCARE, INC. IS ALSO A MEMBER OF THE RURAL WISCONSIN HEALTH COOPERATIVE (RWHC). EACH YEAR, DIVINE SAVIOR HEALTHCARE, INC. PAYS MEMBERSHIP FEES TO THE RWHC. THE RWHC PROVIDES SUPPORT SERVICES FOR A NUMBER OF ITS MEMBER HOSPITALS THROUGHOUT THE STATE OF WISCONSIN. SOME OF THE MANY SERVICES PROVIDED TO MEMBER HOSPITALS INCLUDE PROVIDING ASSISTANCE TO ORGANIZATIONS IN FINDING GRANT FUNDING FOR NEW PROGRAMS, LEGAL SERVICES, REIMBURSEMENT REVIEW SERVICES, ACCOUNTING ASSISTANCE, CONTRACTING FOR THERAPIST AND EMERGENCY ROOM PATIENT CARE COVERAGE, AND ADMINISTRATIVE CONSULTING SERVICES. AS A PART OF THESE SERVICES, THE RWHC ALSO DOES PROVIDE ANALYSIS ON CURRENT HEALTHCARE ISSUES IN AN EFFORT TO PROMOTE AND BETTER HEALTHCARE FOR HOSPITALS IN RURAL COMMUNITIES THROUGHOUT WISCONSIN. ONE OF THESE EFFORTS ALSO INCLUDES SOME LOBBYING ON THE PART OF THE MEMBER ORGANIZATIONS. RWHC DETERMINED THAT APPROXIMATELY $2,897 OF THE FEES PAID BY DIVINE SAVIOR HEALTHCARE IN FISCAL YEAR 2015 RELATED TO LOBBYING ACTIVITIES WITH THE GOAL OF IMPROVING THE HEALTHCARE ENVIRONMENT IN THE STATE OF WISCONSIN.

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

DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

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 .................	3,932,710		3,932,710
b	Buildings ................	61,450,437	24,894,533	36,555,904
c	Leasehold improvements ............
d	Equipment ................	30,271,471	22,716,788	7,554,683
e	Other .................	9,362,111	400,071	8,962,040
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......				57,005,337

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
(3)Other (A) LONG-TERM INVESTMENTS	14,003,282	F
(B) BOARD-DESIGNATED INVESTMENTS	21,476,765	F
(C) TEMPORARILY RESTRICTED INVESTMENTS	67,979	F
(D) FUNDS HELD BY BOND TRUSTEE	6,590,445	F





Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)	42,138,471

Part VIII

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

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









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

Part IX

Other Assets. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value









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

Part X

Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability		(b) Book value
Federal income taxes
DEFERRED COMPENSATION PLAN LIABILITIES		613,557
ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS PAYABLE		1,175,581
ESTIMATED INSURANCE LIABILITIES		1,152,040






Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)		2,941,178
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	89,732,193
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	35,087
e	Add lines 2a through 2d .....................			2e	35,087
3	Subtract line 2e from line 1.....................			3	89,697,106
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	6,012,437
c	Add lines 4a and 4b.......................			4c	6,012,437
5	Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ......			5	95,709,543

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	84,596,344
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	35,087
e	Add lines 2a through 2d......................			2e	35,087
3	Subtract line 2e from line 1.....................			3	84,561,257
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	6,012,437
c	Add lines 4a and 4b.......................			4c	6,012,437
5	Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ......			5	90,573,694

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 ORGANIZATION IS A NONPROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE (THE "CODE") AND IS EXEMPT FROM FEDERAL INCOME TAXES ON RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. THE ORGANIZATION IS ALSO EXEMPT FROM STATE INCOME TAXES ON RELATED INCOME. IN ORDER TO ACCOUNT FOR ANY UNCERTAIN TAX POSITIONS, THE ORGANIZATION DETERMINES WHETHER IT IS MORE LIKELY THAN NOT THAT A TAX POSITION WILL BE SUSTAINED UPON EXAMINATION OF THE TECHNICAL MERITS OF THE POSITION, ASSUMING THE TAXING AUTHORITY HAS FULL KNOWLEDGE OF ALL INFORMATION. IF THE TAX POSITION DOES NOT MEET THE MORE LIKELY THAN NOT RECOGNITION THRESHOLD, THE BENEFIT OF THE TAX POSITION IS NOT RECOGNIZED IN THE ACCOMPANYING FINANCIAL STATEMENTS. THE ORGANIZATION RECORDED NO ASSETS OR LIABILITIES FOR UNCERTAIN TAX POSITIONS OR UNRECOGNIZED TAX BENEFITS IN 2015 OR 2014. FEDERAL RETURNS FOR FISCAL YEARS 2012 AND BEYOND REMAIN SUBJECT TO EXAMINATION BY THE INTERNAL REVENUE SERVICE.
PART XI, LINE 2D - OTHER ADJUSTMENTS:	EXPENSES NET AGAINST REVENUE ON FORM 990 35,087.
PART XI, LINE 4B - OTHER ADJUSTMENTS:	REAL ESTATE TAXES NET AGAINST REVENUE ON AUDITED FINANCIAL STATEMENTS 124,026. BAD DEBT EXPENSE NET AGAINST REVENUE ON AUDITED FINANCIAL STATEMENTS 5,888,411. EXPENSES NET AGAINST REVENUE ON FORM 990
PART XII, LINE 2D - OTHER ADJUSTMENTS:	EXPENSES NET AGAINST REVENUE ON FORM 990 35,087.
PART XII, LINE 4B - OTHER ADJUSTMENTS:	REAL ESTATE TAXES NET AGAINST REVENUE ON AUDITED FINANCIAL STATEMENTS 124,026. BAD DEBT EXPENSE NET AGAINST REVENUE ON AUDITED FINANCIAL STATEMENTS 5,888,411. EXPENSES NET AGAINST REVENUE ON FORM 990

Schedule D (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

SCHEDULE G (Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service

Supplemental Information Regarding
Fundraising or Gaming Activities

Complete if the organization answered "Yes" to Form 990, Part IV, lines 17, 18, or 19, or if the organization entered more than $15,000 on Form 990-EZ, line 6a. right arrow

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

Information about Schedule G (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
DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

Part I

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

filers are not required to complete this part.

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

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

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

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

Yes

If "Yes," list the ten highest paid individuals or entities (fundraisers) pursuant to agreements under which the fundraiser is
to be compensated at least $5,000 by the organization.

(i) Name and address of individual or entity (fundraiser)	(iii) Did fundraiser have custody or control of contributions?
	Yes	No










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

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

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

Cat. No. 50083H

Schedule G (Form 990 or 990-EZ) 2014

Page 2

Part II

Fundraising Events. Complete if the organization answered "Yes" to Form 990, Part IV, line 18, or reported more than $15,000 of fundraising event contributions and gross income on Form 990-EZ, lines 1 and 6b. List events with gross receipts greater than $5,000.

		(a) Event #1 LAVITA NIGHT OF CHAMPIONS (event type)	(d) Total events (add col. (a) through col. (c))
1	Gross receipts . . .	78,950	78,950
2	Less: Contributions . .
3	Gross income (line 1 minus line 2) . . .	78,950	78,950
4	Cash prizes . . .
5	Noncash prizes . .
6	Rent/facility costs . .
7	Food and beverages .
8	Entertainment . . .
9	Other direct expenses .	63,705	63,705
10	Direct expense summary. Add lines 4 through 9 in column (d) ...........		63,705
11	Net income summary. Subtract line 10 from line 3, column (d)...........		15,245

Part III

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

(a) Bingo

(b) Pull tabs/Instant
bingo/progressive bingo

(c) Other gaming

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

Gross revenue . . . .

Cash prizes . . . .

Non-cash prizes . . .

Rent/facility costs . . .

Other direct expenses . .

Volunteer labor . . .

	Yes %
	No

	Yes %
	No

	Yes %
	No

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

Net gaming income summary. Subtract line 7 from line 1, column (d) ......... right arrow

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

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

YesNo

If "No," explain:

10a

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

YesNo

If "Yes," explain:

Schedule G (Form 990 or 990-EZ) 2014

Page 3

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

YesNo

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

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

YesNo

Indicate the percentage of gaming activities conducted in:

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

13a

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

13b

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

Name

Address

15a

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

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

YesNo

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

$ and the

amount of gaming revenue retained by the third party right arrow

If "Yes," enter name and address of the third party:

Name

Address

Gaming manager information:

Name

Gaming manager compensation right arrow

Description of services provided right arrow

Director/officer Employee Independent contractor

Mandatory distributions:

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

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

YesNo

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

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

Part IV

Supplemental Information. Provide the explanations required by Part I, line 2b, columns (iii) and (v), and Part III, lines 9, 9b, 10b, 15b, 15c, 16, and 17b, as applicable. Also provide any additional information (see instructions).

Return Reference	Explanation

Schedule G (Form 990 or 990-EZ) 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

DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

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

Yes

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

Yes

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

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

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

Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?

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

Yes

100% 150% 200% Other %

Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate

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

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the 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) ..	253,187		253,187	0.300 %
b	Medicaid (from Worksheet 3, column a) ....	13,541,507	10,145,688	3,395,819	4.010 %
c	Costs of other means-tested government programs (from Worksheet 3, column b) .
d	Total Financial Assistance and Means-Tested Government Programs .	13,794,694	10,145,688	3,649,006	4.310 %
Other Benefits		284,521	24,855	259,666	0.310 %
e	Community health improvement services and community benefit operations (from Worksheet 4) ..	284,521	24,855	259,666	0.310 %
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)	35,911		35,911	0.040 %
j	Total. Other Benefits ..	320,432	24,855	295,577	0.350 %
k	Total. Add lines 7d and 7j .	14,115,126	10,170,543	3,944,583	4.660 %

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.

		(c) Total community building expense	(e) Net community building expense	(f) Percent of total expense
1	Physical improvements and housing
2	Economic development
3	Community support
4	Environmental improvements
5	Leadership development and training for community members
6	Coalition building
7	Community health improvement advocacy
8	Workforce development	33,000	33,000	0.040 %
9	Other
10	Total	33,000	33,000	0.040 %

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

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

Yes

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

2,241,946

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. ......

1,120,973

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).....

15,745,265

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

19,961,610

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

-4,216,345

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)					Other (describe)
1	DIVINE SAVIOR HEALTHCARE INC 2817 NEW PINERY ROAD PORTAGE,WI53901 80	X	X	X	AMBULANCE SERVICE

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)

	DIVINE SAVIOR HEALTHCARE INC
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 12

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. ............................

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.DSHEALTHCARE.COM/MAIN/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX

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 12

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

Yes

If "Yes" (list url): HTTP://WWW.DSHEALTHCARE.COM/MAIN/COMMUNITY-HEALTH-NEEDS-ASSESSMENT.ASPX

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)

	DIVINE SAVIOR HEALTHCARE INC
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 150.000000000000%
and FPG family income limit for eligibility for discounted care of 300.000000000000%

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

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Part VFacility Information (continued)

	DIVINE SAVIOR HEALTHCARE INC
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

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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
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 5: AS A PART OF THE CHNA PROCESS, DIVINE SAVIOR HEALTHCARE, INC.'S BOARD OF DIRECTORS APPOINTED A TASK FORCE CONSISTING OF REPRESENTATIVES FROM THE BOARD OF DIRECTORS, EMPLOYEES AND MANAGEMENT OF DIVINE SAVIOR HEALTHCARE, INC., AND COMMUNITY MEMBERS AND LEADERS IN ORDER TO HAVE A WIDE PERSPECTIVE OF NEEDS AND INFORMATION BEING REPRESENTED IN THE COMMUNITY TO ACHIEVE BENEFICIAL RESULTS FOR THE CHNA FOR THE HOSPITAL IN PLANNING FOR THE FUTURE. QUANTITATIVE DATA INCLUDING STATISTICS AND DEMOGRAPHIC INFORMATION WERE OBTAINED FROM COUNTY HEALTH STUDIES PERFORMED BY THE TWO COUNTIES IN DIVINE SAVIOR HEALTHCARE, INC.'S PRIMARY SERVICE AREA (COLUMBIA AND MARQUETTE COUNTIES) AS WELL AS PATIENT STATISTICS AND TRENDS FROM DIVINE SAVIOR HEALTHCARE, INC.'S OWN INTERNAL RECORDS. OTHER PUBLISHED SOURCES OF INFORMATION WERE ALSO REFERENCED FOR STATISTICAL AND INFORMATIONAL PURPOSES WHEN NEEDED THROUGHOUT THE PROCESS.INTERVIEWS WERE CONDUCTED WITH COMMUNITY MEMBERS AND INDIVIDUALS WHO WERE REGARDED AS HAVING EXPERTISE IN PUBLIC HEALTH, INDIVIDUALS EMPLOYED WITH GOVERNMENT AGENCIES WITH COMMUNITY HEALTH NEEDS INFORMATION, INDIVIDUALS REPRESENTING COMMUNITY EMPLOYERS, AND INDIVIDUALS WHO WOULD BE ABLE TO ACCESS HEALTH NEEDS INFORMATION FROM A WIDE DEMOGRAPHIC MAKE-UP OF THE POPULATION. DURING INTERVIEWS, PARTICIPANTS FROM THE COMMUNITY WERE ASKED FOR THEIR INPUT REGARDING BOTH HEALTH NEEDS AND POSSIBLE SOLUTIONS TO IDENTIFIED NEEDS. THIS INFORMATION WAS GATHERED, ALONG WITH THE QUANTITATIVE INFORMATION NOTED ABOVE, AND WAS SUMMARIZED FOR THE BOARD OF DIRECTORS OF THE HOSPITAL TO REVIEW AND SUMMARIZE IN TERMS OF A PRIORITY SETTING EXERCISE. FROM THIS EXERCISE, KEY OR PRIORITY NEEDS WERE IDENTIFIED TO BE ADDRESSES AS A RESULT OF THE INFORMATION GATHERED ON HEALTH NEEDS IN THE COMMUNITY AND PRIMARY SERVICE AREA OF DIVINE SAVIOR HEALTHCARE, INC.
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 11: BASED ON THE RESEARCH AND DATA COLLECTION FROM THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE ORGANIZATION IDENTIFIED FOUR CATEGORIES OF HEALTH NEEDS: ACCESS, DISEASE-BASED, WELLNESS AND PREVENTION AND MISCELLANEOUS AND EXISTING RESOURCES AND STRATEGIES FOR ADDRESSING THESE IDENTIFIED NEEDS.BELOW ARE THE WAYS THAT THE ORGANIZATION IS ADDRESSING THESE ITEMS. THESE ARE ALSO OUTLINED IN THE IMPLEMENTATION STRATEGY TO THE COMMUNITY HEALTH NEEDS ASSESSMENT:ACCESS NEEDS:PRIMARY CARE -CURRENTLY RECRUITING FOR NEW PROVIDERS IN FAMILY MEDICINE, INTERNAL MEDICINE AND OB/GYN -EXPLORING A RURAL RESIDENCY TRAINING PROGRAM WITH THE UW MEDICAL SCHOOL -EXPLORING SATELLITE CLINICS, ESPECIALLY IN MARQUETTE COUNTY.SPECIALTY PHYSICIAN SERVICES -RECRUITING FOR INTERNAL MEDICINE PHYSICIANS TO JOIN OUR MEDICAL STAFF -DEVELOPING RELATIONSHIPS WITH EXISTING SPECIALTY PRACTICES IN MADISON TO BRING MORE SPECIALTIES TO ENHANCE OUR ALREADY EXISTING OUTREACH PROVIDER CLINIC THAT CURRENTLY INCLUDES: CARDIOLOGY, DERMATOLOGY, NEUROLOGY, ENT, ONCOLOGY, PODIATRY, OPHTHALMOLOGY, SPECIALTY OB/GYN AND UROLOGY.SENIOR SERVICES -WE RECENTLY INVESTED A GREAT DEAL OF RESOURCES IN THE OPENING OF TIVOLI, OUR RESIDENTIAL CARE FACILITY. TIVOLI OFFERS SKILLED NURSING, MEMORY CARE, ASSISTED LIVING AND SHORT TERM REHABILITATIVE CARE.UNINSURED -DIVINE SAVIOR HEALTHCARE CONTINUES TO PROVIDE SERVICES TO PATIENTS WITHOUT HEALTH CARE COVERAGE THROUGH THE CHARITIBLE CARE PROGRA AND WILL CONTINUE WITH THE PROGRAM. -WE WILL CONTINUE TO OFFER SERVICES TO ASSIST PEOPLE IN LOCATING HEALTH CARE COVERAGE OR ASSISTANCE PROGRAMS. -CONTINUATION OF EFFORTS TO ADVOCATE FOR PUBLIC POLICY AND REGULATORY CHANGE TO IMPROVE HEALTH CARE ACCESS FOR THE POOR AND UNINSURED.DISEASE-BASED NEEDS:CANCER -CONTINUE TO OFFER CANCER RELATED PREVENTION, EDUCATION, DIAGNOSTIC AND THERAPEUTIC SERVICES. -EXPLORING THE POSSIBILITY OF AN INTERVENTIONAL RADIOLOGY PROGRAM.CARDIOVASCULAR & CEREBROVASCULAR -CONTINUE TO OFFER PREVENTION, EDUCATION, DIAGNOSTIC AND TREATMENT SERVICES FOR THESE ILLNESSES. -DIVINE SAVIOR EMERGENCY MEDICAL PROFESSIONALS WILL CONTINUE TO LEAD IN CARE OF THOSE WITH A CARDIOVASCULAR/CEREBROVASCULAR EMERGENCY.DIABETES, PULMONARY, AND KIDNEY DISEASE -PRIMARY CARE PROVIDERS WILL CONTINUE TO CARE EXTENSIVELY FOR THEIR PATIENTS WITH THESE DISEASES AND MORE PROVIDERS ARE BEING RECRUITED SO THAT WE CAN MEET THE NEED TO CARE FOR THOSE WITH THESE MEDICAL CONDITIONS. -PROVIDING A PULMONOLOGIST ON STAFF AS WELL AS A DIALYSIS UNIT AND REGISTERED DIETITIANS. -DIVINE SAVIOR HEALTHCARE WILL CONTINUE TO OFFER AND INCREASE OFFERINGS IN EXERCISE PROGRAMS, COMMUNITY EDUCATION EFFORTS AND WORKPLACE HEALTH INITIATIVES TO ADDRESS ISSUES RELATED TO PHYSICAL ACTIVITY, DIET, OBESITY AND CHRONIC CONDITIONS.ALZHEIMER'S, DEMENTIA AND GERO-PSYCHIATRY -PROVIDE MEMORY CARE FOR THOSE WHO HAVE A NEED FOR RESIDENTIAL CARE AT TIVOLI. -RECRUITMENT OF PRIMARY CARE PROVIDERS WHO HAVE A SPECIAL INTEREST AND EXPERTISE IN GERIATRICS. -WORKING WITH THE PAQUETTE CENTER TO ENHANCE ACCESS TO GERO-PSYCHIATRY SERVICESCHRONIC LOW BACK PAIN -OUR FOCUS WILL BE ON EXPLORING PROGRAMS THAT INVOLVE NONSURGICAL TREATMENT AND PREVENTION OF CHRONIC BACK AND NECK PAIN.WELLNESS/PREVENTION/PUBLIC HEALTH NEEDS:DIVINE SAVIOR HEALTHCARE IS PLEASED TO ALREADY PROVIDE MANY FREE OR LOW COST PROGRAMS TO ADDRESS WELLNESS, PARTICULARLY OBESITY, ADDICTION, PHYSICAL ACTIVITY AND WORK PLACE WELLNESS. WE WILL CONTINUE TO EVALUATE NEEDS FOR PROGRAMS TO ADDRESS THE NEEDS OF OUR COMMUNITY. WE CURRENTLY PROVIDE: -HEALTH SCREENINGS -EXERCISE CLASSES -SUPPORT GROUPS -COMMUNITY EDUCATION -CPR AND FIRST AID TRAINING -CORPORATE HEALTH AND WELLNESS, INCLUDING WORKPLACE WELLNESS PROGRAMSMISCELLANEOUS NEEDS:TRANSPORTATION -LOCAL TAXI SERVICES AND THE COUNTIES ARE PROVIDING SERVICE SUPPORT FOR MEDICAL TRANSPORTATION FOR THOSE WHO NEED IT.TRANSLATION SERVICES -WE CURRENTLY USE A SERVICE THAT PROVIDES PHONE AND VIDEO TRANSLATION TO PATIENTS AND WE ALSO HAVE TWO LOCAL BI-LINGUAL SPANISH SPEAKING TRANSLATORS WHO SUPPLEMENT THIS SERVICE FOR THE SPANISH-SPEAKING COMMUNITY.EMERGENCY DETOX -DIVINE SAVIOR HEALTHCARE WILL CONVENE A MULTI-AGENCY FORUM TO GENERATE APPROACHES TO THIS PROBLEM.THERE WERE ITEMS IDENTIFIED IN THE CHNA WHICH WERE NOT ADDRESSED BY DIVINE SAVIOR HEALTHCARE, INC.; HOWEVER, ALL ITEMS WERE CONSIDERED IF A NEED WAS BROUGHT TO THE ATTENTION OF THE GROUP DURING THE INFORMATION GATHERING PHASE OF THE CHNA PROCESS. SEVERAL OF THE ITEMS WHICH WERE NOT ADDRESSED PRIMARILY WERE NOT ADDRESSED DUE TO THE FINANCIAL CONSTRAINT OF PROVIDING A NEW SERVICE FOR A LIMITED POPULATION OF PEOPLE WITHIN THE PRIMARY SERVICE AREA OR AT THE PRESENT TIME IT WAS DETERMINED THAT A PARTNER ORGANIZATION MAY BE NEEDED TO MAKE A NEW HEALTH SERVICE A FINANCIALLY VIABLE OPTION IN THE LOCAL COMMUNITY. TWO EXAMPLES OF THESE ITEMS WHICH WERE NOTED IN THE CHNA PROCESS WERE ACCESS TO CANCER CARE AND MENTAL HEALTH AND SUBSTANCE ABUSE SERVICES. IT WAS DETERMINED THAT DIVINE SAVIOR HEALTHCARE, INC. DOES NOT HAVE THE POPULATION BASE TO PROVIDE RADIATION ONCOLOGY SERVICES AS THIS WAS MOST EFFECTIVELY AND EFFICIENTLY PROVIDED IN THE MADISON, WISCONSIN AREA WHICH IS WITHIN 30 MINUTES OF THE HOSPITAL. SOME ONCOLOGY SERVICES, INCLUDING CHEMOTHERAPY AND FOLLOW-UP VISITS, ARE PROVIDED BY THE HOSPITAL'S PRIMARY CARE PROVIDERS AS WELL AS VISITING SPECIALISTS, SO IT WAS DETERMINED THAT THE CANCER CARE IN THIS AREA WAS ADEQUATE AT THE CURRENT TIME FOR THE POPULATION, HOWEVER DIVINE SAVIOR HEALTHCARE, INC. WILL ALSO BE CONSIDERING AN INTERVENTIONAL RADIOLOGY PROGRAM IN THE FUTURE TO ASSIST SOME CANCER CARE PATIENTS IF THERE IS A SIGNIFICANT NEED FOR THIS SERVICE IN THE FUTURE. FOR THE MENTAL HEALTH AND SUBSTANCE ABUSE PROGRAMS, DIVINE SAVIOR HEALTHCARE, INC. IDENTIFIED THAT THERE IS A SIGNIFICANT GAP IN FUNDING AVAILABLE FOR MANY PATIENTS IN NEED OF THESE SERVICES; HOWEVER, THERE IS A PRIMARY CARE MENTAL HEALTH CLINIC IN THE COMMUNITY WHICH PROVIDES A SIGNIFICANT AMOUNT OF MENTAL HEALTH SERVICES TO AREA RESIDENTS. DIVINE SAVIOR HEALTHCARE, INC. DETERMINED THAT DUE TO THE VAST FINANCIAL AND SOCIAL NEEDS OF MANY OF THE PATIENTS IN NEED OF THE MENTAL HEALTH AND SUBSTANCE ABUSE PROGRAMS, THAT MANY GROUPS MAY NEED TO PARTNER TOGETHER IN THE FUTURE TO WORK ON PLANNING EFFORTS FOR THESE SERVICES IN THE FUTURE AS THIS IS A VERY COMPLEX ISSUE.SEVERAL OTHER NEEDS WERE NOT ADDRESSED BY DIVINE SAVIOR HEALTHCARE, INC. AS ANOTHER ORGANIZATION WITHIN THE COMMUNITY ALREADY PROVIDES THESE SERVICES WHICH ARE NOT IN THE HOSPITAL'S PRIMARY AREA OF HEALTHCARE EXPERTISE. ONE EXAMPLE OF THESE TYPES OF SERVICES IS A FREE DENTAL CLINIC TO PROVIDE ACCESS TO PATIENTS WHO ARE OTHERWISE UNABLE TO AFFORD PROPER DENTAL CARE. IN RECENT YEARS, A COMMUNITY GROUP HAS ORGANIZED A FREE DENTAL CLINIC TO PROCESS ACCESS TO DENTAL CARE FOR INDIVIDUALS WITH FINANCIAL NEEDS THAT LIMIT THEIR ACCESS TO DENTAL SERVICES.
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 20E: THE FINANCIAL ASSISTANCE POLICY IS POSTED IN EACH OF THE HOSPITAL'S PHYSICIAN CLINICS. FINANCIAL ASSISTANCE INFORMATIONAL CARDS ARE ALSO GIVEN TO ANYONE INDICATING FINANCIAL HARDSHIP, AND THEY ARE ENCOURAGED TO CONTACT A FINANCIAL COUNSELOR FOR FURTHER INFORMATION ON THE FINANCIAL ASSISTANCE POLICY. THE HOSPITAL WILL ONLY INITIATE COLLECTION ACTIVITIES NOTED IN SCHEDULE H, PART V, LINE 17 IF A PATIENT DOES NOT RESPOND OR PROVIDE INFORMATION TO REQUESTS TO APPLY FOR CHARITY CARE.
DIVINE SAVIOR HEALTHCARE, INC.	PART V, SECTION B, LINE 22D: THE HOSPITAL DETERMINES THE AMOUNT CHARGED TO FAP-ELIGIBLE INDIVIDUALS USING AN INCOME-BASED SLIDING-FEE. THE SLIDING FEE CHARGED TO FAP-ELIGIBLE INDIVIDUALS RANGES FROM 0-85 PERCENT OF STANDARD GROSS PATIENT CHARGES.

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?4
Name and address		Type of Facility (describe)
1	TIVOLI EXTENDED CARE FACILITY 2817 NEW PINERY ROAD PORTAGE,WI53901	SKILLED NURSING FACILITY, ASSISTED LIVING FACILITY, AND HOME HEALTH PROGRAM
2	DIVINE SAVIOR HEALTHCARE CLINIC 2817 NEW PINERY ROAD PORTAGE,WI53901	PHYSICIAN CLINIC
3	PARDEEVILLE DIVINE SAVIOR CLINIC 102 GILLETTE STREET PARDEEVILLE,WI53954	PHYSICIAN CLINIC
4	CROSSROADS DIVINE SAVIOR CLINIC N4390 CROSSROADS CLINIC ROAD OXFORD,WI53952	PHYSICIAN CLINIC
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:	DIVINE SAVIOR HEALTHCARE, INC. PREPARES A COMMUNITY BENEFIT REPORT ANNUALLY AND FILES IT WITH THE WISCONSIN HOSPITAL ASSOCIATION (WHA). THE REPORT IS AVAILABLE TO THE GENERAL PUBLIC ON WHA'S WEBSITE.
PART I, LINE 7:	THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST VARIOUS REVENUE AND EXPENSE CATEGORIES TO COMPUTE THE ESTIMATED COMMUNITY BENEFIT EXPENSE UNDER IRS SUGGESTED COSTING METHODS FOR THE FORM 990.
PART I, LINE 7, COLUMN (F):	THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 5,888,411.
PART II, COMMUNITY BUILDING ACTIVITIES:	WHILE THERE IS GROWING ARGUMENT IN THE UNITED STATES ABOUT WHAT CONSTITUTES A NON-PROFIT HOSPITAL'S "COMMUNITY BENEFIT," THESE EFFORTS CONTINUE TO BE A WORK IN PROGRESS. DIVINE SAVIOR HEALTHCARE, INC. PROVIDES SIGNIFICANT CHARITY CARE AND OTHER COMMUNITY BENEFITS AS DEFINED BY THE IRS AND IN ADDITION, THE ORGANIZATION BELIEVES THAT IT PROVIDES A CRITICALLY IMPORTANT COMMUNITY BENEFIT WHICH IS NOT QUANTIFIED. DIVINE SAVIOR HEALTHCARE, INC., LIKE MOST COMMUNITY HOSPITALS, WAS CREATED AND IS MAINTAINED IN ORDER TO PROVIDE CARE LOCALLY WHICH WITHOUT THE HOSPITAL, WOULD NOT BE AVAILABLE LOCALLY. BEYOND INPATIENT HOSPITALIZATIONS, THE HOSPITAL PROVIDES LOCAL ACCESS TO MANY HEALTH SERVICES INCLUDING: BIRTHING CENTER, DIAGNOSTICS, EMERGENCY SERVICES, URGENT CARE, HOME CARE, RENAL DIALYSIS, INFUSION SERVICES, SWING BED SERVICES, NURSING HOME SERVICES, ASSISTED LIVING SERVICES, CLINICAL SERVICES, LABORATORY SERVICES, OCCUPATIONAL HEALTH, REHABILITATION SERVICES, SPECIALTY MEDICINE, SLEEP CENTER, SPEECH PATHOLOGY, SURGICAL SERVICES, WOMEN'S SERVICES, AND AMBULANCE SERVICES, TO NAME SOME OF THE MAJOR SERVICES PROVIDED.
PART III, LINE 2:	THE COSTING METHODOLOGY USED ON FORM 990 IS BASED ON A COST TO CHARGE RATIO WHICH IS DEVELOPED BASED ON THE HOSPITAL'S TOTAL OPERATING EXPENSES, EXCLUDING THE PROVISION FOR BAD DEBTS, DIVIDED BY GROSS PATIENT SERVICE REVENUE. THIS COST TO CHARGE RATIO IS APPLIED AGAINST THE TOTAL CHARGES THAT ARE WRITTEN OFF DURING THE FISCAL YEAR TO ESTIMATE THE COST OF THE CARE OF PATIENTS THAT HAVE ACCOUNTS THAT ARE DEEMED TO BE BAD DEBTS TO THE HOSPITAL. THE HOSPITAL ALSO PROVIDES DISCOUNTS TO ELIGIBLE UNINSURED OR UNDERINSURED PATIENTS UNDER ITS CHARITABLE CARE POLICY. THESE AMOUNTS ARE INCLUDED IN THE CONTRACTUAL ADJUSTMENTS ON THE FINANCIAL STATEMENTS AND ARE NOT INCLUDED IN THE RATIO AS DESCRIBED ABOVE AND APPROVED BY THE IRS FOR USE ON FORM 990. IF CONSIDERED, THESE ADDITIONAL WRITE-OFF AMOUNTS TO UNINSURED OR UNDERINSURED ACCOUNTS WOULD ALSO INCREASE THE ESTIMATED BAD DEBT EXPENSE AMOUNT ASSOCIATED WITH THESE UNCOLLECTIBLE ACCOUNTS TO THE HOSPITAL.
PART III, LINE 3:	MANAGEMENT PROVIDES FOR PROBABLE UNCOLLECTIBLE AMOUNTS, PRIMARILY UNINSURED PATIENTS AND AMOUNTS PATIENTS ARE PERSONALLY REPONSIBLE FOR, THROUGH A CHARGE TO OPERATIONS AND A CREDIT TO AN ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED ON ITS ASSESSMENT OF HISTORICAL COLLECTION LIKELIHOOD AND THE CURRENT STATUS OF INDIVIDUAL PATIENT ACCOUNTS. BALANCES THAT ARE STILL OUTSTANDING AFTER THE ORGANIZATION HAS USED REASONABLE COLLECTION EFFORTS ARE WRITTEN OFF THROUGH A CHARGE TO THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A CREDIT TO PATIENT ACCOUNTS RECEIVABLE. MANY TIMES PATIENTS ARE UNABLE TO COMPLETE THE REQUIRED CHARITY CARE APPLICATION AND ARE TRANSFERRED TO COLLECTION SERVICES EVEN THOUGH THE ORGANIZATION PROVIDES THIS INFORMATION TO ALL PATIENTS AND ASSISTANCE WITH THE APPLICATIONS. DUE TO NO RESPONSES FROM SOME PATIENTS A SIGNIFICANT AMOUNT OF BAD DEBTS COULD BE CONSIDERED AS CHARITY CARE.
PART III, LINE 4:	PATIENT ACCOUNTS RECEIVABLE AND CREDIT POLICY: IN EVALUATING THE COLLECTIBILITY OF PATIENT ACCOUNTS RECEIVABLE, THE ORGANIZATION ANALYZES PAST RESULTS AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SPECIFICALLY, FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE ORGANIZATION ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR DOUBTFUL ACCOUNTS AND A PROVISION FOR BAD DEBTS FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS AND PATIENTS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE ORGANIZATION RECORDS A PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE FOR. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR DOUBTFUL ACCOUNTS. THE AUDITED FINANCIAL STATEMENTS DO NOT INCLUDE A SEPARATE FOOTNOTE REGARDING BAD DEBT EXPENSE.
PART III, LINE 8:	THE TOTAL MEDICARE REVENUE SHOWN IN SCHEDULE H TO THE FORM 990 IS BASED ON THE IRS 990 INSTRUCTIONS AND INCLUDES ONLY A PORTION OF THE GROSS MEDICARE REVENUE OF THE HOSPITAL AND ALSO DOES NOT CONSIDER CONTRACTUAL ADJUSTMENTS FOR THE REIMBURSEMENT THAT IS ACTUALLY RECEIVED FROM THE MEDICARE PROGRAM. AMOUNTS LISTED FOR MEDICARE REVENUES DO NOT INCLUDE SIGNIFICANT PORTIONS OF LABORATORY, RADIOLOGY, AMBULANCE, AND REHABILITATION SERVICES PROVIDED TO MEDICARE BENEFICIARIES AS WELL AS PHYSICIAN SERVICES FOR THE COVERAGE OF THE EMERGENCY DEPARTMENT, ANESTHESIA PROFESSIONAL SERVICES, CLINICAL PHYSICIAN PROFESSIONAL SERVICES, SURGICAL PHYSICIAN PROFESSIONAL SERVICES, HOSPITALIST PHYSICIAN PROFESSIONAL SERVICES, AND REVENUES FOR ANY PATIENTS COVERED UNDER MEDICARE ADVANTAGE PLAN PROGRAMS. PHYSICIAN SERVICES ARE REIMBURSED PRIMARILY ON FEE SCHEDULE REIMBURSEMENT AT RATES THAT ARE OFTEN BELOW THE COSTS OF CARING FOR PATIENTS. EMERGENCY, SURGICAL, AND CLINICAL SERVICES PROVIDED TO MEDICARE PATIENTS ARE VITAL TO THE WELL-BEING OF THE COMMUNITY AND AS SUCH THESE COSTS AND SHORTFALLS SHOULD ALSO BE CONSIDERED AS AN ADDITIONAL BENEFIT THAT DIVINE SAVIOR HEALTHCARE, INC. PROVIDES TO THE COMMUNITY AND SURROUNDING AREAS. THE COSTING METHOD USED ABOVE FOR IRS 990 COMPLIANCE REPORTING IS ALSO BASED ON THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED JUNE 30, 2015 AND DOES NOT CONSIDER MEDICARE NON-ALLOWABLE EXPENSES AS IT IS BASED ON TOTAL HOSPITAL PATIENT SERVICE REVENUES (IGNORING CONTRACTUAL ADJUSTMENTS ON FEE SCHEDULE REIMBURSED ITEMS AND NON-ALLOWABLE MEDICARE EXPENSES AS NOTED ABOVE).WHETHER THERE IS A SHORTFALL OR SURPLUS ON SERVICES PROVIDED TO MEDICARE BENEFICIARIES, THESE PEOPLE, WHICH ARE TYPICALLY ELDERLY OR DISABLED MEMBERS OF THE COMMMUNITY, ARE AN UNDERSERVED POPULATION WHO EXPERIENCE ISSUES WITH ACCESS TO HEALTHCARE SERVICES. WITHOUT TAX-EXEMPT HOSPITALS PROVIDING MEDICARE PATIENT SERVICES, THE CENTERS FOR MEDICARE AND MEDICAID (CMS) WOULD BEAR THE BURDEN OF DIRECTLY PROVIDING SERVICES TO THE ELDERLY AND DISABLED MEMBERS OF THE COMMUNITY.
PART III, LINE 9B:	UNDER THE HOSPITAL'S COLLECTION AND CHARITABLE CARE POLICIES, DIVINE SAVIOR HEALTHCARE, INC. MAKES EVERY ATTEMPT TO IDENTIFY AND PROMOTE CHARITY CARE TO PATIENTS. INCLUDED IN THE HOSPITAL'S CHARITABLE CARE POLICY IT IS NOTED THAT PATIENTS MAY QUALIFY FOR CHARITY CARE EITHER PRIOR TO ADMISSION OR FOLLOWING DISCHARGE. ALL INPATIENT SELF-PAY ADMISSIONS ARE SCREENED BY THE HOSPITAL'S FINANCIAL COUNSELOR TO ALLOW THESE PATIENTS THE ABILITY TO COMPLETE THEIR APPLICATION DURING THEIR STAY AT THE HOSPITAL, DEPENDING UPON THE PATIENT'S CONDITION, OR THE PATIENT'S RESPONSIBLE PARTY MAY BE CONTACTED TO COMPLETE AND RETURN THE FORMS AT A LATER TIME WHEN THEIR CARE ALLOWS THIS COMPLETION.DURING THE PATIENT ACCOUNT COLLECTION PROCESS, SELF-PAY PATIENTS ARE ALSO INFORMED OF THE HOSPITAL'S COLLECTION POLICIES AS WELL AS THE CHARITY AND COMMUNITY CARE PROGRAM TO ALLOW PATIENTS THE OPPORTUNITY TO COMPLETE THE APPROPRIATE FORMS AND QUALIFY UNDER THE PROGRAM. INCLUDED IN THE POLICY, IT IS ALSO NOTED THAT THE ORGANIZATION RESERVES THE RIGHT TO MAKE OR GRANT ADDITIONAL CHARITY CARE EVEN BEYOND THE INCOME AND ASSET GUIDELINES BASED ON CIRCUMSTANCES OR EVENTS IN A PARTICULAR PATIENT'S LIFE DURING DIFFICULT TIMES.
PART VI, LINE 2:	DIVINE SAVIOR HEALTHCARE, INC. ASSESSES THE HEALTH CARE NEEDS OF THE COMMUNITIES AND AREAS IT SERVES BY REVIEWING LOCAL DEMOGRAPHICS AND TRENDS IN PATIENT SERVICE UTILIZATION TO DETERMINE WHICH SERVICES COULD AND SHOULD BE MADE AVAILABLE TO THE COMMUNITY IN A COST-EFFECTIVE MANNER TO BE CONSISTENT WITH THE ORGANIZATION'S MISSION IN THE COMMUNITY. THE ORGANIZATION ALSO REVIEWS STATISTICS IN HOSPITAL, NURSING HOME, CLINIC, HOME HEALTH, AND OTHER ORGANIZATIONAL DEPARTMENTS TO REVIEW THE CURRENT SERVICES BEING OFFERED AND ENSURE THAT RESOURCES ARE BEING APPROPRIATELY ALLOCATED TO AREAS IN NEED BY COMMUNITY MEMBERS AND PATIENTS. THE ORGANIZATION ALSO MEETS WITH LOCAL COMMUNITY MEMBERS AND IT'S PHYSICIAN GROUP TO DETERMINE WHICH SERVICES MAY BENEFIT THE COMMUNITY.AS PART OF THE STRATEGIC PLANNING PROCESS, DIVINE SAVIOR HEALTHCARE, INC. PREVIOUSLY CONDUCTED A COMMUNITY NEEDS ASSESSMENT UTILIZING A CONSULTING SERVICE TO SPEAK DIRECTLY TO COMMUNITY LEADERS AND RESIDENTS TO IDENTIFY COMMUNITY NEEDS. DIVINE SAVIOR HEALTHCARE, INC. CONTINUOUSLY STUDIES PATIENT NEEDS AND IMPLEMENTS FACILITY, PATIENT SERVICE, AND COMMUNITY PLANNING INITIATIVES THAT REQUIRE EXTENSIVE INVESTMENTS OF TIME AND RESOURCES. IN RESPONSE TO THE IDENTIFIED NEED FOR ADDITIONAL SERVICES AND IMPROVED FACILITIES, DIVINE SAVIOR HEALTHCARE, INC. COMPLETED A NEW EXTENDED CARE AND ASSISTED LIVING CAMPUS ADJACENT TO THE CURRENT HOSPITAL FACILITY WITH A TUNNEL BETWEEN THE FACILITIES FOR IMPROVED ACCESS, WHICH SINCE OPENING HAS PROVIDED GREAT BENEFITS TO PATIENTS OVER THE PAST TWO YEARS. IN ADDITION, DIVINE SAVIOR HEALTHCARE, INC. CONTINUES ONGOING RECRUITMENT EFFORTS FOR EMPLOYED PHYSICIANS TO MEET THE PRIMARY AND SPECIALTY CARE NEEDS OF THE COMMUNITY. ONE OF THE AREAS IDENTIFIED AS A NEED WAS ACCESS TO PRIMARY CARE IN THE SURROUNDING COMMUNITIES AND IN RESPONSE TO THIS NEED, DIVINE SAVIOR HEALTHCARE, INC. STUDIED THE FINANCIAL VIABILITY AND COMMUNITY HEALTH NEEDS OF OPENING AN ADDITIONAL SATELLITE CLINIC. PLANNING WAS DONE FOR A NEW CLINIC THROUGHOUT FISCAL YEAR 2013 AND THE ORGANIZATION OPENED AN ADDITIONAL PRIMARY CARE CLINIC IN THE NEIGHBORING COMMUNITY OF OXFORD, WISCONSIN IN FISCAL YEAR 2014. THE ORGANIZATION ALSO BEGAN CONSTRUCTION OF ADDITIONAL CLINICAL SPACE ON THE HOPSITAL CAMPUS IN FISCAL YEAR 2015 TO PROVIDE ADDITIONAL PATIENT ACCESS AND SPACE IN THE FUTURE. DUE TO CHANGES IN THE OVERALL NATIONAL HEALTHCARE ENVIRONMENT, THE ORGANIZATION RESPONDED TO THESE CHANGES BY IMPLEMENTING ELECTRONIC MEDICAL RECORDS IN THE CLINICS AND THE EMERGENCY ROOM OVER THE PAST FOUR YEARS AND CONTINUES TO WORK TOWARD FULL ELECTRONIC MEDICAL RECORDS IN THE ENTIRE ORGANIZATION.MEMBERS OF THE BOARD OF DIRECTORS OF DIVINE SAVIOR HEALTHCARE, INC. ARE ALSO MADE UP OF COMMUNITY LEADERS WHICH ARE IN TOUCH WITH NEEDS IN THE COMMUNITY. THE HOSPITAL ALSO EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED PHYSICIANS IN THE AREA.
PART VI, LINE 3:	UNINSURED AND UNDER INSURED PATIENTS ARE ASKED TO MEET WITH ONE OF THE HOSPITAL'S FINANCIAL COUNSELORS EITHER AT THE TIME SERVICE IS PROVIDED OR WHEN THE PATIENT'S BILL IS GENERATED. THE FINANCIAL COUNSELOR EXPLAINS THE VARIOUS PAYMENT OPTIONS AVAILABLE TO THE PATIENT AS WELL AS THE HOSPITAL'S CHARITY AND COMMUNITY CARE PROGRAM AND OFFERS THE CHARITY CARE APPLICATION WHEN APPROPRIATE. IF OTHER PROGRAMS ARE AVAILABLE TO THE PATIENT, SUCH AS THE WISCONSIN MEDICAID PROGRAM, THESE PATIENTS ARE REFERRED TO THE APPROPRIATE GOVERNMENT AGENCY FOR FURTHER ASSISTANCE.
PART VI, LINE 4:	THE PRIMARY SERVICE AREA FOR DIVINE SAVIOR HEALTHCARE, INC. ENCOMPASSES ALL PERSONS LIVING WITHIN A 20 TO 30 MILE RADIUS OF THE HOSPITAL. SOME OF THE COMMUNITIES INCLUDED IN THIS AREA ARE PORTAGE, PARDEEVILLE, OXFORD, WISCONSIN DELLS, LAKE DELTON, BRIGGSVILLE, WYOCENA, POYNETTE, AND ARLINGTON, WISCONSIN, AMONG MANY OTHERS. THE HOSPITAL PROVIDES A SIGNIFICANT PORTION OF ITS PATIENT CARE SERVICES TO BENEFICIARIES OF THE MEDICARE AND MEDICAID PROGRAMS ESPECIALLY THOSE BENEFICIARIES WHO RESIDE IN THE ORGANIZATION'S EXTENDED AND LONG-TERM CARE FACILITIES OR PATIENTS WHO RECEIVE HOME HEALTH SERVICES FROM THE ORGANIZATION. IN 2015, THESE MEDICARE AND MEDICAID PATIENTS ACCOUNTED FOR APPROXIMATELY 51 PERCENT OF THE PATIENT SERVICES PROVIDED BY THE ORGANIZATION DURING THE YEAR.
PART VI, LINE 5:	AS A RELIGIOUS BASED ORGANIZATION, DIVINE SAVIOR HEALTHCARE, INC. PROVIDES FAITH BASED SERVICES AND EDUCATIONAL OPPORTUNITIES EITHER FREE OF CHARGE OR AT A NOMINAL FEE IN AN ATTEMPT TO PROVIDE THESE OPPORTUNITIES TO THOSE MEMBERS OF THE COMMUNITIES WHO OTHERWISE MAY NOT BE ABLE TO AFFORD OR HAVE ACCESS TO THESE PROGRAMS. THESE EFFORTS ARE PROVIDED THROUGH A VARIETY OF EDUCATIONAL SPEAKER FORUMS, SUPPORT GROUPS, HEALTH SCREENINGS, HEALTH EDUCATION FORUMS, AND OTHER EDUCATIONAL OPPORTUNITIES FOR STUDENTS.
PART VI, LINE 7, REPORTS FILED WITH STATES	WI

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

DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

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....

Yes

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? ..

Yes

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)
1MICHAEL DECKERCEO	(i) (ii)	315,019 ............................... 0	0 ............................... 0	72,876 ............................... 0	13,000 ............................... 0	68,852 ............................... 0	469,747 ............................... 0	0 ............................... 0
2MARLIN NELSONVP FINANCE	(i) (ii)	194,854 ............................... 0	0 ............................... 0	38,406 ............................... 0	11,546 ............................... 0	44,414 ............................... 0	289,220 ............................... 0	0 ............................... 0
3JOSHUA POGORELEC MDPHYSICIAN	(i) (ii)	429,941 ............................... 0	47,757 ............................... 0	41,523 ............................... 0	13,000 ............................... 0	18,426 ............................... 0	550,647 ............................... 0	0 ............................... 0
4DOUGLAS ARNOLD MDPHYSICIAN	(i) (ii)	442,372 ............................... 0	15,000 ............................... 0	31,249 ............................... 0	13,000 ............................... 0	18,426 ............................... 0	520,047 ............................... 0	0 ............................... 0
5JAMES FOSKETT MDPHYSICIAN	(i) (ii)	744,448 ............................... 0	90,999 ............................... 0	22,004 ............................... 0	13,000 ............................... 0	16,280 ............................... 0	886,731 ............................... 0	0 ............................... 0
6FRANK WALTER MDPHYSICIAN	(i) (ii)	648,482 ............................... 0	85,690 ............................... 0	58,862 ............................... 0	13,000 ............................... 0	18,426 ............................... 0	824,460 ............................... 0	0 ............................... 0
7MATTHEW LYNCH MDPHYSICIAN	(i) (ii)	411,101 ............................... 0	35,789 ............................... 0	54,381 ............................... 0	13,000 ............................... 0	18,426 ............................... 0	532,697 ............................... 0	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

Schedule J (Form 990) 2014

Additional Data

Software ID:
Software Version:

- TIN:

Schedule K
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Information on Tax Exempt Bonds

Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet

Attach to Form 990.
SchKMediumBullet

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

OMB No. 1545-0047

2014

Open to Public
Inspection

Name of the organization
DIVINE SAVIOR HEALTHCARE INC

Employer identification number
39-0806250

Part I

Bond Issues

(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	(g) Defeased		(h) On behalf of issuer		(i) Pool financing
(a) Issuer name		(b) Issuer EIN	(c) CUSIP #	(d) Date issued	(e) Issue price	(f) Description of purpose	Yes	No	Yes	No	Yes	No
A	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	39-1337855	97710VA24	02-23-2006	25,469,764	ADVANCE REFUNDING AND EXPECTED FUTURE REPAYMENT OF EXISTING BONDS HELD		X		X		X
B	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	39-1337855		12-10-2009	15,000,000	CONSTRUCTION OF NEW NURSING HOME FACILITY		X		X		X
C	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	39-1337855		05-31-2012	11,594,311	CURRENT REFUNDING OF PRIOR BOND ISSUES		X		X		X
D	WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY	39-1337855		11-07-2014	9,950,000	CONSTRUCTION OF NEW MEDICAL OFFICE BUILDING		X		X		X

Part II

Proceeds

	A		B		C		D
	1 Amount of bonds retired . . . . . . . . . . . . . .	3,199,764		3,137,784		2,307,514		225,000
2 Amount of bonds legally defeased . . . . . . . . . . .
3 Total proceeds of issue . . . . . . . . . . . . . .	25,469,764		15,000,000		11,594,311		9,950,000
4 Gross proceeds in reserve funds . . . . . . . . . . . .	1,600,000
5 Capitalized interest from proceeds . . . . . . . . . . .
6 Proceeds in refunding escrows . . . . . . . . . . . .
7 Issuance costs from proceeds . . . . . . . . . . . .	349,866
8 Credit enhancement from proceeds . . . . . . . . . . .
9 Working capital expenditures from proceeds . . . . . . . . .
10 Capital expenditures from proceeds . . . . . . . . . . .	15,000,000		15,000,000				5,245,332
11 Other spent proceeds . . . . . . . . . . . . . .	23,519,898				11,594,311
12 Other unspent proceeds . . . . . . . . . . . . . .	4,704,668						4,704,668
13 Year of substantial completion . . . . . . . . . . . .	2011		2011
	Yes	No	Yes	No	Yes	No	Yes	No
14 Were the bonds issued as part of a current refunding issue? . . . . .		X		X	X			X
15 Were the bonds issued as part of an advance refunding issue? . . . . .	X			X		X		X
16 Has the final allocation of proceeds been made? . . . . . . . .	X		X		X			X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . .	X		X		X		X

Part III

Private Business Use

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .		X		X		X		X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . .		X		X		X		X

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

Cat. No. 50193E

Schedule K (Form 990) 2014

Page 2

Part III

Private Business Use (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property?
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . . . . . . . . . .		X		X		X		X
d If "Yes" to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property?
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . .	0 %		0 %		0 %		0 %
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . .	0 %		0 %		0 %		0 %
6 Total of lines 4 and 5 . . . . . . . . . . . . .	0 %		0 %		0 %		0 %
7 Does the bond issue meet the private security or payment test? . . . . .		X		X		X		X
8a Has there been a sale or disposition of any of the bond-financed property to a nongovernmental person other than a 501(c)(3) organization since the bonds were issued?. . . . . . . . . . . . . . . . .		X		X		X		X
b If "Yes" to line 8a, enter the percentage of bond-financed property sold or disposed of.
c If "Yes" to line 8a, was any remedial action taken pursuant to Regulations sections 1.141-12 and 1.145-2? . . . . . . . . . . . . .
9 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under Regulations sections 1.141-12 and 1.145-2? . . . . . . .		X		X		X		X

Part IV

Arbitrage

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
1 Has the issuer filed Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate? . .		X		X		X		X
2 If "No" to line 1, did the following apply? . . . .
a Rebate not due yet? . . . . . . . .		X		X		X		X
b Exception to rebate? . . . . . . . .		X	X		X		X
c No rebate due? . . . . . . . .	X			X		X		X
If "Yes" to line 2c, provide in Part VI the date the rebate computation was performed . . . . . .
3 Is the bond issue a variable rate issue? . . . .		X		X		X		X
4a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue?		X		X		X		X
b Name of provider . . . . . . . . .
c Term of hedge . . . . . . . . . .
d Was the hedge superintegrated? . . . .
e Was the hedge terminated? . . . . . .

Schedule K (Form 990) 2014

Page 3

Part IV

Arbitrage (Continued)

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
5a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . . . . .		X		X		X		X
b Name of provider . . . . . . . . .
c Term of GIC . . . . . . . . . .
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . .
6 Were any gross proceeds invested beyond an available temporary period? . . . . . . . .		X		X		X		X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .		X		X		X		X

Part V

Procedures To Undertake Corrective Action

	A		B		C		D
	Yes	No	Yes	No	Yes	No	Yes	No
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations?		X		X		X		X

Part VI

Supplemental Information. Provide additional information for responses to questions on Schedule K (see instructions).

Return Reference	Explanation
DATE REBATE COMPUTATION PERFORMED	ISSUER NAME: WISCONSIN HEALTH AND EDUCATIONAL FACILITIES AUTHORITY DATE THE REBATE COMPUTATION WAS PERFORMED: 02/23/2011

Schedule K (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

DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

Return Reference	Explanation
FORM 990, PART VI, SECTION A, LINE 6	DIVINE SAVIOR HEALTHCARE, INC. IS OWNED AND OPERATED BY THE SISTERS OF THE DIVINE SAVIOR, AN ORDER OF RELIGIOUS WOMEN WHOSE UNITED STATES PROVINCIALATE IS LOCATED IN MILWAUKEE, WISCONSIN.
FORM 990, PART VI, SECTION A, LINE 7A	IN ADDITION TO ELECTED BOARD OF DIRECTORS MEMBERS, THE MEMBERS (SISTERS OF THE DIVINE SAVIOR) MAY APPOINT UP TO THREE DIRECTORS TO SERVE AT THE PLEASURE OF SAID MEMBERS FOR AN INDEFINITE TERM.
FORM 990, PART VI, SECTION A, LINE 7B	APPROVAL OR RATIFICATION OF THE MEMBERSHIP (SISTERS OF THE DIVINE SAVIOR) IS REQUIRED RELATIVE TO THE ACTIONS OF THE BOARD OF DIRECTORS IN REGARD TO THE FOLLOWING MATTERS: -DISSOLUTION OF THE CORPORATION; -MAJOR FINANCING FOR NEW OR EXPANDED FACILITIES, IN SUCH AMOUNTS AS MAY BE ESTABLISHED BY THE MEMBERS; -MORAL DECISIONS RELATING TO THE OPERATION OF THE CORPORATION; -MERGER OR CONSOLIDATION OF CORPORATE OPERATIONS, AND SUCH SIMILAR MATTERS; -THE APPOINTMENT, RETENTION, AND REPLACEMENT OF THE PRESIDENT; -THE BUDGETS AND BORROWINGS; -THE SELECTION AND RETENTION OF SUCH PROFESSIONAL CONSULTANTS, ACCOUNTANTS, AND ATTORNEYS PURSUANT TO POLICIES ESTABLISHED BY THE MEMBERS; -THE APPROVAL OF REVISION OF THE PHILOSOPHY OR CREDO. CERTAIN ACTIVITIES OF DIVINE SAVIOR HEALTHCARE, INC., WHICH INCLUDE BUT ARE NOT LIMITED TO PURCHASING IMMOVABLE ASSETS SUCH AS LAND OR BUILDINGS, BORROWING LARGE SUMS OF MONEY AND ISSUING BONDS, AND BUILDING NEW FACILITIES, ARE SUBJECT TO APPROVAL BY THE CATHOLIC CHURCH IN ROME UNDER THE CODE OF CANON LAW.
FORM 990, PART VI, SECTION B, LINE 11	THE FINANCE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS THE 990 IN DETAIL AT A REGULARLY SCHEDULED MEETING PRIOR TO SUBMISSION. RESPONSES ON THE 990 ARE REVIEWED WITH THE VICE PRESIDENT OF FINANCE FOR THE ORGANIZATION DURING THE MEETING AND AFTER APPROVAL BY THE FINANCE COMMITTEE THE BOARD OF DIRECTORS IS PRESENTED WITH A FINAL COPY OF THE RETURN BEFORE IT IS FILED WITH THE IRS.
FORM 990, PART VI, SECTION B, LINE 12C	THE BOARD OF DIRECTORS DISCLOSES ANY CONFLICT OF INTERESTS ANNUALLY BY COMPLETING A QUESTIONNAIRE AND DISCLOSURE FORM ANNUALLY. EMPLOYEES ARE REQUIRED TO REVIEW THE CONFLICT OF INTEREST POLICY UPON HIRE AND AT ANNUAL INTERVALS. IF ANY SIGNIFICANT CONFLICTS ARISE WITH MEMBERS OF THE BOARD OF DIRECTORS, MANAGEMENT, OR KEY EMPLOYEES, IT IS PROPERLY DOCUMENTED AND FOLLOWED UP ON BY THE APPROPRIATE GOVERNING GROUP OR DEPARTMENT WITHIN THE ORGANIZATION ACCORDING TO THE CONFLICT OF INTEREST POLICY.
FORM 990, PART VI, SECTION B, LINE 15	THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS REVIEWS EVALUATIONS FOR THESE INDIVIDUALS ANNUALLY, INCLUDING THE CEO, AND COMPARES COMPENSATION DATA TO COMPETITIVE MARKET DATA OBTAINED FROM SALARY SURVEYS, AND CONSULTS WITH OUTSIDE ORGANIZATIONS. THESE COMPENSATION AND MARKET DATA OR SURVEY REVIEWS ARE DOCUMENTED WHEN REVIEWED IN THE MINUTES OF THE BOARD OF DIRECTORS' MEETINGS. THE COMPENSATION OF EXECUTIVES OF THE ORGANIZATION REQUIRES APPROVAL OF THE INDEPENDENT VOTING MEMBERS OF THE EXECUTIVE COMMITTEE OF THE BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION C, LINE 19	THE AUDITED FINANCIAL STATEMENTS, GOVERNING DOCUMENTS, AND THE CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST.
FORM 990, PART XI, LINE 2C: OVERSIGHT OF THE INDEPENDENT ACCOUNTANTS	THE ORGANIZATION'S FINANCE COMMITTEE ASSUMES RESPONSIBILITY FOR THE AUDIT OF ITS FINANCIAL STATEMENTS AND SELECTION OF AN INDEPENDENT ACCOUNTANT, SUBJECT TO APPROVAL BY THE MEMBERS. THE PROCESS USED BY THE FINANCE COMMITTEE HAS NOT CHANGED IN THE PAST 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

DIVINE SAVIOR HEALTHCARE INC

Employer identification number

39-0806250

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) SISTERS OF THE DIVINE SAVIOR 4311 NORTH 100TH ST MILWAUKEE,WI53222 39-6054869	RELIGIOUS ORDER	WI	501(C)(3)	LINE 1	N/A		No
(2) ST ANNE'S SALVATORIAN CAMPUS 3800 NORTH 92ND STREET MILWAUKEE,WI53222 39-0985045	PROVIDES HOUSING AND CARE TO THE ELDERY	WI	501(C)(3)	LINE 9	SISTERS OF THE DIVINE SAVIOR		No
(3) VOLUNTEERS OF THE DIVINE SAVIOR HOSPITAL AND NURSING HOME INC 2817 NEW PINERY ROAD PORTAGE,WI53901	BENEFICIAL SUPPORT FOR DIVINE SAVIOR HEALTHCARE	WI	501(C)(3)	LINE 9	DIVINE SAVIOR HEALTHCARE INC	Yes
(4) SASC INC 3800 NORTH 92ND STREET MILWAUKEE,WI53222 26-2512451	SUPPORTING ORGANIZATION TO ST. ANNE'S SALVATORIAN CAMPUS	WI	501(C)(3)	LINE 9	ST ANNE'S SALVATORIAN CAMPUS		No
(5) SDS HOPE HOUSE INC PO BOX 6352 OCEANSIDE,CA920526352 26-4301331	EMERGENCY HOUSING FOR WOMEN	CA	501(C)(3)	LINE 9	SISTERS OF THE DIVINE SAVIOR		No
(6) HADLEY TERRACE INC 3515 WEST HADLEY STREET MILWAUKEE,WI53210 39-1780021	ELDERLY LOW INCOME HOUSING	WI	501(C)(3)	LINE 11A, I	SISTERS OF THE DIVINE SAVIOR		No
(7) DIVINE SAVIOR HOLY ANGELS HIGH SCHOOL INC 4257 NORTH 100TH STREET MILWAUKEE,WI53222 39-0929898	EDUCATION	WI	501(C)(3)	LINE 1	SISTERS OF THE DIVINE SAVIOR		No

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

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

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

Yes

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

Yes

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

Yes

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

Yes

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

Yes

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

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

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

Yes

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

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

(a) Name of related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) SISTERS OF THE DIVINE SAVIOR	R	437,922	CASH PAID
(2) ST ANNE'S SALVATORIAN CAMPUS	D	84,000	CASH RECEIVED

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: TO OPERATE A HOSPITAL AND OTHER HEALTH CARE FACILITIES AND PROGRAMS FOR THE CARE OF THE AGED, INFIRM, INJURED, AND SICK; TO PROMOTE, CONDUCT, AND PARTICIPATE IN RESEARCH PROGRAMS CONCERNING THE CARE OF THE AGED, INFIRM, INJURED, AND SICK IN CONNECTION WITH THE OPERATION OF THE HOSPITAL; AND TO PROMOTE AND PARTICIPATE IN ANY ACTIVITY THE PURPOSE OF WHICH IS TO PROMOTE THE GENERAL HEALTH, REHABILITATION, AND SOCIAL WELFARE OF THE COMMUNITY.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	12
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	12
5	Total number of individuals employed in calendar year 2014 (Part V, line 2a) ......	5	956
6	Total number of volunteers (estimate if necessary) .............	6	167
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) .........	263,120	515,908
9	Program service revenue (Part VIII, line 2g) .........	88,216,802	93,854,291
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	2,196,717	1,397,559
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	-63,066	-58,215
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)...................	90,613,573	95,709,543
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	23,032	4,450
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)	50,532,643	52,948,136
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)....	37,443,007	37,621,108
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	87,998,682	90,573,694
19	Revenue less expenses. Subtract line 18 from line 12.......	2,614,891	5,135,849
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	123,799,236	137,855,791
21	Total liabilities (Part X, line 26).............	54,298,000	63,973,526
22	Net assets or fund balances. Subtract line 21 from line 20.....	69,501,236	73,882,265

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 60,444,045 including grants of $ 4,450 ) (Revenue $ 76,478,945 )
	DIVINE SAVIOR HEALTHCARE, INC. IS AN ACUTE CARE 73-BED HOSPITAL LOCATED IN PORTAGE, WI. INPATIENT SERVICES INCLUDED ADMISSIONS OF ADULTS AND PEDIATRIC PATIENTS WHICH TOTALED 1,598 IN FISCAL YEAR 2015 WITH PATIENT DAYS OF 4,517. THERE WERE ALSO 393 NEWBORN PATIENT DAYS AND 174 SWING BED PATIENT DAYS, AS WELL AS 1,081 OBSERVATION DAYS. DIVINE SAVIOR HEALTHCARE ALSO OFFERS A WIDE ARRAY OF OUTPATIENT SERVICES TO MEET THE HEALTHCARE NEEDS OF THE COMMUNITY. EMERGENCY ROOM, URGENT CARE, SURGERY, AMBULANCE, RENAL DIALYSIS, AND REHABILITATION SERVICES ARE AMONG MANY OF THE OUTPATIENT SERVICES PROVIDED. KEY OUTPATIENT SERVICE STATISTICS IN FISCAL YEAR 2015 INCLUDED 15,175 EMERGENCY ROOM VISITS, 6,634 URGENT CARE VISITS, 24,317 X-RAYS AND 3,079 INFUSION THERAPY VISITS WERE AMONG MANY OF THE PATIENT SERVICES AS NOTED. DIVINE SAVIOR HEALTHCARE ALSO PROMISES TO THE COMMUNITY TO PROVIDE HEALTHCARE SERVICES TO THOSE IN NEED REGARDLESS OF THEIR ABILITY TO PAY AS DEFINED IN THE HOSPITAL'S CHARITY AND COMMUNITY CARE POLICIES AND PROGRAMS. DURING FISCAL YEAR 2015, DIVINE SAVIOR HEALTHCARE'S CHARITY CARE PROGRAM AWARDED APPROXIMATELY $664,989 IN GROSS CHARGES FOR FINANCIAL ASSISTANCE TO PATIENTS WHO COULD NOT OTHERWISE AFFORD CARE.IN ADDITION TO INPATIENT AND OUTPATIENT HOSPITAL SERVICES, DIVINE SAVIOR HEALTHCARE ALSO PROVIDES EDUCATIONAL AND PREVENTATIVE SERVICES AT FREE OR REDUCED COSTS TO COMMUNITY MEMBERS. SOME OF THESE EVENTS OFFERRED TO THE PUBLIC INCLUDE: LOW COST EXERCISE CLASSES, FREE BLOOD PRESSURE SCREENINGS, LOW COST CHOLESTEROL SCREENINGS, LOW COST CHILDBIRTH EDUCATION CLASSES, BLOOD DRIVES, FREE BREASTFEEDING WORKSHOPS, SUPPORT GROUPS, AND LOW COST CPR AND FIRST AID CLASSES.

4b	(Code: ) (Expenses $ 12,822,916 including grants of $ ) (Revenue $ 10,250,633 )
	DIVINE SAVIOR HEALTHCARE, INC. ALSO OWNS AND OPERATES PHYSICIAN PRACTICES IN PORTAGE AND PARDEEVILLE, WI. TOTAL CLINIC VISITS FOR FISCAL YEAR 2014 WERE 63,935. THESE CLINICS PROVIDE FAMILY PRACTICE, INTERNAL MEDICINE, PHYSIATRY, OB, AND SURGICAL SERVICES, AMONG MANY OTHER CLINICAL SERVICES OFFERED TO PATIENTS IN THE COMMUNITY, AND WORK TOGETHER WITH THE HOSPITAL SERVICES OF DIVINE SAVIOR HEALTHCARE IN AN EFFORT TO COORDINATE HOSPITAL AND CLINICAL CARE TO PROVIDE CONVENIENT, COST-EFFECTIVE CARE TO MEMBERS OF THE COMMUNITY. DIVINE SAVIOR ALSO OPERATES A CLINIC IN RURAL OXFORD, A HEALTH SHORTAGE AREA TO BETTER MEET THE RESIDENTS OF THIS COMMUNITY CLOSER TO THEIR HOMES.THE CLINICS SERVICE A LARGE PORTION OF ELDERLY, DISABLED, AND LOW INCOME PATIENTS WHO ARE COVERED UNDER THE MEDICARE AND WISCONSIN MEDICAL ASSISTANCE PROGRAMS. APPROXIMATELY 40.1 PERCENT OF REVENUES GENERATED IN THE DIVINE SAVIOR HEALTHCARE CLINICS IN 2015 WERE COVERED UNDER THE MEDICARE AND MEDICAL ASSISTANCE PROGRAMS. THE CLINICS ARE OFTEN REIMBURSED FROM THESE PROGRAMS AT RATES WELL BELOW THE COST OF CARING FOR THESE PATIENTS, HOWEVER, IT IS DIVINE SAVIOR HEALTHCARE'S MISSION IN THE COMMUNITY TO PROVIDE CARE TO THESE PATIENTS.PATIENTS OF THE DIVINE SAVIOR HEALTHCARE CLINICS ARE ALSO ELIGIBLE FOR THE ORGANIZATION'S CHARITY AND COMMUNITY CARE PROGRAMS WHICH PROVIDE FREE OR REDUCED CARE TO INDIVIDUALS AND FAMILIES BASED ON INCOME AND ASSET GUIDELINES. THE FIGURES PRESENTED IN STATEMENT 4A OF THE HOSPITAL PROGRAM SERVICE ACCOMPLISHMENTS INCLUDE CHARITY CARE AMOUNTS PROVIDED TO CLINIC PATIENTS AS WELL. ADDITIONAL INFORMATION ON THE CHARITY CARE POLICIES CAN ALSO BE FOUND IN SCHEDULE H (HOSPITALS) OF THE FORM 990.

4c	(Code: ) (Expenses $ 7,992,940 including grants of $ ) (Revenue $ 6,878,102 )
	DIVINE SAVIOR HEALTHCARE, INC. ALSO OWNS AND OPERATES AN 83-BED EXTENDED CARE FACILITY AND 40-BED ASSISTED LIVING FACILITY. THE EXTENDED CARE FACILITY OFFERS SKILLED AND INTERMEDIATE CARE NURSING FOR RESIDENTS WHO REQUIRE SHORT-TERM REHABILITATION PROGRAMS OR LONG-TERM CARE. THE FACILITY ALSO OFFERS MEDICATION MANAGEMENT, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, SPEECH THERAPY, IV THERAPY, AND NUTRITION SERVICES, AS WELL AS ACCESS TO OTHER HEALTHCARE AND HOSPITAL SERVICES OFFERED BY DIVINE SAVIOR HEALTHCARE'S HOSPITAL PROGRAMS. IN 2015, 26,520 RESIDENT DAYS OF CARE AND 8,605 ASSISTED LIVING DAYS WERE PROVIDED BY THE EXTENDED CARE FACILITY. A MAJORITY OF THE RESIDENTS RECEIVE CARE UNDER THE WISCONSIN MEDICAL ASSISTANCE OR FAMILY CARE PROGRAMS. DIVINE SAVIOR HEALTHCARE RECOGNIZES THAT THE COST OF CARING FOR THESE INDIVIDUALS OFTEN EXTENDS BEYOND THE AMOUNT THAT IS PAID TO THE FACILITY BY THE MEDICAL ASSISTANCE PROGRAM. DURING FISCAL YEAR 2015, 15,779 DAYS OF CARE WERE PROVIDED TO MEDICAL ASSISTANCE AND FAMILY CARE RECIPIENTS IN THE EXTENDED CARE FACILITY. RESIDENTS OF THE EXTENDED CARE FACILITY AT DIVINE SAVIOR HEALTHCARE WHO HAVE EXHAUSTED ALL OTHER PROGRAMS SUCH AS MEDICAL ASSISTANCE OR THE WISCONSIN FAMILY CARE PROGRAM ARE ALSO ABLE TO APPLY FOR DISCOUNTED OR FREE CARE FOR HOSPITAL OR CLINICAL SERVICES UNDER THE ORGANIZATION'S CHARITY AND COMMUNITY CARE PROGRAMS AS DESCRIBED IN STATEMENTS 4A AND 4B NOTING THE HOSPITAL AND CLINIC PROGRAM SERVICE ACCOMPLISHMENTS. SINCE MOST EXTENDED CARE CHARGES ARE COVERED UNDER WISCONSIN MEDICAL ASSISTANCE PROGRAMS WHEN INCOME LEVELS ARE BELOW ESTABLISHED GOVERNMENT STANDARDS, THESE PROGRAMS ARE MOST OFTEN UTILIZED AS A SOURCE OF PAYMENTS FOR MANY RESIDENTS. IF THESE MEDICAL ASSISTANCE PROGRAMS ARE NOT AVAILABLE DUE TO A UNIQUE CIRCUMSTANCE, THE RESIDENT'S STAY MAY BE EVALUATED FOR CHARITY OR COMMUNITY CARE ON A CASE BY CASE BASIS BY ADMINISTRATION OF THE ORGANIZATION.

4d	Other program services (Describe in Schedule O.)
	(Expenses $ including grants of $ ) (Revenue $ )
4e	Total program service expenses81,259,901

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)............	3,780,753	0	292,796

(A) Name and Title	(B) Average hours per week (list any hours for related organizations below dotted line)		(D) Reportable compensation from the organization (W- 2/1099-MISC)	(E) Reportable compensation from related organizations (W- 2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(A) Name and Title
(18) FRANK WALTER MD........................................................................ PHYSICIAN	40.00 .......................	X	793,034	0	31,426
(19) MATTHEW LYNCH MD........................................................................ PHYSICIAN	40.00 .......................	X	501,271	0	31,426

(A) Name and business address	(B) Description of services	(C) Compensation
INTEGRATED HEALTHCARE STRATEGIES 700 W 47TH ST - SUITE 4 KANSAS CITY,MO64112	AGENCY STAFF	333,689




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 1

				(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
e	Government grants (contributions)1e		19,792

f	All other contributions, gifts, grants, and similar amounts not included above1f		496,116

g	Noncash contributions included in lines 1a-1f:$
h	Total. Add lines 1a-1f.......			515,908
			Business Code
2a	HOSPITAL PAT SERV REV		621990	68,430,307	68,430,307
b	CLINIC REVENUE		621110	11,097,449	11,097,449
c	EXTENDED CARE FACILITY REVENUE		623000	10,770,739	10,770,739
d	OTHER HEATHCARE SERVICE REVENUE		621990	2,363,300	2,363,300
e	HOME HEALTH PROGRAM REVENUE		621610	945,885	945,885
f	All other program service revenue .			246,611			246,611
g	Total. Add lines 2a–2f........			93,854,291
3	Investment income (including dividends, interest, and other similar amounts).......			630,454			630,454
4	Income from investment of tax-exempt bond proceeds..
5	Royalties...........
		(i) Real	(ii) Personal
6a	Gross rents	2,799
b	Less: rental expenses	76,259
c	Rental income or (loss)	-73,460
d	Net rental income or (loss).......			-73,460			-73,460
		(i) Securities	(ii) Other
7a	Gross amount from sales of assets other than inventory	20,377,238	5,000
b	Less: cost or other basis and sales expenses	19,600,602	14,531
c	Gain or (loss)	776,636	-9,531
d	Net gain or (loss)..........			767,105			767,105
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ..
	a		78,950
b	Less: direct expenses ...b		63,705
c	Net income or (loss) from fundraising events..			15,245			15,245
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
b
c
d	All other revenue ....
e	Total. Add lines 11a–11d ......
12	Total revenue. See Instructions......			95,709,543	93,607,680	0	1,585,955


				(A) Beginning of year		(B) End of year
1	Cash–non-interest-bearing .............			2,107,502	1	1,811,118
2	Savings and temporary cash investments .........			9,947,240	2	14,531,033
3	Pledges and grants receivable, net ...........			68,603	3	196,629
4	Accounts receivable, net .............			12,047,521	4	15,139,165
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 .............			929,980	7	931,191
8	Inventories for sale or use ..............			1,638,484	8	1,518,675
9	Prepaid expenses and deferred charges ..........			2,157,218	9	2,145,681
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	105,016,729
b	Less: accumulated depreciation .....	10b	48,011,392	51,158,721	10c	57,005,337
11	Investments—publicly traded securities ..........				11
12	Investments—other securities. See Part IV, line 11 .....			42,079,296	12	42,138,471
13	Investments—program-related. See Part IV, line 11 .....				13
14	Intangible assets ...............				14
15	Other assets. See Part IV, line 11 ...........			1,664,671	15	2,438,491
16	Total assets. Add lines 1 through 15 (must equal line 34)......			123,799,236	16	137,855,791
17	Accounts payable and accrued expenses .........			7,089,642	17	7,888,335
18	Grants payable .................				18
19	Deferred revenue ................				19
20	Tax-exempt bond liabilities .............			45,249,238	20	53,144,013
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 ..				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....................			1,959,120	25	2,941,178
26	Total liabilities. Add lines 17 through 25.........			54,298,000	26	63,973,526
	Organizations that follow SFAS 117 (ASC 958), check here and complete lines 27 through 29, and lines 33 and 34.
27	Unrestricted net assets ..............			69,277,149	27	73,617,657
28	Temporarily restricted net assets ...........			224,087	28	264,608
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 ...........			69,501,236	33	73,882,265
34	Total liabilities and net assets/fund balances ........			123,799,236	34	137,855,791