form-990 return of organization exempt from income...

Form-990 Return of Organization Exempt From Income Tax ' Under section 501(c), 52T, or 4947(a)(1) of the Internal Revenue Code (except black lung

Department of the treasury benefit trust or private foundation) Internal Revenue Seance " The organization may have to use a copy of this return to satisfy state reporting reqwrements .

A For the 2002 calendar ear or tax ear be Innin 07 /0 1 2002 and endin 06/30/2003 B Check M apqmws Please C Name of organization D Employer Identification number

naaras uaeiRS FRANCISCAN change HEALTH SYSTEM-WEST 91-0564491

label or Name change print or Number and street (or P O. box if mail is not delivered to street address) Room/suite E Telephone number Initial return type-

Final raturn See

1717 SOUTH IIJII STREET (253)552-4105 -

H

Amended speccin F Acc,punang U

return Inshur, City or town, state or country, and ZIP + 4 rrwthod Cash ~Accruai Application tions. pending a- TACOMA--WA 98405

other s 1

~ Section 501(c)(3) organizations and 4947(a)(1) nonexempt charitable H and I are not applicable to section 527organlzations trusts must attach a completed Schedule A (Form 990 or 990-EZ) . H(a) Is this a group return for affiliates? F-1 Yes X No

G Web site : tWWW, FHSHEALTH . ORG H(b) If 'Yes,' enter number of affiliates 10, N A J Organization type (check only one) No-7{ 1 501(c)(3 ) .4 (Insert no.) 4947(a)(1) or 527 H(c) Are all affiliates included? Yes frNo

(If 'No,' attach a list. See instruction K Check here 1 if the organization's gross receipts are normally not more than $25,000 The H(d) Is this a separate return

fil=ling? organization need not file a return with the IRS, but if the organization received a Forth 990 Package or ganization covered b a X Yes No

in the mad, it should file a return without financial data Some states require a complete return. I Enter 4-digit GEN 1 0928 M Check 10- U if the organ¢aUon is not required

L Gross receipts Add lines 6b, 8b, 9b, and 10b to line 12 1 500 , 437 , 943 .1 to attach Sch B (Forth 990, 990-EZ, or 990-PF).

Revenue Ex eases and Chan es in Net Assets or Fund Balances See a e 17 of the instructions .) 1 Contributions, gifts, grants, and similar amounts received a Direct public support , , , , , , , , , , , , , , , , , , , , , , , , 1 a 6 , 107 . b Indirect public support , , , , , , , , , , , , , , , , , , , , , , 1 b 5 , 654 , 471 . c Government contributions (grants) , , , , , , , , , , , 1 C 628 , 511 .

Total (add lines 7a through 1c) (cash E 6 ~ 289 ~ X89 . noncash $ ) 1 d

2 Program service revenue including government fees and contracts (from Part VII, line 93) , , , 2

3 Membership dues and assessments , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 3

4 Interest on savings and temporary cash investments , , , , , , , , , , , , , , , , , , , , , , , , , 4

5 Dividends and interest from securities , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 5

6a Gross rents �� 6a -

b Less rental expenses � � � � � � � � � � � , 8b

c Net rental income or (loss) (subtract line 6b from line 6a) , , , , , , , , , , , , , , , , , , , , , , , 6c 7 Other investment income (describe 1 7

> 8 a Gross amount from sales of assets other (A) Securities (B) Other ate' than inventory , , , , , , , , , , , , , , , -6 , 030 , 159 . 8a 39 , 142 .

b Less : cost or other basis and sales expenses , 8b 1 , 345 , 483 . c Gain or (loss)(attachschedule) , ,STMT 1A -6 , 030 , 159 . 8c -1 , 306 f 341 . d Net gain or (loss) (combine line 8c, columns (A) and (B)) , , , , , , , , , , , , , , , , , , , , , , , 8d

9 Special events and activities (attach schedule)

R I :C rru

- e- not including $ of

Mr-Mons; r orted on line 1a), , , , , , , , , , , , , , , , ,

"

9a

b Less : direct rises other than fundraising expenses , , 9 b -Jet

. . . . . . Ll%tae (Q( oss) from special events (subtract line 9b from line 9a) " . . " " " " " " . " " " " " 9c

10a Gross sale EIB ventory, less returns and allowances , , , , , , , , 0a b -~ y- ~~~ss-co s sold 0b

~C-C~Fps~rbfit or loss) from sales of inventory (attach "schedule) (subtract line 10b from line 10a) , , , , , 10c 11 Other revenue (from Part VII, line 103) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 11

12 Total revenue add lines 1d 2 3 4 5 6c 7 8d 9c 10c and 11 " " . . . . " " " . . . . " " . . . 12

13 Program services (from line 44, column (B)) , 13

14 Management and general (from line 44, column (C)) , , , , , , , , , , , , , , , , , , , , , , , , , , 14 (7,1 0 15 Fundraising (from line 44, column (D)) , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , 15 a

18 Payments to affiliates (attach schedule) , , , , , , , , , , $TI4T, I , , , , , , , , , , , , , , , , , 16 17 Total expenses add lines 16 and 44 column A 17

m 18 Excess or (deficit) for the year (subtract line 17 from line 12) , , , , , , , , , , , , , , , , , , , , , , 18 19 Net assets or fund balances at beginning of year (from line 73, column (A)) , , , , , , , , , , 20 Other changes in net assets or fund balances (attach explanation) , , , , , ,STM ,2 , , $TMT, 13 , 20 21 Net assets or fund balances at end of ear combine lines 18 19 and 20 ~ " 21

For Paperwork Reduction Act Notice, see the separate instructions . ~~o1o + 000

SY4473 552B 04/28/2004 17 :59 :55 V02-8 .1 4

6,289,089 . 498,245,674 .

59,530 . 1,834,667 .

-7,336,500 .

499,092,460 . 407,973,406 . 48,418,151 .

i5,2 5,574 . ~\ Forth 990 (2002)

e Other program services (attach schedule) (G SSA f Total of Program Service Expenses (should equal line 44, a 2 E 1020 1 000

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .

91-0564491 Form 090 (2002)

' Statement of All organizations must complete column (A) Columns (B), (C), and (D) ere required for section 501(c)(3) and (4) organizations Functional Ex enses and section 4947(a)(1) nonexempt charitable trusts but optional to others . (See page 21 of the Instructions .)

DO not include amounts ~epOfted on line (A) Total (8) Program (C) Management (D) Fundraising services and eneral

22 Grants and allocations (attach schedule) ,~ (cash 3 10,437,673 . noncasnE ) 22 10 437 673 . 10 , 437 , 673 . ~ ~ ; 4; `S` iT 4 :t

23 Specific assistance to individuals (attach schedule) 23 \1 ` ~~~~ 24 Benefits paid to or for members (attach schedule) 24 ' ~'~,~f f Lt ~.. ~

:~.-~ - ~~g ~

25 Compensation of officers, directors, etc . 25 325 , 232 . 325 , 232 . 26 Other salaries and wages , , , , , , , 26 196 128 086 . 179 284 760 . 16 843 326 . 27 Pension plan contributions , , 27 5 , 493 , 239 . 5 , 087 , 127 . 406 112 . 28 Other employee benefits , , , , , , , 28 19 , 559 , 727 . 17 , 850 , 207 . 1 1 709 , 520 . 29 Payroll taxes , , , , , , , , , , , , , , 28 13 641 513 . 12 131 361 . 1 , 510 , 152 . 30 Professional fundraising fees , , , , , 30 31 Accounting fees , , , , , , , , , , , , 31 163 096 . 163 096 . 32 Legal fees � � � � � � � , 32 271 , 485 . 271 485 . 33 Supplies , , , , , , , , , , , , , , , 33 81 909 939 . 80 370 023 . 1 , 539 , 916 . 34 Telephone � � � � � . � � 34 21 , 463 . 21 , 463 . 35 Postage and shipping , , , , , , , , , 35 314 523 . 304 445 . 10 , 078 . 36 Occupancy , , , , , , , , , , , , , , 38 6 , 734 , 470 . 6 , 146 , 137 . 588 333 . 37 Equipment rental and maintenance, , 37 6 , 940 , 277 . 6 1 438 , 397 . 501 880 . 38 Printing and publications , , , , , , , 38 39 Travel� � � � � � � � � 39 1 , 219 , 388 . 902 763 . 316 625 . 40 Conferences, conventions, and meetings . 40 41 Interest� � � � � � � � , 41 8 , 498 , 270 . 8 , 498 , 270 . 42 Depreciation, depletion, etc. (attach schedule) . . 42 18 880 306 . 17 352 ,749 . 1 , 527 , 557 . 43 Other emensesnotcovered above (itemae)STMT 5 3a 85 , 8 52 870 . _63 , 169 , 494 . 22 683 376 . b 3b c 43c d 3d e 3e

44 Total functional expenses (add lines 22 through 43) Organizations completing columns (B)-P), carry these totals tonnes 13-15 , , , 44 456 391 557 . 407 973 406 . 48 , 418 , 151 .

Joint Costs. Check " X if you are following SOP 98-2 . Are any joint costs from a combined educational campaign and fundraising solicitation reported in (B) Program services , , , , , " E]Yes F XI If "Yes," enter (I) the aggregate amount of these joint costs $ ; (II) the amount allocated to Program services $

Statement of Program Service Accomplishments See page 24 of the instructions . What is the organization's primary exempt purpose? " STMT 6 Program Service

Expenses All organizations must describe their exempt purpose achievements in a clear and concise manner. State the number (Required tor501 (c)(3) and of clients served, publications issued, etc . Discuss achievements that are not measurable (Section 501(c)(3) and (4) (4) orgs , and a947(a)(1) organizations and 4947(aK1) nonexempt charitable trusts must also enter the amount of grants and allocations to others )

trusts, but optional for others )

a SEE STATEMENT A

--------------------------------------------------------------------------- ---------------------------------------------------------------------------

Grants and allocations $ 10 , 437 , 673 )1 407 973 406 . b

----------------------------------------- -----------------------------------------

Gr c

----------------------------------------- -----------------------------------------

Gr d

-----------------------------------------

----------------------------------------- Gr

91-0564491 Form Q90 (2002) 0=12-B a lance Sheets (See page 24 of the instructions .) Note : Where required, attached schedules and amounts within the description (A) (B)

column should be for end-of-year amounts only. Beginning of year End of year

45 Cash - non-interest-bearing . . . . . . . . . . . . . . . . . . . . . . . . . . . 15,041 . 45 15,474 . 46 Savings and temporary cash investments . . . . . . . . . . . . . . . . . . . . - 7,957,794 . 46 41969,175 .

4Ta Accounts receivable . . . . . . . . . . . . . . . . 47a 80,510,776 . b Less : allowance for doubtful accounts . . . . . . 47b 11,707 549 . 58,259,114 . 47c 68,803,227 .

48a Pledges receivable . . . . . . . . . . . . . . . . . 48a b Less : allowance for doubtful accounts . . . . . . . I 48b, 48c

49 Grants receivable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 50 Receivables from officers, directors, trustees, and key employees

(attach schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . so Sla Other notes and loans receivable (attach

schedule) . . . . . . . . . . . . . . . . 151 a 1 897,137 . b Less : allowance for doubtful accounts

. . . . . .

151bi 691,402 . Sic 897,137 . 52 Inventories for sale or use . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8,047,243 . 52 8,977,213 . 53 Prepaid expenses and deferred charges . . . . . . . . . . . . . . . . . . . . . 572,537 . 53 753,201 54 Investments - securities (attach schedule) STI~fT .1 ;2 Po. [:] Cost Rj FMV 86,855,961 . 54 91,365,229 . 55a Investments - land, buildings, and

equipment: basis . . . . . . . . . . . . . . . 55a b Less : accumulated depreciation (attach

schedule) . . . . . 55 55c 56 Investments - other (attach schedule) . . . . . . . . . . . . . . . . . . . . . . 56 57a Land, buildings, and equipment . basis . . . . . 57a 405,240,579*

b Less : accumulated depreciation (attach schedule) . . . . . . . . . . . . . . . . ~~I~T.12A 57bi 208,539,661 . 169,511,042 . 57c 196,700,918

58 Other assets (describe Ili- STMT 13) 14 , 677 481 . 58 6,675,338 .

59 Total assets (add lines 45 through 58) (must equal line 74) . . . . . . . . . . 346,587,615 . 59 379,156,912 . 60 Accounts payable and accrued expenses . . . . . . . . . . . . . . . . . . . . 48,090,246 . 60 45,642,555 . 61 Grants payable . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 62 Deferred revenue . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62

u) 63 Loans from officers, directors, trustees, and key employees (attach 2 schedule) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 ~3

64a Tax-exempt bond liabilities (attach schedule) . . . . . . . . . . . . . . . . . . 64a b Mortgages and other notes payable (attach schedule) . . . . . . $TNT. X4 175,164,671 . 64b 176,587,181 .

65 Other liabilities (describe jo. STMT 18 8, 876, 672 . 65 1,661,602 .

66 Total liabilities (add lines 60 through 65) . . . . . . . . . . . . . . . . . .

232,131,589 . 66 223,891,338 . Organizations that follow SFAS 117, check here loo- LA and complete lines

67 through 69 and lines 73 and 74 . w 67 Unrestricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114, 456, 026 . 67 155,265,574 .

68 Temporarily restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 69 Permanently restricted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Organizations that do not follow SFAS 117, check here and

C complete lines 70 through 74 . 70 Capital stock, trust principal, or current funds . . . . . . . . . . . . . . . . . . r7O o

u) 71 Paid-in or capital surplus, or land, building, and equipment fund . . . . . . . . 71 72 Retained earnings, endowment, accumulated income, or other funds . . . . . 72

< 73 Total net assets or fund balances (add lines 67 through 69 or lines 70 through 72 ; Z column (A) must equal line 19 ; column (B) must equal line 21) . . . . 114 456,026 . 73 1-5-5-,265,574 .

.74 Total liabilities and not assets I fund balances (add lines 66 and 73) . . . . 587,615 . 74 379,156,912 .

Form 990 is available for public inspection and, for some people, serves as the primary or sole source of information about a particular organization . How the public perceives an organization in such cases may be determined by the information presented on its return . Therefore, please make sure the return is complete and accurate and fully describes, in Part III, the organization's programs and accomplishments .

JSA 2E1030 1 000

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 6

91-0564491 4

I per ii-inanclifil btatements wi in Kevenue

pe'S minari btatemems witn i

Return (See Dage 26 of t e instructions . Return NOT APPLICABIJ Total revenue, gains, and other support a Total expenses and losses per per audited financial statements lo. a audited financial statements . . . . Amounts included on line a but not on b Amounts included on line a but not line 12, Form 990: on line 17, Form 990:

(1) Net unrealized gains NOT APPLICABLE (1) Donated services on investments $ and use of facilities $

(2) Donated services (2) Prior year adjustments and use of facilities $ reported on line 20,

(3) Recoveries of prior Form 990 . . . . . $ year grants . . . . $ (3) Losses reported on

(4) Other (specify) line 20, Form 990 $

Add amounts on lines (1) through (4) Poo-c Line a minus line b . . . . . . . . . oo-d Amounts included on line 17,

Form 990 but not on line a: (1) Investment e)penses

not included on line 6b, Form 990 . . . $

(2) Other (specify).

C Line a minus line b d Amounts included on line 12,

Form 990 but not on line a: (1) Investment e)penses

not included on line 6b, Form 990 . . . $

(2) Other (specify) :

$ $ Add amounts on lines (1) and (2) . . Po- d Add amounts on lines (1) and (2) . .0. d

o Total revenue per line 12, Form 990 e Total expenses per line 17, Form 990 (line c plus line d) . . . . . . . . . . Op- e (line c plus line d) . . . . . . . . . . Pp- e

List of Officers, Directors, Trustees, and Key Employees (List each one even if not compensated; see page 26 of

75 Did any officer, director, trustee, or key employee receive aggregate compensation of more than $100,000 from your organization and all related organizations, of which more than $10,000 was provided by the related organizations? 111111~ [:A Yes ONo If "Yes," attach schedule - see page 26 of the instructions . SEE STATEMENT 22

Form 990 (2002)

JSA 2EI040 1 000

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 7

Form,990 (2002)

Add amounts on lines (1) through (4) 0-Lb

(4) Other (specify) :

JSA 2EI041 1 000

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 8

4 U~ Other Information (See page 27 of the instructions .) IYesl No

tO Did the organization engage in any activity not previously reported to the IRS? If 'Yes," attach a detailed description of each activity 76 X 77 Wdre any changes made in the organizing or governing documents but not reported to the IRS? . . . . . . . . . . . . . . . . . . . 77 X

If "Yes," attach a conformed copy of the changes. 7 8 a Did the organization have unrelated business gross income of $ 1,000 or more during the year covered by this return? . . . . . . . . . . 18a

b If "Yes," has it filed a tax return on Form 990-T for this yearl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78b X 79 Was there a liquidation, dissolution, termination, or substantial contraction during the year? If "Yes," attach a statement . . . . . . . . 79 X 80 a Is the organization related (other than by association with a statewide or nationwide organization) through common

membership, governing bodies, trustees, officers, etc , to any other exempt or nonexempt organization? . . . . . . . . . . . . . . . . 80a X b If "Yes," enter the name of the organizationlip. SEE STATENENT B

and check whether it is I X I exempt or L~ nonexempt. 81 a Enter direct or indirect political expenditures . See line 81 instructions . . . . . . . . . . . . . . . . L81 a NONE

b Did the organization file Form 11 20-POL for this year? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81b X 82a Did the organization receive donated services or the use of materials, equipment, or facilities at no charge

or at substantially less than fair rental value? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82a X b If "Yes," you may indicate the value of these items here Do not include this amount as revenue in Part I or as an expense in Part 11 (See instructions in Part 111 .) . . . . . . . . . . . . . . I 82b I NOT DETERMINABLE

83 a Did the organization comply with the public inspection requirements for returns and exemption applications? . . . . . . . 83a X b Did the organization comply with the disclosure requirements relating to quid pro quo contributions? . . . . . . . . . . . 83b NI k

84a Did the organization solicit any contributions or gifts that were not tax deductible? 84a N/_k b If "Yes," did the organization include with every solicitation an express statement that such contributions

or gifts were not tax deduchble? ' * . * * . * . . * * * * * * * . . . * * , , * * . . . . . . .

84b NI k 85 501(c)(4), (5), or (6) organizations. I Were substantially all dues nondeducUble by members? . . . . . . . . . . . . . . 85a NI k

b Did the organization make only in-house lobbying expenditures of $2,000 or less? 85b NI k If "Yes" was answered to either 85a or 85b, do not complete 85c through 85h below unless the organization received a waiver for proxy tax owed for the prior year.

c Dues, assessments, and similar amounts from members . . . . . . . 85C N/A d Section 162(e) lobbying and political expenditures . . . . . . . . . . . . . . . . . . . . . . . . . 85d N/A e Aggregate nondeductible amount of section 6033(e)(I XA) dues notices . . . . . . . . . . . . . . . 85e N/A f Taxable amount of lobbying and political expenditures (line 85d less 85e) . . . . . . . . . . . . . . 85f N/A g Does the organization elect to pay the section 6033(e) tax on the amount on line 85f?

* ' * . . . . . . . . . . . . . . . . . . . . . 85q N1h

h If section 6033(e)(1)(A) dues notices were sent, does the organization agree to add the amount on line 85f to its reasonable estimate of dues allocable to nondeductible lobbying and political expenditures for the following tax year? . . . . . . . . . . . . . . . 85h NI P.

86 501(c)(7) orgs . Enter a Initiation fees and capital contributions included on line 12 . . . . 86a N/A b Gross receipts, included on line 12, for public use of dub facilities . . . . . . . . . . . . 86b N/A

87 501(c)(12) orgs Enter a Gross income from members or shareholders 87a N/A b Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them ) . . . . . . . . . . . . . . . . . . . . . . . . . 87b N/A

88 At any time during the year, did the organization own a 50% or greater interest in a taxable corporation or partnership, or an entity disregarded as separate from the organization under Regulations sections 301 .7701-2 and 301 7701-3? If "Yes," complete Part IX 88 X

89a 501(c)(3) organizations Enter Amount of tax imposed on the organization during the year under- section 491 1 N/A ; section 4912 lll~ N/A section 4955 10, N/A

b 501(c)(3) and 501(c)(4) orgs. Did the organization engage in any section 4958 excess benefit transaction during the year or did it become aware of an excess benefit transaction from a prior year? If "Yes," attach a statement explaining each transaction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 89b I X

c Enter . Amount of tax imposed on the organization managers or disqualified persons during the year under sections 4912, 4955, and 4958 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1110. NON'E

d Enter- Amount of tax on line 89c, above, reimbursed by the organization . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10. NONE 90 a List the states with which a copy of this return is filed Poo.IjONE P.EQUIRED

b Number of employees employed in the pay period that includes March 12, 2002 (See instructions) . . . . . . . . . . . . . . . . . . I 90b 14090 91 Thebooksareincaroof No- MICHAEL FITZGERALD Telephone no 01253-552-4105

Locatedatoo- 1149 biXRKET STREET, TACOMA, WA ZIP + 4 11~ 98402 92 Section 4947(a)(1) nonexempt charitable trusts riling Form 990 in lieu of Form 1041 - Check here . . . . . . . . . . . . . . . . . . . . . . . . 10. 0

and enter the amount of tax-exempt interest received or accrued during the tax year . . . . . . . . . . . . . . . . IN- 192 1 NONE

Form 990 (2002)

Form 990 I

Note : Enter gross amounts unless otherwise Unrelated business income Excluded by section 512, 51 Ind/Gated. (A) (B) (C) (D) Business A Exclusion mount A Amount W.3 r-rogramseiv, revenue. coue _~v V

a STMT 23 8,151,872 . 3, b C d

f Medicare/Medicaid payments . . . . . . . g Fees and contracts from government agencies .

94 Membership dues and assessments . . . 95 In terest on savings and temporary cash investments 14 96 Dividends and interest from securities 14 1 97 Net rental income or (loss) from real estate-

a debt-financed property . . . . . . . . . b not debt-financed property . . . . . . .

98 Not rental Income or (loss) from personal property . . 99 Other investment income . . . . . . . . 100 Gain or (loss) from sales of assets other than inventory 18 -7, 101 Net income or (loss) from special events 102 Gross profit or (loss) from sales of inventory 103 Other revenue a

b C d e

104 Subtotal (add columns (B), (D), and (E)) . 8,151,872 .1 1 -2, 105 Total (add line 104, columns (B), (D), and (E)) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Note : Line 105 plus line Id, Part J, should equal the amount on line 1Z Part /

6 .

11011 .1 486,982,510 . 111111. 492,803,371 .

ABILITY

(A) (B) (C) (D) Name,. addre.ss, and. EIN of.corporation, Percentage of I Nature of activities Total income EANyear

assets

Information Regarding Transfers Associated with Personal Benefit Contracts (See page 33 of the instructions .) (a) Did the organization, during the year, receive any funds, directly or indirectly, to pay premiums on a personal benefit contract? Yes X No ~N o, (b) Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract? Hyes I X I No Note : ff "Yes" to N, file Form 8870 andForm 4720 (see instructions) .

Under enalties of perjury, I declare that I have examined this return, Including accom agrig schedules and statements, and to the best of my knowledge and befief, It is truepqrre5 and complete Declaration of preparer (other than offlcer~ Is ased on all Information of which preparer has any knowledge .

I" "t I '%-qoy Signature ofoffic-er Date'

V t -17A P_ f 'ci,~C~ T::Q Type or print name aQd.W)B

Preparees Date Ch!ck if Preparees SSN or PTIN (See Gen Inst W) self signature pnav 1 ;1;6-q1e -.1 11.F] I Dnn'30AQA'2

EIN 10" 47-

Phone no. --I r% -5

Firm's namii (or yours if self-employed), address, and ZIP + 4

JSA

2EI050 1 000

SY4473 552B 04/28/2004 17 :59 :55 V02-8 .1 9

Line No . I Explain how each activity for which income is reported in column (E) of Part VI I contributed importantly to the accomplishment

SERVICES

Please Sign Here

Paid Preparer's Use Only

-Jai--Z 00!0 Form 990 (2002)

(E) Related or

exempt function

16

GROUP-HEALTH-COOPERATIVE ------------------------

IAL SERVICE 1,179,407 .

IAL SERVICE 1,179,258 .

1AL SERVICE 986,131 .

Schedule A (Form 990 or 990-EZ) 2002

10 SY4473 552B 04/28/2004 17 :54 :15 V02-8.1

SCHEDULE A Organization Exempt Under Section 501(c)(3) OMB No . 1545-0047

(Form 990'or 990-EZ) (Except Private Foundation) and Section 5011(e), 501(f), 501(k),

501(n), or Section 4947(a)(1) Nonexempt Charitable Trust Department of the Treasury Supplementary Information - (See separate instructions .) 2002 Internal Revenue Service 10- MUST be completed by the above organizations and attached to their Form 990 or 990-EZ Name of the organization Employer Identification number

FRANCISCAN HEALTH SYSTE14-WEST 1 91-0564491 Compensation of the Five Highest Paid Employees Other Than Officers, Directors, and Trustees (See page 1 of the instructions . List each one. If there are none, enter "None.")

(a) Name and address of each employee paid more (b) Title and average (d) Contributions to

(9) Expense hours per %wek (c) Compensation employee benefit plan,,$ & account and other

than $50,000 A-M-1 M -ffi- I I A.C.- I

KARI-VITIKAINE14 ------------------1717 SOUTH J STREET TACOMA . WA 98405

EVERETT W . NEWCOMB MEDICAL DIRECTOR 1717 SOUTH J STREET TACOMA, WA 98405 40 HRS/WK 289,979 . 45,193 . NONE

JUNE-C .-BOWMAN --------------------- Simr. CEO 1717 SOUTH J STREET TACOMA, WA 98405 40 HRS/WK 253,573 . 45,748 . NONE

DUNCAN TRIGG PHYSICIAN 1717 SOUTH J STREET TACOMA . WA 98405 40 HRS/WK 240 .672 . 47 .517 . NONE

LAURE-NICHOLS ---------------------- r-STG . PLANNING 1717 SOUTH J STREET

Total number of other employees paid over $50,000 . . . . . . . . . . . . .

.. . . . . . . . . 00. 1166

Compensation of the Five Highest Paid Independent Contractors for Professional Services (See page 2 of the instructions . List each one (whether individuals or firms). If there are none, enter "None.")

(a) Name and address of each independent contractor paid more than $50,000 1 (b) Type of service I (c) Compensation

HRN SERVICES

HOSPITAL CENTRAL SERVICE-ASSOCIATION -----------

TRANSCEND SERVICES

P .O . BOX 402918 . ATLANTA . GA 30384

PATIENT-ACCOUNTING SERVICE-CENTER --------------

Total number of others receiving over $50,000 for professional services

-* * - ' * ' * .. . . . . . . . 111. 131

For Paperwork Reduction Act Notice, see the Instructions for Form 990 and Form 990-EZ. JSA 2EI210 1 000

3 Does the organization make grants for scholarships, fellowships, student loans, etc.? (See Note below ) . . . . . . . . . . . . . 4 Do you have a section 403(b) annuity plan for your employees? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Note : Attach a statement to explain how the organization determines that individuals or organizations receiving grants

The rqa ization is not a private foundation because it is- (Please check only ONE applicable box) 5 A church, convention of churches, or association of churches Section 170(b)(1)(A)(I) 6 A school Section 170(b)(1)(A)(ii) (AJso complete Part V.) 7 X A hospital or a cooperative hospital service organization . Section 170(b)(1)(A)(iii) 8 A Federal, state, or local government or governmental unit. Section 1170(b)(11)(A)(v) 9 A medical research organization operated in conjunction with a hospital . Section 170(b)(1)(A)(ih) . Enter the hospital's name, city,

and state lo~

11 0 An organization operated for the benefit of a college or university owned or operated by a governmental unit Section 170(b)(1)(AXiv)

(Also complete the Support Schedule in Part IV-A )

11aE] An organization that normally receives a substantial part of its support from a governmental unit or from the general public

Section 170(b)(1)(A)(vi) (AJso complete the Support Schedule in Part IV-A )

11lbR A community trust Section 170(b)(1)(AXvi) (Also complete the Support Schedule in Part IV-A.) 12 An organization that normally receives : (1) more than 33 1/3% of its support from contributions, membership fees, and gross

receipts from activities related to its charitable, etc , functions - subject to certain exceptions, and (2) no more than 33 113% of its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses acquired

1 F_1 by the organization after June 30, 1975 . See section 509(a)(2) . (A)so complete the Support Schedule in Part IV-A )

3 An organization that is not controlled by any disqualified persons (other than foundation managers) and supports organizations described in : (1) lines 5 through 12 above ; or (2) section 5011(c)(4), (5), or (6), if they meet the test of section 509(ax2) (See section 509(a)(3) )

(b) Line number from above (a) Name(s) of supported organization(s)

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 11

91-0564491 Schebule A (Form 990 or 990-EZ) 2002 Page 2

Statements About Activities (See page 2 of the instructions .) Yes No

I During the year, has the organization attempted to influence national, state, or local legislation, including any

attempt to influence public opinion on a legislative matter or referendum? If "Yes," enter the total expenses paid

or incurred in connection with the lobbying activities No. $ 4,591 . (Must equal amounts online 38,

Part VIA or line I or Part VI-B.) I X Organizations that made an election under section 501(h) by filing Form 5768 must complete Part WA Other

organizations checking "Yes," must complete Part IA-B AND attach a statement giving a detailed description of

the lobbying activities

2 During the year, has the organization, either directly or indirectly, engaged in any of the following acts with any

substantial contributors, trustees, directors, officers, creators, key employees, or members of their families, or

with any taxable organization with which any such person is affiliated as an officer, director, trustee, majority

owner, or principal beneficiary? (ff the answer to any question is "Yes," attach a detailed statement explaining

the transactions)

a Sale, exchange, or leasing of property? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SEE.STATEMENT C . L2a L X . . . . . . . . . .

b Lending of money or other extension of credit? . . . . . . . . . . . . . . . . . . . . . . . . . . . . !~~E.STATEMENT C

SEE STATEMENT C c Furnishing of goods, services, or facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STMT 25

d Payment of compensation (or payment or reimbursement of expenses if more than $1,000)? . . . . . . . . . . . . . . . . . .

e Transfer of any part of its income or assetsl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

Reason for Non-Private Foundation Status (See pages 3 through 5 of the instructions .)

14 F-1 An organization organized and operated to test for public safety Section 509(a)(4) (See page 5 of the instructions.) JSA Schedule A (Form 990 or 990-EZ) 2002 2E1220 1 000

18 Gross income from interest, dividends, amounts received from payments on securities loans (section 5112(a)(5)), rents, royalties, and unrelated business taxable income (less section 511 taxes) from businesses acquired by the organization after June 30, 1975 . . . . .

19 Net income from unrelated business activities not included in line 18 . . . . . . . . .

20 Tax revenues levied for the organization's benefit and either paid to it or expended on its behalf . . . . . . . . . . . . . - . . .

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

. . . . . . . . . . .

. . . . . . . . . . . . . . . 26 Organizations described on lines 10 or 11 : a Enter 2% of amount in column (e), line 24 kTQT, API?"CAP;4 . . . b Prepare a list for your records to show the name of and amount contributed by each person (other than a governmental unit or publicly supported organization) whose total gifts for 1998 through 2001 exceeded the amount shown in line 26a Do not file this list with your return . Enter the total of all these excess amounts

c Total support for section 509(a)(1) test Enter line 24, column (e) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Add Amounts from column (e) for lines 18 19

22 26b . . . . . . . . . o Public sunnort (line 26c minus line 26d total)

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 12

Schedule A (Form 990 or 990-EZ) 2002 91-0564491 -

Page 3

L~~ Support Schedule (Complete only if you checked a box on line 10, 11, or 12 .) Use cash method ofacuMdApPLICAVILE . Note : You may use the worksheet in the instructions for convertinTfrom the accrual to the cash method of accountinq.

Calendar year (or fiscal year beginning In) . . . . . 15 Gifts, grants, and contributions received. (Do

not include unusual arants See line 28.1 . . . . .

Gross receipts from admissions, merchandise sold or services performed, or furnishing of facilities In any activity that is related to the

21 The value of services or facilities furnished to the organization by a governmental unit without charge. Do not include the value of services or facilities generally furnished to the

22 Other income Attach a schedule Do not include qain or (loss) from sale of capital assets

17 . . . . . . . . . . . . .

. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . f Public support percentage (line 26e (numerator) d Ivided by I Ine 26c (denominator)) . . . . . . . . . . . . . . . . . . . %

27 Organizations described on line 12'. a For amounts included in lines 115, 16, and 117 that were received from a "disqualified person," prepare a list for your records to show the name of, and total amounts received in each year from, each "disqualified person Do not file this list with your return . Enter the sum of such amounts for each year:

(2001) . . . . . . . . . . . . . . . . (2000) . . . . . . . . . . . . . . . . . . . (1999) - - -

NOT APPLICABLE _ (1998) . . . . . . . . . . . . . . b For any amount included in line 17 that was received from each person (other than "disqualified persons"), prepare a list for your records to

show the name of, and amount received for each year, that was more than the larger of (1) the amount on line 25 for the year or (2) $5,000 (Include in the list organizations described in lines 5 through 11, as well as individuals ) Do not file this list with your retum. After computing the difference between the amount received and the larger amount described in (1) or (2), enter the sum of these differences (the excess amounts) for each year- (2001) . . . . . . . . . . . . . . . . (2000) - - - - - - - - - - - - - - - - - - - (1999) - - - - - - - - - - - - - - - - - - - (1998) - - - - - - - - - - - - - - -

c Add : Amounts from column (e) for lines . 15 16 17 20 21 . . . . . . . . . . . . oo.

d Add . Line 27a total and line 27b total . . . . . . . . . . . . . . lo. e Public support (line 27c total minus line 27d total) . . . . . . . . . . . . . . . . . . . . . . . .

. . . f Total support for section 509(a)(2) test Enter amount from line 23, column (e) . . . . . . . . . . 11.1 27f g Public support percentage (line 27e (numerator) divided by line 27f (denominator)) . . . . . . . . . . . . . . . . . .

28 Unusual Grants : For an organization described in line 10, 11, or 12 that received any unusual grants during 1998 through 2001, prepare a list for your records to show, for each year, the name of the contributor, the date and amount of the grant, and a brief description of the nature of the grant. Do not file this list with your return . Do not Include these grants In line 15.

JSA Schedule A (Form 990 or 990-EZ) 2002 2E1221 1000

91-0564491

b Has the organization's right to such aid ever been revoked or suspended? . . . . . . . . . . . . . . . . . . . . . . 34b If you answered "Yes" to either 34a or b, please explain using an attached statement.

36 Does the organization certify that it has complied with the applicable requirements of sections 4.01 through 4.05 of Rev. Proc . 75-50, 1975-2 C .B . 587, covering racial nondiscrimination? If "No," attach an explanation . . . . . . 35

JSA 2EI230 1 000 Schedule A (Forrn 990 or 990-EZ) 2002

13 SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1

k

Schedule A (~orm 990 or 990-EZ) 2002 NOT APPLICABLE Page 4

Private School Questionnaire (See page 7 of the instructions .) (To be completed ONLY by schools that checked the box on line 6 in Part IV)

29 Does the organization have a racially nondiscriminatory policy toward students by statement in its charter, bylaws, jYesj No other governing instrument, or in a resolution of its governing body? . . . . . . . . . . . . . . . . . . . . . . . . . 29

30 Does the organization include a statement of its racially nondiscriminatory policy toward students in all its brochures, catalogues, and other written communications with the public dealing with student admissions, programs, and scholarships? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30

31 Has the organization publicized its racially nondiscriminatory policy through newspaper or broadcast media during the period of solicitation for students, or during the registration period if it has no solicitation program, in a way that makes the policy known to all parts of the general community it serves? . . . . . . . . . . . . . . . . 31 If "Yes," please describe ; if "No," please explain . (If you need more space, attach a separate statement.) ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

32 Does the organization maintain the following: ----------------------------------------------------------------------------- ---

a Records indicating the racial composition of the student body, faculty, and administrative staff? 32a b Records documenting that scholarships and other financial assistance are awarded on a racially nondiscriminatory

basis? c Copies of all catalogues, brochures, announcements, and other written communications to the public dealing

with student admissions, programs, and scholarships? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . d Copies of all material used by the organization or on its behalf to solicit contributions? . . . . . . . . . . . . . . . .

If you answered "No" to any of the above, please explain. (If you need more space, attach a separate statement.) -----------------------------------------------------------------------------

33 Does the organization discriminate by race in any way with respect to : -----------------------------------------------------------------------------

Students' rights or privileges? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

Admissions policies? 33 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

c Employment of faculty or administrative staff? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33

d Scholarships or other financial assistance? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

e

Educational policies? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

f Use of facilities? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

g Athletic programs? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

h Other extracurricular activities?

If you answered "Yes" to any of the above, please explain. (if you need more space, attach a separate statement.)

---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

34a Does the organization receive any financial aid or assistance from a governmental agency? . . . . . . . . . . . . .

Schedule A (Form 990 or 990-EZ) 2002 91-0564491 Page 5 Lobbying Expenditures by Electing Public Charities (See page 9 of the instructions .) (To e completed ONLY by an eligible organization that filed Form 5768) NOT APPLICABLE

Check Iii. a if the organization belongs to an affiliated group . Check Do- bHif You checked "a" and "limited control" provisions aDDIv .

Affiliated group To be completed totals for ALL electing

I organizations

Not over $500,000 . . . . . . . . . . . . 20% of the amount on line 40 . . . . . . . . .

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 41

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 . . . . . . . . . . . . . . . . 42 Grassroots nontaxable amount (enter 25% of line 41) . . . . .

. 43 Subtract line 42 from line 36 . Enter -0- if line 42 is more than line 36 44 Subtract line 41 from line 38 . Enter -0- if line 41 is more than line 38

Lobbying Expenditures During 4-Year Averaging Period

Calendar year (or fiscal year beginning In) Poo-

Lobbying nontaxable amount . . . a e a m m Lobbying ceiling amount

W (d) 2000 199

(e) Total

SY4473 552B 04/28/2004 17 :54 :15 V02-8.1 14

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred .)

36 Total lobbying expenditures to influence public opinion (grassroots lobbying) . . . 36 37 Total lobbying expenditures to influence a legislative body (direct lobbying) 37 38 Total lobbying expenditures (add lines 36 and 37) . . . . . . . . . . . . . . . . . . 38 39 Other exempt purpose expenditures

' * ' ' * * ' " . . . . . . . . . . . . . . 39

40 Total exempt purpose expenditures (add lines 38 and 39) 40 41 Lobbying nontaxable amount . Enter the amount from the f~ll~w* irg*ta"b'le'-'

If the amount on line 40 is - The lobbying nontaxable amount is -

on : If there is an amount on either line 43 orline 44, you must file Form 4720.1 4-Year Averaging Period Under Section 501(h)

(Some organizations that made a section 501(h) election do not have to complete all of the five columns below See the instructions for lines 45 throucih 50 on Daae 11 of the instructions .)

(a) (b) 2002 2001

Grassroots nontaxable

48 amount . . . . . . . .

Grassroots ceiling amount

49 (150% of line 48(e))

Grassroots lobbying

50 expenditures . . . . . . Lobbying Activity by Nonelecting Public Charities

(For reporting only by organizations that did not complete Part Vl-A) (See Da-qe 11 of the i structions .) During the year, did the organization attempt to influence national, state or local legislation, including any

Yes No Amount attempt to influence public opinion on a legislative matter or referendum, through the use of.

a Volunteers X lb Paid staff or manageme*nt'(ln~l~die*co' n p* e'ns'a*tio'n* in' e"x'pe*n*se*s*re*po*r*ted' 'on' li*ne's'c*th*ro'u*g*h X c Media advertisements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X d Mailings to members, legislators, or the public . . . . . . . . . . . . . . . . . . . . . . . . . X 500. e Publications, or published or broadcast statements . . . . . . . . . . . . . . . . . . . . . . . . . . X f Grants to other organizations for lobbying purposes . . . . . . . . . . . . . . . . . . . . . . . . . x g Direct contact with legislators, their staffs, government officials, or a legislative body . ~STMT .2.6 . -X 4,091 . h Rallies, demonstrations, seminars, conventions, speeches, lectures, or any other means X I Total lobbying expenditures (Add lines c through h.) . . . . . . . . . . . . . . . . . . . . . . . . . . I .' - ~ 4,591 .

If "Yes" to any of the above, also attach a statement giving a detailed description of the lobbying activities . JSA Schedule A (Form 990 or 990-EZ) 2002 2E1240 1 000

Schedule A (Form 990 or 990-EZ) 2002 91-0564491 Page 6 Information Regarding Transfers To and Transactions and Relationships With Noncharitable Exempt Organizations (See page 12 of the instructons .)

51 'Did the reporting organization directly or indirectly engage in any of the following with any other organization described in section 501 (c) of the Code (other than section 501 (c)(3) organizations) or in section 527, relating to political organizations?

a Transfers from the reporting organization to a noncharitable exempt organization of: 0-(1) Cash 51 a(l) X (H) Other assets a(II) X

b Other transactions : (1) Sales or exchanges of assets with a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . b(l) X

(Ii) Purchases of assets from a noncharitable exempt organization . . . . . . . . . . . . . . . . . . . . . . . . . b(II) x (111) Rental of facilities, equipment, or other assets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b(III) X (iv) Reimbursement arrangements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . b(iv) X (v) Loans or loan guarantees .

. . . i . . . . . i . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Nv) X

(vi) Performance of services or membership or fundraising solicitations . . . b(vi) X c Sharing of facilities, equipment, mailing lists, other assets, or paid employees

. . . . . . c X

d If the answer to any of the above is "Yes," complete the following schedule Column (b) should always show the fair market value of the goods, other assets, or services given by the reporting organization . If the organization received less than fair market value in any

52a Is the organization directly or indirectly affiliated with, or related to, one or more tax-exempt organizations described in section 501 (c) of the Code (other than section 501 (c)(3)) or in section 527? . . . . . . . . .

. 10, [-] Yes a No

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 15

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 19

FRANCISCAN HEALTH SYSTEM-WEST 91-0564491

FORM 990, PART I - PAYMENTS TO AFFILIATES

DESCRIPTION AMOUNT ----------- ------

CATHOLIC HEALTH INITIATIVES 6,112,488 . 1999 BROADWAY, SUITE 2600, DENVER, CO 80202 NATIONAL ASSESSMENT

------------ TOTAL 6,112,488 .

STATEMENT 1

COOZIOC/90 :a3GN3 MV3A XVI ~6"9WWNG

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(Itc,90c,l) ESVISVEl ILVZZ9'f Zgt'86Z't ZVI'6f SIV40JL

Z69 Z69 EO/OE/go snOuLA lu;)wdinbg alqvOAOWlOfL'W slgssV SnOuuA (998'99Z) 998'99Z - WOE/% WOZ/170 Xl!nbg MHd - jUQUqSaALq

(EC8'Z8Z) EWNZ - fo/OE/go snoLWA juatudinbg alqtOAOW lOfUw Jupowaw -Iyivd (EL8'6ZI) EL8'6ZI - MUM sno!JBA lu;)tudinbg ;)IqLOAOVJ lOfL'w SIOPH ioq-MH (M't,99) Z8E't,99 tOZ'98t,'E 989'091't, - EO/10/90 88/10/80 juawdinbg alqLOAOW JOftl ON

. w tualsxs sNddD ON EO/OE/go snoLMA watudinbg alqtoAoWiofuW iuawdinbg iouiW snOPUA

OEVI OZE, I I EWE 196't, 09L'Z CO/10/90 Z6/1 0/90 juawdinbg olquDAOW 10fuw lazil!jals o3surv

;)uiq3tW punosL,-nlfl OOOE I (IH 16Z'9Z 60Z'01 9EL'ZEI 5t,6'Zt, I oog,5c ZO/ 10/0 1 96/1 0/tO iumdinbg olquDAOW 10fuw

(SSO'D 3fl'IVA NOIJLVID3Hdaa JLSOJ 311vs Ivolm aios u3mfloz)v AlH3dOHd AO 3dAJL 13SSV AO NOIldlUJS3(I NaV9 MOOR 13N (lalvqfwaX)v IVNIDIHO S(Maaolld 31va 3iva

(69 I'OEO'9) dl 'wej6OJd JU9WjS9AUj 6uilejado IHO W04 SSO-1

SaIJLM33S

I

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 20


I

FORM 990, PART I - OTHER INCREASES IN FUND BALANCES -------- -------- ------- ==


CHANGE IN UNREALIZED GAINS IN SECURITIES 7,777,695 . CONSOLIDATION OF RELATED ENTITY 143,242 .

------------ TOTAL 7,920,937 .

STATEMENT 2

I

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 21


FORM 990, PART I - OTHER DECREASES IN FUND BALANCES


MISSION & MINISTRY FUND CONTRIBUTIONS 739,956 . CAPITAL RESOURCE POOL CONTRIBUTIONS 2,959,848 .

------------ TOTAL 3,699,804 .

STATEMENT 3

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aw Wilmsaas 01 diHSHOIXTM

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'9LEC89ZZ 'V6V69TE9 'OL8ZS8S8 sriviol ---------- ---------- ---------- 'VVL'V98 szoiA*dzs azsvHouna uzHLo

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*Z8L'LSE'Z 'LLS'S6T asNzclxz sriozmvrmzz)six 'E6E'SSZ SZOIAUSS UZIMMELKI

*6ZOVESVZ zsKzcTxz maza awe ,LSB,oz 'LS8'OZ CIOBS xmavzs "SET'LZ SHZJ IMMEMMEK XIUZdO'dd

*szs'ozg saza xomzvv Noilo = 00 NOIIVZIX'KOHV

'969'Z90't *9TE'VT9 *ZT6'9L9't sszmauvmv oirland *6CT'VZL'T asxzaxz sxiv7o mmiazK

'960'ZL *89L'SE8'S *V98'LO6'E sasmzoill CKV smml 'ZZ9'Z8Z *8ZZ'L99 smoiLdrdoseas akm szaa

*SEE,Zzv 'ELT'9LT '80S'86S E)NImrmsxoo *6LZTOEET *SZ88VVVZ 'VOTOSLLE szoiAuas azsvHo*tma

'L68'8LO'E Z:)IA'dMS rMHOISSZaO'dd U2R.10 imminuoza axy vinsimuzAaw

*LSL'SOC 'L8S'TT8'E 'VVE'LTT'V zoxv~msxi

----------- -------- ----- -----------

rrundamao aNv SZOIAdZS 7VIOM NOIIdlldc)sza ,LXM*Taf)VKVK KwuVoud

STATEMENT 6

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 24


FORM 990, PART III - ORGANIZATION'S PRIMARY EXEMPT PURPOSE

THE PRIMARY EXEMPT PURPOSE OF FRANCISCAN HEALTH SYSTEM-WEST IS TO PROVIDE HEALTHCARE SERVICES TO THE RESIDENTS OF THE SURROUNDING AREA REGARDLESS OF ABILITY TO PAY .

I

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 25


FORM 990, PART IV - OTHER NOTES AND LOANS RECEIVABLE

BORROWER : STEPHEN GUTTING . M .D . ORIGINAL AMOUNT : 174,897 . INTEREST RATE : 5 .750000 DATE OF NOTE : 12/08/2000 MATURITY DATE : 12/01/2005 REPAYMENT TERMS : MONTHLY INSTALT NTS SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140,988 . ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54,804 .

---------------

BORROWER : JOHN LUBER, M.D . ORIGINAL AMOUNT : 150,000 . INTEREST RATE : 7 .000000 DATE OF NOTE : 07/01/1998 MATURITY DATE : 01/01/2006 REPAYMENT TERMS : $18,000 PER YEAR, PLUS INTEREST SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION:


---------------

BORROWER : GEORGE JACKSON, M.D . ORIGINAL AMOUNT : 3,758 . INTEREST RATE : 5 .750000 DATE OF NOTE : 11/01/2002 MATURITY DATE : 01/01/2003 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,384 . ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NONE

---------------

STATEMENT 7

I

BORROWER : RAJU PATEL, M .D . ORIGINAL AMOUNT : 82,518 . INTEREST RATE : 5 .750000 DATE OF NOTE : 06/02/2002 MATURITY DATE : 07/31/2007 REPAYMENT TERMS : MONTHLY AMORTIZATION STARTING 11/2003 SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 26

FRANCISCAN HEALTH SYSTEM-WEST 91-0564491 1

I

BORROWER : CLIFF ROBERTSON, M .D . ORIGINAL AMOUNT : 12,154 . INTEREST RATE : NONE DATE OF NOTE : 01/02/2002 MATURITY DATE : 10/01/2004 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :


---------------

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

BORROWER : JONATHON Y . JIN, M .D . ORIGINAL AMOUNT : 100,000 . INTEREST RATE : 7 .500000 DATE OF NOTE : 09/22/1999 MATURITY DATE : 09/20/2005 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

20,000 . 82,518 .

---------------

17,367 . NONE

---------------

STATEMENT 8

91-0564491

BORROWER : LAPWWOOD CLINIC ORIGINAL AMOUNT : 633,477 . INTEREST RATE : 6 .500000 DATE OF NOTE : 09/27/1996 MATURITY DATE : 11/01/2006 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : CAPITAL FINANCING DESCRIPTION AND FMV CASH OF CONSIDERATION :


---------------

BORROWER : JOHN READ, ORIGINAL AMOUNT : INTEREST RATE : DATE OF NOTE : MATURITY DATE : REPAYMENT TERMS : SECURITY PROVIDED : PURPOSE OF LOAN : DESCRIPTION AND FMV OF CONSIDERATION:

M. D . 135,072 .

5 .250000 08/01/2002 08/31/2006

MONTHLY AMORTIZATION NONE PHYSICIAN RECRUITMENT CASH

STATEMENT 9

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 27

FRANCISCAN HEALTH SYSTKtd-WEST I


---------------

BORROWER : PETER SHIN, M .D . ORIGINAL AMOUNT : 70,173 . INTEREST RATE : 7 .500000 DATE OF NOTE : 10/01/2001 MATURITY DATE : 08/01/2005 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NONE ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135,072 .

---------------

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 28


BORROWER : ROBERTO SECAIRA, M.D . ORIGINAL AMOUNT : 56,341 . INTEREST RATE : 5 .250000 DATE OF NOTE : 09/01/2002 MATURITY DATE : 08/01/2007 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :


---------------

BORROWER : MONSOUR SHIRBACHEH, M.D . ORIGINAL AMOUNT : 172,177 . INTEREST RATE : 5 .250000 DATE OF NOTE : 10/01/2002 MATURITY DATE : 10/01/2007 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :


---------------

BORROWER : NEIL HANNIGAN, M .D . ORIGINAL AMOUNT : 106,431 . INTEREST RATE : 5 .250000 DATE OF NOTE : 10/01/2002 MATURITY DATE : 10/01/2008 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :


---------------

STATEMENT 10

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 29


BORROWER : ROGER KEILMAN ORIGINAL AMOUNT : 80,454 . INTEREST RATE : 5 .250000 DATE OF NOTE : 12/01/1996 MATURITY DATE : 11/01/2006 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : PHYSICIAN RECRUITMENT DESCRIPTION AND FMV CASH OF CONSIDERATION :


---------------

TOTAL BEGINNING OTHER NOTES AND LOANS RECEIVABLE 691,402 .

TOTAL ENDING OTHER NOTES AND LOANS RECEIVABLES 897,137 .

STATEMENT 11

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 30


FORM 990, PART IV - INVESTMENTS - SECURITIES

ENDING DESCRIPTION BOOK VALUE ----------- ----------

CHI INVESTMENT PROGRAM-EQUITY 53,975,932 . CHI INVESTMENT PROGRAM-FIXED 37,389,297 .

--------------- TOTALS 91,365,229 .

STATEMENT 12

Book Value

Balance @ 6/30/2003 17,296,605 84,165,779 6,375,516

19,712,936 39,819,083 29,330,999 196,700,918

Balance @ 6/30/2003

1,109,476 42,487,665 9,299,563

44,709,643 110,933,314

208,539,661

Balance @ 6/30/2003 18,406,081

126,653,444 15,675,079 64,422,579 150,752,397 29,330,999

405,240579

Description LAND & LAND IMPROVEMENTS BUILDINGS LEASEHOLDIMPROVEMENTS FIXED EQUIPMENT MAJOR MOVEABLE EQUIPMENT CONSTRUCTION IN PROGRESS Total Balance @ 6/3012003

Depreciation is calculated on a straight line basis over the useful life of the asset

STATEMIENT 12A

FRANCISCAN HEALTH SYSTEM-WEST EIN : 91-0564491 TAX YEAR ENDED: 06/30/2003

Detail of Property, Plant, & Equipment

Fixed Assets Accumulated Depreciation

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 31


FORM 990, PART IV - OTHER ASSETS


A/R PHARMACEUTICAL RESEARCH NONE DUE FROM IRS NONE DUE FROM PACLAB NONE CURRENT DUE FROM AFFILIATES NONE OTHER RECEIVABLES NONE GH LEASE ACQUISITION COSTS NONE 3RD-PARTY PAYOR RECEIVABLE NONE INV.-TACOMA IMAGING 50,000 . INV .-OPEN BORE MRI 119,882 . INV .-CAPS, INC . NONE INV.-DIGESTIVE HEALTH NETWORK 267,774 . INV.-PASC 6,300 . INV.-FRANCISCAN SERVICES, INC . 5,763,177 . INV.-PACLAB 420,075 . INV.-PHYSICIAN HEALTH NETWORK NONE DEPOSITS 12,006 . DEFERRED FINANCING 36,124 .

--------------- TOTALS 6,675,338 .

STATEMENT 13

I

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 32


FORM 990, PART IV - MORTGAGES AND OTHER NOTES PAYABLE

LENDER : CATHOLIC HEALTH INITIATIVES ORIGINAL AMOUNT : 1,628,042 . INTEREST RATE : 5 .530000 DATE OF NOTE : 11/25/1997 MATURITY DATE : 12/01/2010 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : CAPITAL FINANCING DESCRIPTION AND FMV CASH OF C014SIDERATION :

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,186,313 . ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,072,987 .

---------------

LENDER : BANK OF AMERICA ORIGINAL AMOUNT : 4,830,000 . INTEREST RATE : 7 .040000 DATE OF NOTE : 10/30/1995 MATURITY DATE : 11/01/2002 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : BUILDING PURPOSE OF LOAN : CAPITAL FINANCING DESCRIPTION AND FMV CASH OF CONSIDERATION :


---------------

LENDER : CATHOLIC HEALTH INITIATIVES ORIGINAL AMOUNT : 61,572,925 . INTEREST RATE : 5 .530000 DATE OF NOTE : 01/26/2000 MATURITY DATE : 12/01/2021 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : CAPITAL FINANCING DESCRIPTION AND FMV CASH OF CONSIDERATION:


---------------

STATEMENT 14

I

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 33

FRANCISCAN HEALTH SYSTEM-WEST 91-0564491 1

LENDER : CATHOLIC HEALTH INITIATIVES ORIGINAL AMOUNT : 1,900,000 . INTEREST RATE : 5 .530000 DATE OF NOTE : 01/12/1998 MATURITY DATE : 12/01/2007 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : CAPITAL FINANCING DESCRIPTION AND FMV CASH OF CONSIDERATION :

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1,177,745 . ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 988,308 .

---------------



---------------



---------------

STATEMENT 15

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 34




---------------



---------------

LENDER : CATHOLIC HEALTH INITIATIVES ORIGINAL AMOUNT : 4,284,127 . INTEREST RATE : 5 .530000 DATE OF NOTE : 11/25/1997 MATURITY DATE : 12/01/2012 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : CAPITAL FINANCING DESCRIPTION AND FMV CASH OF CONSIDERATION:

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3,307,517 . ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NONE

---------------

STATEMENT 16

I

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 35


LENDER : CATHOLIC HEALTH INITIATIVES ORIGINAL AMOUNT : 8,906,377 . INTEREST RATE : 5 .530000 DATE OF NOTE : 11/25/1997 MATURITY DATE : 12/01/2018 REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : CAPITAL FINANCING DESCRIPTION AND FHV CASH OF CONSIDERATION :


---------------

LENDER : CATHOLIC HEALTH INITIATIVES ORIGINAL AMOUNT : 14,000,000 . INTEREST RATE : 5 .530000 DATE OF NOTE : 01/10/2003 MATURITY DATE : TO BE DETERMINED REPAYMENT TERMS : MONTHLY AMORTIZATION SECURITY PROVIDED : NONE PURPOSE OF LOAN : CAPITAL FINANCING DESCRIPTION AND FMV CASH OF CONSIDERATION :

BEGINNING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NONE ENDING BALANCE DUE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14,000,000 .

---------------

TOTAL BEGINNING MORTGAGES AND OTHER NOTES PAYABLE 175,164,671 .

TOTAL ENDING MORTGAGES AND OTHER NOTES PAYABLE 176,587,181 .

STATEMENT 17

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 36


FORM 990, PART IV - OTHER LIABILITIES


INFUSION PUMP CONTRACTS 1,367,136 . DUE TO 3RD-PARTY PAYORS 294,466 .

--------------- TOTALS 1,661,602 .

STATEMENT 18

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I

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 43


SCHEDULE A, PART III - EXPLANATION FOR LINE 2D

SEE FORM 990, PART V AND LINE 75

STATEMENT 25

91-0564491

CEO TRAVELED TO WASHINGTON D .C . ON ADVOCACY TRIPS .

STATEMENT 26

SY4473 552B 04/28/2004 17 :54 :15 V02-8 .1 44

FRANCISCAN HEALTH SYSTEM-WEST

SCHEDULE A, PART VI-B - DIRECT CONTACT WITH LEGISLATORS

PAID EVERGREEN ASSOCIATES $1,591 FOR PUBLIC AFFAIRS/FEDERAL LIAISON SERVICES .

Cost of charity care provided

55,212 244,647 235,101

14,561 "032 Other benefits for the poor

Total quantifiable benefit to the poor

Benefit to the Broader Community: Unpaid costs of Medicare and other senior programs 14,455,945 Non-billed services for the community 1,561,225 Education and research provided to the community 151,694 Other community benefits 297,903

Total quantifiable benefit to the broader community 16,466,767

31,027,799

STATEMENT A

Community Health Annual Report Franciscan Health System

FY 2003 Summary

INTRODUCTION Franciscan Health System has a long history of being involved in the community through many of its outreach programs . Our mission calls us to "create healthier communities" . Some of the programs and services highlighted in this report have been the work of the community health councils and the two community coalitions in Federal Way and Lakewood . Other programs services not highlighted include our Cancer Care outreach services, tobacco cessation and prevention programs, W.I.C . services, immunizations and many more.

During the fiscal year ending June 30, 2003, Franciscan Health System provided benefits to persons who are poor and the broader community of more than $31 million, as described below . More than 35,000 people have benefited these services .

Benefit To The Poor And Broader Communit

Benefit to the Poor:

Unpaid cost of Medicaid

Non-billed services for the poor Cash and in-kind donations

Total

5,768,362 8,257,710

Total Quantifiable Community Benefit

Issues of Access-Franciscan Health System is a member of the Pierce County Coalition for Healthcare. The coalition consists of Multicare, Good Samaritan, Community Health Care, Tacoma-Pierce County Health Department, Group Health, Regence, and United Way. The initial work of the coalition was to put caseworkers in the Emergency rooms to identify those individuals who were insurable and who were truly uninsured . During calendar year 2002 over 1,500 referrals were made from the three emergency rooms

STATEMENT A

within FHS to the outreach worker . Eighty-one percent were contacted, and applications were submitted for approximately 32 percent who were found to be uninsured . Approximately 76 percent of the applications submitted for Medicaid have been approved and a total of $359,575 of charges have been recovered, inclusive of the charges billed to insurance . All referrals that were without a primary care physician were directed to Community Health Care .

Health Adventures St. Clare Hospital completed its fifth year, St . Francis its third year, and St . Joseph Medical Center its second year of Health Adventures . All three hospitals have maintained their partnership with their local Boys & Girls Club . St . Clare Hospital has expanded Health Adventures to a 2-year program, adding the Lakewood Police Department and Lakewood Fire Department to present learning modules. St . Clare has also expanded their partnership to include Lochburn Middle School and Mann Middle School for student recruitment . All programs have been very successful and have had anywhere between 8 and 15 students (each with an adult mentor) complete the program each year .

Partners For a Healthier Community Cops and Docs was piloted in the Clover Park School District at Lochburn Middle School in May 2003 . The program was presented to 196 eighth grade students . It was well received by students, teachers, and administrative staff. St . Clare Hospital and the Lakewood Police Department have received approval to present this program at all four middle schools in the Clover Park School District in school year 2003/2004 . The Federal Way School District has Cops and Docs presented at all its Middle Schools, with over 1600 students participating .

Lakewood's Promise St . Clare Hospital became a "Site of Promise" in 2003 . St . Clare continues to support the Promise effort in offering the programs outlined above, as well as providing representation on the Lakewood's Promise Leadership Team. The Lakewood Promise Collaboration benefited from a CHI Healthy Communities Planning Grant to assist with its three-year plan . Through the grant resource teams were identified and established in five schools to provide continuity of services for students in need .

Project Fit America Franciscan Health System partnered with Project Fit America to provide exercise equipment for Heartwood Elementary School at McChord Air Force Base and Whitman Elementary School in Tacoma . The partnership with PFA, Heartwood, Whitman and FHS encourages the increased physical activity of youth during and after school . The UCLA Research department is collecting outcomes of the project . Please refer to attachments for the testing results and positive outcomes of the students .

Remembering When The Remembering When partnership between Franciscan Health System and our local fire departments was expanded to also include Central Pierce Fire Department

STATEMENT A

(Spanaway/Parkland/Graham) . We continue to offer a program once a month (except December) in one of seven communities within the FHS service area . The fire departments continue to track the success of this program by implementing a pre and post-survey, as well as tracking the fall and fire related calls they receive from senior citizens . This Remembering When Coalition of Pierce County (FHS and local fire departments) recently received a $2,400 grant to pilot a home safety visit program in Lakewood and Gig Harbor . This program will begin the fall of 2003, and will include not only fall and fire prevention information but also the installation of basic risk reduction devices .

Building the Bridge Building the Bridge (BTB) community coalition of Federal Way, Washington is dedicated to visioning ; planning and calling into action the pillars that build a healthy community. Currently the coalition comprises 42 stakeholders including citizens, education leaders, business leaders, health care representatives, the faith community, city government, human service agencies representatives, law enforcement and interested community advocates . The following goals and objectives will be the work of Building the Bridge in the Westway community. .

1.Create a vision for Building the Bridge A. Identify the desired vision for the community of Westway B. Create a working coordinating committee within the neighborhood of Westway

2.Develop a four-year plan for the community of Westway A. Complete asset-mapping process for Westway B. Create connections between current services and identified priorities .

3. Develop effective communication vehicles A. Create a monthly forum to relay information to residents B. Create vehicles to enhance two-way communication

A CHI Healthy Communities Grant was received for FY04 to assist with the goals and objectives

For more information regarding the community services initiatives of Franciscan Health System please contact Dianna Kielian, Vice President of Mission and Community Health at 253-581-3111

STATEMENT B Form 990, Part VI, Question 80alb

EXEMPT ENTITY NAME CITY STATE NONEXEMPT

S.E .T For Health New Mexico Albuquerque NM Exempt St Joseph Development Corp Albuquerque NM Nonexempt St Joseph -Healthcare Foundation Albuquerque NM Exempt St Joseph Healthcare PSO, Inc Albuquerque NM Nonexempt St Joseph Healthcare System Albuquerque NM Exempt St Joseph Healthcare System Auxiliary Albuquerque NM Exempt St Joseph Community Health Services Albuquerque NM Exempt Franciscan Healthcare Corporation Aston PA Exempt St Elizabeth Health Care Foundation Baker City OR Exempt St Elizabeth Health Services, Inc Baker City OR Exempt Flaget Healthcare Inc Bardstown KY Exempt Lakewood Health Center Baudefte MN Exempt Berea Hospital, Inc Berea KY Exempt Appletree Court Breckenridge MN Exempt St Francis Home Breckenridge MN Exempt St Francis Medical Center Breckenridge MN Exempt Nazareth Assurance Company Burlington Vr Nonexempt Carrington Health Center Carrington ND Exempt Caduceus Medical Associates, Inc Chattanooga TN Nonexempt Memorial Health Care System Foundation Chattanooga TN Exempt Memorial Health Care System, Inc Chattanooga TN Exempt Mountain Management Services Inc Chattanooga TN Nonexempt OccuNet Chattanooga TN Nonexempt MHP Foundation Chattanooga TN Exempt Memorial Mission Ambulatory Chattanooga TN Nonexempt Community Limited Care Dialysis Center Cincinnati OH Exempt Good Samaritan Hospital Cincinnati OH Exempt Good Samaritan Hospital Foundation of Cincinnati Cincinnati OH Exempt Healthcare Employment Solutions Cincinnati OH Nonexempt Universal Health Corp Cincinnati OH Exempt Catholic Health Initiatives Colorado Foundation Colorado Spnngs CO Exempt Total Healthcare Colorado Springs CO Exempt Audubon Land Company, LLC Colorado Springs CO Nonexempt Good Samaritan Hospital & Health Center Dayton OH Exempt Samaritan Health Foundation Dayton OH Exempt Samaritan Health Partners Dayton OH Exempt The Mana-Joseph Living Care Center Dayton OH Exempt Alternative Insurance Management Services Denver CO Nonexempt Bachmann Realty Investments Denver CO Nonexempt Bachmann Services, Inc Denver CO Nonexempt Catholic Health Initiatives Denver CO Exempt CHI Operating Investment Program LP Denver CO Nonexempt Comcare Services, Inc Denver CO Nonexempt First Initiatives Insurance Co Ltd Denver CO Nonexempt Franciscan Services, Inc and Subsidiaries Denver CO Nonexempt HMSO, Inc Denver CO Nonexempt National Pension Trust Denver CO Nonexempt SJH Services Corp Denver CO Nonexempt CHI Welfare Benefit Administration and Development Trust Denver CO Nonexempt Bishop Drumm Retirement Center Des Moines A Exempt Charles T Cownie Annuity Trust #1 Des Moines LA Nonexempt CHI - Iowa, Corp Des Moines A Exempt House of Mercy Des Moines A Exempt Iowa Kidney Stone Center Des Moines A Exempt Joseph A Schuster Annuity Trust #1 Des Moines IA Nonexempt Mercy Clinics, Inc Des Moines [A Exempt Mercy College of Health Sciences Des Moines A Exempt Mercy Foundation of Des Moines, A Des Moines LA Exempt Mercy Medical Center - Centerville Des Moines A Exempt Mercy Park Apartments Des Moines 1A Nonexempt Mercy Professional Practice Associates, Inc Des Moines A Exempt Heart Partners, LLC Des Moines A Nonexempt Mercy Hospital Of Devils Lake Devils Lake ND Exempt Greater Plains Health Group Dickinson ND Nonexempt St Joseph Lifecare Foundation Dickinson ND Exempt St Joseph's Hospital & Health Center Dickinson ND Exempt Mercy Medical Center Durango CO Exempt Catholic Health Initiatives - Colorado Englewood CO Exempt Sisters of Chanty VEBA Erlanger KY Exempt Villa Nazareth, Inc Fargo ND Exempt

Form 990, Part V1, Question 80a/b STATEMENT B

EXEMPT ENTITY NAME CITY STATE NONEXEMPT St Catherine Hospital Garden City KS Exempt Saint Francis Foundation Grand Island NE Exempt Saint Francis Medical Center Grand Island NE Exempt Health Support Services Grand Island NE Nonexempt Central Kansas Health Services Association Great Bend KS Nonexempt Central Kansas Medical Center Great Bend KS Exempt St Joseph Memorial Hospital Great Bend KS Exempt Samaritan Health Partners Insurance Ltd Hamilton Bermuda Exempt Health First Inc Joplin MO Nonexempt Maude Norton Memorial Hospital Joplin MO Exempt Mercy Agency Services-Nevada, Inc Joplin MO Nonexempt Mercy Clinics Joplin MO Exempt Mercy Health Services Inc & Subsidiaries Joplin MO Nonexempt Mercy Lifecare Systems Joplin MO Exempt Mercy Regional Health Foundation Joplin MID Exempt Nevada Medical Center, Inc Joplin MO Nonexempt NEVO, Inc Joplin MO Nonexempt St John's Regional Medical Center Joplin MO Exempt Central Nebraska Home Care Services Kearney NE Nonexempt Good Samaritan Health System, Inc Kearney NE Exempt Good Samaritan Hospital Kearney NE Exempt Good Samaritan Hospital Foundation Kearney NE Exempt Good Samaritan Outreach Services Kearney NE Nonexempt Health Systems Enterprises, Inc Kearney NE Nonexempt Bachmann Realty Investment, Inc Lancaster PA Nonexempt Bachmann Realty Corp Lancaster PA Exempt Bachmann Services, Inc Lancaster PA Nonexempt St Joseph Health Ministries Lancaster PA Exempt St Joseph Health Ministries Foundation Lancaster PA Exempt Bluegrass Regional Imaging Center Lexington KY Nonexempt Continuing Care Hospital Lexington KY Exempt St Joseph Healthcare Inc Lexington KY Exempt St Joseph Office Park Condos Lexington KY Nonexempt St Joseph Hospital Medical Foundation, Inc Lexington KY Exempt St Joseph Hospital Foundation Lexington KY Exempt Health Care Management, Inc Lincoln NE Nonexempt LincCare Lincoln NE Nonexempt Nebraska Surgery Center Lincoln NE Nonexempt Saint Elizabeth Foundation Lincoln NE Exempt Saint Elizabeth Health Services Lincoln NE Exempt Saint Elizabeth Health Systems Lincoln NE Exempt Saint Elizabeth Physician Network Lincoln NE Exempt Saint Elizabeth Regional Medical Center Lincoln NE Exempt Lisbon Area Health Services Lisbon ND Exempt Alvema Apartments Little Falls MN Exempt St Gabriel's Centracare LLC Little Falls MIN Nonexempt Unity Family Healthcare Little Falls MN Exempt St Vincent Infirmary Medical Center Little Rock AR Exempt St Vincent Community Health Services, Inc Little Rock AR Nonexempt St Anthony's Hospital Association Little Rock AR Exempt St Vincent Foundation Little Rock AR Exempt St Vincent Medical Group Little Rock AR Exempt St Vincent Physician Hospital Organization Little Rock AR Nonexempt Marymount Medical Center London KY Exempt Cantas Health Services, Inc Louisville KY Exempt Cantas Physicians Group Louisville KY Exempt BC Holding Company, Inc Louisville KY Nonexempt Cantas Foundation Louisville KY Exempt Cantas Rehab Services, LLC Louisville KY Nonexempt Our Lady of the Way Hospital, Inc Martin KY Exempt Good Samaritan Health Center Foundation Of Merrill WI, Inc Merrill WI Exempt Good Samaritan Health Center Of Merrill WI, Inc Merrill WI Exempt Mednow, Inc Nampa ID Nonexempt Mercy Medical Center Nampa ID Exempt Mercy Medical Center Employee Health Care Plan Nampa ID Exempt Mercy O/P Surgery Center, LLC Nampa ID Nonexempt St Marys Hospital Foundation NE City NE Exempt St Marys Hospital NE City NE Exempt Oakes Community Hospital Oakes ND Exempt Alegent Health - Bergan Mercy Health System Omaha NE Exempt Bergan Mercy Foundation Omaha NE Exempt

ip ~1 -

Form 990, Part VI, Question 80a/b STATEMENT B

EXEMPT ENTITY NAME CITY STATE NONEXEMPT Mercy Health Care Foundation Omaha NE Exempt Mercy Hospital, Coming [A Omaha NE Exempt Mercy Hospital Founclaton Council Bluffs Omaha NE Exempt Mercy Medical Office Building Omaha NE Exempt The Mercy Center Omaha NE Exempt Auxiliary of Holy Rosary Hospital Ontario OR Exempt Holy Rosary Hospital Medical Benefit Trust Ontario OR Exempt Pathway Hospice LLC Ontario OR Nonexempt The Dominican Sisters of Ontario, Inc Ontano OR Exempt St Joseph's Area Health Services Park Rapids MN Exempt St Anthony Development Company Pendleton OR Nonexempt St Anthony Hospital Pendleton OR Exempt St Anthony Hospital Foundation Pendleton OR Exempt Gettysburg Medical Center Pierre SD Exempt St Marys Healthcare Center Pierre SO Exempt Mt St Joseph, Inc Portland OR Exempt St Mary Corwin Auxilliary Pueblo CO Exempt Bomemann Healthcare Corp Reading PA Exempt CGH Realty Co. Inc Reading PA Exempt Community General Hospital Reading PA Exempt SJH Services Corp Reading PA Nonexempt St Joseph Medical Center Foundation Reading PA Exempt St Joseph Regional Health Network Reading PA Exempt Ambulatory Surgery Center Of Roseburg, LLC Roseberg OR Nonexempt Canyonville Health Clinic, Inc Roseberg OR Nonexempt Linus Oakes Roseberg OR Exempt Mercy Foundation Roseberg OR Exempt Mercy Healthcare, Inc Roseberg OR Exempt Mercy Medical Center, Inc Roseberg OR Exempt Mercy Rehabilitation & Care Center, Inc Roseberg OR Exempt Mercy Service Corporation Roseberg OR Nonexempt Therapeutic Services, Inc Roseberg OR Nonexempt Franciscan Villa of South Milwaukee South Milwaukee WI Exempt Franciscan Foundation Tacoma WA Exempt Franciscan Health System - West Tacoma WA Exempt Franc4scan Medical Group Tacoma WA Exempt Management Service Organization Tacoma WA Nonexempt Physician Health System Network Tacoma WA Nonexempt St Joseph Development Corp Tacoma WA Nonexempt O'Dea Medical Arts Limited Partnership Towson MID Nonexempt St Joseph Medical Center Towson MD Exempt St Joseph Medical Center Foundation Towson MD Exempt Towson Management, Inc. Towson MD Nonexempt Towson Physician Services Towson MD Exempt Mercy Hospital of Valley City Valley City ND Exempt Medquest Incorporated Williston NO Nonexempt Mercy Hospital of Williston Williston ND Exempt Mercy Medical Foundation Williston NO Exempt

STATEMENT C

Franciscan Health System-West Schedule A, Part III EIN: 91-0564491 Fiscal Year Ending June 30, 2003

Schedule A, Part III Statements About Activities

Franciscan Health System-West (FHS) engaged in the following acts with members of its Board of Directors . All transactions were negotiated at arms-length and were at fair market value .

Name Type of Transaction Explanation Dale Howard, M.D. C Dale Howard is under contract with FHS as a

medical director . Jonathan Jin, M.D . B,A FHS has a loan receivable from Jonathan Jin .

Additionally, Jonathan Jin leases space in one of FHS' medical office buildings .

Art Knodel, M.D . C Art Knodel is under contract with FHS as a medical director .

Larry Treleven C FHS uses the services of Sprague Pest Control, which is owned by Larry Treleven .

. . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . Signature and Verification

Under penalties of perjury, I declare that I have examined this form, Including accompanying schedules and statements, and to the best of my kno%*Aedge and belief, It Is true . correct, and complete, and that I am authorized to prepare this form

3ignat re 1111~ C- qLet~ 'ntle ll~TAX Notice to Applicant - To Be Complee

We have approved this application . Please attach this form to the organization's return . We have not approved this application . However, we have granted a 10-day grace p date of the organization's return (including any prior extensions) . This grace period Is otherwise required to be made on a timely return . Please attach this form to the organize

D We have not approved this application . After considering the reasons stated In Item T. to file . We are not granting a 1 0-day grace period. We cannot consider this application because it was filed after the due date of the return Other

By : r- - -

City or town, province or state, and country (including postal or ZIP code)

Form 11808 (12-2000) Page 2 9 If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part 11 and check this box . . . . . . . .

;Er Noti : On*vffl*lete PartH Nyou have already been granted an automatic 3-month extension on a previously flied Form 8868.

0 If you a filing for an Automatic 3-Month Extension, complete only Part I (on page 1) . MM Additional (not automatic) 3-Month Extension of Time - Must Fil 0 1 Inal and One Copy.

Type or Name of Exempt Organization Employer Identification number

print FRANCISCAN HEALTH SYSTEM-WEST 91-0564491 CH. k #h. Number, street, and room or suite no . If a P.O . box. see Instructions . For IRS use only Y extended due date for 1717 SOUTH "J" STREET filing the City, town or post office, state, and ZIP code. For a foreign address, see Instructions. Mum. See Instructions . I TACOMA, WA 98405

Check type of return to be filed (File a separate application for each return): Form 990 Form 990-EZ Form 990-T (sec . 401 (a) or 408(a) trust) Form 1041-A Form 5227 F-~ Form 8870 Form 990-BL R Form 990-PF R Form 990-T (trust other than above) RForm 4720 Rorm 6069

STOP: Do not complete Part 11 If you were not already granted an automatic 3-month extension on a previously filed Form 8868 . .

"VA

* If the organization does not have an office or placeQf business in the United States, check this bo . . . . . . . ;-E:F e If this is for a Group Return, enter the ization's four digit Group Exemption Number (GEN) 0928 If this is for the whole group, check this box 10o. Off. If it is for part of the group, check this box No. L-- ~~a ach a list with the names and EINs of all members the extension is for 4 1 request an additional 3-month extension of time until 05/ly/2004 6 For calendar year or other tax year beginning 07/01/2002 and ending 06/30/2003 6 If this tax year is for less than 12 months, check reason : LJ Initial return LJ Final return L_J Change in accounting period 7 State in detail why you need the extension ADDITIONAL TPffliIIS NEEDED IN ORDER TO FILE A

COMPLETE AND ACCURATE RETURN .

8a If this application is for Form 990-13L, 990-PF, 990-T, 4720, or 6069, enter the tentative tax~ less any nonrefundable credits See instructions

b If this application is for Form 990-PF, 990-T, 4720, or 6069, ente any refundable credits and estimated tax payments made . Include any prior year overpayment allowed as a credit and any amount paid previously with Form 8668

. I . . . . . . . . . . .

* ' * * * ' ' c Balance Due . Subtract line 8b from line 8a . Include your payment with this form, or, if required, deposit with FM coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) . See inef,",fi^n.

Alternate Mailing Address - Enter the address if you want the copy of this application 11br Will returned to an address different than the one entered above.

Name

Type or Num bar and street (Include suite, room, or apt no.) Or a P.O. box number print I

Date Do- '

FEB 10 2004

DEN

" If you are filing for an Automatic 3-Month Extension, complete only Part I and check this box . . . . . . . . . . . . . .

. . Do. LXJ " If you are filing for an Additional (not automatic) 3-Month Extension, complete only Part 11 (on page 2 of this form). Note : Do notcomplete PartHuntess; you have alreadybeen grantedan automatic 3-monM extension on aprieviously filed Form 886& = Automatic 3-Month Extension of Time - Only submit odginal (no copies needed) Note: Form 990-Tcofporddons requesting an automatic 6-month extension - check this box and complete Part I only . . . . . . . 0. F All other corporations (including Form 990-C Mers) must use Form 7004 to request an extension of time to file income tax returns. Pardtn rships, REMICs and trusts must use Form 8736 to request an extension of time to file Form 1065, 1066, or 1041 . Type! or Name of Exempt Organization Employer Identification number print I FRANCISCAN HEALTH SYSTEM-WEST 1 91-0564491

Number, street, and room or suite no . If a P.O . box, see Instructions . File by the due date for filing your return See Instructions City, town or post office, state, and ZIP code . For a foreign address, see

SY4473 552B 11/13/2003 11 :26 :00 V02-8 .1

Form 8868 Application for Extension of Time To File an (Dec6mber 2000) Exempt Organization Return OMB No . 1545-1709 Department of the Treasury Internal Revenue Service 10- File a separate application for each return .

Check type of return to be flied (file se arate application for each return) : X Form 990 Form 990-T (corporation) Form 4720

Form 990-BL Form 990-T(sec. 401 (a) or 408(a) trust) Form 5227 Form 990-EZ Form 990-T (trust other than above) Form 6069 Form 990-PF Form 100-A Form 8870

" If the organization does not have an office or place of business in the United States, check this box -----

. o- D " If this is for a Group Return, enter the Organization's four digit Group Exemption Number (GEN) 0928 . if this is for the whole group, check this box Op- F-1 If it is for part of the group, check this box PP. and attach a list with the names and EINs of all members the extension will cover . I I request an automatic 3-month (6-month, for 990-T corporation) extension of time until 02/16 2004

to file the exempt organization return for the organization named above. The extension is for the organization's return for.

Ili. H calendar year or

11111.

X

tax year beginning 07/01 2002 , and ending 06/30 2003

2 If this tax year is for less than 12 months, check reason : E] Initial return 1-1 Final returnEl Change in accounting period

3a If this application is for Form 990-13L, 990-PF, 990-T, 4720, or 6069, enter the tentative tax, less any nonrefundable credits See instructions

b If this application is for Form 990-PF or 990-T, enter any refundable credits and estimated tax payments made. Include any prior year overpayment allowed as a credit . . . . . . . . . . . . . . . . . . . . . . . . . .

c Balance Due. Subtract line 3b from line 3a. Include your payment with this form, or, if required, deposit with FTD coupon or, if required, by using EFTPS (Electronic Federal Tax Payment System) See instructions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

.. $

Signature and Verdication Under penalties of perjury, I declare that I have examined thIs form, Including accompanying schedules and statements, and to the best of my knowledge and belief It Is true, correct, and complete, and that I am authorized to prepare this form

f Signature Ic elic~ Title 01' TAX ANAIYST Date 11111~ (1/13/63 For Paperwork Reduction Act Notice, see Instruction Form8868 (12-2000)

JSA 21`8054 1000

form-990 return of organization exempt from income...

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