2013-11-14T16:53:24-06:00 2012-12-31 990 2012-01-01 431735565 SAINT LUKE'S HOSPITAL OF CHILLICOTHE SAIN 6606461480 100 CENTRAL STREET CHILLICOTHE MO 64601 MATT WENZEL 6606461480 2013-11-14 2012 2016-02-24 21:20:13Z HEDRICK MEDICAL CENTER MATT WENZEL 100 CENTRAL STREET CHILLICOTHE MO 64601 43162816 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1888 MO CRITICAL ACCESS HOSPITAL 11 7 347 62 0 0 126745 100734 37656413 43030296 461099 31786 0 0 38244257 43162816 41689 33812 0 0 17798451 17277804 0 0 0 18801560 21696970 36641700 39008586 1602557 4154230 24413957 28738496 2595226 2635855 21818731 26102641 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 34077074 33812 43030296 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. 34077074 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 0 0 0 0 0 0 0 1 0 0 0 1 43 0 1 347 1 0 0 0 0 0 0 0 0 0 0 X 11 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 100 CENTRAL STREET CHILLICOTHE MO 64601 X MICHAEL PALMER 1.00 X X 0 0 0 DON SIPES 1.00 50.00 X X 0 339041 55262 DARREL RINEHART 1.00 X 0 0 0 ROLLIE STADLMAN 1.00 X X 0 0 0 DELOS CLOW 40.00 X 281859 0 31364 JANE NEAL 1.00 X 0 0 0 CHRISTOPHER HULETT TERMED 912 1.00 X 131375 0 1336 CYNTHIA CHRISTENSEN 1.00 50.00 X X 0 267955 45110 BETTY PRESTON-STEELE 1.00 X X 0 0 0 CAROL SLOAN 1.00 X 0 0 0 DONALD METRY 1.00 X 37485 0 0 JAMES SUCHSLAND 1.00 X 0 0 0 TERRY PLASTER 40.00 X 47127 0 11422 MATT WENZEL 40.00 X 212324 0 43669 JANET BUCKMAN 40.00 X 176061 0 15699 CATHERINE HAMILTON 40.00 X 110370 0 21975 GREGORY MILLER 40.00 X 316373 0 29078 SALWAT SHAMI 40.00 X 124323 0 17273 JENNA GIBSON 40.00 X 127703 0 25555 JASON GAULT 40.00 X 360277 0 30247 YULIA VAKSMAN 40.00 X 280168 0 19023 2205445 606996 347013 10 0 1 0 EMS LLC 920 MAIN STREET SUITE 300 KANSAS CITY MO 64105 ER PHYSICIANS 1803888 HAVE A NICE DAY ANESTHESIA ASSOCIATES 2106 WOODCREST CHILLICOTHE MO 64601 ANESTHESIA SERVICES 793448 SHARED MEDICAL SERVICES PO BOX 330 COTTAGE GROVE WI 53527 READS MRI SCANS 286125 CPSI PO BOX 850309 6600 WALL ST MOBILE AL 36685 SOFTWARE SYSTEM SETUP AND SERVICE 282067 WEATHERBY LOCUMS 6451 NORTH FEDERAL HIGHWAY SUITE 8 FT LAUDERDALE FL 33308 TEMP HELP 228586 7 47795 52939 100734 NET PATIENT REVENUE 622110 41056739 41056739 EHR MEANINGFUL USE FDS 622110 1275540 1275540 PATIENT REHAB SERVICES 622210 413731 413731 RENT FROM AFFILIATES 531120 100756 100756 CAFETERIA SALES 622110 86904 86904 96626 96626 43030296 31786 31786 43162816 43030296 0 31786 X 33812 33812 1084579 445932 638647 12326133 11770755 555378 204459 186255 18204 2759177 2513513 245664 903456 823017 80439 324233 324233 85782 85782 6158091 5574793 583298 18295 4328 13967 1263281 1126613 136668 106062 74818 31244 1855036 1745094 109942 162782 132649 30133 78838 1893 76945 1539552 1267898 271654 250651 109901 140750 BAD DEBTS 3932198 3932198 MEDICAL SUPPLIES 3758222 3755064 3158 SHARED SERVICES-SLHS 1990461 495320 1495141 DUES & SUBSCRIPTIONS 94697 36995 57702 78789 46226 32563 39008586 34077074 4931512 0 6717888 10136484 2271663 965281 6384313 5239537 38279 33870 527482 495658 259164 179591 8138200 5241314 3685835 2896886 4341023 8514202 178416 59506 9894 217481 24413957 28738496 2221780 2039974 373446 595881 2595226 2635855 X 21818731 26102641 21818731 26102641 24413957 28738496 X 4154230 129680 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 8110 0 0 0 8110 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LINE F - PORTION OF DUES PAID TO VARIOUS HOSPITAL AND MEDICAL ASSOCIATIONS USED TOWARD LOBBYING ACTIVITIES. 1398030 1176143 221887 5470460 3354956 2115504 1269710 710215 559495 2896886 STATE STREET INVESTMENTS 8514202 F 8514202 PAYABLES TO AFFILIATES 243375 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 352506 595881 X 39392643 0 39392643 3770173 3770173 43162816 35076273 0 35076273 3932313 3932313 39008586 DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: 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: RISK RETENTION GROUP SUBSCRIBER SAVINGS ACCOUNT DIVIDEND 11,042. EXPENSES RECORDED IN OTHER INCOME 115. UNREALIZED GAINS ON INVESTMENTS -173,180. BAD DEBT NETTED WITH PATIENT SERVICE REVENUE PER BOOKS 3,932,198. ROUNDING -2. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING PART XII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES RECORDED IN OTHER INCOME 115. BAD DEBT NETTED WITH PATIENT SERVICE REVENUE PER BOOKS 3,932,198. 1 1 X 1 X 133.000000000000 1 X 1 1 1 0 0 756919 756919 0.02160 7021014 6885659 135355 0.00390 7777933 6885659 892274 0.02550 8214 8214 0.00020 4288311 3807218 481093 0.01370 45900 45900 0.00130 4342425 3807218 535207 0.01520 12120358 10692877 1427481 0.04070 0 3932198 15432198 15350602 81596 X 1 1 1 1 HEDRICK MEDICAL CENTER

100 CENTRAL ST CHILLICOTHE MO 64601

X X X X HEDRICK MEDICAL CENTER 1 1 1 133.000000000000 1 200.000000000000 1 X X X 1 1 X X X 1 0 1 X 0 0 2 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 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, L7 COL(F): TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) OF $39,008,585 LESS BAD DEBT EXPENSE OF $3,938,719 EQUALS TOTAL EXPENSE OF $35,069,866 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART II: 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 2, BAD DEBT BAD DEBT EXPENSE IS REPORTED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT IT ALIGNS WITH GAAP. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR UNCOLLECTIBLE ACOCUNTS. 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 WOULD BE 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. HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 14G: THE HOSPITAL FOLLOWS THE SAINT LUKE'S HEALTH SYSTEM POLICIES FOR UNINSURED. IN ADDITION TO THESE POLICIES, 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. 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 11 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 YMCA 1725 LOCUST STREET CHILLICOTHE MO 64601 431493664 501(C)(3) 12000 DONATION FOR THE YMCA BUILDING FUND AND OTHER CONTRIBUTIONS. CHILLICOTHE EDUCATION FOUNDATION PO BOX 530 CHILLICOTHE MO 64601 431624183 501(C)(3) 8333 DONATION FOR JERRY LITTON MEMORIAL STADIUM. 2 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE PROVIDED TO QUALIFIED 501(C)(3) CHARITIES. ALL DONEE INFORMATION IS KEPT AS PART OF THE ORGANIZATION'S BOOKS AND RECORDS. 0 0 0 0 0 0 0 1 0 DON SIPES 0 235195 0 66841 0 37005 0 37870 0 17392 0 394303 0 17999 DELOS CLOW 234934 0 45000 0 1925 0 11250 0 20114 0 313223 0 0 0 CYNTHIA CHRISTENSEN 0 189000 0 53358 0 25597 0 39300 0 5810 0 313065 0 15500 MATT WENZEL 169384 0 41604 0 1336 0 23704 0 19965 0 255993 0 0 0 JANET BUCKMAN 154780 0 20447 0 834 0 7131 0 8568 0 191760 0 0 0 GREGORY MILLER 170131 0 145572 0 670 0 10000 0 19078 0 345451 0 0 0 JENNA GIBSON 123926 0 3060 0 717 0 5951 0 19604 0 153258 0 0 0 JASON GAULT 295881 0 63561 0 835 0 10000 0 20247 0 390524 0 0 0 YULIA VAKSMAN 254743 0 24789 0 636 0 4766 0 14257 0 299191 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. THIS INCENTIVE COMPENSATION IS EVALUATED AS PART OF THE REVIEW OF MARKET COMPETITIVE DATA AND REASONABLENESS OF OVERALL COMPENSATION AND BENEFITS. SUPPLEMENTAL INFORMATION PART III 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 DIRECTOR RECRUITMENT LOAN DURING FAMILY PRACTICE RESIDENCY X 65803 24359 0 1 1 JASON GAULT MD HIGHEST COMPENSATE RECRUITMENT LOAN DURING GENERAL SURGERY RESIDENCY X 37067 9511 0 1 1 33870 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 FOR REVIEW PRIOR TO FILING. THE 990 WAS 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 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. 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. OTHER FEES FORM 990, PART IX, LINE 11G PHYSICIAN REMUNERATION: PROGRAM SERVICE EXPENSES 3,120,051. MANAGEMENT AND GENERAL EXPENSES 150. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,120,201. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 421,671. MANAGEMENT AND GENERAL EXPENSES 152,423. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 574,094. OTHER SERVICES: PROGRAM SERVICE EXPENSES 2,033,071. MANAGEMENT AND GENERAL EXPENSES 430,725. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,463,796. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: RISK RETENTION GROUP SUBSCRIBER SAVINGS ACCOUNT DIVIDEND -11,042. PENSION LIABILITY TRANSFER TO SLHS -32,459. UNREALIZED GAIN INVESTMENTS 173,180. ROUNDING 1. NUMBER REPORTED IN BOX 3 OF FORM 1096 PART V, LINE 1A 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 10920 ELM AVENUE KANSAS CITY MO 64134 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 2121 SUMMIT KANSAS CITY MO 64108 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 CUSHING MEMORIAL HOSPITAL CORPORATION 711 MARSHALL LEAVENWORTH KS 66048 480543792 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S CANCER INSTITUTE LLC 4323 WORNALL ROAD PEET KANSAS CITY MO 64111 431933950 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S CARE 10920 ELM AVENUE KANSAS CITY MO 64134 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 APPLIED FOR 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 MEDICAL PARK ASSOCIATES A LP 601 S 169 HWY SMITHVILLE MO 64089 431311049 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 10920 ELM AVENUE KANSAS CITY MO 64134 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 10920 ELM AVENUE KANSAS CITY MO 64134 371471890 INSURANCE SC N/A C 0 ST LUKE'S HEALTH VENTURES INC 4320 WORNALL ROAD STE 410 KANSAS CITY MO 64111 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 SPELMAN DEVELOPMENT CORPORATION 601 S 169 HWY SMITHVILLE MO 64089 431296007 MEDICAL OFFICE BUILDING RENTALS MO N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 TRANSACTIONS WITH RELATED ORGANIZATIONS SCHEDULE R, PART V, ITEM 1 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.