2021-11-05T11:24:14-05:00 2020-12-31 346565596 ERNST & YOUNG US LLP 101 E WASHINGTON ST SUITE 910 PHOENIX AZ 85004 990 2020-01-01 237379161 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC SIST 3038135190 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 JANIE WADE EVP FINANCE & CFO 3038135190 2021-11-05 0 JANIE WADE 999009999 PATRICK SHIELDS P01508556 6023223000 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z LYDIA JUMONVILLE 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 740355469 0 X WWW.SCLHEALTH.ORG X 1972 KS WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE. 17 16 4038 0 4027467 0 12216198 18263240 572463192 596210229 81936542 114710662 6730832 8070843 673346764 737254974 9835691 7707645 0 0 324044045 371430594 0 0 0 364753380 376340328 698633116 755478567 -25286352 -18223593 2821772081 3461075103 2648676633 3044682246 173095448 416392857 X WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE. 0 0 736036667 7707645 604246338 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCL HEALTH) IS A FAITH-BASED, NONPROFIT HEALTHCARE ORGANIZATION THAT OPERATES EIGHT HOSPITALS, TWO SAFETY NET CLINICS, ONE CHILDREN'S MENTAL HEALTH CENTER, HOME HEALTH AND MORE THAN 200 PHYSICIAN CLINICS IN THREE STATES - COLORADO, KANSAS AND MONTANA. THE HEALTH SYSTEM INCLUDES MORE THAN 15,900 FULL-TIME ASSOCIATES AND MORE THAN 800 EMPLOYED PROVIDERS.BASED IN DENVER, THE HEALTH NETWORK IS DEDICATED TO IMPROVING THE HEALTH OF THE COMMUNITIES AND INDIVIDUALS IT SERVES, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE. IN 2020, SCL HEALTH SYSTEM CONTRIBUTED $294 MILLION IN COMMUNITY BENEFIT, INCLUDING SERVICES FOR THE POOR, HEALTH SCREENINGS, EDUCATIONAL PROGRAMS, COMMUNITY DONATIONS AND RESEARCH.SCL HEALTH WAS FOUNDED BY THE SISTERS OF CHARITY OF LEAVENWORTH (SCL), WHO TRACE THEIR ORIGIN AS A RELIGIOUS COMMUNITY TO THE 1600S IN FRANCE, WHERE VINCENT DE PAUL AND LOUISE DE MARILLAC ESTABLISHED THE DAUGHTERS OF CHARITY. THESE WOMEN WERE DEDICATED TO SERVING THE SICK AND POOR THROUGH AN ACTIVE MINISTRY.IN 1857, A SMALL CONGREGATION OF SISTERS FROM NASHVILLE, TENN., LED BY MOTHER XAVIER ROSS, VENTURED TO THE EDGE OF AN EXPANDING FRONTIER IN THE THEN-INDIAN TERRITORY OF KANSAS. THEY OPENED THE FIRST PRIVATE HOSPITAL IN THE STATE IN 1864, WITH THE FIRST TRAINED NURSE IN THE STATE AND SURELY THE FIRST WOMAN IN THE WESTERN TERRITORY TO RUN A HOSPITAL. IN 1873, THE SISTERS FOUNDED WHAT IS NOW SAINT JOSEPH HOSPITAL IN DENVER, THE OLDEST PRIVATE TEACHING HOSPITAL IN COLORADO, AND ONE OF THE FIVE COLORADO HOSPITALS OF SCL HEALTH.SCL HEALTH WAS FORMED IN 1972 TO STRENGTHEN AND UNIFY THE HEALTHCARE FACILITIES SPONSORED BY SCL. IN 2011, THE SISTERS TRANSFERRED SPONSORSHIP OF SCL HEALTH TO LEAVEN MINISTRIES. OUR ORGANIZATION'S RICH HERITAGE AND ENDURING LEGACY SERVE AS THE FOUNDATION FOR OUR HEALTH MINISTRY TODAY, AND OUR MISSION, VISION AND VALUES SERVE AS THE FRAMEWORK FOR OUR SUCCESS.SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) IS THE PARENT CORPORATION OF A LARGE HOSPITAL AND HEALTHCARE SYSTEM. SCLHS IS THE MANAGEMENT COMPANY PROVIDING CENTRALIZED SERVICES FOR ALL SCL HEALTH SUBSIDIARIES.SCLHS PERFORMS NUMEROUS COORDINATED AND CENTRALIZED SERVICES FOR THE ENTITIES & CARE SITES THAT COMPRISE ITS SYSTEM, SUCH AS ADMINISTERING FINANCING & CAPITAL FORMATION PROGRAMS, ETHICAL & RELIGIOUS DIRECTION, FINANCIAL REPORTING, TAX SERVICES, HUMAN RESOURCES FUNCTIONS INCLUDING EXECUTIVE RECRUITING & ADMINISTERING & MAINTAINING WELFARE, BENEFIT & RETIREMENT PLANS, INFORMATION TECHNOLOGY SERVICES INCLUDING ELECTRONIC MEDICAL RECORD SYSTEMS, BUSINESS MANAGEMENT SYSTEMS, EQUIPMENT & CONNECTIVITY, INTERNAL AUDIT FUNCTIONS, LEGAL SERVICES, PHYSICIAN NETWORK DEVELOPMENT, PROCUREMENT & SUPPLY CHAIN MANAGEMENT, INCLUDING MEDICAL DEVICES, SUPPLIES & EQUIPMENT, PROFESSIONAL LIABILITY INSURANCE THROUGH A CAPTIVE PROVIDER INCLUDING GROUP EXCESS COVERAGE AND REINSURANCE AND LITIGATION MANAGEMENT, PUBLIC RELATIONS, COMMUNICATIONS & LEGISLATIVE AFFAIRS, REAL ESTATE MANAGEMENT SERVICES, INCLUDING LEASING & CONSTRUCTION, PURCHASE & SALE, REGULATORY COMPLIANCE SERVICES, REVENUE CYCLE MANAGEMENT SERVICES INCLUDING BILLING & COLLECTIONS, RISK MANAGEMENT SERVICES INCLUDING SELF-INSURANCE, GROUP EXCESS COVERAGE & REINSURANCE, LITIGATION MANAGEMENT, INSPECTION & CONTROLS.THE CENTRALIZATION OF MANAGEMENT SERVICES PROVIDES FOR HIGH QUALITY, COST EFFECTIVE AND COMPASSIONATE HEALTH CARE MANAGEMENT AND MEDICAL SERVICES FOR THE COMMUNITIES WE SERVE. THEREFORE, THESE MANAGEMENT SERVICES RELATE DIRECTLY TO THE EXEMPT PURPOSE OF OWNING AND MANAGING PUBLIC HOSPITALS AND A HEALTHCARE SYSTEM. OUR MISSION, VISION AND VALUES ARE LISTED BELOW. MISSIONWE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.VISIONINSPIRED BY OUR FAITH, WE WILL PARTNER WITH OUR PATIENTS AND COMMUNITIES TO EXCEED THEIR EXPECTATIONS FOR HEALTH.VALUESCARING SPIRIT - WE HONOR THE SACRED DIGNITY OF EACH PERSON.EXCELLENCE - WE SET AND SURPASS HIGH STANDARDS.GOOD HUMOR - WE CREATE JOYFUL AND WELCOMING ENVIRONMENTS.INTEGRITY - WE DO THE RIGHT THING WITH OPENNESS AND PRIDE.SAFETY - WE DELIVER CARE THAT SEEKS TO ELIMINATE ALL HARM FOR PATIENTS AND ASSOCIATES. STEWARDSHIP - WE ARE ACCOUNTABLE FOR THE RESOURCES ENTRUSTED TO US. 736036667 1 1 0 1 0 0 0 0 0 1 1 1 1 0 1 0 0 1 0 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 410 0 1 4038 1 1 1 1 CJ EI LU 0 0 0 0 0 0 0 0 1 0 X 17 16 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 X KYLE ENGMAN 3038135543 500 ELDORADO BLVD SUITE 4200 BROOMFIELD CO 80021 LYDIA JUMONVILLE SYSTEM PRESIDENT & CEO 50.00 0.00 X X 2008456 0 414548 MARK KORTH EVP CHIEF OPERATING OFF HOSP OPS 50.00 0.00 X 1332358 0 171096 BUUP KIM MD PHYSICIAN CLINIC 50.00 0.00 X 1414827 0 37611 JANIE WADE TREASURER / EVP CHIEF FINANCIAL OFFICER 50.00 0.00 X 1187084 0 156978 JAMES VALIN MD VICE PRESIDENT / EVP CHIEF CLINICAL OFFICER 50.00 0.00 X 1105337 0 152887 TAJQUAH HUDSON EVP CHIEF STRATEGY & GROWTH OFFICER 50.00 0.00 X 1067062 0 183615 ROBERT TERRY MD PHYSICIAN 50.00 0.00 X 1129695 0 46253 JOHN WICKLUND PRESIDENT REGIONAL WESTERN CO & LMC 0.00 50.00 X 1112145 0 35357 ROSLAND MCLEOD SECRETARY / SVP CHIEF LEGAL OFFICER 50.00 0.00 X 909676 0 183099 LOUIS ROSS MD PHYSICIAN CLINIC 50.00 0.00 X 1017652 0 48984 SHAWN DUFFORD MD SVP CHIEF MEDICAL OFFICER SYS 50.00 0.00 X 857429 0 108930 ROBERT LYNAGH MD PHYSICIAN CLINIC 50.00 0.00 X 875639 0 50150 CRAIG RICHARDVILLE SVP CHIEF INFORMATION OFFICER 50.00 0.00 X 678210 0 93764 STEVEN CHYUNG SVP SUPPLY CHAIN & REAL ESTATE 50.00 0.00 X 668889 0 99717 TAMARA SAUNAITIS SVP CHIEF HUMAN RESOURCES OFFICER 50.00 0.00 X 649008 0 101335 KAREN SCREMIN VP FINANCE OPERATIONS 50.00 0.00 X 585450 0 73137 MEGAN MAHNCKE PRESIDENT SCL HLTH FDNS & SVP MKTG 50.00 0.00 X 529186 0 81345 BARBARA JAHN VP SERVICE LINES AND OPERATIONS 50.00 0.00 X 534889 0 73017 DAVID PRINGLE SVP MISSION INTEGRATION 50.00 0.00 X 548950 0 42154 SIMON PAYNE MD VP CHIEF MEDICAL OFFICER TRANSFORMATION TEAM 50.00 0.00 X 499065 0 88740 LOUIS CAPPONI VP CHIEF MEDICAL INFORMATICS OFFICER 50.00 0.00 X 483887 0 69963 TROY SPRING VP REVENUE CYCLE 50.00 0.00 X 437484 0 80753 LAURA WIGHTMAN SVP CHIEF NURSING OFFICER SYS 50.00 0.00 X 447385 0 54767 MARK WILKINSON VP TREASURER 50.00 0.00 X 424875 0 59757 LYNN SMITH ASST SECRETARY / BOARD GOV PROG MGR 50.00 0.00 X 120123 0 17654 KATHRYN PAUL PAST CHAIR / VICE CHAIR 2.00 0.00 X X 10500 0 0 MICHAEL FORDYCE MEMBER 1.00 0.00 X 10050 0 0 DOUGLAS ADEN MEMBER 1.00 0.00 X 8500 0 0 ALAN YORDY MEMBER 1.00 0.00 X 8500 0 0 PAMELA FEDERBUSCH MEMBER 1.00 0.00 X 8000 0 0 STEVEN HUEBNER CHAIR 2.00 0.00 X X 8000 0 0 ROBERT WILSON MEMBER 1.00 0.00 X 8000 0 0 C GORDON HOWIE MEMBER 1.00 0.00 X 7500 0 0 MARIO CARRERA MEMBER 1.00 0.00 X 7000 0 0 NGUYEN-VU PHAM MEMBER 1.00 0.00 X 6500 0 0 BETH BECKMAN MEMBER 1.00 0.00 X 5750 0 0 SISTER LYNN CASEY SCL MEMBER 1.00 0.00 X 0 0 0 SISTER MAUREEN HALL SCL MEMBER 1.00 0.00 X 0 0 0 MARY BETH MIKOLS MEMBER 1.00 0.00 X 0 0 0 SISTER CONSTANCE PHELPS SCL MEMBER 1.00 0.00 X 0 0 0 MICHAEL SALEM MD MEMBER 1.00 0.00 X 0 0 0 20713061 0 2525611 645 0 1 0 AYA HEALTHCARE INC 5935 CORNERSTONE CT WEST STE 300 SAN DIEGO CA 92121 CONTRACT LABOR 18312526 DELOITTE CONSULTING LLP 4022 SELLS DRIVE HERMITAGE TN 37076 CONSULTING SERVICES 6651597 CHG COMPANIES INC PO BOX 972651 DALLAS TX 75397 CONTRACT LABOR 4161005 WEATHERBY LOCUMS INC PO BOX 972633 DALLAS TX 75397 CONTRACT LABOR 3877023 SAUNDERS EXPRESS LLC 86 INVERNESS PLACE NORTH ENGLEWOOD CO 80112 CONSTRUCTION SERVICES 3864136 117 14458778 3804462 18263240 MANAGEMENT SERVICES 561000 384212053 384122053 90000 PATIENT SERVICE REVENUE 621110 195552819 194597217 955602 PROGRAM RELATED INVESTMENTS 622110 12460412 12460412 JOINT VENTURES-MEDICAL SERVICES 621400 5621899 5621899 COMMUNITY HOSPITAL SERVICES 622110 -1636954 -1636954 596210229 47784653 2981865 44802788 34734 0 34734 34734 34734 70026504 0 3100495 70026504 -3100495 66926009 66926009 VENDOR ADMINISTRATION REBATE 900099 8036109 8036109 8036109 737254974 603200736 4027467 111763531 7707645 7707645 17470358 11263992 6206366 253764957 253764957 58014799 58014799 24751495 24751495 17428985 17428985 7050420 7050420 999438 999438 169958 169958 5015718 5015718 25074327 25074327 7162451 7162451 31381079 31381079 92845 92845 12552497 12552497 1961323 1961323 1144583 1144583 96892336 96892336 41215810 41215810 1814123 1814123 MEDICAL SUPPLIES 63150094 63150094 MAINTENANCE SERVICES 54133883 54133883 SELF-INSURED MAINTENANC 6554981 6554981 NON-MEDICAL SUPPLIES 4978031 4978031 14996431 14996431 755478567 736036667 19441900 0 159786578 149426663 9034124 8348273 6618584 6590078 2168178 2110332 31345594 27568087 484859918 249396935 231668837 235462983 1572238228 2193612039 451489583 461407398 331136427 317288908 26285948 59260342 2821772081 3461075103 116359817 172931924 3040815 3019922 1228321730 1187847502 1300954271 1680882898 2648676633 3044682246 X 157841715 401639649 15253733 14753208 173095448 416392857 2821772081 3461075103 X -18223593 180886805 80634197 X 0 1 X 1 1 1 X X 10 ST JAMES HEALTHCARE 810231785 3 0 0 0 SAINT JOSEPH HOSPITAL INC 840417134 3 0 0 0 SCL HEALTH - FRONT RANGE INC 841103606 3 0 0 0 ST MARY'S HOSPITAL AND MEDICAL CENTER INC 840425720 3 0 0 0 SCL HEALTH - MONTANA 810232124 3 0 6700000 0 HOLY ROSARY HEALTHCARE 810231792 3 0 0 0 CARITAS CLINICS INC 481009910 3 0 303778 0 MARIAN CLINIC INC 481046905 3 0 157403 0 MOUNT ST VINCENT HOME 840405260 10 0 500000 0 BRIGHTON COMMUNITY HOSPITAL ASSOCIATION 840482695 3 0 0 0 10 7661181 0 0 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 X 1 1 SCHEDULE A, PART IV, SECTION A, LINE 1 THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. IS THE PARENT OF EACH OF ITS SUPPORTED ORGANIZATIONS AND CONTROLS THEM AS PART OF AN INTEGRATED HEALTH SYSTEM. EACH SUPPORTED ORGANIZATION IS CONTROLLED BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. A CLOSE AND HISTORIC ORGANIZATIONAL RELATIONSHIP ENSURES THAT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND ITS SUPPORTED ORGANIZATIONS SHARE A SUBSTANTIAL IDENTITY OF INTERESTS. SCHEDULE A, PART IV, SECTION A, LINE 5A THE ORGANIZATION REMOVED THE FOLLOWING PREVIOUSLY SUPPORTED ORGANIZATION DURING THE TAX YEAR: ST. FRANCIS HEALTH CENTER, INC. EIN: 48-0547719 ST. FANCIS HEALTH CENTER, INC. SOLD ITS HOSPITAL OPERATIONS TO A THIRD PARTY IN NOVEMBER 2017. THE ORGANIZATION WAS THEN PERFORMING WRAP UP ACTIVITIES WHICH INCLUDED COLLECTING ACCOUNTS RECEIVABLE AND PAYING ANY REMAINING OUTSTANDING LIABILITIES. A FINAL TAX RETURN WAS FILED FOR THE YEAR ENDING DECEMBER 31, 2019. A NOTICE OF BUSINESS CLOSURE WAS FILED WITH THE STATE OF KANSAS IN 2018. DUE TO KANSAS STATUTE OF LIMITATIONS, ST. FRANCIS HEALTH CENTER, INC. CANNOT BE FULLY DISSOLVED UNTIL 5 YEARS AFTER SELLING ITS OPERATIONS. THEREFORE, THERE ARE NO ARTICLES OF DISSOLUTION, RESULUTION, OR PLANS FOR DISSOLUTION. SCHEDULE A, PART IV, SECTION A, LINE 6 SUPPORT WAS PROVIDED TO MEDICAL AND OTHER CHARITABLE ORGANIZATIONS NOT CONSIDERED SUPPORTED ORGANIZATIONS. HOWEVER, THESE INSTITUTIONS ARE SUPPORTING MEDICAL AND OTHER ACTIVITIES BENEFITING THE COMMUNITIES SERVED BY SUPPORTED ORGANIZATIONS. AMOUNTS GRANTED ARE INSIGNIFICANT TO THE OVERALL OPERATIONS OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. SCHEDULE A, PART IV, SECTION E, LINE 3A SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) IS THE SOLE MEMBER OF THE SUPPORTED ORGANIZATIONS. SCLHS APPROVES MEMBERS OF THE SUPPORTED ORGANIZATIONS' BOARD OF DIRECTORS. SCHEDULE A, PART IV, SECTION E, LINE 3B SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) HAS CERTAIN RESERVE POWERS TO APPROVE CHANGES TO THE ARTICLES OF INCORPORATION AND THE BYLAWS INCLUDING THE APPOINTMENT OR REMOVAL OF BOARD MEMBERS AND THE PRESIDENT/CEO. SCLHS ALSO HAS CERTAIN RESERVE POWERS OVER ANY CHANGE IN OWNERSHIP OF THE CORPORATION, CHANGE IN MISSION, ACQUISITION OF ASSETS, DISPOSAL OF ASSETS, LEASING OF ASSETS, INCURRENCE OF DEBT, MERGER OR DISSOLUTION, APPROVAL OF STRATEGIC PLANS AND BUDGETS, APPOINTMENT OF AUDITORS AND OVERSIGHT AND APPROVAL OF COMPENSATION AND BENEFITS FOR DIRECTORS, OFFICERS, KEY EMPLOYEES AND PHYSICIANS. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 169958 169958 0 PART II-B, LINE 1: LOBBYING EXPENSES OF $75,404 WERE DERIVED AS A PERCENTAGE OF DUES PAID TO THE AMERICAN HOSPITAL ASSOCIATION. ADDITIONAL LOBBYING EXPENSES OF $94,554 WERE DERIVED FROM FEES FOR ADVOCACY SERVICES RELATED TO COLORADO AND MONTANA LEGISLATIVE ACTIVITIES. 2000000 2000000 2000000 2000000 2000000 2000000 2000000 2000000 2000000 2000000 0.00000 1.00000 0.00000 0 0 72468062 72468062 42097730 11670420 30427310 26985733 12216090 14769643 328664387 225510425 103153962 14644006 14644006 235462983 EXECUTIVE DB PLAN INVESTMENTS 32461022 F HEDGE FUNDS 125697600 F JOINT VENTURE - NORTHERN ROCKIES HEALTHCARE ALLIANCE, LLC 4774 F JOINT VENTURE - DENVER WEST ENDOSCOPY CTR, LLC 775907 F JOINT VENTURE - E + PET IMAGING X, LP -2226 F JOINT VENTURE - LUTHERAN CAMPUS ASC, LLC 2395310 F JOINT VENTURE - GOOD SAMARITAN ASC, LLC 22522 F JOINT VENTURE - SCLH-GI ENDOS CTR HLDGS, LLC 904542 F JOINT VENTURE - TOUCHSTONE IMAGING 8171228 F JOINT VENTURE - REHAB HOSPITAL OF MT 1362111 F OPPORTUNISTIC INVESTMENTS 65789064 F REAL RETURN INVESTMENTS 215934554 F SWEEP ACCOUNTS 7244133 F VHA STOCK INVESTMENT 646857 F 461407398 NOTES REC - SCL HEALTH - FRONT RANGE, INC. 138426000 C NOTES REC - ST. JOSEPH HOSPITAL, INC. 178862908 C 317288908 INTERCOMPANY PAYABLE 1520191804 DEFERRED COMPENSATION PLAN PAYABLE 40532037 INTEREST RATE SWAP PAYABLE 18470503 BROKER PAYABLE 66096751 ACCRUED LIABILITY - OPERATING LEASE 31107935 ACCRUED LIABILITY - FINANCING LEASE 1849030 GUARANTEE FEE PAYABLE 2610168 CAPITAL LEASE OBLIGATION 24670 1680882898 PART V, LINE 4: SCLHS HAS A PERMANENT ENDOWMENT IN THE AMOUNT OF $2,000,000. THE EARNINGS FROM THE PERMANENT ENDOWMENT ARE TO BE USED FOR EDUCATIONAL PURPOSES AS DETERMINED BY SCLHS MANAGEMENT. CENTRAL AMERICA/CARIBBEAN 0 0 PROGRAM SERVICES CAPTIVE INSURANCE PREMIUM 17759504 EUROPE/CARIBBEAN 0 0 INVESTMENTS, PROGRAM-RELATED 4547708 0 0 0 0 0 0 22307212 0 22307212 1 0 1 1 1 0 PART III ACCOUNTING METHOD: SCHEDULE F, PART I, LINE 3 INVESTMENTS REPORTED IN SCHEDULE F ARE ACCOUNTED FOR ON THE ACCRUAL BASIS OF ACCOUNTING. SCLHS' EXPENDITURES (PREMIUMS PAID) FOR ITS CAPTIVE INSURANCE PREMIUMS WERE $17,759,504 NET OF PREMIUM DISCOUNTS. 1 1 X 1 X 1 X 1 1 1 0 1 1 1137551 617454 520097 0.00070 20301046 20124954 176092 0.00020 21438597 20742408 696189 0.00090 84392 84392 0.00010 5529193 2779862 2749331 0.00360 5613585 2779862 2833723 0.00370 27052182 23522270 3529912 0.00460 1 1517410 20616969 49250584 -28633615 X 1 1 1 DENVER WEST ENDOSCOPY CENTER LLC OUTPATIENT ENDOSCOPY SERVICES 0.51000 0.00000 0.49000 2 LUTHERAN CAMPUS ASC LLC OUTPATIENT SURGERY 0.28350 0.00000 0.71650 3 SCLH-GI ENDOSCOPY CENTER HOLDINGS LLC ENDOSCOPY SERVICES 0.51000 0.00000 0.49000 4 NORTHGLENN ENDOSCOPY CENTER LLC ENDOSCOPY SERVICES 0.51000 0.00000 0.49000 1 1 REHABILITATION HOSPITAL OF MONTANA LLC 3572 HESPER ROAD BILLINGS MT 59102 WWW.REHABHOSPITALOFMONTANA.COM 13564 X X REHABILITATION HOSPITAL OF MONTANA LLC 1 1 1 0 0 1 X 200.000000000000 400.000000000000 X X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 REHABILITATION HOSPITAL OF MONTANA, LLC PART V, SECTION B, LINE 2: THE REHABILITATION HOSPITAL OF MONTANA BEGAN OPERATIONS IN AUGUST 2019. PART V, SECTION B, LINES 16A, 16B, 16C, FAP APPLICATION WEBSITE: WWW.REHABHOSPITALOFMONTANA.COM/PATIENT-EXPERIENCE/FINANCIAL-ASSISTANCE 114 1 - CANCER CENTERS OF COLORADO LLC 500 ELDORADO BLVD STE 4300 BROOMFIELD CO 80021 CANCER CENTER 2 - GS CAMPUS ASC LLC 500 ELDORADO BLVD STE 4300 BROOMFIELD CO 80021 SURGERY CENTER 3 - LUTHERAN CAMPUS ASC LLC 3455 LUTHERAN PKWY STE 150 WHEATRIDGE CO 80033 OUTPATIENT SURGERY 4 - DENVER WEST ENDOSCOPY CENTER LLC 382 S ARTHUR AVENUE LOUISVILLE CO 80027 OUTPATIENT ENDOSCOPY SERVICES 5 - NORTHGLENN ENDOSCOPY CENTER LLC 11900 GRANT STREET NORTHGLENN CO 80233 OUTPATIENT ENDOSCOPY SERVICES 6 - TOUCHSTONE MEDICAL IMAGING - AURORA 3055 SOUTH PARKER RD BLDG A STE 103 AURORA CO 80014 RADIOLOGY SERVICES 7 - TOUCHSTONE MEDICAL IMAGING - CASTLE ROCK 3911 AMBROSIA ST CASTLE ROCK CO 80109 RADIOLOGY SERVICES 8 - TOUCHSTONE MEDICAL IMAGING - DRY CREEK 125 INVERNESS DR EAST STE 140 ENGLEWOOD CO 80112 RADIOLOGY SERVICES 9 - TOUCHSTONE MEDICAL IMAGING - HIGHLINE 26 WEST DRY CREEK CIR STE 160 LITTLETON CO 80120 RADIOLOGY SERVICES 10 - TOUCHSTONE MEDICAL IMAGING - LAFAYETTE 390 EMPIRE ROAD STE 102 LAFAYETTE CO 80026 RADIOLOGY SERVICES 11 - TOUCHSTONE MEDICAL IMAGING - LAKEWOOD 14062 DENVER WEST PKWY BLDG 52 STE 180 LAKEWOOD CO 80401 RADIOLOGY SERVICES 12 - TOUCHSTONE MEDICAL IMAGING - MAMMOGRAPHY 7615 W 38TH AVENUE SUITE B-107 WHEAT RIDGE CO 80033 RADIOLOGY SERVICES 13 - TOUCHSTONE MEDICAL IMAGING - RED ROCKS 400 INDIANA ST SUITE 210 GOLDEN CO 80401 RADIOLOGY SERVICES 14 - TOUCHSTONE MEDICAL IMAGING - SUPERIOR 3 SUPERIOR WAY SUITE 150 SUPERIOR CO 80027 RADIOLOGY SERVICES 15 - TOUCHSTONE MEDICAL IMAGING - THORNTON 12021 PENNSYLVANIA ST STE 106 THORNTON CO 80241 RADIOLOGY SERVICES 16 - TOUCHSTONE MEDICAL IMAGING - UPTOWN 1007 E COLFAX AVE DENVER CO 80218 RADIOLOGY SERVICES 17 - TOUCHSTONE MEDICAL IMAGING - WHEAT RIDGE 7615 WEST 38TH AVENUE STE B115 WHEAT RIDGE CO 80033 RADIOLOGY SERVICES 18 - TOUCHSTONE MEDICAL IMAGING - BILLINGS 1739 SPRING CREEK LANE BILLINGS MT 59106 RADIOLOGY SERVICES 19 - SCL FRONT RANGE HOME HEALTH LLC 8300 W 38TH AVENUE WHEAT RIDGE CO 80033 HOME HEALTH 20 - SJ EAST CAMPUS ASC LLC 1830 FRANKLIN ST SUITE 200 DENVER CO 80218 SURGERY CENTER 21 - SCL HEALTH MED GRP - BILLINGS - HEART 2900 12TH AVE N STE 204E BILLINGS MT 59101 OUTPATIENT PHYSICIAN CLINIC 22 - SCL HEALTH MED GRP - BILLINGS - INTERNAL 2900 12TH AVE N STE 310W BILLINGS MT 591017588 OUTPATIENT PHYSICIAN CLINIC 23 - SLOAN'S LAKE INFUSION CENTER 1601 LOWELL BLVD STE 150 DENVER CO 802041545 OUTPATIENT PHYSICIAN CLINIC 24 - SCL HEALTH MED GRP - BUTTE - ROCKY MOUNT 435 S CRYSTAL ST STE 300 BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 25 - SCL HEALTH MED GRP - BILLINGS - HEART & 2900 12TH AVE N STE 400E BILLINGS MT 591017504 OUTPATIENT PHYSICIAN CLINIC 26 - SCL HEALTH MED GRP - BILLINGS - BROADWAT 2019 BROADWATER AVE BILLINGS MT 591024810 OUTPATIENT PHYSICIAN CLINIC 27 - SCL HEALTH MED GRP - BILLINGS - UROLOGY 2900 12TH AVE N STE 160W BILLINGS MT 591017502 OUTPATIENT PHYSICIAN CLINIC 28 - SCL HEALTH MED GRP - BILLINGS - LAUREL 1035 1ST AVE LAUREL MT 590442119 OUTPATIENT PHYSICIAN CLINIC 29 - SCL HEALTH MED GRP - BILLINGS - HEIGHTS 32 WICKS LN BILLINGS MT 591053810 OUTPATIENT PHYSICIAN CLINIC 30 - SCL HEALTH MED GRP - BILLINGS - WEST GRA 2750 GRAND AVE BILLINGS MT 591022629 OUTPATIENT PHYSICIAN CLINIC 31 - SCL HEALTH MED GRP - BILLINGS - NORTH SH 2223 MISSION WAY BILLINGS MT 591020160 OUTPATIENT PHYSICIAN CLINIC 32 - ST JAMES EMERGENCY PHYSICIANS 400 S CLARK ST BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 33 - SCL HEALTH MED GRP - BILLINGS - GASTROEN 1144 N BROADWAY STE C BILLINGS MT 591010110 OUTPATIENT PHYSICIAN CLINIC 34 - SCL HEALTH MED GRP - BILLINGS - BROADWAT 2019 BROADWATER AVE BILLINGS MT 591024810 OUTPATIENT PHYSICIAN CLINIC 35 - SCL HEALTH MED GRP - BILLINGS - NORTH 27 1027 N 27TH STREET BILLINGS MT 591010701 OUTPATIENT PHYSICIAN CLINIC 36 - SCL HEALTH MED GRP - BILLINGS - MIDWIFER 2900 12TH AVE N STE 245W BILLINGS MT 591017506 OUTPATIENT PHYSICIAN CLINIC 37 - SCL HEALTH MED GRP - BILLINGS - PAIN CEN 2900 12TH AVE N STE 335W BILLINGS MT 591017506 OUTPATIENT PHYSICIAN CLINIC 38 - SCL HEALTH MED GRP - BILLINGS - INTERNAL 2900 12TH AVE N STE 160W BILLINGS MT 591017588 OUTPATIENT PHYSICIAN CLINIC 39 - SCL HEALTH MED GRP - BILLINGS - DERMATOL 2900 12TH AVE N STE 265W BILLINGS MT 591017513 OUTPATIENT PHYSICIAN CLINIC 40 - SCL HEALTH MED GRP - BILLINGS - NEPHROLO 2900 12TH AVE STE 160W BILLINGS MT 591017508 OUTPATIENT PHYSICIAN CLINIC 41 - SCL HEALTH MED GRP - BILLINGS - SLEEP AN 2900 12TH AVE N STE 500 E BILLINGS MT 591010127 OUTPATIENT PHYSICIAN CLINIC 42 - SCL HEALTH MED GRP - BILLINGS - HARDIN 16 N MILES HARDIN MT 590342356 OUTPATIENT PHYSICIAN CLINIC 43 - SCL HEALTH MED GRP - BUTTE - UROLOGY 305 W PORPHYRY STE 100 BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 44 - SCL HEALTH MED GRP - BILLINGS - RED LODG 10 ROBINSON LN PO BOX 70 RED LODGE MT 590680070 OUTPATIENT PHYSICIAN CLINIC 45 - SCL HEALTH MED GRP - BILLINGS - LONG TER 2223 MISSION WAY BILLINGS MT 59102 OUTPATIENT PHYSICIAN CLINIC 46 - SCL HEALTH MED GRP - BUTTE - OBGYN 305 W PORPHYRY STE 200 BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 47 - ST JAMES MEDICAL GROUP LAB 435 S CRYSTAL ST STE 210 BUTTE MT 597011506 OUTPATIENT PHYSICIAN CLINIC 48 - SCL HEALTH MED GRP - BUTTE - HEART 435 S CRYSTAL ST STE 220 BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 49 - SCL HEALTH MED GRP - BILLINGS - BEHAVIOR 2900 12TH AVE N STE 280W BILLINGS MT 591017516 OUTPATIENT PHYSICIAN CLINIC 50 - SCL HEALTH MED GRP - BILLINGS - MATERNAL 2900 12TH AVE N STE 130W BILLINGS MT 591017504 OUTPATIENT PHYSICIAN CLINIC 51 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 1232 N 30TH STE 200 BILLINGS MT 591010128 OUTPATIENT PHYSICIAN CLINIC 52 - ST JAMES CANCER CENTER 400 S CLARK ST BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 53 - SCL HEALTH MED GRP - LEWISTOWN 70 CATTAIL DR LEWISTOWN MT 594574123 OUTPATIENT PHYSICIAN CLINIC 54 - SCL HEALTH MED GRP - BILLINGS - PHYSIATR 2900 12TH AVE N STE 500E BILLINGS MT 591010136 OUTPATIENT PHYSICIAN CLINIC 55 - SCL HEALTH MED GRP - BILLINGS - CODY 720 LINDSAY LN STE A CODY WY 824144103 OUTPATIENT PHYSICIAN CLINIC 56 - SCL HEALTH MED GRP - BILLINGS - OCCUPATI 2019 BROADWATER AVE BILLINGS MT 591024810 OUTPATIENT PHYSICIAN CLINIC 57 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 1232 N 30TH STE 300 BILLINGS MT 59101 OUTPATIENT PHYSICIAN CLINIC 58 - ST JAMES THERAPY- WHITEHALL 309 EAST LEGION WHITEHALL MT 59759 OUTPATIENT PHYSICIAN CLINIC 59 - SCL HEALTH MED GRP - BILLINGS - ABSAROKE 55 N MONTANA PO BOX 425 ABSAROKEE MT 590010425 OUTPATIENT PHYSICIAN CLINIC 60 - SCL HEALTH MED GRP - BUTTE - BOULDER 214 S MAIN ST BOULDER MT 59632 OUTPATIENT PHYSICIAN CLINIC 61 - SCL HEALTH MED GRP - BUTTE - SURGERY 435 S CRYSTAL ST STE 220 BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 62 - SCL HEALTH MED GRP - BOZEMAN 711 W MAIN ST BOZEMAN MT 59715 OUTPATIENT PHYSICIAN CLINIC 63 - SCL HEALTH MED GRP - BILLINGS - NEUROLOG 2600 WILSON ST MILES CITY MT 59301 OUTPATIENT PHYSICIAN CLINIC 64 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 1232 N 30TH STE 200 BILLINGS MT 591010128 OUTPATIENT PHYSICIAN CLINIC 65 - SCL HEALTH MED GRP - BILLINGS - WEIGHT M 2900 12TH AVE N STE 160W BILLINGS MT 591017588 OUTPATIENT PHYSICIAN CLINIC 66 - SCL HEALTH MED GRP - BUTTE - NEUROLOGY 435 S CRYSTAL ST STE 300 BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 67 - ST JAMES THERAPY- BOULDER 214 S MAIN BOULDER MT 59632 OUTPATIENT PHYSICIAN CLINIC 68 - SCL HEALTH MED GRP - BILLINGS - NEUROLOG 650 FERGUSON STE 1 BOZEMAN MT 59715 OUTPATIENT PHYSICIAN CLINIC 69 - SCL HEALTH MED GRP - BILLINGS - UROLOGY 2600 WILSON ST MILES CITY MT 59301 OUTPATIENT PHYSICIAN CLINIC 70 - SCL HEALTH MED GRP - BILLINGS - NEUROSUR 2600 WILSON MILES CITY MT 59301 OUTPATIENT PHYSICIAN CLINIC 71 - SCL HEALTH MED GRP - BILLINGS - NEUROLOG 621 3RD ST S GLASGOW MT 59230 OUTPATIENT PHYSICIAN CLINIC 72 - SCL HEALTH MED GRP - BILLINGS - NEPHROLO 2600 WILSON ST MILES CITY MT 59301 OUTPATIENT PHYSICIAN CLINIC 73 - SCL HEALTH MED GRP - BILLINGS - MIDWIFER 16 N MILES AVE STE 101 HARDIN MT 59034 OUTPATIENT PHYSICIAN CLINIC 74 - SCL HEALTH MED GRP - BILLINGS - UROLOGY 202 PROSPECT GLENDIVE MT 59330 OUTPATIENT PHYSICIAN CLINIC 75 - SCL HEALTH MED GRP - BILLINGS - NEPHROLO 720 LINDSAY LN STE A CODY WY 824144103 OUTPATIENT PHYSICIAN CLINIC 76 - SCL HEALTH MED GRP - BILLINGS - NEUROLOG 216 14TH AVE SW SIDNEY MT 59270 OUTPATIENT PHYSICIAN CLINIC 77 - SCL HEALTH MED GRP - BILLINGS - HEART BO 650 FERGUSON STE 1 BOZEMAN MT 59715 OUTPATIENT PHYSICIAN CLINIC 78 - SCL HEALTH MED GRP - BILLINGS - UROLOGY 720 LINDSAY LN STE A CODY WY 82414 OUTPATIENT PHYSICIAN CLINIC 79 - SCL HEALTH MED GRP - BILLINGS - UROLOGY 1106 BIGHORN AVE WORLAND WY 82401 OUTPATIENT PHYSICIAN CLINIC 80 - SCL HEALTH MED GRP - BILLINGS - HEART MI 2600 WILSON ST MILES CITY MT 59301 OUTPATIENT PHYSICIAN CLINIC 81 - SCL HEALTH MED GRP - BILLINGS - UROLOGY 216 14TH AVE SW SIDNEY MT 59270 OUTPATIENT PHYSICIAN CLINIC 82 - SCL HEALTH MED GRP - BILLINGS - HEART LE 408 WENDELL AVE STE 7 LEWISTOWN MT 59457 OUTPATIENT PHYSICIAN CLINIC 83 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 2600 WILSON ST MILES CITY MT 59301 OUTPATIENT PHYSICIAN CLINIC 84 - SCL HEALTH MED GRP - BILLINGS - HEART CO 720 LINDSAY LANE STE A CODY WY 824144103 OUTPATIENT PHYSICIAN CLINIC 85 - SCL HEALTH MED GRP - BILLINGS - NEPHROLO 408 WENDELL AVE STE 7 LEWISTOWN MT 59457 OUTPATIENT PHYSICIAN CLINIC 86 - SCL HEALTH MED GRP - BILLINGS - NEUROSUR 720 LINDSAY LN CODY WY 82414 OUTPATIENT PHYSICIAN CLINIC 87 - SCL HEALTH MED GRP - BILLINGS - NEUROSUR 650 FERGUSON STE 1 BOZEMAN MT 59715 OUTPATIENT PHYSICIAN CLINIC 88 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 720 LINDSAY LANE STE A CODY WY 82414 OUTPATIENT PHYSICIAN CLINIC 89 - SCL HEALTH MED GRP - BILLINGS - HEART BO 711 W MAIN ST BOZEMAN MT 59715 OUTPATIENT PHYSICIAN CLINIC 90 - SCL HEALTH MED GRP - BILLINGS - NEUROLOG 408 WENDELL AVE STE 7 LEWISTOWN MT 59457 OUTPATIENT PHYSICIAN CLINIC 91 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 650 S FERGUSON ST STE 1 BOZEMAN MT 59718 OUTPATIENT PHYSICIAN CLINIC 92 - SCL HEALTH MED GRP - BILLINGS - NEUROSUR 216 14TH AVE SW SIDNEY MT 59270 OUTPATIENT PHYSICIAN CLINIC 93 - SCL HEALTH MED GRP - BILLINGS - UROLOGY 408 WENDELL AVE STE 7 LEWISTOWN MT 59457 OUTPATIENT PHYSICIAN CLINIC 94 - SCL HEALTH MED GRP - BILLINGS - HEART & 720 LINDSEY LANE STE A CODY WY 824144103 OUTPATIENT PHYSICIAN CLINIC 95 - SCL HEALTH MED GRP - BILLINGS - MATERNAL 1333 W 5TH ST STE 210 SHERIDAN WY 82801 OUTPATIENT PHYSICIAN CLINIC 96 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 435 S CRYSTAL ST STE 300 BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 97 - SCL HEALTH MED GRP - BILLINGS - NEPHROLO 1106 BIG HORN AVE WORLAND WY 824012803 OUTPATIENT PHYSICIAN CLINIC 98 - SCL HEALTH MED GRP - BILLINGS - MATERNAL 216 14TH AVE SW SIDNEY MT 59270 OUTPATIENT PHYSICIAN CLINIC 99 - SCL HEALTH MED GRP - BILLINGS - HEART & 2600 WILSON ST MILES CITY MT 59301 OUTPATIENT PHYSICIAN CLINIC 100 - SCL HEALTH MED GRP - BILLINGS - HEART RE 10 ROBINSON LANE RED LODGE MT 590689010 OUTPATIENT PHYSICIAN CLINIC 101 - SCL HEALTH ST VINCENT NEUROSURGERY 132 N GOULD ST SHERIDAN WY 82801 OUTPATIENT PHYSICIAN CLINIC 102 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 650 SOUTH FERGUSON STE 1 BOZEMAN MT 59718 OUTPATIENT PHYSICIAN CLINIC 103 - SCL HEALTH MED GRP - BILLINGS - HEART SI 216 14TH AVE SW SIDNEY MT 59270 OUTPATIENT PHYSICIAN CLINIC 104 - SCL HEALTH ST VINCENT NEUROSURGERY 401 15TH AVE SOUTH GREAT FALLS MT 59405 OUTPATIENT PHYSICIAN CLINIC 105 - SCL HEALTH MED GRP - BILLINGS - HEART LE 408 WENDELL AVE STE 7 LEWISTOWN MT 59457 OUTPATIENT PHYSICIAN CLINIC 106 - SCL HEALTH MED GRP - BILLINGS - LOCKWOOD 1932 EAST HIGHWAY 87 EAST BILLINGS MT 591016699 OUTPATIENT PHYSICIAN CLINIC 107 - ST JAMES CARDIAC INTERPRETATIONS 400 S CLARK ST BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 108 - SCL HEALTH MED GRP - BILLINGS - NEPHROLO 16 N MILES AVE STE 101 HARDIN MT 59034 OUTPATIENT PHYSICIAN CLINIC 109 - SCL HEALTH MED GRP - BILLINGS - PEDIATRI 650 SOUTH FERGUSON STE 1 BOZEMAN MT 59718 OUTPATIENT PHYSICIAN CLINIC 110 - SCL HEALTH MED GRP - BUTTE PEDIATRIC SPE 435 S CRYSTAL ST BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC 111 - SCL HEALTH MED GRP - BILLINGS - DERMATOL 720 LINDSAY LN STE A CODY WY 82414 OUTPATIENT PHYSICIAN CLINIC 112 - SCL HEALTH MED GRP - BUTTE - BEHAVIORAL 400 S CLARK ST BUTTE MT 597012328 OUTPATIENT PHYSICIAN CLINIC 113 - SCL HEALTH MED GRP - SIDNEY PEDIATRIC SP 216 14TH AVE SW SIDNEY MT 59270 OUTPATIENT PHYSICIAN CLINIC 114 - SCL HEALTH MED GRP - BILLINGS - NEUROLOG 435 S CRYSTAL ST BUTTE MT 59701 OUTPATIENT PHYSICIAN CLINIC PART I, LINE 7: THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A, 7B AND 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2, IN THE SCHEDULE H, FORM 990 INSTRUCTIONS. FORM 990, SCHEDULE H, PART I, LINES 7E, 7F, 7G, 7H AND 7I ARE REPORTED AT COST AS REPORTED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. 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 $ 1,517,410. PART II, COMMUNITY BUILDING ACTIVITIES: N/APART III, LINE 1:THE ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) STATEMENT NO. 15 TO THE EXTENT THAT HFMA STATEMENT NO. 15 FOLLOWS THE GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) FOR THE REPORTING OF BAD DEBT. PART III, LINE 2: THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS AT CHARGES AS RECORDED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ALLOWANCE FOR BAD DEBT IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING THE BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS.THE BAD DEBT ALLOWANCE IS CALCULATED AS A PERCENTAGE OF PATIENT RECEIVABLES AFTER DEDUCTIONS FOR ESTIMATED PROVISIONS FOR CONTRACTUAL ADJUSTMENTS (DISCOUNTS) ON SERVICES PROVIDED TO ENROLLEES OF MEDICARE, MEDICAID, THIRD-PARTY PAYOR PROGRAMS, CHARITY CARE, UNINSURED DISCOUNTS, AND OTHER ADMINISTRATIVE ADJUSTMENTS. PART III, LINE 4: THE ALLOWANCE FOR BAD DEBT IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING THE BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS.THE BAD DEBT ALLOWANCE IS CALCULATED AS A PERCENTAGE OF PATIENT RECEIVABLES AFTER DEDUCTIONS FOR ESTIMATED PROVISIONS FOR CONTRACTUAL ADJUSTMENTS (DISCOUNTS) ON SERVICES PROVIDED TO ENROLLEES OF MEDICARE, MEDICAID, THIRD-PARTY PAYOR PROGRAMS, CHARITY CARE, UNINSURED DISCOUNTS, AND OTHER ADMINISTRATIVE ADJUSTMENTS.THE ORGANIZATION HAS A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES PATIENTS OPPORTUNITIES TO APPLY FOR FREE OR DISCOUNTED CARE AND/OR TO BE ENROLLED IN A GOVERNMENT SPONSORED MEDICAL CARE PROGRAM. THE PROCESS INCLUDES IDENTIFYING PATIENTS WITH A FINANCIAL CONCERN AND PROVIDING FINANCIAL COUNSELING AND ASSISTANCE IN APPLYING FOR THE ORGANIZATION'S CHARITY CARE AND OTHER FINANCIAL ASSISTANCE PROGRAMS.CERTAIN PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT BECAUSE THE ORGANIZATION DOES NOT HAVE SUFFICIENT INFORMATION TO DETERMINE IF THE PATIENT WOULD QUALIFY FOR FREE CARE OR FINANCIAL AID. THEREFORE, IT IS POSSIBLE THAT SOME BAD DEBT IS ACTUALLY CHARITY CARE. HOWEVER, IF A PATIENT ACCOUNT IS WRITTEN OFF TO BAD DEBT AND THE COLLECTION AGENCY LATER DETERMINES THAT THE PATIENT WOULD HAVE QUALIFIED FOR FREE CARE OR FINANCIAL AID, THEN THE BAD DEBT EXPENSE IS RECLASSIFIED TO CHARITY CARE. THE FOLLOWING IS THE TEXT OF THE FOOTNOTE IN THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES THE BAD DEBT ALLOWANCE AND BAD DEBT EXPENSE: NET PATIENT SERVICE REVENUE GENERALLY RELATES TO CONTRACTS WITH PATIENTS IN WHICH THE PERFORMANCE OBLIGATIONS ARE TO PROVIDE HEALTH CARE SERVICES TO PATIENTS OVER A PERIOD OF TIME. REVENUE IS ESTIMATED FOR PATIENTS WHO HAVE NOT BEEN DISCHARGED AS OF THE REPORTING PERIOD BASED ON ACTUAL CHARGES INCURRED TO DATE IN RELATION TO TOTAL EXPECTED CHARGES. SCL HEALTH BELIEVES THIS METHOD PROVIDES A FAITHFUL DEPICTION OF THE TRANSFER OF SERVICES OVER THE TERM OF THE PERFORMANCE OBLIGATION BASED ON THE INPUTS NEEDED TO SATISFY THE OBLIGATION. THE CONTRACTUAL RELATIONSHIP WITH PATIENTS ALSO TYPICALLY INVOLVES A THIRD-PARTY PAYER (MEDICARE, MEDICAID, MANAGED CARE PLANS, AND COMMERCIAL INSURANCE COMPANIES), AND THE TRANSACTION PRICES FOR THE SERVICES PROVIDED ARE DEPENDENT UPON THE TERMS PROVIDED BY OR NEGOTIATED WITH THE THIRD-PARTY PAYERS. THE PAYMENT ARRANGEMENTS WITH THIRD-PARTY PAYERS FOR THE SERVICES PROVIDED TO THE RELATED PATIENTS TYPICALLY SPECIFY PAYMENT OR REIMBURSEMENT TO SCL HEALTH AT OTHER-THAN-STANDARD CHARGES.BECAUSE ALL OF ITS PERFORMANCE OBLIGATIONS RELATE TO CONTRACTS WITH A DURATION OF LESS THAN ONE YEAR, SCL HEALTH HAS ELECTED TO APPLY THE OPTION EXEMPTION, AND THEREFORE, IS NOT REQUIRED TO DISCLOSE THE AGGREGATE AMOUNT OF THE TRANSACTION PRICE ALLOCATED TO PERFORMANCE OBLIGATIONS THAT ARE UNSATISFIED OR PARTIALLY SATISFIED AT THE END OF THE REPORTING PERIOD. THE UNSATISFIED OR PARTIALLY SATISFIED PERFORMANCE OBLIGATIONS REFERRED TO ABOVE ARE PRIMARILY RELATED TO INPATIENT SERVICES AT THE END OF THE REPORTING PERIOD. THE PERFORMANCE OBLIGATIONS FOR THESE CONTRACTS ARE GENERALLY COMPLETED WHEN PATIENTS ARE DISCHARGED, WHICH GENERALLY OCCURS WITHIN DAYS OR WEEKS OF THE END OF THE REPORTING PERIOD.NET PATIENT SERVICE REVENUE IS REPORTED AT ESTIMATED AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED AND INCLUDES ESTIMATES OF IMPLICIT PRICE CONCESSIONS AND RETROACTIVE REVENUE ADJUSTMENTS DUE TO AUDITS, REVIEWS, AND INVESTIGATIONS. IMPLICIT PRICE CONCESSIONS RELATE PRIMARILY TO UNINSURED PATIENTS AND PATIENTS WITH CO-PAYS, CO-INSURANCE AND DEDUCTIBLES AND ARE ESTIMATED BASED ON HISTORICAL COLLECTION DATA. RETROACTIVE ADJUSTMENTS ARE CONSIDERED IN THE RECOGNITION OF REVENUE ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED, AND SUCH AMOUNTS ARE ADJUSTED IN FUTURE PERIODS AS ADJUSTMENTS BECOME KNOWN OR AS YEARS ARE NO LONGER SUBJECT TO SUCH AUDITS, REVIEWS, OR INVESTIGATIONS. PART III, LINE 8: THE ORGANIZATION BELIEVES THAT AT LEAST SOME PORTION OF THE COSTS WE INCUR IN EXCESS OF PAYMENTS RECEIVED FROM THE FEDERAL GOVERNMENT FOR PROVIDING MEDICAL SERVICES TO MEDICARE ENROLLEES AND BENEFICIARIES UNDER THE FEDERAL MEDICARE PROGRAM (SHORTFALL OR MEDICARE SHORTFALL) CONSTITUTES A COMMUNITY BENEFIT. PROVIDING THESE SERVICES CLEARLY LESSENS THE BURDENS OF THE GOVERNMENT BY ALLEVIATING THE FEDERAL GOVERNMENT FROM HAVING TO DIRECTLY PROVIDE THESE MEDICAL SERVICES. AS DEMONSTRATED AND CALCULATED ON FORM 990, SCHEDULE H, PART III, LINES 5, 6 AND 7, OUR MEDICARE "ALLOWABLE COSTS" CLEARLY EXCEED THE PAYMENTS WE RECEIVE FOR PROVIDING THESE MEDICAL SERVICES UNDER THE MEDICARE PROGRAM. BY ABSORBING THE MEDICARE SHORTFALL COSTS WE ARE PROVIDING A COMMUNITY BENEFIT AS WELL AS EASING THE BURDEN OF THE FEDERAL GOVERNMENT HAVING TO COVER THESE COSTS.TO ARRIVE AT THE FORM 990, SCHEDULE H, PART III, LINE 6 AMOUNT, WE USED ACTUAL MEDICARE CHARGES FROM INTERNAL RECORDS AND APPLIED AN ESTIMATED COST TO CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. THE ESTIMATED MEDICARE COST TO CHARGE RATIO IS THE PRIOR PERIOD MEDICARE COST REPORT COST TO CHARGE RATIO. PART III, LINE 9B: AN INTEGRAL COMPONENT OF OUR MISSION IS TO BE GOOD FINANCIAL STEWARDS. THIS REQUIRES US TO DETERMINE WHICH PATIENTS ARE IN NEED OF CHARITY CARE AND WHICH ARE ABLE TO CONTRIBUTE SOME PAYMENT FOR CARE RECEIVED. WEMAINTAIN A BALANCE THAT ENABLES US TO CONTINUE TO PROVIDE CHARITY CARE TOTHOSE WHO NEED IT MOST AND ENSURE THAT WE MANAGE OUR RESOURCES SOWE CAN CONTINUE TO BE HERE WHEN PEOPLE NEED US MOST. THE ORGANIZATION NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION AND DISCHARGE. IN ADDITION, THE PATIENTS RECEIVE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY WITH THEIR PATIENT BILLS. PATIENTS ARE CONTACTED MULTIPLE TIMES ABOUT UNPAID BALANCES PRIOR TO INITIATING ANY COLLECTION ACTION. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION PROCESS, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED. PART VI, LINE 2: THE REHABILITATION HOSPITAL OF MONTANA BEGAN OPERATIONS IN AUGUST 2019 AS A FREESTANDING, 34-BED REHABILITATION HOSPITAL TO TREAT PATIENTS RECOVERING FROM CONDITIONS SUCH AS STROKE, TRAUMATIC BRAIN INJURY AND SPINAL CORD INJURY FROM ACROSS THE STATE OF MONTANA. A CHNA INCLUDING STATEWIDE DATA RELATED TO DISEASES ADDRESSED BY THE REHABILITATION HOSPITAL OF MONTANA AND UNDERLYING RISK FACTORS WILL BE CONDUCTED IN 2021. IN 2020 A CHNA COVERING YELLOWSTONE COUNTY, MONTANA, WAS CONDUCTED BY REHABILITATION HOSPITAL OF MONTANA PARTNER ORGANIZATIONS ST. VINCENT HEALTHCARE AND BILLINGS CLINIC IN COLLABORATION WITH CITY-COUNTY HEALTH DEPARTMENT, RIVERSTONE HEALTH UTILIZING PRC, A NATIONALLY RECOGNIZED HEALTHCARE CONSULTING FIRM. THE YELLOWSTONE COUNTY CHNA INCORPORATED: 1) PRIMARY QUANTITATIVE DATA (A 400 HOUSEHOLD TELEPHONE COMMUNITY HEALTH SURVEY), 2) SECONDARY QUANTITATIVE DATA (EXISTING PUBLIC HEALTH DATA) AND 3) PRIMARY QUALITATIVE DATA (ONLINE KEY INFORMANT SURVEYS). 154 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY INCLUDING REPRESENTATIVES OF COMMUNITY BASED ORGANIZATIONS, EDUCATION, GOVERNMENT, BUSINESS, HEALTHCARE AND PUBLIC HEALTH. IN ADDITION, FEEDBACK FROM DIVERSE GROUPS WAS COLLECTED USING STREETWYZE/ISEEED, AN ONLINE COMMUNITY ENGAGEMENT PLATFORM. STREETWYZE PROVIDED THE OPPORTUNITY FOR COMMUNITY MEMBERS TO SHARE FIRST-HAND PERCEPTIONS AND EXPERIENCES OF THEIR COMMUNITY. A PROJECT SPECIFIC PROMPT WAS CREATED TO SOLICIT FEEDBACK SPECIFICALLY RELATED TO COMMUNITY HEALTH BARRIERS AND OPPORTUNITIES. A TOTAL OF 428 DATA POINTS WERE COLLECTED THROUGH 120 UNIQUE USER ACCOUNTS. THE REHABILITATION HOSPITAL OF MONTANA WAS AN ACTIVE PARTICIPANT IN THE YELLOWSTONE COUNTY CHNA PROCESS. FINDINGS FROM THE YELLOWSTONE COUNTY CHNA WILL HELP TO INFORM THE 2021 COMMUNITY HEALTH NEEDS ASSESSMENT. KEY STAKEHOLDERS REPRESENTING HEALTH CONDITIONS ADDRESSED BY THE REHABILITATION HOSPITAL OF MONTANA WILL BE CONSULTED AS THE CHNA IS DEVELOPED. THIS CHNA WILL PROVIDE AN UNDERSTANDING OF NEEDS STATEWIDE AND WILL INCLUDE THE USE OF SECONDARY DATA SUCH AS COUNTY HEALTH RANKINGS AND THE BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM (BRFSS). PART VI, LINE 3: THE ORGANIZATION NOTIFIES PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY UPON ADMISSION AND PRIOR TO DISCHARGE. NOTICES ABOUT THE FINANCIAL ASSISTANCE POLICY ARE DISPLAYED THROUGHOUT THE HOSPITAL. IN ADDITION, PATIENTS RECEIVE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY WITH THEIR PATIENT BILLS. THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE POSTED ON THE HOSPITAL'S WEBSITE. THE POLICY AND APPLICATION ARE ALSO AVAILABLE UPON REQUEST. THE ORGANIZATION HAS A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES PATIENTS OPPORTUNITIES TO APPLY FOR FREE OR DISCOUNTED CARE AND/OR TO BE ENROLLED IN A GOVERNMENT SPONSORED MEDICAL CARE PROGRAM. THE PROCESS INCLUDES IDENTIFYING PATIENTS WITH A FINANCIAL CONCERN, PROVIDING FINANCIAL COUNSELING AND ASSISTANCE IN APPLYING FOR THE ORGANIZATION'S CHARITY CARE AND OTHER FINANCIAL ASSISTANCE PROGRAMS. PART VI, LINE 4: POPULATION AND GEOGRAPHY: THE STATE OF MONTANA HAS A POPULATION OF 1,084,225. BETWEEN THE 2010 AND 2020 CENSUS, THE STATESIDE POPULATION INCREASED BY 9.5%. 16.5% OF MONTANA RESIDENTS ARE OVER AGE 65 AND 22.3% ARE UNDER AGE 18. THE STATE HAS EQUAL POPULATIONS OF MEN AND WOMEN. MONTANA HAS A TOTAL LAND AREA OF 145,545.42 SQUARE MILES AND A POPULATION DENSITY OF 7.44 PEOPLE PER SQUARE MILE. (CENSUS.GOV/QUICKFACTS)RACE AND ETHNICITY: MOST RESIDENTS OF MONTANA (88.9%) ARE WHITE. APPROXIMATELY 6.7% OF RESIDENTS ARE NATIVE AMERICAN/ALASKA NATIVE, 4.1% ARE HISPANIC OR LATINO, AND 2.8% REPORT TWO OR MORE RACES. LESS THAN 1% OF THE POPULATION ARE BLACK, ASIAN, OR NATIVE HAWAIIAN/OTHER PACIFIC ISLANDER. (CENSUS.GOV/QUICKFACTS)POVERTY AND ECONOMICS: THE MEDIAN HOUSEHOLD INCOME (IN 2019 DOLLARS) FROM 2015-2019 WAS $54,970. APPROXIMATELY 12.6% OF RESIDENTS LIVE IN POVERTY. DATA FROM THE U.S. CENSUS BUREAU REPORTS 86,787 VETERANS IN THE STATE, APPROXIMATELY 10.6% OF THE TOTAL POPULATION. APPROXIMATELY 93.6% OF MONTANA RESIDENTS HAVE A HIGH SCHOOL DIPLOMA, WITH 32% OF RESIDENTS HAVING A BACHELOR'S DEGREE OR HIGHER.HEALTH STATUS: MOST RESIDENTS IN MONTANA HAVE HEALTHCARE COVERAGE, BUT 10.3% REPORT NO HEALTHCARE COVERAGE (BRFSS, 2018). A SIMILAR PERCENTAGE OF RESIDENTS (10.1%) REPORTED BEING UNABLE TO GET NEEDED MEDICAL CARE DUE TO COST IN 2018. NEARLY A THIRD OF RESIDENTS (27.2%) HAD NO PRIMARY CARE PROVIDER. MOST RESIDENTS (73%) REPORTED A ROUTINE HEALTH VISIT IN THE LAST YEAR. THE MAJORITY OF MONTANA RESIDENTS (84.5%) REPORT EXCELLENT-GOOD OVERALL HEALTH, BUT 15.5% OF RESIDENTS REPORT FAIR/POOR OVERALL HEALTH. RESIDENTS WITH LOWER INCOMES WERE MORE LIKELY TO REPORT FAIR/POOR OVERALL HEALTH THAN RESIDENTS OF HIGHER INCOMES. AN ADDITIONAL 9.2% OF RESIDENTS UNDER AGE 65 HAVE A DISABILITY. (BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, 2015-2018). PART VI, LINE 5: A COLLECTIVE COMMUNITY HEALTH IMPROVEMENT PLAN WAS DEVELOPED IN 2020 INCLUDING JOINT VENTURE PARTNERS BILLINGS CLINIC AND ST. VINCENT HEALTHCARE WITH PARTICIPATION FROM REHABILITATION HOSPITAL OF MONTANA STAFF. THIS COLLECTIVE CHIP ADDRESSES THE IDENTIFIED NEEDS OF MENTAL HEALTH, SUBSTANCE ABUSE, NUTRITION, PHYSICAL ACTIVITY AND HEALTHY WEIGHT THROUGH A FOCUS ON HEALTHY NEIGHBORHOODS, HEALTHY CONNECTIONS, AND HEALTHY INVESTMENTS. THE REHABILITATION HOSPITAL OF MONTANA PARTICIPATED IN THE HEALTHY CONNECTIONS WORKGROUP IN 2020 WHICH FOCUSED ON ADDRESSING SOCIAL ISOLATION AMONG SENIORS DUE TO WINTER WEATHER AS ITS FIRST PROJECT FOR THE STRATEGY WORKING GROUP. FUNDING WAS REQUESTED FROM AMERICA WALKS TO SUPPORT THE "BE A GOOD NEIGHBOR" PROJECT WHICH PAIRED VOLUNTEERS FROM A LOCAL COLLEGE TO HELP SHOVEL SIDEWALKS FOR SENIORS AND INDIVIDUALS WITH DISABILITIES. A MARKETING CAMPAIGN TO REMIND ABLE-BODIED PEOPLE OF THE IMPACT SHOVELING THEIR WALK MAKES FOR OTHERS WAS ALSO DEVELOPED. INDIVIDUALS EXPERIENCING SOCIAL ISOLATION ARE AT AN INCREASED RISK OF POOR HEALTH WITH OUTCOMES SUCH AS INCREASED STRESS, MENTAL ILLNESS, SUBSTANCE ABUSE, DISABILITY, AND PHYSICAL INACTIVITY. WELCOMING PUBLIC SPACES AND CIVIC ENGAGEMENT OPPORTUNITIES SUCH AS VOLUNTEERING, MENTORING, AND COMMUNITY GROUPS THAT BUILD SOCIAL TIES OR CAPITAL IMPROVE INDIVIDUAL HEALTH OUTCOMES AND THE QUALITY OF LIFE WITHIN A COMMUNITY.WHEN THE REHABILITATION HOSPITAL OF MONTANA HAS EXCESS REVENUE OVER OPERATING EXPENSES, THOSE FUNDS ARE USED TO OBTAIN CURRENT HEALTHCARE TECHNOLOGIES AND EQUIPMENT, IMPROVE PATIENT CARE, PROVIDE MEDICAL TRAINING EDUCATION AND RESEARCH, AND TO EXPAND ACCESS TO POINTS OF CARE. THESE INVESTMENTS ENSURE WE WILL BE ABLE TO CARE FOR FUTURE GENERATIONS. THE REHABILITATION HOSPITAL OF MONTANA PARTICIPATES IN COLLABORATIVE COMMUNITY HEALTH IMPROVEMENT EFFORTS AS PART OF THE HEALTHY BY DESIGN COALITION, A COLLABORATIVE SPONSORED BY JOINT VENTURE PARTNERS BILLINGS CLINIC AND ST. VINCENT HEALTHCARE IN CONJUNCTION WITH RIVERSTONE HEALTH, AND COMMITS IN-KIND RESOURCES TO FULFILL GOALS OUTLINED IN THE COLLABORATIVE COMMUNITY HEALTH IMPROVEMENT PLAN FOR YELLOWSTONE COUNTY. PART VI, LINE 6: SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) IS THE PARENT ORGANIZATION OF A LARGE HEALTHCARE SYSTEM. SCLHS AND ITS AFFILIATED ENTITIES HAVE A COMMON CALLING AND MISSION: "WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE." WE STRIVE TO PROVIDE HIGH-QUALITY, COMPASSIONATE AND AFFORDABLE HEALTHCARE IN EACH OF OUR HOSPITAL SITES AND THEIR RESPECTIVE COMMUNITIES, AS WELL AS IN A VARIETY OF OUTPATIENT SETTINGS AND IN THE HOME. SCLHS IS A FAITH-BASED, NONPROFIT HEALTHCARE ORGANIZATION THAT OPERATES EIGHT HOSPITALS, TWO SAFETY NET CLINICS, ONE CHILDREN'S MENTAL HEALTH CENTER, HOME HEALTH AND MORE THAN 200 PHYSICIAN CLINICS IN THREE STATES - COLORADO, KANSAS AND MONTANA. THE HEALTH SYSTEM INCLUDES MORE THAN 15,900 EMPLOYEES AND MORE THAN 800 EMPLOYED PROVIDERS.AS OUR HEALTH SYSTEM GROWS, WE'RE LEVERAGING THAT GROWTH TO ACHIEVE BENEFITS OF SCALE - IDENTIFYING COST AND OTHER ADVANTAGES THAT WE GAIN DUE TO OUR SIZE. WE'RE ALSO WORKING TO STREAMLINE AND UNIFY OUR SYSTEM-WIDE PROCESSES TO ELIMINATE COSTLY DUPLICATION OF EFFORT. WE ACTIVELY ENCOURAGE OUR PEOPLE TO PURSUE CREATIVE IDEAS THAT IMPROVE EFFICIENCY, SERVICE AND THE OVERALL CARE EXPERIENCE. WHEN OUR ASSOCIATES OR LEADERSHIP TEAMS IDENTIFY BEST PRACTICES IN ANY AREA OF CARE, WE RAPIDLY REPLICATE THOSE ACROSS ALL CARE SITES.THE ORGANIZATION PROMOTES THE HEALTH OF THE COMMUNITY BY DELIVERING DIRECT HIGH QUALITY HEALTHCARE SERVICES THAT ARE RESPONSIVE TO THE NEEDS OF ITS PATIENTS AND THEIR FAMILIES. THIS INCLUDES COORDINATING COMMUNITY BENEFIT PROCESSES, PROVIDING GUIDANCE WITH COMMUNITY NEEDS ASSESSMENTS, AND ESTABLISHING CONSISTENT FINANCIAL ASSISTANCE AND CHARITY CARE POLICIES AND PROCEDURES. ADDITIONALLY, SCLHS BENEFITS AFFILIATES THROUGH QUALITY IMPROVEMENT AND PERFORMANCE EXCELLENCE INITIATIVES; SYSTEM-WIDE INFORMATION TECHNOLOGY IMPLEMENTATION AND INFRASTRUCTURE; STRATEGIC AND OPERATIONS DIRECTION AND OVERSIGHT; SUPPLY CHAIN MANAGEMENT AND PURCHASING; FINANCE ADMINISTRATION, REVENUE CYCLE SUPPORT, BENEFITS ADMINISTRATION, RISK MANAGEMENT; DISASTER PLANNING AND CRISIS ASSISTANCE, CENTRAL CASH MANAGEMENT AND INVESTMENT, INTERNAL AUDIT, LEGAL SERVICES, TAX SERVICES AND MISSION INTEGRATION.PART VI, LINE 7:STATE FILING OF COMMUNITY BENEFIT REPORT - NOT APPLICABLE. 1 SCL HEALTH - MONTANA 1233 NORTH 30TH STREET BILLINGS MT 59101 810232124 501(C)(3) 6700000 SUPPORT MISSION MOUNT SAINT VINCENT HOME 4159 LOWELL BOULEVARD DENVER CO 80211 840405260 501(C)(3) 500000 SUPPORT MISSION CARITAS CLINICS 818 NORTH 7TH STREET LEAVENWORTH KS 66048 481009910 501(C)(3) 303778 SUPPORT MISSION MARIAN CLINIC 1001 SW GARFIELD AVE TOPEKA KS 66604 481046905 501(C)(3) 157403 SUPPORT MISSION SCL HEALTH FOUNDATION 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 823290526 501(C)(3) 15000 SUPPORT MISSION 5 0 PART I, LINE 2: SCLHS' MISSION DEPARTMENT REQUIRES WRITTEN STATEMENTS THREE TIMES A YEAR REGARDING THE PROGRESS AND STATUS OF THE GRANT. X 0 1 X X X X X X 1 1 0 0 0 0 0 1 0 LYDIA JUMONVILLE SYSTEM PRESIDENT & CEO 1224172 0 473730 0 310554 0 394423 0 20125 0 2423004 0 271088 0 MARK KORTH EVP CHIEF OPERATING OFF HOSP OPS 1143005 0 171821 0 17532 0 145044 0 26052 0 1503454 0 0 0 BUUP KIM MD PHYSICIAN CLINIC 827931 0 554324 0 32572 0 11281 0 26330 0 1452438 0 0 0 JANIE WADE TREASURER / EVP CHIEF FINANCIAL OFFI 896127 0 276809 0 14148 0 132801 0 24177 0 1344062 0 0 0 JAMES VALIN MD VICE PRESIDENT / EVP CHIEF CLINICAL 718908 0 260299 0 126130 0 124200 0 28687 0 1258224 0 107316 0 TAJQUAH HUDSON EVP CHIEF STRATEGY & GROWTH OFFICER 612787 0 225937 0 228338 0 174893 0 8722 0 1250677 0 133016 0 ROBERT TERRY MD PHYSICIAN 642201 0 479337 0 8157 0 14126 0 32127 0 1175948 0 0 0 JOHN WICKLUND PRESIDENT REGIONAL WESTERN CO & LMC 573291 0 213952 0 324902 0 17100 0 18257 0 1147502 0 0 0 ROSLAND MCLEOD SECRETARY / SVP CHIEF LEGAL OFFICER 539825 0 203358 0 166493 0 155369 0 27730 0 1092775 0 140548 0 LOUIS ROSS MD PHYSICIAN CLINIC 842968 0 172340 0 2344 0 17100 0 31884 0 1066636 0 0 0 SHAWN DUFFORD MD SVP CHIEF MEDICAL OFFICER SYS 547484 0 203263 0 106682 0 94488 0 14442 0 966359 0 77410 0 ROBERT LYNAGH MD PHYSICIAN CLINIC 826968 0 42469 0 6202 0 17100 0 33050 0 925789 0 0 0 CRAIG RICHARDVILLE SVP CHIEF INFORMATION OFFICER 497557 0 161894 0 18759 0 73771 0 19993 0 771974 0 0 0 STEVEN CHYUNG SVP SUPPLY CHAIN & REAL ESTATE 416949 0 158485 0 93455 0 71161 0 28556 0 768606 0 53814 0 TAMARA SAUNAITIS SVP CHIEF HUMAN RESOURCES OFFICER 420233 0 159081 0 69694 0 71472 0 29863 0 750343 0 47299 0 KAREN SCREMIN VP FINANCE OPERATIONS 432700 0 97424 0 55326 0 64720 0 8417 0 658587 0 47299 0 MEGAN MAHNCKE PRESIDENT SCL HLTH FDNS & SVP MKTG 354337 0 126498 0 48351 0 54171 0 27174 0 610531 0 26071 0 BARBARA JAHN VP SERVICE LINES AND OPERATIONS 386377 0 92658 0 55854 0 55830 0 17187 0 607906 0 43532 0 DAVID PRINGLE SVP MISSION INTEGRATION 347032 0 132116 0 69802 0 17100 0 25054 0 591104 0 0 0 SIMON PAYNE MD VP CHIEF MEDICAL OFFICER TRANSFORMAT 390114 0 99319 0 9632 0 66200 0 22540 0 587805 0 0 0 LOUIS CAPPONI VP CHIEF MEDICAL INFORMATICS OFFICER 269773 0 94918 0 119196 0 61535 0 8428 0 553850 0 0 0 TROY SPRING VP REVENUE CYCLE 316135 0 80723 0 40626 0 51671 0 29082 0 518237 0 34099 0 LAURA WIGHTMAN SVP CHIEF NURSING OFFICER SYS 341443 0 87852 0 18090 0 44895 0 9872 0 502152 0 0 0 MARK WILKINSON VP TREASURER 304626 0 75772 0 44477 0 47803 0 11954 0 484632 0 30186 0 PART I, LINE 1A TAX INDEMNIFICATION AND GROSS-UP PAYMENTS THE ORGANIZATION AND RELATED ORGANIZATIONS ALLOW FOR CERTAIN TAX INDEMNIFICATION AND GROSS-UP PAYMENTS IN THE INSTANCES OF RELOCATION. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS THAT RECEIVED TAX GROSS-UP PAYMENTS IN 2020 WERE: MARK KORTH - $54,475. PART I, LINE 1B TAX INDEMNIFICATION AND GROSS-UP PAYMENTS - WRITTEN POLICY THE ORGANIZATION AND RELATED ORGANIZATIONS DO NOT HAVE A FORMAL WRITTEN POLICY FOR TAX INDEMNIFICATION AND GROSS-UP PAYMENTS. HOWEVER, BEFORE ANY TAX INDEMNIFICATION AND GROSS-UP PAYMENTS ARE MADE; PROPER APPROVAL FROM THE EMPLOYEE'S MANAGER IS REQUIRED. IN ADDITION, APPROVAL IS ALSO REQUIRED FROM HUMAN RESOURCES. PART I, LINE 3 COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS MANAGED BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCL HEALTH) BOARD COMPENSATION COMMITTEE (COMMITTEE) ON BEHALF OF SCL HEALTH AND ALL OF ITS AFFILIATES. THE COMMITTEE REVIEWS AND APPROVES COMPENSATION ARRANGEMENTS OF THE OFFICERS AND SENIOR MANAGEMENT AND MAKES RECOMMENDATIONS TO SCL HEALTH'S BOARD FOR APPROVAL OF ANY CHANGES TO COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT. THE COMMITTEE'S REVIEW IS CONDUCTED IN A MANNER THAT IS INTENDED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS RULES OF INTERNAL REVENUE CODE SECTION 4958. THE COMMITTEE CONDUCTS THE REVIEW WITH THE ASSISTANCE OF AN EXPERIENCED AND INDEPENDENT COMPENSATION CONSULTING FIRM THAT HAS DEEP NATIONAL EXPERTISE IN HEALTH SYSTEMS' EXECUTIVE COMPENSATION PROGRAMS AND LEVELS. THE COMMITTEE OBTAINS AND RELIES UPON CURRENT, COMPARABLE MARKET DATA FOR PEER ORGANIZATIONS PRIOR TO MAKING COMPENSATION RELATED DECISIONS. THE INFORMATION REVIEWED INCLUDES COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR FUNCTIONALLY COMPARABLE POSITIONS, THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA SERVED BY SCL HEALTH AND CURRENT COMPENSATION SURVEYS COMPILED BY AN INDEPENDENT FIRM. CONSISTENT WITH THE PAY PHILOSOPHY SET BY SCL HEALTH'S BOARD, THE COMMITTEE EMPHASIZES THE IMPORTANCE OF ENSURING TOTAL REMUNERATION IS REASONABLE AND APPROPRIATE WHEN REVIEWING AND MAKING RECOMMENDATIONS WITH RESPECT TO COMPENSATION PACKAGES FOR THE OFFICERS AND SENIOR MANAGEMENT. AS PART OF THE REVIEW PROCESS, SCL HEALTH USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF OFFICERS AND SENIOR MANAGEMENT. 1) COMPENSATION COMMITTEE 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYMENT CONTRACTS 5) COMPENSATION SURVEYS AND STUDIES 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ITEMS LISTED ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. PART I, LINES 4A-B SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS THE ORGANIZATION AND RELATED ORGANIZATIONS PERIODICALLY INCUR SEVERANCE PAYMENTS TO FORMER EMPLOYEES. THE INDIVIDUALS AND THE AMOUNTS PAID FOR SEVERANCE IN 2020 WERE: LOUIS CAPPONI - $114,094. SCHEDULE J, PART I, LINE 4B PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN A RELATED ORGANIZATION PROVIDES NONQUALIFIED DEFERRED COMPENSATION PLANS (NQDC) KNOWN AS SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (SERP) FOR EXECUTIVES (SENIOR MANAGEMENT) TO COMPENSATE FOR REGULATORY IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. IN 2014, IN AN EFFORT TO REDUCE LONG-TERM COST AND HAVE GREATER CONTROL OVER FINANCIAL RISK, THE SERP WAS CONVERTED FROM A DEFINED BENEFIT (DB) TO A DEFINED CONTRIBUTION (DC) DESIGN. CERTAIN MEMBERS OF SENIOR MANAGEMENT WHOSE BENEFITS WERE CONVERTED FROM DB TO DC WOULD HAVE BEEN DISPROPORTIONATELY AND NEGATIVELY AFFECTED BY THE CHANGE, SO THE COMMITTEE DETERMINED IT WOULD BE APPROPRIATE TO GRANT "TRANSITION CREDITS" IN ORDER TO MITIGATE THE NEGATIVE IMPACT OF THE CHANGE ON THEIR RETIREMENT BENEFITS. THIS IS A COMMON APPROACH EMPLOYED BY OTHER ORGANIZATIONS UNDERGOING A SIMILAR TRANSITION. THE TRANSITION CREDITS VEST IN ACCORDANCE WITH THE TERMS OF THE DC SERP (I.E., AFTER THREE YEARS) AND ARE PAID TO THE EXECUTIVE UPON VESTING. NQDC SERP PLANS PRIOR TO 2014 PRIOR TO 2014, THE RELATED ORGANIZATION'S NQDC SERP PLAN PROVIDED A BENEFIT TO ELIGIBLE PARTICIPANTS BASED ON A PERCENTAGE OF THEIR BASE COMPENSATION. THE VESTING PERIOD IS 5 YEARS OR WHEN THE PARTICIPANT IS AGE 65 OR OLDER. THERE WERE NO CONTRIBUTIONS TO THIS PLAN AFTER DECEMBER 31, 2013. FOR AMOUNTS CONTRIBUTED TO THE NQDC SERP PLAN PRIOR TO 2014, VESTED AMOUNTS ARE PAYABLE UPON THE END OF EMPLOYMENT. THE VESTED AMOUNTS WITHDRAWN INCLUDE AMOUNTS PREVIOUSLY TAXED TO THE RECIPIENT AND AMOUNTS TAXABLE TO THE RECIPIENT IN THE CURRENT YEAR. THE TAXABLE AMOUNTS ARE INCLUDED ON THE RECIPIENT'S W-2. ANY DISTRIBUTIONS FROM THIS PLAN ARE REPORTED BELOW. IN 2019, THE RELATED ORGANIZATION CONSOLIDATED FOUR NON QUALIFED DEFERRED COMPENSATION PLANS INTO ONE PLAN. AS PART OF THIS EFFORT, ALL VESTED BALANCES FROM THE SERP PLANS PRIOR TO 2014 WERE PAID TO THE PARTICIPANTS IN 2020. THERE ARE NO REMAINING PARTICIPANTS IN THE LEGACY PLANS. NQDC SERP PLANS STARTING IN 2014 STARTING IN 2014, THE RELATED ORGANIZATION'S NQDC SERP PLAN PROVIDED A BENEFIT TO ELIGIBLE PARTICIPANTS BASED ON A PERCENTAGE OF THEIR BASE COMPENSATION. THE VESTING PERIOD IS ROLLING 3 YEARS OR WHEN THE PARTICIPANT IS AGE 65 OR OLDER. THERE WERE NO CONTRIBUTIONS TO THIS PLAN BEFORE JANUARY 1, 2014. ANY DISTRIBUTIONS FROM THIS PLAN ARE REPORTED BELOW. STARTING IN 2014, FOR CONTRIBUTIONS TO THE NQDC SERP PLAN, CERTAIN PARTICIPANTS ARE VESTED OR BECAME VESTED IN THE PLAN DURING 2020. VESTED AMOUNTS ARE PAYABLE TO THE RECIPIENT. THE VESTED AMOUNTS ARE TAXABLE TO THE RECIPIENT IN THE CURRENT YEAR. THE TAXABLE AMOUNTS ARE INCLUDED ON THE RECIPIENT'S W-2. THE AMOUNTS WITHDRAWN FROM THE NQDC SERP PLANS IN 2020 WERE: LYDIA JUMONVILLE - $391,631, ROSLAND MCLEOD - $190,175, JAMES VALIN, MD - $107,316, STEVEN CHYUNG - $121,148, SHAWN DUFFORD, MD - $152,626, TAJQUAH HUDSON - $301,154, BARBARA JAHN - $90,095, MEGAN MAHNCKE - $26,071, DAVID PRINGLE - $40,324, TAMARA SAUNAITIS - $47,299, KAREN SCREMIN - $87,103, TROY SPRING - $34,099, MARK WILKINSON - $74,729, JOHN WICKLUND - $433,241. IN ACCORDANCE WITH THE REQUIREMENTS OF SCHEDULE J, DEFERRED COMPENSATION EARNED OVER THE VESTING PERIOD IS REPORTED IN COLUMN C AND ANY AMOUNTS VESTED/PAID FROM A DEFERRED COMPENSATION PLAN ARE REPORTED IN COLUMN B(III). THUS, THE SAME AMOUNT WOULD BE REPORTED TWICE (FIRST WHEN IT ACCRUED DURING THE VESTING PERIOD AND AGAIN WHEN IT IS VESTED/PAID). THIS RESULTS IN THE APPEARANCE OF CERTAIN EXECUTIVES RECEIVING MORE THAN THEY ARE ACTUALLY PAID FROM THE DEFERRED COMPENSATION PLANS. COLUMN F IS INTENDED TO RECONCILE THIS DUPLICATION (BY REPORTING AMOUNTS INCLUDED IN COLUMN B(III) THAT HAD BEEN REPORTED AS DEFERRED COMPENSATION ON A SCHEDULE J FOR A PREVIOUS YEAR). HOWEVER, THE SIGNIFICANCE OF THE AMOUNTS LISTED IN COLUMN F IS OFTEN OVERLOOKED AND GIVEN THE COMPLEXITY OF THE SCHEDULE J REPORTING REQUIREMENTS, THE AMOUNTS SHOWN ARE EASILY MISUNDERSTOOD. TO DETERMINE TOTAL AMOUNT EARNED (RATHER THAN THE AMOUNT VESTED/PAID OUT) DURING THE YEAR, SUBTRACT THE AMOUNT IN COLUMN F FROM COLUMN E. PART I, LINE 7 OTHER NON-FIXED PAYMENTS THE AT-RISK COMPENSATION (ARC) PLAN WAS ESTABLISHED TO ENABLE SCL HEALTH TO ATTRACT AND ENGAGE QUALIFIED LEADERS AND TO PROVIDE SUCH LEADERS WITH AN ADDITIONAL PERFORMANCE COMPENSATION OPPORTUNITY TO PROMOTE AND FURTHER ITS CHARITABLE MISSION AND STRATEGIC IMPERATIVES. THE PLAN OPERATES ON A CALENDAR-YEAR BASIS AND AWARD OPPORTUNITIES ARE A PERCENTAGE OF LEADERS' BASE PAY AS DETERMINED BY THEIR MANAGEMENT LEVEL AT SCL HEALTH. ACTUAL AWARDS WILL BE PAID OUT BASED ON ATTAINMENT OF SELECTED SCL HEALTH BOARD-APPROVED GOALS, INCLUDING OPERATING INCOME, STEWARDSHIP, QUALITY, PATIENT AND ASSOCIATE SAFETY AND PATIENT EXPERIENCE AND FULFILLMENT OF OUR MISSION. AWARDS ARE BASED ON THE BOARD'S DETERMINATION ON HOW WELL THE HEALTH CARE SYSTEM PERFORMS RELATIVE TO THE PLAN'S STATED PERFORMANCE STANDARDS AND THE WEIGHT GIVEN TO EACH OF THE PERFORMANCE MEASURES AS DEFINED FOR THAT PLAN YEAR. THE AT RISK COMPENSATION PLAN SHALL BE INTERPRETED, APPLIED AND ADMINISTERED AT ALL TIMES IN ACCORDANCE WITH CODE SECTION 409A AND GUIDANCE ISSUED THEREUNDER. THE HEALTH CARE SYSTEM RESERVES THE RIGHT TO AMEND OR TERMINATE THIS PLAN AT ANY TIME FOR ANY REASON. ADDITIONAL OFFICER AND BOARD DISCLOSURES THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCL HEALTH) AND RELATED TAX EXEMPT ORGANIZATIONS CONSISTS OF EIGHT HOSPITALS, NINE FOUNDATIONS, TWO SAFETY-NET CLINICS, ONE CHILDREN'S MENTAL HEALTH CENTER, HOME HEALTH AND MORE THAN 200 PHYSICIAN CLINICS IN THREE STATES - COLORADO, KANSAS AND MONTANA. THE HEALTH SYSTEM INCLUDES MORE THAN 15,900 FULL-TIME ASSOCIATES AND MORE THAN 800 EMPLOYED PROVIDERS. SCL HEALTH AND RELATED TAX EXEMPT ORGANIZATIONS ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. IN KEEPING WITH SCL HEALTH'S CORE VALUE OF STEWARDSHIP, SCL HEALTH'S BOARD COMPENSATION COMMITTEE (COMMITTEE) HAS RETAINED THE SERVICES OF AN INDEPENDENT COMPENSATION ADVISOR. THE COMPENSATION ADVISOR IS RESPONSIBLE FOR ADVISING THE COMMITTEE ON ALL MATTERS RELATING TO EXECUTIVE COMPENSATION INCLUDING SUPPORTING THE COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. THE SISTERS WHO SERVE AS OFFICERS AND/OR BOARD MEMBERS ARE MEMBERS OF THE SISTERS OF CHARITY OF LEAVENWORTH (A RELIGIOUS ORDER OF WOMEN). THE SISTERS HAVE TAKEN VOWS OF POVERTY AND RECEIVE NO COMPENSATION, EXPENSE ACCOUNT ALLOWANCE, OR CONTRIBUTIONS TO BENEFIT PLANS FOR THEIR SERVICES TO THE HEALTH CARE SYSTEM. HOWEVER, A PAYMENT IS MADE DIRECTLY TO THE SISTERS OF CHARITY OF LEAVENWORTH FOR THE SERVICES OF THOSE WHO PERFORM PROFESSIONAL, ADMINISTRATIVE, AND OTHER SUCH SERVICES. A COLORADO HEALTH FACILITIES AUTHORITY 840752932 NONEAVAIL 2011-06-15 62620000 7/18/02 & 2/4/09 REFI 0 0 0 B COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AN84 2013-11-12 302719375 CONSTRUCT HOSPITAL FACILITY 0 0 0 C COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648A5S0 2016-05-12 221970000 CONSTRUCT HOSPITAL FACILITY 1 0 0 D COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648FLQ5 2019-10-03 481924656 5/20/10 REFINANCE 0 0 0 A 8510000 62620000 420000 62200000 2011 1 0 1 1 B 302719375 3005563 299713812 2013 0 0 1 1 C 110990000 221976622 1908538 220068084 2016 0 0 1 1 D 481924656 2884023 479040633 2019 1 0 1 1 A 0 1 1 1 0 0 0 1 B 0 1 1 1 0 0 0 1 C 0 1 1 1 0 0 0 1 D 0 1 1 1 0 0 0 1 A 0 0 0 1 1 0 0 0 1 B 0 0 0 1 0 0 0 0 1 C 0 1 0 0 1 0 0 0 1 D 0 1 0 0 0 0 0 0 1 A 1 B 1 C 1 D 1 PART IV, LINE 2C REBATE COMPLETION DATES: A - COLORADO HEALTH FACILITIES AUTHORITY 2011 - 6/15/20 B - COLORADO HEALTH FACILITIES AUTHORITY 2013 - 11/12/20 PART I COLUMN (E) & PART II LINE 3 ANY DIFFRENCE BETWEEN ISSUE PRICE REPORTED ON PART I, COLUMN (E) AND TOTAL PROCEEDS REPORTED ON PART II, LINE 3 IS DUE TO INVESTMENT EARNINGS. A MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KMZ1 2019-10-03 151631944 05/20/10 REFINANCE 0 0 0 B COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648FMB7 2019-10-03 111860603 05/12/16 REFINANCE 0 0 0 A 151631944 990619 150641325 2019 1 0 1 1 B 111860603 870603 110990000 2019 1 0 1 1 A 0 1 1 1 0 0.00100 0.00100 0 0 1 B 0 1 1 1 0 0 0 1 A 0 1 0 0 0 0 0 0 1 B 0 1 0 0 0 0 0 0 1 A 1 B 1 FORM 990, PART VI, SECTION A, LINE 6 THE MEMBERS OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) SHALL BE THE MEMBERS OF LEAVEN MINISTRIES. THE MEMBERS OF LEAVEN MINISTRIES SHALL SERVE AS MEMBERS OF SCLHS DURING THEIR TERMS OF OFFICE AS MEMBERS OF LEAVEN MINISTRIES. FORM 990, PART VI, SECTION A, LINE 7A THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THE CORPORATION AND THE CHAIR OF LEAVEN MINISTRIES, OR HIS/HER DESIGNEE, SHALL BE EX-OFFICIO MEMBERS OF THE BOARD WITH FULL VOTING RIGHTS. THE CHAIR OF LEAVEN MINISTRIES SHALL APPOINT AN ADDITIONAL MEMBER OF THE CORPORATION TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. THE BOARD OF DIRECTORS SHALL ENSURE THE PRESENCE OF REPRESENTATIVES NOMINATED BY THE PARTICIPATING ENTITIES ON THIS BOARD AND ON THE BOARD OF ANY CORPORATION OF WHICH THIS CORPORATION IS A CONTROLLING MEMBER. EXCEPT FOR EX-OFFICIO MEMBERS OF THE BOARD OF DIRECTORS, THE MEMBERS SHALL APPOINT DIRECTORS AT THE ANNUAL MEETING OF THE MEMBERS. A SLATE OF NAMES PROPOSED BY A NOMINATING COMMITTEE OF THE BOARD OF DIRECTORS FOR APPOINTMENT AS DIRECTORS SHALL BE SUBMITTED TO THE MEMBERS BY THE CHAIRPERSON OF THE BOARD, PROVIDED, HOWEVER, THAT THE MEMBERS MAY APPOINT INDIVIDUALS AS DIRECTORS WHO HAVE NOT BEEN NOMINATED BY THE NOMINATING COMMITTEE. FORM 990, PART VI, SECTION A, LINE 7B THE MEMBERS OF THE CORPORATION SHALL BE THE MEMBERS OF LEAVEN MINISTRIES. THE MEMBERS OF LEAVEN MINISTRIES SHALL SERVE AS MEMBERS OF THE CORPORATION DURING THEIR TERM OF OFFICE AS MEMBERS OF LEAVEN MINISTRIES. IN ADDITION TO ALL MATTERS REQUIRED BY LAW OR BY THE ARTICLES OF INCORPORATION OR OTHER PROVISIONS OF THESE BYLAWS WHICH ARE REQUIRED TO BE PERFORMED BY THE MEMBERS, THE MEMBERS SHALL HAVE THE SOLE PREROGATIVE TO ACT UPON ANY OF THE FOLLOWING MATTERS AND, IF ANY ACTION WITH RESPECT TO ANY OF THE FOLLOWING IS INITIATED BY A BODY OTHER THAN THE MEMBERS, IT SHALL NOT BECOME EFFECTIVE UNTIL APPROVED BY AN AFFIRMATIVE VOTE OF THE MEMBERS: TO ESTABLISH/APPROVE THE MISSION/PHILOSOPHY OF THIS CORPORATION AND ANY CORPORATION OF WHICH THIS CORPORATION IS THE CONTROLLING MEMBER; TO ADOPT, AMEND OR REPEAL THE ARTICLES OF INCORPORATION OR BYLAWS OF THIS CORPORATION AND THE ARTICLES AND BYLAWS OF ANY CORPORATION OF WHICH THIS CORPORATION IS THE CONTROLLING MEMBER; TO FIX THE NUMBER OF DIRECTORS OF THIS CORPORATION AND APPOINT THE CORPORATION'S BOARD OF DIRECTORS, AFTER RECEIVING RECOMMENDATIONS FROM THE BOARD, PROVIDED THAT THE MEMBERS' APPOINTMENT AUTHORITY SHALL NOT BE LIMITED TO THE NOMINATIONS RECEIVED; TO REMOVE, WITH OR WITHOUT CAUSE, AFTER CONSULTATION WITH THE BOARD OF DIRECTORS, ANY MEMBER OF THE BOARD OF THIS CORPORATION; TO APPOINT AND REMOVE, WITH OR WITHOUT CAUSE, AFTER CONSULTATION WITH THE BOARD OF DIRECTORS, THE PRESIDENT/CHIEF EXECUTIVE OFFICER OF THIS CORPORATION; TO APPROVE FOR THIS CORPORATION, OR FOR ANY CORPORATION OF WHICH THIS CORPORATION IS THE CONTROLLING MEMBER, THE INCURRENCE OF INDEBTEDNESS OR THE SALE, TRANSFER, ASSIGNMENT, OR ENCUMBERING OF THE ASSETS, PURSUANT TO POLICIES ESTABLISHED FROM TIME TO TIME BY THE MEMBERS OF THIS CORPORATION; TO APPROVE THE MERGER, DISSOLUTION OR CORPORATE RESTRUCTURING OF THIS CORPORATION OR ANY CORPORATION OF WHICH THIS CORPORATION IS THE CONTROLLING MEMBER. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT. THE FORM 990 IS REVIEWED BY SENIOR MANAGEMENT. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE FILING OF THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. ANY QUESTIONS ARE ADDRESSED TO THE TAX DIRECTOR OF SCLHS PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. THE FORM 990 WAS ALSO REVIEWED BY AN OUTSIDE ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCL HEALTH) REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES ITS CONFLICT OF INTEREST POLICY BY PROVIDING EDUCATION AND TRAINING FOR ITS EMPLOYEES, STAFF, OFFICERS AND DIRECTORS. PERSONS CONSIDERED TO BE IN AN INFLUENTIAL POSITION, SUCH AS BOARD MEMBERS, OFFICERS, PHYSICIANS, EXECUTIVES AND DIRECTOR LEVEL MANAGERS ARE ALL REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT UPON HIRE/APPOINTMENT AND ON AN ANNUAL BASIS TO DISCLOSE ANY POTENTIAL CONFLICT ISSUES. THESE STATEMENTS ARE CAREFULLY REVIEWED BY THE SCL HEALTH INTEGRITY AND COMPLIANCE DEPARTMENT AND APPROPRIATE LEADERSHIP. A REPORT IS PROVIDED TO SCL HEALTH'S PRESIDENT/CEO AND THE BOARD OF DIRECTORS. THE BUSINESS AND AFFAIRS OF SCL HEALTH WILL AT ALL TIMES BE CONDUCTED IN A MANNER THAT IS SOLELY IN THE BEST INTERESTS OF SCL HEALTH AND NOT BE INFLUENCED BY CONFLICTING INTERESTS OF PERSONS RESPONSIBLE FOR ADMINISTERING THOSE AFFAIRS. THE EXISTENCE OF ANY CONFLICTS OF INTEREST WILL BE DISCLOSED AND THE PROCEDURES SET FORTH HEREIN WILL BE FOLLOWED. CERTAIN TRANSACTIONS DETERMINED TO CONSTITUTE A CONFLICT OF INTEREST ARE PROHIBITED. ANY PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER SCL HEALTH IS CONSIDERED AN INTERESTED PERSON. THIS TERM INCLUDES, BUT IS NOT LIMITED TO THE FOLLOWING: - BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS AND DIRECTORS; - SENIOR LEADERS AND EXECUTIVES (CEO, PRESIDENT, SVP, VP, EXECUTIVE DIRECTORS); - EMPLOYED PHYSICIANS AND PHYSICIANS IN MEDICAL STAFF LEADERSHIP ROLES (E.G., DEPARTMENT CHAIRS, MEMBERS OF MEDICAL STAFF COMMITTEES); - MEDICAL DIRECTORS OF CLINICAL PROGRAMS THAT ASSESS, REVIEW, RECOMMEND OR REQUEST PURCHASE OF ANY SPECIFIC PHARMACEUTICAL PRODUCTS, MEDICAL DEVICES, SUPPLIES AND/OR EQUIPMENT; - DEPARTMENT DIRECTORS; AND - OTHER SELECT INDIVIDUALS IDENTIFIED BY LEADERSHIP WHICH MAY INCLUDE, BUT IS NOT LIMITED TO, SUPPLY CHAIN AND FINANCE. UPON BECOMING AN INTERESTED PERSON AND ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO DISCLOSE ANY RELATIONSHIPS THAT CONSTITUTE OR MIGHT LEAD TO A CONFLICT OF INTEREST BY COMPLETING THE CURRENT CONFLICT OF INTEREST AND GIFT DISCLOSURE STATEMENT ("STATEMENT") AS APPROVED BY THE CHIEF INTEGRITY AND COMPLIANCE OFFICER. THE CHIEF INTEGRITY AND COMPLIANCE OFFICER WILL OVERSEE THE REVIEW OF THE STATEMENTS AND THE RESOLUTION OF ANY IDENTIFIED CONFLICTS OF INTEREST AND ALERT THE SCL HEALTH CEO AND/OR THE CHAIR OF THE SCL HEALTH BOARD OF DIRECTORS TO ANY ITEMS OF CONCERN. WHEN AN INTERESTED PERSON BECOMES AWARE OF A CONFLICT OF INTEREST WHICH HAS NOT BEEN DISCLOSED ON A STATEMENT, HE OR SHE SHALL CONTACT THE LOCAL COMPLIANCE AND PRIVACY OFFICER OR THE CHIEF INTEGRITY AND COMPLIANCE OFFICER, OBTAIN A STATEMENT FORM, COMPLETE AND RETURN IT TO THE SCL HEALTH INTEGRITY AND COMPLIANCE DEPARTMENT. WHENEVER AN INTERESTED PERSON BECOMES AWARE THAT AN ARRANGEMENT WITH RESPECT TO WHICH HE OR SHE HAS A CONFLICT OF INTEREST IS BEING CONSIDERED, THE INTERESTED PERSON MUST DISCLOSE ALL MATERIAL FACTS CONCERNING THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST TO HIS OR HER SUPERVISOR (IF AN EMPLOYEE OTHER THAN THE ORGANIZATIONS SCL HEALTH CEO) OR TO THE APPLICABLE BOARD OR COMMITTEE CHAIR (IF THE SCL HEALTH CEO OR A BOARD OR COMMITTEE MEMBER), EVEN IF THE CONFLICT OF INTEREST HAS BEEN PREVIOUSLY DISCLOSED. WITH REGARD TO EMPLOYEES OTHER THAN THE SCL HEALTH CEO, THE INTERESTED PERSON'S SUPERVISOR WILL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. WITH REGARD TO THE SCL HEALTH CEO AND BOARD OR COMMITTEE MEMBERS, THE REMAINING MEMBERS OF THE BOARD OR COMMITTEE WILL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. PERSON(S) RESPONSIBLE FOR THE DETERMINATION SHOULD OBTAIN FURTHER GUIDANCE FROM THE SCL HEALTH INTEGRITY AND COMPLIANCE OR LEGAL DEPARTMENTS. UPON MAKING HIS OR HER DISCLOSURE, THE INTERESTED PERSON WILL LEAVE THE MEETING OR OTHERWISE REMOVE HIM OR HERSELF FROM THE DELIBERATIONS OR OTHER DECISION-MAKING PROCESS UNTIL SUCH TIME AS A DETERMINATION IS REACHED. IF A DETERMINATION HAS BEEN MADE THAT NO CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON MAY BE PRESENT AND PARTICIPATE IN THE DELIBERATION REGARDING THE TRANSACTION OR ARRANGEMENT. HOWEVER, IF AN INTERESTED PERSON HAS BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST, HE OR SHE MAY NOT PARTICIPATE IN THE DELIBERATION OR DECISION REGARDING THE TRANSACTION OR ARRANGEMENT; BE PRESENT DURING THE DELIBERATION OR DECISION-MAKING; OR BE ALLOWED TO MAKE A PRESENTATION PRIOR TO THE DELIBERATION AND DECISION-MAKING ACTIVITIES. WHEN AN INTERESTED PERSON HAS A CONFLICT OF INTEREST, THE DECISION-MAKER/DECISION-MAKING BODY CONSIDERING THE TRANSACTION OR ARRANGEMENT WILL TAKE REASONABLE MEASURES, PRIOR TO APPROVING OR ENTERING INTO THE TRANSACTION OR ARRANGEMENT, TO ENSURE THAT THE PROPOSAL IS IN SCL HEALTH'S BEST INTERESTS. THE PROPOSED TRANSACTION OR ARRANGEMENT MAY PROCEED IF THE DECISION-MAKER/DECISION-MAKING BODY, AFTER HAVING BEEN FULLY INFORMED OF THE MATERIAL FACTS ESTABLISHING THE CONFLICT OF INTEREST, DETERMINES THAT THE TRANSACTION OR ARRANGEMENT IS IN SCL HEALTH'S BEST INTERESTS AND IS FAIR AND REASONABLE. A MAJORITY VOTE OF THE DISINTERESTED DECISION-MAKERS IS REQUIRED WHEN A DETERMINATION IS MADE BY A BOARD, COMMITTEE OR OTHER DECISION-MAKING BODY. MANAGEMENT OF POTENTIAL CONFLICTS IS DONE BY THE CHIEF INTEGRITY AND COMPLIANCE OFFICER AND/OR CARE SITE COMPLIANCE AND PRIVACY OFFICERS AND REPORTED ANNUALLY TO THE CARE SITE LEADERSHIP COMMITTEES AND/OR SYSTEM INTEGRITY AND COMPLIANCE COMMITTEE AND TO THE AUDIT COMMITTEE, ORGANIZATIONAL INTEGRITY AND COMPLIANCE COMMITTEE OF THE SCL HEALTH BOARD OF DIRECTORS. ANY REPORTED CONFLICTS OR POTENTIAL CONFLICTS WILL ALSO BE REPORTED TO AND REVIEWED BY THE SCL HEALTH TAX DIRECTOR FOR COMPLIANCE WITH THE FORM 990 TAX RETURN. FORM 990, PART VI, SECTION B, LINE 15 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCL HEALTH) PROCESS FOR DETERMINING COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS THE RESPONSIBILITY OF THE COMPENSATION COMMITTEE. COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS MANAGED BY THE SCL HEALTH BOARD COMPENSATION COMMITTEE (COMMITTEE) ON BEHALF OF SCL HEALTH AND ALL OF ITS AFFILIATES. THE COMMITTEE REVIEWS AND APPROVES COMPENSATION ARRANGEMENTS OF THE OFFICERS AND SENIOR MANAGEMENT AND MAKES RECOMMENDATIONS TO SCL HEALTH'S BOARD FOR APPROVAL OF ANY CHANGES TO COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT. THE COMMITTEE'S REVIEW IS CONDUCTED IN A MANNER THAT IS INTENDED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS RULES OF INTERNAL REVENUE CODE SECTION 4958. THE COMMITTEE CONDUCTS THE REVIEW WITH THE ASSISTANCE OF AN EXPERIENCED AND INDEPENDENT COMPENSATION CONSULTING FIRM THAT HAS DEEP NATIONAL EXPERTISE IN HEALTH SYSTEMS' EXECUTIVE COMPENSATION PROGRAMS AND LEVELS. THE COMMITTEE OBTAINS AND RELIES UPON CURRENT, COMPARABLE MARKET DATA FOR PEER ORGANIZATIONS PRIOR TO MAKING COMPENSATION RELATED DECISIONS. THE INFORMATION REVIEWED INCLUDES COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR FUNCTIONALLY COMPARABLE POSITIONS, THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA SERVED BY SCL HEALTH AND CURRENT COMPENSATION SURVEYS COMPILED BY AN INDEPENDENT FIRM. CONSISTENT WITH THE PAY PHILOSOPHY SET BY SCL HEALTH'S BOARD, THE COMMITTEE EMPHASIZES THE IMPORTANCE OF ENSURING TOTAL REMUNERATION IS REASONABLE AND APPROPRIATE WHEN REVIEWING AND MAKING RECOMMENDATIONS WITH RESPECT TO COMPENSATION PACKAGES FOR THE OFFICERS AND SENIOR MANAGEMENT. AS PART OF THE REVIEW PROCESS, SCL HEALTH USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF OFFICERS AND SENIOR MANAGEMENT. 1) COMPENSATION COMMITTEE 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYMENT CONTRACTS 5) COMPENSATION SURVEYS AND STUDIES 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ITEMS LISTED ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND GOVERNING DOCUMENTS AVAILABLE UPON REQUEST. FORM 990, PART XI, LINE 9: CHANGE IN SELF INSURED LIABILITY -440,311. TRANSFER OF ASSETS FROM SUBSIDIARY 35,571,120. FAS 158 UNRECOGNIZED EXPENSE FOR THE FROZEN DB PLAN 45,478,145. OTHER EXPENSE TIMING DIFFRENCES 25,243. 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