2014-11-17T10:51:34-06:00 2013-12-31 990 2013-01-01 431735565 SAINT LUKE'S HOSPITAL OF CHILLICOTHE SAIN 6606461480 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 MATT WENZEL CEO 6606461480 2014-11-17 2013 2015-11-30 17:44:51Z HEDRICK MEDICAL CENTER MATT WENZEL 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 41992637 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1888 MO CRITICAL ACCESS HOSPITAL 12 7 360 72 0 0 100734 175335 43030296 41566576 31786 250726 0 0 43162816 41992637 33812 28204 0 0 17277804 18241178 0 0 0 21696970 21258131 39008586 39527513 4154230 2465124 28738496 33364294 2635855 4925308 26102641 28438986 X SAINT LUKE'S HOSPITAL OF CHILLICOTHE IS COMMITTED TO PROVIDING THE HIGHEST LEVEL OF EXCELLENCE IN HEALTH CARE AND HEALTH RELATED SERVICES. 0 0 34469577 28204 41566576 SAINT LUKE'S HOSPITAL OF CHILLICOTHE D/B/A HEDRICK MEDICAL CENTER ("HMC") IS A LICENSED CRITICAL ACCESS HOSPITAL PROVIDING BOTH INPATIENT AND OUTPATIENT SERVICES. HMC IS LOCATED IN CHILLICOTHE (LIVINGSTON COUNTY), MISSOURI, APPROXIMATELY 90 MILES NORTHEAST OF KANSAS CITY. HEDRICK MEDICAL CENTER IS A FAITH-BASED, NOT-FOR-PROFIT COMMUNITY HOSPITAL COMMITTED TO THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE AND HEALTH RELATED SERVICES IN A CARING ENVIRONMENT. AS A MEMBER OF SAINT LUKE'S HEALTH SYSTEM, HMC IS DEDICATED TO ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF THE COMMUNITIES SERVED. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS CHARITY CARE POLICIES FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. IN ADDITION TO THE ACTIVE MEDICAL STAFF, HMC'S SPECIALTY CLINICS HOST MORE THAN 30 VISITING SPECIALISTS.THE HOSPITAL ALSO PROVIDES HEALTH RELATED ACTIVITIES AND SERVICES IN SUPPORT OF THE COMMUNITY, INCLUDING BUT NOT LIMITED TO SOCIAL WORK SERVICES, SPIRITUAL SERVICES, AND COMMUNITY EDUCATION / HEALTH FAIRS. 34469577 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 1 1 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 1 45 0 1 360 1 0 0 0 0 0 0 0 0 0 0 X 12 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 6606461480 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 X MICHAEL PALMER DIRECTOR-CHAIRMAN 1.00 X X 0 0 0 DON SIPES DIRECTOR-PRESIDENT 1.00 50.00 X X 0 334800 58828 DARREL RINEHART DIRECTOR 1.00 X 0 0 0 ROLLIE STADLMAN DIRECTOR-VICE CHAIRMAN 1.00 X X 0 0 0 DELOS CLOW DIRECTOR & EMPLOYED PHYSIC 40.00 X 283019 0 28776 JANE NEAL DIRECTOR 1.00 X 0 0 0 CYNTHIA CHRISTENSEN DIRECTOR-TREASURER 1.00 50.00 X X 0 262562 45101 BETTY PRESTON-STEELE DIRECTOR-SECRETARY 1.00 X X 0 0 0 CAROL SLOAN DIRECTOR 1.00 X 0 0 0 DONALD METRY DIRECTOR 1.00 X 32650 10688 0 JAMES SUCHSLAND DIRECTOR & EMPLOYED PHYSIC 40.00 X 236032 0 12012 LINDEN CHAPMAN DIRECTOR 1.00 X 0 0 0 TERRY PLASTER ASSIST SECR & EMPLOYEE 40.00 X 46986 0 11448 MATT WENZEL CEO 40.00 X 231050 0 48094 JANET BUCKMAN CFO 40.00 X 184743 0 16601 CATHERINE HAMILTON CNO 40.00 X 113561 0 23561 CHRISTOPHER HULETT PHYSICIAN 40.00 X 296937 0 16768 GREGORY MILLER PHYSICIAN 40.00 X 381519 0 31166 JASON GAULT PHYSICIAN 40.00 X 378329 0 31933 YULIA PENISTON PHYSICIAN 40.00 X 276709 0 31073 CASSANDRA PETERS PHARMACY MGR 40.00 X 123438 0 12272 2584973 608050 367633 12 0 1 0 EMS LLC 920 MAIN STREET SUITE 300 KANSAS CITY MO 64105 ER PHYSICIANS 1819417 HAVE A NICE DAY ANESTHESIA ASSOCIATES 2106 WOODCREST CHILLICOTHE MO 64601 ANESTHESIA SERVICES 900000 CPSI PO BOX 850309 6600 WALL ST MOBILE AL 36685 SOFTWARE SYSTEM SETUP AND SERVICE 313404 SHARED MEDICAL SERVICES PO BOX 330 COTTAGE GROVE WI 53527 READS MRI SCANS 265400 CASE CONTRACTING LLC P O BOX 1233 CHILLICOTHE MO 64601 CONSTRUCTION SERVICES 158221 9 75185 100150 175335 NET PATIENT REVENUE 622110 40260455 40260455 PHARMACY 622110 535407 535407 EHR MEANINGFUL USE FDS 622110 356142 356142 PATIENT REHAB SERVICES 622210 170660 170660 243912 243912 41566576 250726 250726 41992637 41566576 0 250726 X 28204 28204 1235881 559837 676044 13429157 12548023 881134 177185 158371 18814 2421966 2164794 257172 976989 873249 103740 8542 8542 70549 70549 6261814 5703028 558786 8463 956 7507 1413051 1158160 254891 88019 88019 1769274 1669078 100196 101295 78724 22571 70381 5790 64591 1327454 1044080 283374 258553 115195 143358 MEDICAL SUPPLIES 3875068 3866138 8930 BAD DEBTS 3860945 3860945 SHARED SERVICES-SLHS 1987000 585865 1401135 DUES & SUBSCRIPTIONS 106834 48485 58349 50889 655 50234 39527513 34469577 5057936 0 10136484 13157191 965281 867708 5239537 5764453 33870 10439 495658 449701 179591 155316 10367601 6514896 2896886 3852705 8514202 8697357 59506 65441 217481 343983 28738496 33364294 2039974 3545513 595881 1379795 2635855 4925308 X 26102641 28338986 100000 26102641 28438986 28738496 33364294 X 2465124 -53609 -75170 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1510 0 0 0 1510 0 PART II-B, LINE 1: LINE F - PORTION OF DUES PAID TO VARIOUS HOSPITAL AND MEDICAL ASSOCIATIONS USED TOWARD LOBBYING ACTIVITIES. 158106 1976 156130 1398030 1497758 -99728 5662618 4006238 1656380 3148847 1008924 2139923 3852705 STATE STREET INVESTMENTS 8697357 F 8697357 PAYABLES TO AFFILIATES 443572 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 936223 1379795 X 37978083 -53609 -53609 38031692 3960945 3960945 41992637 35666569 1 1 35666568 3860945 3860945 39527513 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAX ON ITS RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. MANAGEMENT IS NOT AWARE OF ANY UNCERTAINTIES IN INCOME TAX POSITIONS. TAX YEARS ENDING ON AND BEFORE DECEMBER 31, 2008, ARE NOT SUBJECT TO EXAMINATION BY TAXING AUTHORITIES. PART XI, LINE 4B - OTHER ADJUSTMENTS: RESTR DONATIONS RECORDED IN TEMP REST NET ASSETS FOR BKS; REV FOR TAX 100,000. BAD DEBT NET WITH PATIENT SERVICE REVENUE PER BOOKS 3,860,945. ROUNDING PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NETTED WITH PATIENT SERVICE REVENUE PER BOOKS 3,860,945. 1 1 X 1 X 133.000000000000 1 X 1 1 0 0 727868 727868 0.02040 5452368 5312252 140116 0.00390 6180236 5312252 867984 0.02430 40844 40844 0.00110 296 296 0.00000 4214599 3745888 468711 0.01310 28204 320 27884 0.00080 4283943 3746208 537735 0.01500 10464179 9058460 1405719 0.03930 3788 3788 0.00010 1160 1160 0.00000 4948 4948 0.00010 0 3860945 16422717 16503181 -80464 X 1 1 1 1 HEDRICK MEDICAL CENTER 100 CENTRAL ST CHILLICOTHE MO 64601 422-18 X X X X HEDRICK MEDICAL CENTER 1 1 X X X X X X X X X 13 1 0 1 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X X X X X X X 1 0 1 1 133.000000000000 1 200.000000000000 1 X X X 1 1 X X X X 1 0 X X X X 1 X 0 0 HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 3: KEY COMMUNITY STAKEHOLDERS WERE CONTACTED EITHER IN-PERSON, OVER-THE-PHONE, OR DURING MONTHLY COMMUNITY WELLNESS COMMITTEE MEETINGS WITH HOSPITAL EXECUTIVES AND REPRESENTATIVES FROM COMMUNITY ORGANIZATIONS; THEY INCLUDE:EXECUTIVE LEADERS OF HEDRICK MEDICAL CENTERLIVINGSTON COUNTY HEALTH CENTERLIVINGSTON COUNTY COMMISSIONSALT (SIMPLY ACHIEVING LIFE'S TRIUMPHS) MEN'S HOMELESS SHELTERCHILLICOTHE FIRE DEPARTMENTRSVPYMCAFAMILY SUPPORT DIVISIONNORTH CENTRAL MISSOURI MENTAL HEALTHAREA AGENCY ON AGINGC2000FIRST STEPSSALT/ALCOHOLICS ANONYMOUSPREFERRED FAMILY HEALTHCARE, INC.UNIVERSITY OF MISSOURI EXTENSIONNORTH CENTRAL MISSOURI CHILDREN'S ADVOCACY CENTERCHILLICOTHE CORRECTIONAL CENTERACCESS IICHILLICOTHE HOUSING AUTHORITYPREFERRED FAMILY HEALTHCARESOCIAL SECURITY ADMINISTRATION HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 14G: THE HOSPITAL FOLLOWS THE SAINT LUKE'S HEALTH SYSTEM POLICIES FOR UNINSURED. THE HOSPITAL PROVIDES EDUCATION ON FINANCIAL ASSISTANCE ELIGIBILITY TO PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES THROUGH MANY SOURCES INCLUDING THE SLHS WEB SITE, INFORMATION ON BILLING STATEMENTS, INFORMATION UPON CHECK-IN LOCATED IN THE ADMITTING PATIENT PACKETS, ON OUR B-131 RELEASE TO TREAT FORMS SIGNED BY ALL PATIENTS REQUESTING SERVICES, AND VISITS BY SOCIAL WORKER TEAMS WHEN AN INPATIENT AS WELL AS FOLLOW UP CALLS AFTER DISCHARGE. FINANCIAL ASSISTANCE OR MEDICAID APPLICATIONS ARE REQUESTED ON ALL UNINSURED PATIENTS PRIOR TO DISCHARGE.THE HOSPITAL ALSO CONTRACTS WITH ELIGIBILITY ENROLLMENT SERVICE COMPANIES TO SCREEN ALL UNINSURED PATIENTS, ANY PATIENT IDENTIFIED BY A SOCIAL WORKER OR CASE MANAGER, AS WELL AS ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR MEDICAID OR OTHER GOVERNMENT COVERAGE. HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 18E: SEE RESPONSE TO LINE 14G PART V, SECTION B, LINE 6 AS PERMITTED BY IRS TRANSITION RULES, THE ORGANIZATION ADOPTED ITS IMPLEMENTATION STRATEGY BY MAY 15, 2014 AND THEREFORE IS DEEMED TO SATISFY THE REQUIREMENT TO ADOPT THE STRATEGY IN THE SAME YEAR THE CHNA WAS COMPLETED AND WIDELY AVAILABLE, 2013. 3 HEDRICK FAMILY CARE 861 FAIRWAY DRIVE CHILLICOTHE MO 64601 RURAL HEALTH CLINIC HMC REHAB 1422 NORTH WASHINGTON SUITE A CHILLICOTHE MO 64601 RURAL REHABILITATION CLINIC NORTH MISSOURI MEDICAL CLINIC 530 PARK LANE CHILLICOTHE MO 64601 RURAL HEALTH CLINIC PART I, LINE 7: COST OF CHARITY CARE AND UNREIMBURSED HEALTH SERVICES WERE CALCULATED USING THE APPROPRIATE COST TO CHARGE RATIO FROM THE HOSPITAL'S COST REPORT. PART I, LN 7 COL(F): TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) OF $39,527,513 LESS BAD DEBT EXPENSE OF $3,860,945 EQUALS TOTAL EXPENSE OF $35,666,568 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: THE ORGANIZATION IS INVOLVED IN SEVERAL COMMUNITY ORGANIZATIONS THAT ARE DEDICATED TO THE IMPROVEMENT OF LIFE IN THE COMMUNITY THROUGH PHYSICAL IMPROVEMENTS AND HOUSING. THE ORGANIZATION HELPS SUPPORT HABITAT FOR HUMANITY THROUGH DONATIONS OF TIME BY EMPLOYEES AND MONETARY NEEDS. MANY OF OUR EMPLOYEES PARTICIPATE IN LOCAL ORGANIZATIONS AND CHURCH GROUPS THAT ARE WORKING TO HELP THE COMMUNITY GROW AND BE BETTER. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE MEDICAL CENTER ANALYZES ITS PAST HISTORY AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES OF REVENUE TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND PROVISION FOR BAD DEBTS. MANAGEMENT REGULARLY REVIEWS DATA ABOUT THESE MAJOR PAYOR SOURCES OF REVENUE IN EVALUATING THE SUFFICIENCY OF THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE, THE MEDICAL CENTER ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS, IF NECESSARY (FOR EXAMPLE, FOR EXPECTED UNCOLLECTIBLE DEDUCTIBLES AND COPAYMENTS ON ACCOUNTS FOR WHICH THE THIRD-PARTY PAYOR HAS NOT YET PAID, OR FOR PAYORS WHO ARE KNOWN TO BE HAVING FINANCIAL DIFFICULTIES THAT MAKE THE REALIZATION OF AMOUNTS DUE UNLIKELY). FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS (WHICH INCLUDES BOTH PATIENTS WITHOUT INSURANCE AND PATIENTS WITH DEDUCTIBLE AND COPAYMENT BALANCES DUE FOR WHICH THIRD-PARTY COVERAGE EXISTS FOR PART OF THE BILL), THE MEDICAL CENTER RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. THE DIFFERENCE BETWEEN THE STANDARD RATES (OR THE DISCOUNTED RATES IF NEGOTIATED) AND THE AMOUNTS ACTUALLY COLLECTED AFTER ALL REASONABLE COLLECTION EFFORTS HAVE BEEN EXHAUSTED IS CHARGED OFF AGAINST THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS.BAD DEBT IS RECORDED CONSISTENT WITH FINANCIAL STATEMENTS. PART III, LINE 9B: IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE ACCOUNT IS ADJUSTED ACCORDINGLY. ANY REMAINING BALANCE IS COLLECTED UNDER THE DEBT COLLECTION POLICY. OUR COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. ALTHOUGH WE ARE NOT LEGALLY BOUND BY THE FAIR DEBT COLLECTION PRACTICES ACT, THE PRINCIPLES ADDRESSED ARE GENERALLY FOLLOWED. PART VI, LINE 2: THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, ANNUAL STRATEGIC PLANNING PROCESS. WE INVITE COMMUNITY FEEDBACK. WE ALSO SEND PATIENT SATISFACTION SURVEYS TO OUR PATIENTS TO MEASURE HOW WE ARE MEETING THEIR NEEDS. PART VI, LINE 3: SEE RESPONSE TO PART V, LINE 14G. PART VI, LINE 4: HEDRICK MEDICAL CENTER IS LOCATED IN CHILLICOTHE, MISSOURI. THE HOSPITAL IS WITHIN AN 90 MILE DRIVE OF THE KANSAS CITY METROPOLITAN AREA. THE CITY OF CHILLICOTHE POPULATION IS 8,968, WHILE LIVINGSTON COUNTY (THE COUNTY THE HOSPITAL IS LOCATED) POPULATION IS 14,558. THE MEDIAN AGE IS 39.7 AND MEDIAN HOSEHOLD INCOME IS $32,793. PERSONS 65 YEARS OLD AND OVER MAKE UP 19% OF THE POPULATION WITH 23% OF THE POPULATION UNDER 18 YEARS OF AGE. PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSISTS OF 10 AREA HOSPITALS AND SEVERAL PRIMARY AND SPECIALTY CARE PRACTICES, AND PROVIDES A RANGE OF INPATIENT, OUTPATIENT, AND HOME CARE SERVICES. FOUNDED AS A FAITH-BASED, NOT-FOR-PROFIT ORGANIZATION, OUR MISSION INCLUDES A COMMITMENT TO THE HIGHEST LEVELS OF EXCELLENCE IN HEALTH CARE AND THE ADVANCEMENT OF MEDICAL RESEARCH AND EDUCATION. THE HEALTH SYSTEM IS AN ALIGNED ORGANIZATION IN WHICH THE PHYSICIANS AND HOSPITALS ASSUME RESPONSIBILITY FOR ENHANCING THE PHYSICAL, MENTAL, AND SPIRITUAL HEALTH OF PEOPLE IN THE METROPOLITAN KANSAS CITY AREA AND THE SURROUNDING REGION. 1 WRIGHT MEMORIAL HOSPITAL FOUNDATION 191 IOWA BLVD TRENTON MO 64683 562548994 501(C)(3) 5300 DONATION FOR WALKING TRAIL CHILLICOTHE EDUCATION FOUNDATION PO BOX 530 CHILLICOTHE MO 64601 341573983 501(C)(3) 8334 SUPPORT FOR CHILLICOTHE SCHOOLS 2 0 PART I, LINE 2: GRANTS ARE PROVIDED TO QUALIFIED CHARITIES FOR GENERAL OPERATIONS AND TO BE USED IN FULFILLING THE EXEMPT PURPOSE OF THE GRANTEE CHARITABLE ORGANIZATION. SUCH GRANTS FURTHER OR SUPPORT A CHARITABLE PURPOSE OF THE ORGANIZATION. 0 0 0 0 0 0 0 1 0 DON SIPES DIRECTOR-PRESIDENT 0 252783 0 44550 0 37467 0 39677 0 19151 0 393628 0 19889 DELOS CLOW DIRECTOR & EMPLOYED PHYSIC 280777 0 0 0 2242 0 11475 0 17301 0 311795 0 0 0 CYNTHIA CHRISTENSEN DIRECTOR-TREASURER 0 197500 0 35975 0 29087 0 40400 0 4701 0 307663 0 20443 JAMES SUCHSLAND DIRECTOR & EMPLOYED PHYSIC 194918 0 40000 0 1114 0 4729 0 7283 0 248044 0 0 0 MATT WENZEL CEO 184335 0 44996 0 1719 0 25749 0 22345 0 279144 0 12376 0 JANET BUCKMAN CFO 168270 0 15378 0 1095 0 7484 0 9117 0 201344 0 0 0 CHRISTOPHER HULETT PHYSICIAN 296839 0 0 0 98 0 2575 0 14193 0 313705 0 0 0 GREGORY MILLER PHYSICIAN 380571 0 0 0 948 0 10200 0 20966 0 412685 0 0 0 JASON GAULT PHYSICIAN 352416 0 0 0 25913 0 10200 0 21733 0 410262 0 0 0 YULIA PENISTON PHYSICIAN 256032 0 0 0 20677 0 10200 0 20873 0 307782 0 0 0 PART I, LINE 7 THE ORGANIZATION HAS ADOPTED A MANAGEMENT INCENTIVE COMPENSATION PLAN FOR CERTAIN MEMBERS OF SENIOR AND MIDDLE MANAGEMENT TO PROMOTE EFFECTIVE MANAGEMENT OF OPERATIONS, QUALITY OF CARE AND SERVICE, AND OPTIMAL USE OF RESOURCES. THE INCENTIVES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY CONTINGENT ON ACHIEVING QUALITY, PATIENT SATISFACTION, EMPLOYEE RETENTION, FINANCIAL AND OTHER OPERATIONAL PERFORMANCE TARGETS ESTABLISHED BY THE BOARD'S COMPENSATION COMMITTEE ON AN ANNUAL BASIS. INCENTIVE AWARDS ARE PAID AT THE DISCRETION OF THE BOARD OF DIRECTORS AND DO NOT ACCRUE TO THE BENEFIT OF THE INDIVIDUALS UNTIL AFTER FINANCIAL RESULTS HAVE BEEN DETERMINED FOR THE CALENDAR YEAR. THIS INCENTIVE COMPENSATION IS EVALUATED AS PART OF THE REVIEW OF MARKET COMPETITIVE DATA AND REASONABLENESS OF OVERALL COMPENSATION AND BENEFITS. SCHEDULE J, PART II DON SIPES AND CYNTHIA CHRISTENSEN DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. COMPENSATION REPORTED FOR BOARD MEMBERS IS FOR PHYSICIAN SERVICES RENDERED TO THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED. GREGORY MILLER MD HIGHEST COMPENSATED EMPLOYEE RECRUITMENT LOAN DURING FAMILY PRACTICE RESIDENCY X 65803 10439 0 1 1 10439 JEANNA SUCHSLAND JEANNA SUCHSLAND AND DIRECTOR, JAMES SUCHSLAND ARE FAMILY MEMBERS 29406 JEANNY SUCHSLAND IS EMPLOYED BY THE ORGANIZATION 0 FORM 990, PART VI, SECTION A, LINE 2 DON SIPES AND CYNTHIA CHRISTENSEN HAVE A BUSINESS RELATIONSHIP BECAUSE DON SIPES IS AN OFFICER AND CYNTHIA CHRISTENSEN IS A HIGHEST COMPENSATED EMPLOYEE OF THE SOLE CORPORATE MEMBER, SAINT LUKE'S HEALTH SYSTEM, A 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS SAINT LUKE'S HEALTH SYSTEM, A 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY IS ELECTED BY THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS SPECIFIED RESERVE POWERS OVER MAJOR DECISIONS SUCH AS AMENDMENTS TO ARTICLES AND BYLAWS, DEBT, BUDGETS, CAPITAL EXPENDITURES AND STRATEGIC OPERATING DECISIONS. AS PART OF AN INTEGRATED HEALTH SYSTEM, THE SOLE MEMBER ALSO PROVIDES VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED JOINTLY BY ACCOUNTING STAFF OF THE ENTITY AND SAINT LUKE'S HEALTH SYSTEM (SYSTEM) TAX STAFF. THE RETURN IS REVIEWED BY THE ENTITY'S CFO OR CEO BEFORE FILING. THE 990 DRAFT WAS ALSO PRESENTED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS PRIOR TO FILING. THE 990 IS PROVIDED TO THE ORGANIZATION'S BOARD MEMBERS BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C SAINT LUKE'S HEALTH SYSTEM AND ITS AFFILIATES, INCLUDING THE FILING ORGANIZATION, HAVE COMPREHENSIVE WRITTEN CONFLICT OF INTEREST POLICIES APPLICABLE TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES. ANY ACTUAL, POSSIBLE OR PERCEIVED CONFLICT OF INTEREST IS EXPECTED TO BE HANDLED THROUGH FULL AND TIMELY DISCLOSURE OF ANY SUCH INTEREST, TOGETHER WITH ABSENCE OF PERSUASION IN ANY DISCUSSION AND IN ANY VOTE WHEREIN THE INTEREST IS INVOLVED. DISCLOSURE IS TO BE MADE WHEN THE INTEREST ARISES, AT ANY TIME THE INTEREST BECOMES A MATTER OF GOVERNING BOARD ACTION, AND THEN ANNUALLY THROUGH COMPLETION OF A CONFLICT OF INTEREST QUESTIONNAIRE. THE SYSTEM VICE PRESIDENT OF INTERNAL AUDIT OR THE SYSTEM VICE PRESIDENT OF HUMAN RESOURCES REVIEWS COMPLETED QUESTIONNAIRES AND FURTHER INVESTIGATES POSSIBLE CONFLICTS OF INTEREST. A REPORT IS PROVIDED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS AND ANY IDENTIFIED CONFLICT OF INTEREST IS REPORTED TO THE APPLICABLE ENTITY. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE SAINT LUKE'S HEALTH SYSTEM BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS, DISCUSSES, SETS AND APPROVES COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT EXECUTIVE AND CFO. INDEPENDENT, EXTERNAL DIRECTORS SERVE ON THE COMPENSATION COMMITTEE. AN INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY PROVIDES A WRITTEN REPORT AND REASONABLENESS OPINION. THE CONSULTANT REVIEWS THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY AND ANALYZES MARKET COMPETITIVENESS (IN TOTAL AND BY EACH COMPENSATION AND BENEFIT ELEMENT) FOR THE EXECUTIVES USING APPROPRIATE COMPARABILITY DATA. COMPENSATION COMMITTEE ACTIONS ARE CONTEMPORANEOUSLY DOCUMENTED. THE PROCESS SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE. COMPENSATION FOR OFFICERS NOT REVIEWED BY THE COMPENSATION COMMITTEE IS SET/APPROVED ANNUALLY BY SAINT LUKE'S HEALTH SYSTEM EXECUTIVE MANAGEMENT BASED ON MARKET COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION AND AMENDMENTS THERETO ARE MADE AVAILABLE TO THE PUBLIC BY THE FILING OF THOSE DOCUMENTS WITH THE MO SECRETARY OF STATE. ALSO, THE ORGANIZATION IS INCLUDED WITHIN THE COMBINED FINANCIAL STATEMENTS OF SAINT LUKE'S HEALTH SYSTEM INC THAT ARE MADE AVAILABLE TO THE PUBLIC BY THE POSTING OF THOSE DOCUMENTS THROUGH EMMA AND ARE ATTACHED TO THIS RETURN. THE ORGANIZATION'S OTHER GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART VII DON SIPES AND CYNTHIA CHRISTENSEN DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. COMPENSATION REPORTED FOR BOARD MEMBERS IS FOR SERVICES AS EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED. FORM 990, PART IX, LINE 11G PHYSICIAN REMUNERATION: PROGRAM SERVICE EXPENSES 3,093,015. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,093,015. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 477,653. MANAGEMENT AND GENERAL EXPENSES 178,295. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 655,948. OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,640,581. MANAGEMENT AND GENERAL EXPENSES 248,260. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,888,841. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 491,779. MANAGEMENT AND GENERAL EXPENSES 132,231. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 624,010. FORM 990, PART XI, LINE 9: PENSION LIABILITY TRANSFER TO SLHS -75,170. UNREALIZED GAIN INVESTMENTS ROUNDING PART V, LINE 1A, NUMBER REPORTED IN BOX 3 OF FORM 1096 HEDRICK MEDICAL CENTER (HMC) IS PART OF SAINT LUKE'S HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM. THE MAJORITY OF HMC VENDORS ARE PAID THROUGH A CENTRALIZED PAYMENT SYSTEM WITH 1099S ISSUED BY THE CENTRALIZED SERVICE ENTITY. ST LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 HEALTH CARE MO 501(C)(3) 170B1AIII 0 SAINT LUKE'S HEALTH SYSTEM 901 E 104TH ST KANSAS CITY MO 64131 431747502 HEALTH SYSTEM KS 501(C)(3) 509(A)(3) - TYPE 1 ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKE'S NORTHLAND HOSPITAL CORPORATION 601 S 169 HWY SMITHVILLE MO 64089 440545393 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S SOUTH HOSPITAL INC 12300 METCALF AVE OVERLAND PARK KS 66213 481203262 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S EAST HOSPITAL 100 NE SAINT LUKES BLVD LEES SUMMIT MO 64086 562488077 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S MEDICAL GROUP 6750 ANTIOCH STE 210 SHAWNEE MISSION KS 66204 431598353 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 CRITTENTON 10918 ELM AVENUE KANSAS CITY MO 64134 440545808 HEALTH CARE MO 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKE'S HEALTH SYSTEM HOME CARE AND HOSPICE 3100 BROADWAY STE 1000 KANSAS CITY MO 64111 431127200 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 ST LUKE'S OF TRENTON 191 IOWA BLVD TRENTON MO 64683 431707306 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S HOSPITAL OF GARNETT 421 SOUTH MAPLE GARNETT KS 66032 742849611 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 CABOT WESTSIDE HEALTH CENTER 901 E 104TH ST KANSAS CITY MO 64131 440546280 HEALTH CARE MO 501(C)(3) 170B1AVI SAINT LUKE'S HEALTH SYSTEM 0 MIDWEST EAR INSTITUTE INC 4200 PENNSYLVANIA STE 100 KANSAS CITY MO 64111 480905027 HEALTH CARE KS 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKES CUSHING HOSPITAL 711 MARSHALL LEAVENWORTH KS 66048 480543792 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S CARE 901 E 104TH ST KANSAS CITY MO 64131 260185090 HEALTH CARE MO 501(C)(3) 509(A)(3) - TYPE 1 SAINT LUKE'S HEALTH SYSTEM 0 MEDICAL PLAZA IMAGING ASSOCIATES LLC 4401 WORNALL ROAD KANSAS CITY MO 64111 431609584 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S COLLEGE OF HEALTH SCIENCES 624 WESTPORT ROAD KANSAS CITY MO 64111 272716128 POST-SECONDARY NURSING EDUCATION MO 501(C)(3) 170B1AII ST LUKES HOSPITAL OF KANSAS CITY 0 SLCC INC 4330 WORNALL RD SUITE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SLNC INC 4401 WORNALL ROAD KANSAS CITY MO 64111 451470888 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL RD STE 410 KANSAS CITY MO 64111 431357824 OWN & OPERATE MEDICAL OFFICE BUILDING MO N/A ST LUKES SURGICENTER-LEE'S SUMMIT LLC 11221 ROE AVE STE 230 OVERLAND PARK KS 66211 470853481 HEALTH CARE MO N/A SAINT LUKES SOUTH SURGERY CENTER LLC 11221 ROE AVE STE 230 OVERLAND PARK KS 66211 201721929 HEALTH CARE KS N/A FAMILY ADVOCATES LLC 10918 ELM AVENUE KANSAS CITY MO 64134 202739036 FOSTER CARE MO N/A SAINT LUKE'S CARDIOLOGY SERVICES LLC 901 E 104TH ST KANSAS CITY MO 64131 263726426 HEALTH CARE MO N/A SAINT LUKE'S -GI DIAGNOSTICS LLC 4321 WASHINGTON SUITE 5700 KANSAS CITY MO 64111 274142549 HEALTH CARE MO N/A SAINT LUKE'S HEALTH SYSTEM RISK RETENTION GROUP 901 E 104TH ST KANSAS CITY MO 64131 371471890 INSURANCE SC N/A C 0 ST LUKE'S HEALTH VENTURES INC 901 E 104TH ST KANSAS CITY MO 64131 431278476 ACCOUNTING MO N/A C 0 MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL ROAD STE 410 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A C 0 VENTURE FINANCIAL SERVICES INC 9500 E 63RD STREET STE 202 RAYTOWN MO 64133 431605740 COLLECTIONS MO N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 1 SCHEDULE R, PART V, ITEM 1, TRANSACTIONS WITH RELATED ORGANIZATIONS SAINT LUKE'S HEALTH SYSTEM (SYSTEM) AND ITS AFFILIATED ENTITIES OPERATE AS A HIGHLY INTEGRATED HEALTH CARE DELIVERY SYSTEM. THE SYSTEM MANAGES AND OPERATES RELATED HOSPITALS AND THEIR AFFILIATES AS A COMMON MISSION ORIENTED HEALTH CARE SYSTEM IN ORDER TO BETTER SERVE THE HEALTH-RELATED NEEDS OF GREATER KANSAS CITY AND SURROUNDING AREAS. AS A RESULT, THERE ARE NUMEROUS INTERCOMPANY INTERACTIONS INCLUDING CENTRALIZED SUPPORT SERVICES AND SHARING OF RESOURCES AND COSTS.