LUTHERAN MEDICAL CENTER PROFESSIONAL &: Form 990, tax year 2012
View the entire original 990 at ProPublica ↗
- Organization
- LUTHERAN MEDICAL CENTER PROFESSIONAL & (EIN 74-2571584)
- Tax period
- 2012-01-01 to 2012-12-31
- Filed
- 2013-11-14
- IRS object ID
- 201303189349308035
- Schema version
- 2012v2.1
- Source
- Download XML · Original 990 at ProPublica
Every field in the e-filed return. Faint text is the IRS element name, for citing.
Return header ReturnHeader
| Field | Value | IRS element (for citing) |
|---|---|---|
| Timestamp | 2013-11-14T18:51:46-06:00 | Timestamp |
| Tax Period End Date | 2012-12-31 | TaxPeriodEndDate |
Preparer Firm PreparerFirm
Preparer Firm Business Name PreparerFirmBusinessName
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | ERNST & YOUNG US LLP | BusinessNameLine1 |
Preparer Firm US Address PreparerFirmUSAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 178 SOUTH RIO GRANDE ST SUITE 400 | AddressLine1 |
| City | SALT LAKE CITY | City |
| State | UT | State |
| ZIP Code | 84101 | ZIPCode |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Return Type | 990 | ReturnType |
| Tax Period Begin Date | 2012-01-01 | TaxPeriodBeginDate |
Filer Filer
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 742571584 | EIN |
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | Lutheran Medical Center Professional | BusinessNameLine1 |
| Business Name Line2 | & General Liability Self-Insured Trust | BusinessNameLine2 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| In Care Of Name | % EXEMPLA C/O SHARON OWENS | InCareOfName |
| Name Control | LUTH | NameControl |
| Phone | 3034674145 | Phone |
US Address USAddress
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2480 W 26TH AVE | AddressLine1 |
| Address Line2 | Suite 200B | AddressLine2 |
| City | DENVER | City |
| State | CO | State |
| ZIP Code | 80211 | ZIPCode |
Officer Officer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name | ROBERT LADENBURGER | Name |
| Title | PRESIDENT/CEO | Title |
| Date Signed | 2013-11-13 | DateSigned |
Preparer Preparer
| Field | Value | IRS element (for citing) |
|---|---|---|
| Phone | 8013503300 | Phone |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Tax Year | 2012 | TaxYear |
| Build TS | 2016-02-24 21:20:13Z | BuildTS |
Form 990 IRS990
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Of Principal Officer Person | Robert Ladenburger | NameOfPrincipalOfficerPerson |
| Gross Receipts | 861898 | GrossReceipts |
| Group Return For Affiliates | false | GroupReturnForAffiliates |
| Organization501c3 | X | Organization501c3 |
| Web Site | www.exempla.org | WebSite |
| Type Of Organization Trust | X | TypeOfOrganizationTrust |
| Year Formation | 1999 | YearFormation |
| State Legal Domicile | CO | StateLegalDomicile |
| Activity Or Mission Description | PROVIDE INSURANCE COVERAGE FOR MEDICAL MALPRACTICE AND GENERAL LIABILITY CLAIMS FOR EXEMPLA INC. AND ITS AFFILIATED NON-PROFIT ORGANIZATIONS. | ActivityOrMissionDescription |
| Nbr Voting Members Governing Body | 9 | NbrVotingMembersGoverningBody |
| Nbr Independent Voting Members | 5 | NbrIndependentVotingMembers |
| Total Nbr Employees | 0 | TotalNbrEmployees |
| Total Nbr Volunteers | 5 | TotalNbrVolunteers |
| Total Gross UBI | 0 | TotalGrossUBI |
| Contributions Grants Prior Year | 0 | ContributionsGrantsPriorYear |
| Contributions Grants Current Year | 0 | ContributionsGrantsCurrentYear |
| Program Service Revenue Prior Year | 0 | ProgramServiceRevenuePriorYear |
| Program Service Revenue CY | 0 | ProgramServiceRevenueCY |
| Investment Income Prior Year | 134983 | InvestmentIncomePriorYear |
| Investment Income Current Year | 861898 | InvestmentIncomeCurrentYear |
| Other Revenue Prior Year | 0 | OtherRevenuePriorYear |
| Other Revenue Current Year | 0 | OtherRevenueCurrentYear |
| Total Revenue Prior Year | 134983 | TotalRevenuePriorYear |
| Total Revenue Current Year | 861898 | TotalRevenueCurrentYear |
| Grants And Similar Amnts Prior Year | 0 | GrantsAndSimilarAmntsPriorYear |
| Grants And Similar Amnts CY | 0 | GrantsAndSimilarAmntsCY |
| Benefits Paid To Members Prior Year | 0 | BenefitsPaidToMembersPriorYear |
| Benefits Paid To Members CY | 0 | BenefitsPaidToMembersCY |
| Salaries Etc Prior Year | 0 | SalariesEtcPriorYear |
| Salaries Etc Current Year | 0 | SalariesEtcCurrentYear |
| Total Prof Fundrsng Exp Prior Year | 0 | TotalProfFundrsngExpPriorYear |
| Total Prof Fundrsng Exp CY | 0 | TotalProfFundrsngExpCY |
| Total Fundrsng Exp Current Year | 0 | TotalFundrsngExpCurrentYear |
| Other Expense Prior Year | 22044 | OtherExpensePriorYear |
| Other Expenses Current Year | 58078 | OtherExpensesCurrentYear |
| Total Expenses Prior Year | 22044 | TotalExpensesPriorYear |
| Total Expenses Current Year | 58078 | TotalExpensesCurrentYear |
| Revenues Less Expenses Prior Year | 112939 | RevenuesLessExpensesPriorYear |
| Revenues Less Expenses CY | 803820 | RevenuesLessExpensesCY |
| Total Assets BOY | 14102165 | TotalAssetsBOY |
| Total Assets EOY | 14899289 | TotalAssetsEOY |
| Total Liabilities BOY | 576374 | TotalLiabilitiesBOY |
| Total Liabilities EOY | 0 | TotalLiabilitiesEOY |
| Net Assets Or Fund Balances BOY | 13525791 | NetAssetsOrFundBalancesBOY |
| Net Assets Or Fund Balances EOY | 14899289 | NetAssetsOrFundBalancesEOY |
| Mission Description | THE MISSION OF EXEMPLA, INC. IS TO FOSTER HEALING AND HEALTH FOR THE GREATER DENVER, COLORADO METROPOLITAN SERVICE AREA. THE LUTHERAN MEDICAL CENTER PROFESSIONAL & GENERAL LIABILITY SELF-INSURANCE TRUST PROVIDES INSURANCE COVERAGE FOR MEDICAL MALPRACTICE AND GENERAL LIABILITY CLAIMS FOR EXEMPLA INC. AND ITS AFFILIATED NON-PROFIT ORGANIZATIONS. | MissionDescription |
| Significant New Program Services | false | SignificantNewProgramServices |
| Significant Change | false | SignificantChange |
| Expense | 58078 | Expense |
| Grants | 0 | Grants |
| Revenue | 0 | Revenue |
| Description | THE LUTHERAN MEDICAL CENTER PROFESSIONAL & GENERAL LIABILITY SELF INSURANCE TRUST SERVES SOLELY AS AN INVESTMENT AND FINANCING VEHICLE FOR THE MANAGEMENT AND PAYMENT OF MEDICAL MALPRACTICE CLAIMS ON BEHALF OF EXEMPLA, INC. EXEMPLA, INC. IS A RELATED EXEMPT CORPORATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. | Description |
| Total Program Service Expense | 58078 | TotalProgramServiceExpense |
| Described In501 C3 | true | DescribedIn501C3 |
| Schedule B Required | false | ScheduleBRequired |
| Political Activities | false | PoliticalActivities |
| Lobbying Activities | false | LobbyingActivities |
| Subject To Proxy Tax | false | SubjectToProxyTax |
| Donor Advised Funds | false | DonorAdvisedFunds |
| Conservation Easements | false | ConservationEasements |
| Collections Of Art | false | CollectionsOfArt |
| Credit Counseling | false | CreditCounseling |
| Term Or Permanent Endowments | false | TermOrPermanentEndowments |
| Report Land Bldg Equip | false | ReportLandBldgEquip |
| Report Invest Oth Securities | false | ReportInvestOthSecurities |
| Report Prog Rel Invest | false | ReportProgRelInvest |
| Report Other Assets | false | ReportOtherAssets |
| Report Other Liabilities | false | ReportOtherLiabilities |
| Report Fin48 Footnote | false | ReportFin48Footnote |
| Independent Audit Financial Stmt | false | IndependentAuditFinancialStmt |
| Consolidated Audit Financial Stmt | true | ConsolidatedAuditFinancialStmt |
| School | false | School |
| Foreign Office | false | ForeignOffice |
| Foreign Activities | false | ForeignActivities |
| More Than5000 K To Organizations | false | MoreThan5000KToOrganizations |
| More Than5000 K To Individuals | false | MoreThan5000KToIndividuals |
| Professional Fundraising | false | ProfessionalFundraising |
| Fundraising Activities | false | FundraisingActivities |
| Gaming | false | Gaming |
| Hospital | false | Hospital |
| Grants To Organizations | false | GrantsToOrganizations |
| Grants To Individuals | false | GrantsToIndividuals |
| Schedule J Required | true | ScheduleJRequired |
| Tax Exempt Bonds | false | TaxExemptBonds |
| Excess Benefit Transaction | false | ExcessBenefitTransaction |
| Prior Excess Benefit Transaction | false | PriorExcessBenefitTransaction |
| Loan To Officer Or DQP | false | LoanToOfficerOrDQP |
| Grant To Related Person | false | GrantToRelatedPerson |
| Bsnss Rltnshp With Organization | false | BsnssRltnshpWithOrganization |
| Bsnss Rltnshp Thru Family Member | false | BsnssRltnshpThruFamilyMember |
| Officer Entity With Bsnss Rltnshp | false | OfficerEntityWithBsnssRltnshp |
| Deductible Non Cash Contributions | false | DeductibleNonCashContributions |
| Deductible Contributions Of Art | false | DeductibleContributionsOfArt |
| Terminated | false | Terminated |
| Partial Liquidation | false | PartialLiquidation |
| Disregarded Entity | false | DisregardedEntity |
| Related Entity | true | RelatedEntity |
| Related Org Controlled Entity | true | RelatedOrgControlledEntity |
| Transaction Related Entity | false | TransactionRelatedEntity |
| Transfers To Exempt Non Chrtbl Org | false | TransfersToExemptNonChrtblOrg |
| Activities Conducted Partnership | false | ActivitiesConductedPartnership |
| Schedule O Required | true | ScheduleORequired |
| Number Forms Transmitted With1096 | 0 | NumberFormsTransmittedWith1096 |
| Number W2 G Included | 0 | NumberW2GIncluded |
| Number Of Employees | 0 | NumberOfEmployees |
| Unrelated Business Income | false | UnrelatedBusinessIncome |
| Foreign Financial Account | false | ForeignFinancialAccount |
| Prohibited Tax Shelter Trans | false | ProhibitedTaxShelterTrans |
| Taxable Party Notification | false | TaxablePartyNotification |
| Non Deductible Contributions | false | NonDeductibleContributions |
| Quid Pro Quo Contributions | false | QuidProQuoContributions |
| Form8282 Property Disposed Of | false | Form8282PropertyDisposedOf |
| Funds To Pay Premiums | false | FundsToPayPremiums |
| Premiums Paid | false | PremiumsPaid |
| Indoor Tanning Services | false | IndoorTanningServices |
| Info In Schedule O Part VI | X | InfoInScheduleOPartVI |
| Nbr Voting Governing Body Members | 9 | NbrVotingGoverningBodyMembers |
| Number Independent Voting Members | 5 | NumberIndependentVotingMembers |
| Family Or Business Relationship | false | FamilyOrBusinessRelationship |
| Delegation Of Management Duties | false | DelegationOfManagementDuties |
| Changes To Organizing Docs | false | ChangesToOrganizingDocs |
| Material Diversion Or Misuse | false | MaterialDiversionOrMisuse |
| Members Or Stockholders | false | MembersOrStockholders |
| Election Of Board Members | false | ElectionOfBoardMembers |
| Decisions Subject To Approval | false | DecisionsSubjectToApproval |
| Minutes Of Governing Body | true | MinutesOfGoverningBody |
| Minutes Of Committees | true | MinutesOfCommittees |
| Officer Mailing Address | false | OfficerMailingAddress |
| Local Chapters | false | LocalChapters |
| Form990 Provided To Governing Body | true | Form990ProvidedToGoverningBody |
| Conflict Of Interest Policy | true | ConflictOfInterestPolicy |
| Annual Disclosure Covered Persons | true | AnnualDisclosureCoveredPersons |
| Regular Monitoring Enforcement | true | RegularMonitoringEnforcement |
| Whistleblower Policy | true | WhistleblowerPolicy |
| Document Retention Policy | true | DocumentRetentionPolicy |
| Compensation Process CEO | false | CompensationProcessCEO |
| Compensation Process Other | false | CompensationProcessOther |
| Investment In Joint Venture | false | InvestmentInJointVenture |
| Upon Request | X | UponRequest |
The Books Are In Care Of TheBooksAreInCareOf
| Field | Value | IRS element (for citing) |
|---|---|---|
| Name Person | EXEMPLA CO SHARON OWENS | NamePerson |
| Telephone Number | 3038135280 | TelephoneNumber |
Address US AddressUS
| Field | Value | IRS element (for citing) |
|---|---|---|
| Address Line1 | 2480 W 26TH AVE 200B | AddressLine1 |
| City | DENVER | City |
| State | CO | State |
| ZIP Code | 80211 | ZIPCode |
Form990 Part VII Section A Form990PartVIISectionA (13 entries)
| TitleTitle | Average Hours Per WeekAverageHoursPerWeek | Average Hours Per Week RelatedAverageHoursPerWeekRelated | Individual Trustee Or DirectorIndividualTrusteeOrDirector | OfficerOfficer | Reportable Comp From OrganizationReportableCompFromOrganization | Reportable Comp From Related OrgsReportableCompFromRelatedOrgs | Other CompensationOtherCompensation | FormerFormer |
|---|---|---|---|---|---|---|---|---|
| MICHAEL A SLUBOWSKI | ||||||||
| CHAIRMAN | 1.0 | 50.0 | X | X | 0 | 1513703 | 36584 | |
| Koger Propst | ||||||||
| DIRECTOR, VICE CHAIR | 1.0 | 50.0 | X | X | ||||
| Felix W Cook Sr | ||||||||
| Director | 1.0 | 50.0 | X | |||||
| Sister Amy Willcott | ||||||||
| Director | 1.0 | 0.0 | X | X | ||||
| MARLA J WILLIAMS | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | |||||
| SALLY WOOLSEY | ||||||||
| DIRECTOR | 1.0 | 0.0 | X | |||||
| LYDIA JUMONVILLE | ||||||||
| SVP FINANCE & CFO | 1.0 | 50.0 | X | X | 0 | 665251 | 89581 | |
| RICK LOPES MD | ||||||||
| SVP HEALTH NETWORKS | 1.0 | 50.0 | X | 0 | 917605 | 55755 | ||
| STEVE COBB MD | ||||||||
| PRESIDENT EPN | 1.0 | 50.0 | X | 0 | 272196 | 60439 | ||
| BRUCE WARING MD | ||||||||
| DIRECTOR THROUGH 10/20/12 | 1.0 | 0.0 | X | 0 | 0 | 0 | ||
| TODD A CONKLIN | ||||||||
| SVP & CFO, TREASURER | 1.0 | 50.0 | X | 0 | 626681 | 76029 | ||
| ROBERT LADENBURGER | ||||||||
| EVP Hospital ops | 1.0 | 50.0 | X | 0 | 1376046 | 106636 | ||
| Kathryn Ballinger | ||||||||
| Former VP/Gen Coun./Secretary | 0.0 | 0.0 | 0 | 314537 | 0 | X | ||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Reportable Comp From Org | 0 | TotalReportableCompFromOrg |
| Total Reportable Comp Frm Rltd Orgs | 5686019 | TotalReportableCompFrmRltdOrgs |
| Total Other Compensation | 425024 | TotalOtherCompensation |
| Number Individuals GT100 K | 0 | NumberIndividualsGT100K |
| Formers Listed | true | FormersListed |
| Total Comp GT150 K | true | TotalCompGT150K |
| Compensation From Other Sources | false | CompensationFromOtherSources |
| Number Of Contractors GT100 K | 0 | NumberOfContractorsGT100K |
| Total Contributions | 0 | TotalContributions |
| Total Program Service Revenue | 0 | TotalProgramServiceRevenue |
Investment Income InvestmentIncome
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 369843 | TotalRevenueColumn |
| Exclusion | $369,843 | ExclusionAmount |
Income From Invest Bond Proceeds IncomeFromInvestBondProceeds
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Royalties Revenue RoyaltiesRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Rental Income Or Loss RentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Real | 0 | Real |
| Personal | 0 | Personal |
Net Rental Income Or Loss NetRentalIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Gross Amount Sales Assets GrossAmountSalesAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 492055 | Securities |
Gain Or Loss GainOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Securities | 492055 | Securities |
Net Gain Or Loss Investments NetGainOrLossInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 492055 | TotalRevenueColumn |
| Exclusion | $492,055 | ExclusionAmount |
Net Income From Fundraising Events NetIncomeFromFundraisingEvents
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income From Gaming NetIncomeFromGaming
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
Net Income Or Loss NetIncomeOrLoss
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 0 | TotalRevenueColumn |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Other Revenue | 0 | TotalOtherRevenue |
Total Revenue TotalRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Revenue Column | 861898 | TotalRevenueColumn |
| Exclusion | $861,898 | ExclusionAmount |
Grants To Domestic Orgs GrantsToDomesticOrgs
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Grants To Domestic Individuals GrantsToDomesticIndividuals
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Foreign Grants ForeignGrants
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Benefits To Members BenefitsToMembers
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Current Officers Directors CompCurrentOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Comp Disqual Persons CompDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Salaries And Wages OtherSalariesAndWages
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Pension Plan Contributions PensionPlanContributions
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Employee Benefits OtherEmployeeBenefits
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payroll Taxes PayrollTaxes
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Management FeesForServicesManagement
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Legal FeesForServicesLegal
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Accounting FeesForServicesAccounting
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Lobbying FeesForServicesLobbying
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Prof Fundraising FeesForServicesProfFundraising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 50209 | Total |
| Program Services | 50209 | ProgramServices |
Fees For Services Other FeesForServicesOther
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Advertising Advertising
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Office Expenses OfficeExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Information Technology InformationTechnology
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Royalties Royalties
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Occupancy Occupancy
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Travel
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Conferences Meetings ConferencesMeetings
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Interest Interest
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Payments To Affiliates PaymentsToAffiliates
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Depreciation Depletion DepreciationDepletion
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Insurance Insurance
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 0 | Total |
Other Expenses OtherExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Description | MISCELLANEOUS | Description |
| Total | 7869 | Total |
| Program Services | 7869 | ProgramServices |
Total Functional Expenses TotalFunctionalExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total | 58078 | Total |
| Program Services | 58078 | ProgramServices |
| Management And General | 0 | ManagementAndGeneral |
| Fundraising | 0 | Fundraising |
Cash Non Interest Bearing CashNonInterestBearing
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Savings And Temp Cash Investments SavingsAndTempCashInvestments
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Pledges And Grants Receivable PledgesAndGrantsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Accounts Receivable AccountsReceivable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Officers Etc ReceivablesFromOfficersEtc
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Receivables From Disqual Persons ReceivablesFromDisqualPersons
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Notes Loans Receivable Net OtherNotesLoansReceivableNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 1017957 | EOY |
Inventories For Sale Or Use InventoriesForSaleOrUse
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
Investments Pub Traded Securities InvestmentsPubTradedSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14102165 | BOY |
| EOY | 13881332 | EOY |
Investments Other Securities InvestmentsOtherSecurities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Investments Program Related InvestmentsProgramRelated
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Intangible Assets IntangibleAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Assets Total OtherAssetsTotal
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Assets TotalAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14102165 | BOY |
| EOY | 14899289 | EOY |
Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Grants Payable GrantsPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Deferred Revenue DeferredRevenue
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Tax Exempt Bond Liabilities TaxExemptBondLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Escrow Account Liability EscrowAccountLiability
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Loans From Officers Directors LoansFromOfficersDirectors
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Unsecured Notes Loans Payable UnsecuredNotesLoansPayable
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Other Liabilities OtherLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 576374 | BOY |
| EOY | 0 | EOY |
Total Liabilities TotalLiabilities
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 576374 | BOY |
| EOY | 0 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Follow SFAS117 | X | FollowSFAS117 |
Unrestricted Net Assets UnrestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13525791 | BOY |
| EOY | 14899289 | EOY |
Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Permanently Restricted Net Assets PermanentlyRestrictedNetAssets
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 0 | BOY |
| EOY | 0 | EOY |
Total Net Assets Fund Balances TotalNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 13525791 | BOY |
| EOY | 14899289 | EOY |
Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances
| Field | Value | IRS element (for citing) |
|---|---|---|
| BOY | 14102165 | BOY |
| EOY | 14899289 | EOY |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Reconcilation Revenue Expenses | 803820 | ReconcilationRevenueExpenses |
| Reconciliation Unrealized Invest | 569678 | ReconciliationUnrealizedInvest |
| Method Of Accounting Accrual | X | MethodOfAccountingAccrual |
| Accountant Compile Or Review | false | AccountantCompileOrReview |
| FS Audited | true | FSAudited |
FS Audited Basis FSAuditedBasis
| Field | Value | IRS element (for citing) |
|---|---|---|
| Financial Statement Consolidated | X | FinancialStatementConsolidated |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Audit Committee | true | AuditCommittee |
| Federal Grant Audit Required | false | FederalGrantAuditRequired |
Schedule A IRS990ScheduleA
| Field | Value | IRS element (for citing) |
|---|---|---|
| Supporting Organization509a3 | X | SupportingOrganization509a3 |
| Supporting Org509a3 Type1 | X | SupportingOrg509a3Type1 |
| Certification Checkbox | X | CertificationCheckbox |
| Contrib By Controlling Individual | false | ContribByControllingIndividual |
| Contribution By Related Party | false | ContributionByRelatedParty |
| Contrib By35 Controlled Entity | false | ContribBy35ControlledEntity |
Supported Org Information SupportedOrgInformation
Name Name
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EXEMPLA INC | BusinessNameLine1 |
| Field | Value | IRS element (for citing) |
|---|---|---|
| EIN | 841103606 | EIN |
| Type Of Organization | 03 | TypeOfOrganization |
| Listed In Governing Doc | true | ListedInGoverningDoc |
| Amount | $0 | Amount |
| Field | Value | IRS element (for citing) |
|---|---|---|
| Total Number Of Supported Orgs | 1 | TotalNumberOfSupportedOrgs |
Schedule J IRS990ScheduleJ
| Field | Value | IRS element (for citing) |
|---|---|---|
| Severance Payment | true | SeverancePayment |
| Supplemental Nonqual Retire Plan | true | SupplementalNonqualRetirePlan |
| Equity Based Comp Arrangement | false | EquityBasedCompArrangement |
| Comp Based On Revenue Of Filing Org | false | CompBasedOnRevenueOfFilingOrg |
| Comp Based On Revenue Related Orgs | false | CompBasedOnRevenueRelatedOrgs |
| Comp Based Net Earnings Filing Org | false | CompBasedNetEarningsFilingOrg |
| Comp Based Net Earnings Relate Orgs | false | CompBasedNetEarningsRelateOrgs |
| Any Non Fixed Payments | true | AnyNonFixedPayments |
| Initial Contract Exception | false | InitialContractException |
Form990 Schedule J Part II Form990ScheduleJPartII (7 entries)
| TitleTitle | Base Compensation Filing OrgBaseCompensationFilingOrg | Comp Based On Related OrgsCompBasedOnRelatedOrgs | Bonus Filing OrgBonusFilingOrg | Bonus Related OrgsBonusRelatedOrgs | Other Compensation Filing OrgOtherCompensationFilingOrg | Other Compensation Related OrgsOtherCompensationRelatedOrgs | Deferred Comp Filing OrgDeferredCompFilingOrg | Deferred Comp Related OrgsDeferredCompRelatedOrgs | Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg | Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs | Total Compensation Filing OrgTotalCompensationFilingOrg | Total Compensation Related OrgsTotalCompensationRelatedOrgs | Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg | Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| TODD A CONKLIN | ||||||||||||||
| SVP & CFO, TREASURER | 0 | 377511 | 0 | 236016 | 0 | 13154 | 0 | 59483 | 0 | 16546 | 0 | 702710 | 0 | 0 |
| MICHAEL A SLUBOWSKI | ||||||||||||||
| CHAIRMAN | 0 | 993061 | 0 | 398970 | 0 | 121672 | 0 | 24119 | 0 | 12465 | 0 | 1550287 | 0 | 0 |
| ROBERT LADENBURGER | ||||||||||||||
| EVP Hospital ops | 0 | 660676 | 0 | 203467 | 0 | 511903 | 0 | 94171 | 0 | 12465 | 0 | 1482682 | 0 | 0 |
| LYDIA JUMONVILLE | ||||||||||||||
| SVP FINANCE & CFO | 0 | 499288 | 0 | 152073 | 0 | 13890 | 0 | 73035 | 0 | 16546 | 0 | 754832 | 0 | 0 |
| RICK LOPES MD | ||||||||||||||
| SVP HEALTH NETWORKS | 0 | 507612 | 0 | 96853 | 0 | 313140 | 0 | 43290 | 0 | 12465 | 0 | 973360 | 0 | 0 |
| STEVE COBB MD | ||||||||||||||
| PRESIDENT EPN | 0 | 238645 | 0 | 24557 | 0 | 8994 | 0 | 46845 | 0 | 13594 | 0 | 332635 | 0 | 0 |
| Kathryn Ballinger | ||||||||||||||
| Former VP/Gen Coun./Secretary | 0 | 0 | 0 | 0 | 0 | 314537 | 0 | 0 | 0 | 0 | 0 | 314537 | 0 | 314537 |
Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| COMPENSATION OF THE ORGANIZATION'S CEO | PART I, QUESTION 3 | THE ORGANIZATION RELIED ON A RELATED ORGANIZATION, EXEMPLA, INC. THAT USED EACH OF THE METHODS DESCRIBED IN SCHEDULE J, PART I TO ESTABLISH COMPENSATION OF THE ORGANIZATION'S CEO. |
| SEVERANCE AND CHANGE OF CONTROL PAYMENTS | PART I, QUESTION 4A | A CHANGE OF CONTROL PAYMENT WAS MADE TO KATHRYN BALLINGER IN THE AMOUNT OF $314,537 IN 2012. SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) PERIODICALLY INCURS SEVERANCE PAYMENTS RELATED TO FORMER EMPLOYEES. |
| SUPPLEMENTAL NONQUALIFED DEFERRED COMPENSATION PLAN | PART I, QUESTION 4B | EXEMPLA HAS A 457(F) SUPPLEMENTAL NONQUALIFIED DEFERED COMPENSATION PLAN, IN WHICH CERTAIN KEY OFFICERS PARTICIPATE. FURTHER, OTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR IRS 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. ON THE ADVICE OF COUNSEL, SCLHS HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2012 WERE: MICHAEL SLUBOWSKI-$41,506, ROBERT LADENBURGER-$195,770, and RICHARD LOPES-$57,996. |
| INCENTIVE PLANS | PART I, QUESTION 7 | INCENTIVE COMPENSATION IS PAID BY EXEMPLA, INC. AND SCLHS, RELATED ORGANIZATIONS. THE MANAGEMENT INCENTIVE PLANS ARE BASED ON A COMBINATION OF MEASURES. MANAGEMENT AND SENIOR LEADERSHIP ARE ELIGIBLE FOR THE INCENTIVE COMPENSATION. PERFORMANCE CATEGORIES ARE MADE UP OF A COMBINATION OF CLINICAL QUALITY MEASURES AND OPERATING INCOME. THE OPERATING INCOME CATEGORY IS GENERALLY RELATED TO THE NET EARNINGS OF THE DIVISION IN WHICH THE INDIVIDUAL WORKS, OR IN THE CASE OF SYSTEM SERVICES SENIOR MANAGEMENT, THE NET EARNINGS OF THE COMPANY. |
| COMPENSATION OF BOARD MEMBER | SCHEDULE J, PART II | SCLHS CONSISTS OF ELEVEN HOSPITALS AND THREE CLINICS (AFFILIATES) IN FOUR STATES INCLUDING EXEMPLA, INC. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. MICHAEL A. SLUBOWSKI IS PRESIDENT & CHIEF EXECUTIVE OFFICER FOR SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS). HE ALSO SERVES AS A MEMBER OF THE EXEMPLA, INC.'S (EXEMPLA) BOARD AND AS CHAIRMAN. THE COMPENSATION REFLECTED IS THAT OF MR. SLUBOWSKI'S POSITION AS AN SCLHS EXECUTIVE AND NOT AS A MEMBER OF EXEMPLA'S BOARD. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE. |
Schedule O IRS990ScheduleO
General Explanation GeneralExplanation (4 entries)
| IdentifierIdentifier | Return ReferenceReturnReference | ExplanationExplanation |
|---|---|---|
| 990 REVIEW PROCESS | FORM 990, PART VI, QUESTION 11b | All form 990 reporting was reviewed internally with senior management. All questions and changes proposed were addressed prior to filing. A complete copy of the final Form 990 was provided electronically to each voting member of the board of directors prior to its submission to the Internal Revenue Service. |
| MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY | FORM 990, PART VI, QUESTION 12C | THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES ITS CONFLICT OF INTEREST POLICY BY PROVIDING EDUCATION AND TRAINING FOR EACH OF ITS EMPLOYEES, STAFF, OFFICERS AND DIRECTORS, AS WELL AS HAVING EACH OF THE KEY EMPLOYEES, DIRECTORS, AND OFFICERS COMPLETE A CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS TO DISCLOSE ANY POTENTIAL CONFLICT ISSUES. THESE STATEMENTS ARE CAREFULLY REVIEWED BY THE LEGAL DEPARTMENT. WHEN A CONFLICT IS IDENTIFIED, THE LEGAL DEPARTMENT COMPILES ALL REPORTED CONFLICTS, AND EVALUATES THE DISCLOSURES FOR ACTUAL CONFLICTS. A REPORT IS PROVIDED TO ORGANIZATION'S PRESIDENT/CEO REGARDING KEY EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. THOSE WITH IDENTIFIED CONFLICTS OF INTEREST MUST RECUSE THEMSELVES FROM ANY MEETING DURING THE DISCUSSION AND VOTE THEREOF. |
| PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEES | FORM 990 PART VI QUESTION 15A & 15B | ALL COMPENSATION IS PAID BY EXEMPLA, INC. OR SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS), BOTH OF WHICH ARE RELATED NON-PROFIT ORGANIZATIONS. WHEN REVIEWING AND SETTING COMPENSATION FOR 'DISQUALIFIED PERSONS', EXEMPLA'S PROCESS INCLUDES: THE COMPENSATION COMMITTEE OF THE BOARD IS CHARGED WITH THE RESPONSIBILITY FOR SETTING THE OVERALL COMPENSATION PHILOSOPHY AND FOR EVALUATING THE TOTAL COMPENSATION PROGRAMS FOR DISQUALIFIED PERSONS. THE BOARD MEMBERS ARE INDEPENDENT MEMBERS AND IN THESE DISCUSSIONS THE CEO RECUSES HIMSELF FROM THE DISCUSSIONS AROUND HIS OWN COMPENSATION. THE COMMITTEE OBTAINS VALID, COMPARABLE MARKET DATA (FROM INDEPENDENTLY PUBLISHED SOURCES) FOR COMPARABLE POSITIONS AND FROM FORM 990 FILINGS. THIS COMMITTEE ENGAGES THE SERVICES OF AN INDEPENDENT EXPERT IN EXECUTIVE COMPENSATION TO REVIEW THE MARKET DATA AND PROVIDE AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PROGRAM. FOR THE PAST SEVERAL YEARS, THE INDEPENDENT FIRM HAS BEEN WATSON WYATT. WATSON WYATT VALIDATES THE PROCESS USED BY MANAGEMENT FOR IDENTIFYING 'DISQUALIFIED PERSONS' AND THEN CONDUCTS A COMPARABILITY STUDY/ANALYSIS OF PAY AT SIMILAR TYPES AND SIZES OF ORGANIZATIONS AND REVIEWS BASE SALARY, INCENTIVE (OR OVER-BASE PROGRAMS), BENEFITS, RETIREMENT PLANS AND PERQUISITES. WATSON WYATT REVIEWS THE FINDINGS WITH THE BOARD COMMITTEE AND MINUTES ARE PREPARED AND SHARED WITH ALL THE VOTING BOARD MEMBERS EACH YEAR THAT DOCUMENTS THE DISCUSSION AND ANY ACTIONS THAT MAY HAVE BEEN TAKEN. A COPY OF A FORMAL OPINION LETTER PREPARED BY WATSON WYATT FOLLOWING THE DISCUSSION WITH THE COMPENSATION COMMITTEE IS PROVIDED TO THE BOARD CHAIR AND SHARED WITH THE FULL BOARD. THIS PROCESS IS UNDERTAKEN EACH YEAR. SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES, INCLUDING EXEMPLA. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: 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 ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.) IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY AT THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. |
| AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC | FORM 990, PART VI, QUESTION 19 | GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND RELATED DOCUMENTATION ARE PROVIDED UPON REQUEST AS DEEMED APPROPRIATE. |
Schedule R IRS990ScheduleR
Form990 Schedule R Part II Form990ScheduleRPartII (28 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivitiesPrimaryActivities | Legal Domicile StateLegalDomicileState | Exempt Code SectionExemptCodeSection | Public Charity StatusPublicCharityStatus | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Controlled OrgControlledOrg |
|---|---|---|---|---|---|---|---|---|---|---|
| SISTERS OF CHARITY LEAVENWORTH HLTH SYST | ||||||||||
| 2420 W 26TH AVE SUITE 100D | DENVER | CO | 80211 | 237379161 | SUPPORT MMBRS | KS | 501(c)(3) | 11B-TYPE II | NA | false |
| CARITAS CLINICS INC | ||||||||||
| 818 NORTH 7TH STREET | LEAVENWORTH | KS | 66048 | 481009910 | CLINIC SVCS | KS | 501(c)(3) | 3 | SCLHS | true |
| MARIAN CLINIC INC | ||||||||||
| 1001 SW GARFIELD | TOPEKA | KS | 66604 | 481046905 | CLINIC SVCS | KS | 501(c)(3) | 3 | SCLHS | true |
| MARILLAC CLINIC INC | ||||||||||
| 2333 N 6TH STREET | GRAND JUNCTION | CO | 81501 | 841085822 | CLINIC SVCS | CO | 501(c)(3) | 3 | SCLHS | true |
| PROVIDENCE MEDICAL CENTER | ||||||||||
| 8929 PARALLEL PARKWAY | KANSAS CITY | KS | 66112 | 480784446 | HEALTHCARE | KS | 501(c)(3) | 3 | SCLHS | true |
| ST JOHN HOSPITAL INC | ||||||||||
| 3500 SOUTH FOURTH STREET | LEAVENWORTH | KS | 66048 | 480543768 | HEALTHCARE | KS | 501(c)(3) | 3 | PMC | true |
| BETHANY COMMUNITY PLAZA INC | ||||||||||
| 15 NORTH 12TH STREET | KANSAS CITY | KS | 66102 | 481207407 | HEALTHCARE | KS | 501(c)(3) | 3 | PMC | true |
| PROVIDENCEST JOHN FOUNDATION INC | ||||||||||
| 8929 PARALLEL PARKWAY | KANSAS CITY | KS | 66112 | 480925688 | SUPPORT 501C3 | KS | 501(c)(3) | 7 | PMC | true |
| ST FRANCIS HEALTH CENTER INC | ||||||||||
| 1700 SW 7TH STREET | TOPEKA | KS | 66606 | 480547719 | HEALTHCARE | KS | 501(c)(3) | 3 | SCLHS | true |
| ST FRANCIS HEALTH CENTER FOUNDATION | ||||||||||
| 1700 SW 7TH STREET | TOPEKA | KS | 66606 | 481092520 | SUPPORT 501C3 | KS | 501(c)(3) | 11A-TYPE I | SFHC | true |
| ST MARYS HOSPITAL & MEDICAL CENTER INC | ||||||||||
| 2635 N 7TH STREET | GRAND JUNCTION | CO | 81502 | 840425720 | HEALTHCARE | CO | 501(c)(3) | 3 | SCLHS | true |
| ST MARYS HOSPITAL DEVELOPMENT FOUNDATION | ||||||||||
| 2635 N 7TH STREET | GRAND JUNCTION | CO | 81502 | 237001007 | SUPPORT 501C3 | CO | 501(c)(3) | 11A-TYPE I | SMHMC | true |
| SAINT JOSEPH HOSPITAL FOUNDATION | ||||||||||
| 1835 FRANKLIN STREET | DENVER | CO | 80218 | 840735096 | SUPPORT 501C3 | CO | 501(c)(3) | 11A-TYPE I | SJH | true |
| HOLY ROSARY HEALTHCARE | ||||||||||
| 2600 WILSON | MILES CITY | MT | 59301 | 810231792 | HEALTHCARE | MT | 501(c)(3) | 3 | SCLHS | true |
| HOLY ROSARY HEALTHCARE FOUNDATION INC | ||||||||||
| 2600 WILSON | MILES CITY | MT | 59301 | 202270238 | SUPPORT 501C3 | MT | 501(c)(3) | 11A-TYPE I | HRHC | true |
| ST VINCENT HEALTHCARE | ||||||||||
| 1233 NORTH 30TH | BILLINGS | MT | 59101 | 810232124 | HEALTHCARE | MT | 501(c)(3) | 3 | SCLHS | true |
| ST VINCENT HEALTHCARE FOUNDATION | ||||||||||
| PO BOX 35200 | BILLINGS | MT | 59107 | 810468034 | SUPPORT 501C3 | MT | 501(c)(3) | 7 | SVHC | true |
| NORTHWEST RESEARCH & EDUCATION INSTITUTE | ||||||||||
| 315 NORTH 25TH STREET | BILLINGS | MT | 59101 | 201343024 | COMM HLTH RES | MT | 501(c)(3) | 9 | SVHC | true |
| ST JAMES HEALTHCARE | ||||||||||
| 400 SOUTH CLARK STREET | BUTTE | MT | 59701 | 810231785 | HEALTHCARE | MT | 501(c)(3) | 3 | SCLHS | true |
| ST JAMES HEALTHCARE FOUNDATION | ||||||||||
| 400 SOUTH CLARK STREET | BUTTE | MT | 59701 | 651202190 | SUPPORT 501C3 | MT | 501(c)(3) | 11A-TYPE I | SJHC | true |
| SAINT JOHNS HEALTH CENTER | ||||||||||
| 2121 SANTA MONICA BLVD | SANTA MONICA | CA | 90404 | 951684082 | HEALTHCARE | CA | 501(c)(3) | 3 | SCLHS | true |
| JOHN WAYNE CANCER INSTITUTE | ||||||||||
| 2000 SANTA MONICA BLVD | SANTA MONICA | CA | 90404 | 954291515 | CANCER R&D | CA | 501(c)(3) | 4 | SJHC | true |
| SAINT JOHNS HOSPITAL & HEALTH CTR FNDTN | ||||||||||
| 2121 SANTA MONICA BLVD | SANTA MONICA | CA | 90404 | 956100079 | SUPPORT 501C3 | CA | 501(c)(3) | 11A-TYPE I | SJHC | true |
| EXEMPLA INC FKA LUTHERAN HOSPITAL | ||||||||||
| 2420 W 26TH AVE SUITE 100D | DENVER | CO | 80211 | 841103606 | HEALTHCARE | CO | 501(c)(3) | 3 | SCLHS | false |
| EXEMPLA LUTHERAN MEDICAL CENTER FNDTN | ||||||||||
| 2480 W 26TH AVESUITE 360B | DENVER | CO | 80211 | 208846152 | SUPPORT 501C3 | CO | 501(c)(3) | 7 | EXEMPLA INC | true |
| EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN | ||||||||||
| 200 EXEMPLA CIRCLE | LAFAYETTE | CO | 80026 | 841649162 | SUPPORT 501C3 | CO | 501(c)(3) | 7 | EXEMPLA INC | true |
| SAINT JOSEPH HOSPITAL | ||||||||||
| 1835 FRANKLIN STREET | DENVER | CO | 80218 | 840417134 | HEALTHCARE | CO | 501(c)(3) | 3 | SCLHS | true |
| MOUNT ST VINCENT HOME INC | ||||||||||
| 4159 LOWELL BOULEVARD | DENVER | CO | 80211 | 840405260 | RESIDENT CARE | CO | 501(c)(3) | 11A-TYPE I | SCLHS | true |
Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Business Name Line1DirectControllingEntityName/BusinessNameLine1 | Predominant Income TypePredominantIncomeType | Disproportionate AllocationsDisproportionateAllocations | Code VCodeVAmount | General Or Managing PartnerGeneralOrManagingPartner |
|---|---|---|---|---|---|---|---|---|---|---|---|
| PAVILION IMAGING LLC | |||||||||||
| 750 WELLINGTON | GRAND JUNCTION | CO | 81501 | 030516198 | RADIOLOGY | CO | NA | N/A | false | $0 | false |
| GRAND VALLEY SURGICAL CENTER LLC | |||||||||||
| 710 WELLINGTON | GRAND JUNCTION | CO | 81501 | 841505075 | OP SURGERY | CO | NA | N/A | false | $0 | false |
| SAN JUAN CANCER CENTER LLC | |||||||||||
| 600 SOUTH 5TH STREET | MONTROSE | CO | 81401 | 202856331 | OP CANCER | CO | NA | N/A | false | $0 | false |
| BILLINGS MRI CENTER LLC | |||||||||||
| 1041 NORTH 29TH STREET | BILLINGS | MT | 59101 | 810450943 | MRI-PET SCAN | MT | NA | N/A | false | $0 | false |
| LUTHERAN CAMPUS ASC LLC | |||||||||||
| 3455 LUTHRN PKW SUITE 150 | WHEATRIDGE | CO | 800336028 | 020749532 | OP SURGERY | CO | NA | N/A | false | $0 | false |
| COLORADO SURGICAL VENTURES LLC | |||||||||||
| 30 S WACKER DR SUITE 2302 | CHICAGO | IL | 60605 | 208038915 | OP SURGERY | CO | NA | N/A | false | $0 | false |
| COLORADO SURGICAL HOSPITAL LLC | |||||||||||
| 30 S WACKER DR SUITE 2302 | CHICAGO | IL | 60605 | 208038977 | OP SURGERY | CO | NA | N/A | false | $0 | false |
Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)
| Address Line1AddressUS/AddressLine1 | CityAddressUS/City | StateAddressUS/State | ZIP CodeAddressUS/ZIPCode | EINEIN | Primary ActivityPrimaryActivity | Legal Domicile StateLegalDomicileState | Type Of EntityTypeOfEntity | Address Line1AddressForeign/AddressLine1 | CityAddressForeign/City | Province Or StateAddressForeign/ProvinceOrState | CountryAddressForeign/Country | Postal CodeAddressForeign/PostalCode | Legal Domicile Foreign CountryLegalDomicileForeignCountry |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| CARITAS INC AND SUBSIDIARIES | |||||||||||||
| 9801 RENNER BOULEVARD SUITE 100 | LENEXA | KS | 66219 | 480941069 | OTHER MEDICAL | KS | C CORP | ||||||
| LEAVEN INSURANCE COMPANY LTD | |||||||||||||
| 980370522 | INSURANCE | 23 LIME TREE BAY AVE PO BOX 1051 | GEORGETOWN | GRAND CAYMAN | CJ | KY1-1102 | CJ | ||||||
| Field | Value | IRS element (for citing) |
|---|---|---|
| Receipt Of Int Ann Rents Royalties | false | ReceiptOfIntAnnRentsRoyalties |
| Gift Grant Or Cap Contr To Other Org | false | GiftGrantOrCapContrToOtherOrg |
| Gift Grant Or Cap Contr Fr Other Org | false | GiftGrantOrCapContrFrOtherOrg |
| Loans Or Guarantees To Other Org | false | LoansOrGuaranteesToOtherOrg |
| Loans Or Guarantees From Other Org | true | LoansOrGuaranteesFromOtherOrg |
| Sale Of Assets To Other Org | false | SaleOfAssetsToOtherOrg |
| Purchase Of Assets From Other Org | false | PurchaseOfAssetsFromOtherOrg |
| Exchange Of Assets | false | ExchangeOfAssets |
| Rental Of Facilities To Other Orgs | false | RentalOfFacilitiesToOtherOrgs |
| Rental Of Facilities Fr Other Orgs | false | RentalOfFacilitiesFrOtherOrgs |
| Perform Of Services For Other Orgs | false | PerformOfServicesForOtherOrgs |
| Perform Of Services By Other Orgs | false | PerformOfServicesByOtherOrgs |
| Sharing Of Facilities | false | SharingOfFacilities |
| Sharing Of Paid Employees | false | SharingOfPaidEmployees |
| Reimbursement Paid To Other Org | false | ReimbursementPaidToOtherOrg |
| Reimbursement Paid By Other Org | false | ReimbursementPaidByOtherOrg |
| Other Transfer To Other Org | false | OtherTransferToOtherOrg |
| Other Transfer From Other Org | true | OtherTransferFromOtherOrg |
Transactions Related Orgs Table TransactionsRelatedOrgsTable
Name Of Other Organization NameOfOtherOrganization
| Field | Value | IRS element (for citing) |
|---|---|---|
| Business Name Line1 | EXEMPLA INC | BusinessNameLine1 |