2013-08-05T09:28:04-05:00 2012-09-30 481066439 BERBERICH TRAHAN & CO PA 3630 SW BURLINGAME ROAD TOPEKA KS 666112050 990 2011-10-01 480543789 STORMONT-VAIL HEALTHCARE INC STOR 7853546000 1500 SW 10TH AVENUE TOPEKA KS 666041353 KEVIN J HAN 7853546000 2013-08-02 1 CHERYL G HAYWARD P00016097 7852343427 2011 2016-02-24 21:20:13Z KEVIN J HAN 1500 SW 10TH AVENUE TOPEKA KS 666041353 583817481 0 X WWW.STORMONTVAIL.ORG X 1894 KS STORMONT-VAIL'S MISSION IS "WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY" BY PROVIDING QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. 15 13 4649 550 0 5556 518666 556438 509975162 554101812 4865737 20878532 845140 899423 516204705 576436205 0 0 0 0 294024917 321871961 0 0 0 189861294 204146186 483886211 526018147 32318494 50418058 486242743 554200087 314771451 340105644 171471292 214094443 X WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY 0 0 513456565 553997883 STORMONT-VAIL HEALTHCARE, INC. (MEDICAL CENTER) PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. FOR THE YEAR ENDED SEPTEMBER 30, 2012, 21,311 INPATIENTS, 62,625 EMERGENCY ROOM PATIENTS, 1,947 NEWBORNS, AND OVER 500 NEONATAL INTENSIVE CARE BABIES WERE SERVED. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THE MEDICAL CENTER'S MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION REGARDLESS OF ABILITY TO PAY. AS PART OF THIS MISSION, THE MEDICAL CENTER PROVIDES CARE TO PERSONS COVERED BY MEDICARE AND MEDICAID PATIENTS. FOLLOWING ARE SOME OF THE BENEFITS PROVIDED AT REDUCED RATES FOR THE FISCAL YEAR:IN ADDITION TO THE CHARITY CARE PROVIDED, THE MEDICAL CENTER ALSO PROVIDED SERVICE TO PATIENTS THAT RESULTED IN UNCOLLECTIBLE AMOUNTS AS FOLLOWS:BAD DEBT EXPENSE AT COST $11,118,643SHORTFALL OF MEDICARE PAYMENTS AT COST $45,810,756SHORTFALL OF MEDICAID PAYMENTS AT COST $20,899,295 THE MEDICAL CENTER ALSO PROVIDES OTHER HEALTH CARE SERVICES AND PROGRAMS FOR THE BENEFIT OF THE COMMUNITY, FREE OR AT REDUCED RATES. EXAMPLES OF THESE INCLUDE: SUBSIDY OF NURSING EDUCATION, MEDICAL EDUCATION, AND ALLIED HEALTH EDUCATION OPERATING THE REGIONS ONLY LEVEL III NEONATAL INTENSIVE CARE UNIT (NICU) SERVING A HIGH PERCENTAGE OF MEDICALLY INDIGENT PATIENTS OPERATING A LEVEL II TRAUMA CENTER SERVING NORTHEAST KANSAS PROVIDE SUPPORT TO LIFESTAR, THE AIR AMBULANCE SERVICE IN NORTHEAST KANSAS OVER 20 SUPPORT GROUPS HAVE BEEN ORGANIZED FOR A VARIETY OF TOPICS APPROXIMATELY 56,000 HOURS OF VOLUNTEER TIME WERE DONATED TO THE MEDICAL CENTER HELPING TO REDUCE THE COST OF PROVIDING HEALTH CARE MAINTAINING THE HEALTH SCIENCES LIBRARY THAT IS MADE AVAILABLE TO THE PUBLIC FREE OF CHARGE AS A MEDICAL RESOURCE STORMONT VAIL EMPLOYEES SUPPORT THE CARE LINE, WHICH IS AN EMERGENCY FUND FOR PATIENTS IN FINANCIAL DISTRESS, PROVIDING SERVICES AND SUPPLIES ON A SHORT-TERM BASIS USE OF POZEZ EDUCATION CENTER FACILITIES FOR A VARIETY OF COMMUNITY GROUPS AND PROGRAMS DONATED CASH OR IN-KIND GIFTS TO VARIOUS COMMUNITY ORGANIZATIONS PARTICIPATED IN NUMEROUS CLINICAL RESEARCH TRIALS THROUGH THE CLINICAL RESEARCH DEPARTMENT STORMONT-VAIL WEST BEHAVIORAL HEALTH SERVICES OPERATES A SUBSTANCE ABUSE PROGRAM OPERATED A PALLIATIVE CARE PROGRAM TO PROVIDE COMFORT CARE TO PATIENTS WITH CHRONIC CONDITIONS PROVIDE SUPPORT AND EDUCATION FOR PATIENTS WITH DIABETES THROUGH THE DIABETES LEARNING CENTER. STORMONT-VAIL IS A REGIONAL NETWORK OF 29 LOCATIONS IN NORTHEAST KANSAS IMPROVING ACCESS TO MEDICAL CARE IN SEVERAL CITIES THAT OTHERWISE WOULD NOT HAVE ACCESS, PARTICULARLY ON WEEKENDS MATERNAL FETAL MEDICINE PROGRAM PROVIDED CARE AND ACCESS TO SCREENINGS AND GENETIC COUNSELING FOR WOMEN WITH AT-RISK PREGNANCIES. OPERATED THE HEALTHWISE 55 PROGRAM WHICH PROVIDED OUTREACH PROGRAMS TO INDEPENDENT LIVING FACILITIES IN TOPEKA OFFERED BLOOD PRESSURE CLINICS AT WEST RIDGE MALL AS WELL AS OUTREACH BLOOD PRESSURE CLINICS AT SIX OTHER LOCATIONS STORMONT-VAIL PROVIDED THE REGION'S ONLY PERINATOLOGIST PROVIDING CARE FOR HIGH-RISK PREGNANCIES STORMONT-VAIL MAINTAINED THE LIFELINE PROGRAM, THE PERSONAL RESPONSE SYSTEM OFFERED ONLINE CHILDBIRTH CLASSES THROUGH STORMONT-VAILS WEB SITE PARTNERED WITH THE MARCH OF DIMES FOR THE NICU FAMILY SUPPORT PROGRAM STORMONT-VAIL WAS A MEDAL OF HONOR WINNER FOR THE SEVENTH CONSECUTIVE YEAR FOR ORGAN RETRIEVAL AND TISSUE CONVERSION THE HEALTH CONNECTION PROGRAM, WHICH PROVIDES PHYSICIAN REFERRAL AND AFTER-HOUR ACCESS TO A NURSE, RECEIVED 398,629 CALLS PROVIDED HEALTH INFORMATION THROUGH THE TOPEKA & SHAWNEE COUNTY PUBLIC LIBRARY'S HEALTH INFORMATION NEIGHBORHOOD PARTNERED WITH BUILDING BLOCKS TO PROVIDE CHILDCARE SERVICES TO STAFF AND THE COMMUNITY STORMONT-VAIL CLINICAL EDUCATORS PARTICIPATED IN THE AMERICAN HEALTH ASSOCIATION'S CPR FOR FAMILY AND FRIENDS CLASS TO TEACH OTHERS CPR THE TRAUMA SERVICES DEPARTMENT PROVIDED COMMUNITY EDUCATION PROGRAMS ON FALL PREVENTION STORMONT-VAIL WEST BEHAVIORAL HEALTH SERVICES PARTICIPATED IN A DEPRESSION SCREENING FOR THE COMMUNITY PARTNERED IN THE KANSAS RED RIBBON CAMPAIGN TO PROMOTE A HEALTHY, DRUG-FREE LIFESTYLE FOR YOUTH A SKIN SCREENING CLINIC FOR THE COMMUNITY WAS HELD AT THE COTTON-O'NEIL CANCER CENTER SPONSORED TOUR DE DIALYSIS, A 100-MILE BIKE RIDE TO RAISE AWARENESS AND FUNDS FOR PATIENT NEEDS AT THE KANSAS DIALYSIS SERVICES CONNECT WITH THE COMMUNITY THROUGH THE ORGANIZATION WEBSITE, STORMONT.ORG PARTICIPATED IN THE BI-STATE STROKE EDUCATION CONSORTIUM PARTNERED WITH HEALTH INNOVATION NETWORK OF KANSAS, A COALITION THAT GREW TO 17 HOSPITALS SHARING INFORMATION, EDUCATION AND OTHER NEEDED SERVICES THE BOY TO MAN AND GIRL TO WOMAN COMMUNICATION EDUCATION PROGRAMS FACILITATE CONVERSATION BETWEEN ADULTS AND PRE-TEENS ABOUT FUTURE PHYSICAL AND EMOTIONAL CHANGES STORMONT VAIL AND ITS EMPLOYEES DONATED FUNDS AND STAFF TIME TO THE MEALS ON WHEELS PROGRAM STORMONT VAIL AND ITS EMPLOYEES DONATED FUNDS AND STAFF TIME TO THE UNITED WAY 513456565 1 1 0 1 0 0 0 0 0 1 1 1 1 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 223 0 1 4649 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEVIN HAN 7853546000 1500 SW 10TH STREET TOPEKA KS 66604 STEVEN WATKINS MD 60.00 X X 902612 0 96687 S KENNETH ALEXANDERIII 0.00 X 0 0 0 PAMELA JOHNSON BETTS 0.00 X 0 0 0 C RICHARD BONEBRAKEMD 0.00 X 0 0 0 GARY B FLEENOR 0.00 X 0 0 0 JOHN B DICUS 0.00 X 0 0 0 RANDALL L PETERSON 60.00 X X 0 0 0 JAMES HAINES 0.00 X X 0 0 0 PATRICIA PRESSMAN PHD 0.00 X 0 0 0 SUEANN V SCHULTZ 0.00 X 0 0 0 NANCY J PERRY 0.00 X X 0 0 0 JAMES SCHMANK 0.00 X 0 0 0 ANDREW J JETTER 0.00 X 0 0 0 JAMES PARRISH 0.00 X 0 0 0 RICHARD WIENCKOWSKI 0.00 X 0 0 0 ROBERT O'NEIL MD 10.00 X 117906 0 1089 ERIC VOTH MD 60.00 X 362924 0 80447 DOUGLAS ROSE MD 60.00 X 377414 0 147811 KEVIN DISHMAN MD 60.00 X 875863 0 63568 DAVID CUNNINGHAM 50.00 X 233783 0 54551 CAROL WHEELER 50.00 X 359734 0 200753 BERNIE BECKER 50.00 X 304373 0 143943 KENT PALMBERG MD 60.00 X 668209 0 349589 DEBRA YOCUM 50.00 X 287737 0 59271 JANET STANEK 55.00 X 439155 0 112390 CAROL PERRY 50.00 X 318900 0 136286 KEVIN HAN 60.00 X 281417 0 107940 MATTHEW WILLS MD 60.00 X 2137038 0 32359 TEWODRO ADDISSE MD 60.00 X 954341 0 29452 DAVID LUTES MD 60.00 X 903851 0 45148 CHU CHI CHENMD 60.00 X 1120813 0 69081 PETER TUTUSKA MD 60.00 X 829195 0 64294 MAYNARD OLIVERIUS 60.00 X 915312 0 171338 12390577 0 1965997 334 1 1 0 RADIOLOGY & NUCLEAR MEDICINE LLC 823 MULVANE SUITE 1 TOPEKA KS 66606 RADIOLOGY PHYSICIAN SERVICES 2170425 ANESTHESIA ASSOCIATES 823 MULVANE SUITE 2A TOPEKA KS 66606 ANESTHESIA PHYSICIAN SERVICES 1874613 PROBASCO & ASSOCIATES PA 615 S TOPEKA BLVD TOPEKA KS 66603 COLLECTION AGENCY 1619069 KANSAS DIALYSIS SERVICES 634 SW MULVANE TOPEKA KS 66606 DIALYSIS SERVICES 748487 PERINATAL CONSULTANTS 900 SW ROBINSON TOPEKA KS 66614 PHYSICIAN SERVICES 746000 24 268482 287956 261469 556438 NET PATIENT SERVICE RE 621300 542001306 542001306 HEALTH RECORDS INCENTI 519100 6764958 6764958 NUTRITIONAL SERVICES 621300 2274823 2274823 EDUCATION SERVICES/SCH 611600 2068151 2068151 LIFELINE 621300 453058 453058 539516 539516 554101812 9486242 9486242 899423 0 899423 899423 899423 18507919 265647 7011700 369576 11496219 -103929 11392290 -103929 11496219 576436205 553997883 0 21881884 8412316 4060005 4352311 249590923 248504624 1086299 17197422 16974071 223351 31037933 31020590 17343 15633367 15424250 209117 3414084 2842312 571772 153850 153850 148980 148980 17942598 17395755 546843 1156447 1156447 2683160 2345803 337357 7683781 7682881 900 7345530 7339530 6000 175849 175849 6354150 6347516 6634 19023701 19012640 11061 3363071 1208108 2154963 SUPPLIES 83204535 83200294 4241 PROVISION FOR UNCOLLECT 33363039 33363039 REPAIR & MAINTENANCE 7042922 7042008 914 CONTRIBUTION TO S-V FOU 360000 360000 10730489 7698013 3032476 526018147 513456565 12561582 0 6097475 6029203 72328936 92574769 74917091 75923316 5088446 5802499 3686374 4343928 403241695 209945620 185138917 193296075 82918308 118429539 53651647 55369328 2415549 2431430 486242743 554200087 58576399 62243012 135870000 144490000 5944140 4554153 114380912 128818479 314771451 340105644 X 170670374 213263622 668059 697962 132859 132859 171471292 214094443 486242743 554200087 X 50418058 -7794907 X X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 0 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE KANSAS HOSPITAL ASSOCIATION. THESE ORGANIZATIONS HAVE INFORMED THE TAXPAYER THAT A PORTION OF THEIR DUES ARE ATTRIBUTED TO LOBBYING AND ADVOCACY ACTIVITIES. THAT PERCENTAGE FOR 2011 IS 15% AND THE AMOUNT IS $ 16,973. OCCASIONALLY, THE CEO WILL SPEAK TO LEGISLATORS REGARDING BILLS THAT WOULD AFFECT THE ORGANIZATION OR HEALTHCARE INDUSTRY. 244424 9618 254042 239410 5014 244424 239400 10 239410 235668 3732 239400 0.52300 0.47700 0 0 14286596 14286596 240408254 103111797 137296457 145061252 106833823 38227429 3485593 3485593 193296075 21713504 F MORGAN CREEK FUND, LTD CLASS A 39,673 SHARES HELD 33655824 F 55369328 RESERVE FOR THIRD-PARTY PAYORS 5418036 ACCRUED PENSION PAYABLE 123380873 DUE TO RELATED PARTIES 19570 128818479 576436205 526018147 50418058 4225624 -12020531 -7794907 42623151 582953495 4225624 2440646 6666270 576287225 148980 148980 576436205 540330344 14461177 14461177 525869167 148980 148980 526018147 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE USED IN ACCORDANCE WITH THE DIRECTION OF THE APPLICABLE DONOR GIFT INSTRUMENT AT THE TIME THE GIFT IS ADDED TO THE FUND. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X: AS OF SEPTEMBER 30, 2012 AND 2011 THERE WERE NO UNCERTAIN TAX BENEFITS INDENTIFIED AND RECORDED AS A LIABILITY. PART XI, LINE 8 - OTHER ADJUSTMENTS: EQUITY IN NET INCOME OF CONSOLIDATED AFFILIATES 2,041,068. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS -14,416,272. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES 281,058. BOOK AMORTIZATION GREATER THAN TAX -44,905. INTEREST RATE SWAP 118,520. TOTAL TO SCHEDULE D, PART XI, LINE 8: -12,020,531. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED AFFILIATE NET INCOME 2,041,068. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES 281,058. INTEREST RATE SWAP 118,520. PART XIII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS 14,416,272. BOOK AMORTIZATION GREATER THAN TAX 44,905. 1 1 1 X 1 X 1 1 1 0 1 1 10785704 10785704 0.02050 58672027 37772732 20899295 0.03970 69457731 37772732 31684999 0.06020 2403582 232884 2170698 0.00410 3743538 1954530 1789008 0.00340 9864481 9077149 787332 0.00150 266367 266367 0.00050 16277968 11264563 5013405 0.00950 85735699 49037295 36698404 0.06970 0 11118643 176064239 221874995 -45810756 X 1 1 1 1 STORMONT-VAIL HEALTHCARE

1500 SW 10TH STREET TOPEKA KS 66604

X X X STORMONT-VAIL HEALTHCARE 1 0 1 1 150.000000000000 1 400.000000000000 1 X X X X 1 1 X 1 0 0 0 0 30 CANCER CENTER

1414 SW 8TH AVENUE TOPEKA KS 66606

CANCER CENTER HEART CENTER

929 MULVANE TOPEKA KS 66606

CARDIOLOGY OFFICE FAMILY PRACTICE

901 GARFIELD TOPEKA KS 66606

FAMILY PRACTICE PHYSICIAN OFFICES COTTON O'NEIL PHYSICIAN CLINICS

823 MULVANE TOPEKA KS 66606

VARIOUS PHYSICIAN OFFICES STORMONT VAIL WEST

3707 SW 6TH STREET TOPEKA KS 66606

PSYCHIATRIC COTTON O'NEIL GI CENTER

720 LANE TOPEKA KS 66606

GI CLINIC ORTHOPEDICS KOSM

909 SW MULVANE TOPEKA KS 66604

ORTHOPEDIC PHYSICIAN OFFICE EMPORIA CLINIC

1301 SW 12TH STREET EMPORIA KS 66801

PHYSICIAN OFFICES 6TH & FRAZIER

3520 SW 6TH STREET TOPEKA KS 66606

PHYSICIAN OFFICES REHABILTATION SERVICES

4019 SW 10TH AVE TOPEKA KS 66606

REHABILITATION THERAPY CROCO CLINIC

2909 SE WALNUT DR TOPEKA KS 66605

PHYSICIAN OFFICES PEDIATRICARE

4100 SW 15TH STREET TOPEKA KS 66604

PEDIATRICS PHYSICIAN OFFICE STORMONT VAIL SLEEP CENTER

920 SW WASHBURN TOPEKA KS 66606

SLEEP CENTER URISH CLINIC

6725 SW 29TH STREET TOPEKA KS 66614

PHYSICIAN OFFICES MISSION WOODS CLINIC

6650 MISSION VALLEY DRIVE TOPEKA KS 66614

PHYSICIAN OFFICES WAMEGO CLINIC

1704 COMMERCIAL CIRCLE WAMEGO KS 66547

PHYSICIAN OFFICES CARBONDALE CLINIC

211 EAST MAIN CARBONDALE KS 66614

PHYSICIAN OFFICES OSAGE CITY CLINIC

131 WEST MARKET OSAGE CITY KS 66523

PHYSICIAN OFFICES OSKALOOSA CLINIC

209 W JEFFERSON OSKALOOSA KS 66066

PHYSICIAN OFFICES NORTH TOPEKA CLINIC

1130 N KANSAS AVENUE TOPEKA KS 66608

PHYSICIAN OFFICES LAWRENCE CLINIC

330 ARKANSAS LAWRENCE KS 66044

PHYSICIAN OFFICES ROSSVILLE CLINIC

423 MAIN ROSSVILLE KS 66533

PHYSICIAN OFFICES MERIDEN CLINIC

407 E WYANDOTTE MERIDEN KS 66512

PHYSICIAN OFFICES OCCUPATIONAL MEDICINE

1504 SW 8TH STREET TOPEKA KS 66606

WORKERS COMP PHYSICIAN OFFICE LEBO CLINIC

118 W 4TH LEBO KS 66856

PHYSICIAN OFFICES ALMA CLINIC

701 MISSOURI ALMA KS 66401

PHYSICIAN OFFICES RETAIL CLINIC GENERAL

2600 NW ROCHESTER ROAD TOPEKA KS 66617

PHYSICIAN OFFICES CARDIAC THORACIC SURGEONS

830 MULVANE TOPEKA KS 66606

PHYSICIAN OFFICES MEDICAL ASSOCIATES OF MANHATTAN

1133 COLLEGE AVE STE E-110 MANHATTAN KS 66502

PHYSICIAN OFFICES MRI OF KANSAS

631 SW MULVANE TOPEKA KS 66606

MRI CENTER PART III, LINE 4: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLE ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED ON AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. STORMONT-VAIL ONLY CHARGES INTEREST ON MEDICAL SERVICE DIVISON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF TO BAD DEBT WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. COSTING METHODOLOGY:THE BAD DEBT EXPENSE WAS CALCULATED BY USING THE ACTUAL BAD DEBT WRITE-OFFS FROM THE HOSPITAL AND THE COST TO CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM FOR OTHER PAYORS MULTIPLIED BY THE BAD DEBT WRITE-OFFS. THE CLINIC BAD DEBTS WERE ESTIMATED AND A COST TO CHARGE RATIO WAS APPLIED TO DETERMINE COST. PART III, LINE 8: BOTH THE COST ACCOUNTING AND COST TO CHARGE RATIO METHOD ARE USED. STORMONT-VAIL HEALTHCARE PART V, SECTION B, LINE 13G: FOR PATIENTS EXPRESSING THE INABILITY TO PAY, THEY ARE PROVIDED WITH CUSTOMER SERVICE PHONE NUMBERS ON THE WEBSITE, PATIENT STATEMENTS, PATIENT HANDBOOKS, AND BROCHURES GIVEN TO ALL INPATIENTS AND OUTPATIENTS. X X X X 0 1 0 0 0 1 0 0 0 STEVEN WATKINS MD 835460 0 63469 0 3683 0 88149 0 8538 0 999299 0 0 0 ERIC VOTH MD 311611 0 49335 0 1978 0 65734 0 14713 0 443371 0 0 0 DOUGLAS ROSE MD 322000 0 52765 0 2649 0 143327 0 4484 0 525225 0 0 0 KEVIN DISHMAN MD 822914 0 52391 0 558 0 48718 0 14850 0 939431 0 0 0 DAVID CUNNINGHAM 188576 0 43326 0 1881 0 40319 0 14232 0 288334 0 0 0 CAROL WHEELER 274641 0 80794 0 4299 0 192390 0 8363 0 560487 0 0 0 BERNIE BECKER 246220 0 55015 0 3138 0 135952 0 7991 0 448316 0 0 0 KENT PALMBERG MD 519486 0 140669 0 8054 0 341051 0 8538 0 1017798 0 0 0 DEBRA YOCUM 234381 0 51107 0 2249 0 55318 0 3953 0 347008 0 0 0 JANET STANEK 334979 0 97199 0 6977 0 97973 0 14417 0 551545 0 0 0 CAROL PERRY 259820 0 56663 0 2417 0 123738 0 12548 0 455186 0 0 0 KEVIN HAN 256437 0 21827 0 3153 0 107298 0 642 0 389357 0 0 0 MATTHEW WILLS MD 2136198 0 0 0 840 0 17114 0 15245 0 2169397 0 0 0 TEWODRO ADDISSE MD 917134 0 36649 0 558 0 24922 0 4530 0 983793 0 0 0 DAVID LUTES MD 877102 0 24834 0 1915 0 40234 0 4914 0 948999 0 0 0 CHU CHI CHENMD 1082143 0 33126 0 5544 0 64156 0 4925 0 1189894 0 0 0 PETER TUTUSKA MD 800788 0 24834 0 3573 0 49062 0 15232 0 893489 0 0 0 MAYNARD OLIVERIUS 646307 0 254176 0 14829 0 162405 0 8933 0 1086650 0 0 0 PART I, LINE 4B MAYNARD OLIVERIUS $ 161,405. DAVID CUNNINGHAM $ 19,382. BERNARD BECKER $ 81,212. KENT PALMBERG, M.D. $ 278,901. DEBRA YOCUM $ 16,368. JANET STANEK $ 52,104. CAROL PERRY $ 23,143. STEVEN WATKINS, M.D. $ 30,000. ERIC VOTH, M.D. $ 9,000. DOUGLAS ROSE, M.D. $ 116,025. KEVIN DISHMAN, M.D. $ 1,650. PART I, LINE 6 CERTAIN EMPLOYEES OF THE ORGANIZATION ARE ELIGIBLE FOR BONUSES UPON ACHIEVEMENT OF VARIOUS PERFORMANCE MEASURES AS OUTLINED IN THE ANNUAL INCENTIVE PLAN. KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BJT6 2007-08-27 50064927 HEALTH FACILITIES 0 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLG1 2008-03-31 27950075 HEALTH FACILITIES 0 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 484538MC9 2011-08-31 61193487 HEALTH FACILITIES 0 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48453BNS3 2012-08-14 8750000 HEALTH FACILITIES 0 0 0 53519801 18107157 689770 1048000 30220000 2009 1 1 1 1 27950075 27677500 272575 2008 1 0 1 1 61206412 50325531 863086 7628407 2389388 1 0 0 1 8750014 148649 5543759 3057606 0 0 0 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X SCHEDULE K SUPPLENTAL INFORMATION THE PROJECTS FOR THE 2011 AND 2012 BOND ISSUES WERE NOT COMPLETED AS OF SEPTEMBER 30, 2012 X MEDICAL EQUIPMENT 2 181719 FMV X COMPUTER EQUIPMENT 3 32747 FMV X OTHER EQUIPMENT 3 47003 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE RETURN IS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW. ANY CHANGES ARE COMMUNICATED TO THE PAID PREPARER. A COPY OF THE RETURN IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL. WITH THE BOARD'S APPROVAL, THE PAID PREPARER THEN FILES THE RETURN ELECTRONICALLY. FORM 990, PART VI, SECTION B, LINE 12C THE OFFICERS, DIRECTORS AND KEY EMPLOYEES SUBMIT CONFLICT OF INTEREST STATEMENTS TO THE CHAIRMAN OF THE AUDIT COMMITTEE OF STORMONT-VAIL HEALTHCARE EACH YEAR. THE CHAIRMAN REVIEWS THE RESPONSES AND REPORTS TO THE AUDIT COMMITTEE FOR THEIR REVIEW, ANY APPROPRIATE ACTION IF REQUIRED AND APPROVAL. THE CHAIRMAN ALSO THEN REPORTS THE RESULTS TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE PERFORMANCE COMMITTEE OF THE STORMONT-VAIL HEALTHCARE BOARD OF DIRECTORS ENGAGED INTEGRATED HEALTHCARE STRATEGIES, AN EXECUTIVE COMPENSATION CONSULTING FIRM, TO PROVIDE RECOMMENDATIONS REGARDING ALL ASPECTS OF COMPENSATION OF THE ORGANIZATION'S SENIOR LEADERSHIP GROUP, INCLUDING THE PRESIDENT & CEO. THAT ENGAGEMENT INCLUDED THE FOLLOWING COMPONENTS: -REVIEW OF BACKGROUND DATA, INCLUDING INFORMATION ON CURRENT PROGRAM; -COMPILATION OF DATA ON COMPENSATION AND BENEFIT PRACTICES OF COMPARABLE ORGANIZATIONS; -COMPARISON OF BASE SALARIES AT SVHC TO BASE SALARY LEVELS IN THE MARKET; -COMPARISON OF ANNUAL AND LONG-TERM INCENTIVES AT SVHC TO INCENTIVE LEVELS IN THE MARKET; -ANALYSIS OF BENEFITS ON BOTH A QUANTITATIVE AND QUALITATIVE BASIS; -COMPARISON OF SVHC TOTAL COMPENSATION (BASE, INCENTIVE, BENEFITS) TO PEER GROUP TOTAL COMPENSATION; -PREPARATION OF REPORT TO FACILITATE SVHC BOARD DISCUSSION OF THE TOTAL COMPENSATION; AND -RECOMMENDATIONS REGARDING ESTABLISHMENT OF SALARY RANGES FOR SENIOR LEADERSHIP POSITIONS. THE DELIBERATIONS AND DECISIONS OF THE PERFORMANCE COMMITTEE AND THE BOARD OF DIRECTORS ARE DOCUMENTED IN MEETING MINUTES MAINTAINED BY SVHC. FORM 990, PART VI, SECTION C, LINE 19 STORMONT-VAIL HEALTHCARE, INC. MAKES THEIR FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION AS PART OF THE 990 INFORMATION RETURN. ANY CHANGES TO THE GOVERNING DOCUMENTS ARE INCLUDED WITH THE 990 RETURN. AT THIS TIME, THE HEALTH CENTER DOES NOT MAKE THEIR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 4,225,624. EQUITY IN NET INCOME OF CONSOLIDATED AFFILIATES 2,041,068. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS -14,416,272. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES 281,058. BOOK AMORTIZATION GREATER THAN TAX -44,905. INTEREST RATE SWAP 118,520. TOTAL TO FORM 990, PART XI, LINE 5: -7,794,907. PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. FORM 990, PART III, LINE 4B, PROGRAM SERVICE ACCOMPLISHMENTS: IN ADDITION TO THESE COMMUNITY CONTRIBUTIONS, STORMONT-VAIL PROVIDED SUPERVISED CLINICAL EXPERIENCE FOR OVER 998 STUDENTS AND 144,910 HOURS TO THE FOLLOWING ENTITIES: NAME/LOCATION TYPE OF STUDENTS DEPT/DIVISION ATCHISON HOSPITAL NURSING STAFF PATIENT CARE SERVICES BAKER UNIVERSITY NURSING MULTIPLE BALL STATE UNIVERSITY NURSING MULTIPLE BARTON CO COMMUNITY COLLEGE PARAMEDIC MULTIPLE BENEDICTINE COLLEGE NURSING MULTIPLE CLARKSON COLLEGE PA PEDIATRICCARE COFFEY COUNTY HOSPITAL NURSING MULTIPLE COLBY COMMUNITY COLLEGE PT REHAB SERVICES COMMUNITY HEALTH SYSTEM-ONAGA NURSING MULTIPLE EMPORIA STATE UNIVERSITY NURSING MEDICAL ARTS CLINIC-EMPORIA FORT HAYS NURSING NURSING MULTIPLE FRONTIER SCHOOL OF MIDWIFERY NURSING THE BIRTHPLACE HIAWATHA COMMUNITY HOSPITAL NURSING PATIENT CARE SERVICES INSTITUTE OF MIDWIFERY MIDWIFERY STUDENTS BIRTHPLACE UNIVERSITY OF KANSAS MEDICAL RECORDS HEALTH INFORMATION UNIVERSITY OF KANSAS NURSING PATIENT CARE SERVICES UNIVERSITY OF KANSAS PHARMACY PHARMACY UNIVERSITY OF KANSAS SOCIAL WORK BEHAVIORAL HEALTH UNIVERSITY OF MINNESOTA ADMIN INTERN ADMINISTRATION UNIVERSITY OF MISSOURI-KC NURSING COTTON-O'NEIL CLINICS MORRIS COUNTY EMS EMTS EMERGENCY DEPT MORRIS COUNTY EMS NURSING PATIENT CARE SERVICES MORRIS COUNTY EMS PHARMACY PHARMACY NEOSHO COMMUNITY COLLEGE NURSING PATIENT CARE SERVICES PRONERVE SURGERY ROCKHURST UNIVERSITY PT/OT REHABILITATION SERVICES ROCKY VISTA UNIVERSITY MEDICAL STUDENT COTTON-O'NEIL CLINICS SABETHA HOSPITAL NURSING STAFF PATIENT CARE SERVICES UNIVERSITY OF SOUTHERN INDIANA NURSING PATIENT CARE SERVICES TEXAS WESLEYAN UNIVERSITY CRNA SURGERY USD #501 HIGH SCHOOL MULTIPLE WALDEN UNIVERSITY NURSING PATIENT CARE SERVICES WASHBURN UNIVERSITY KINESIOLOGY HEART CENTER WASHBURN UNIVERSITY HEALTH INFORMATION HEALTH INFORMATION MGMT. WASHBURN UNIVERSITY NURSING MULTIPLE WASHBURN UNIVERSITY OT REHABILITATION SERVICES WASHBURN UNIVERSITY PT ASSISTANTS REHABILITATION SERVICES WASHBURN UNIVERSITY IMAGING SCIENCES MEDICAL IMAGING WASHBURN UNIVERSITY RADIOLOGIC CERTIFICATE CT WASHBURN UNIVERSITY RADIATION THERAPY CANCER CENTER WASHBURN UNIVERSITY RESP THERAPY PULMONARY CARE WASHBURN UNIVERSITY SOCIAL WORK SV BEHAVIORAL HEALTH WASHBURN UNIVERSITY ULTRASOUND-CARDIO RADIOLOGY/ULTRASOUND WASHBURN UNIVERSITY ULTRASOUND-GEN RADIOLOGY ULTRASOUND WASHBURN INSTITUTE OF TECHNOLOGY LPNS MULTIPLE WASHBURN INSTITUTE OF TECHNOLOGY SURG TECHS SURGICAL SERVICES/TSDS WASHBURN INSTITUTE OF TECHNOLOGY EMT PATIENT CARE SERVICES WICHITA STATE UNIVERSITY NURSING MULTIPLE WICHITA STATE UNIVERSITY PA MULTIPLE STORMONT-VAIL FOUNDATION 1500 SW 10TH AVE TOPEKA KS 66604 480980926 GENERATE VOLUNTARY GIFTS TO SUPPORT STORMONT-VAIL HEALTHCARE KS 501(C)(3) LINE 7 STORMONT-VAIL HEALTHCARE 0 STORMONT-VAIL HEALTHCARE AUXILARY 1500 SW 10TH AVE TOPEKA KS 66604 486140517 PROVIDE GIFT SHOP, RESTAURANT AND PROJECTS FOR THE CONVENIENCE OF PATIENTS KS 501(C)(3) LINE 11A, I N/A 0 STORMONT-VAIL SERVICES INC 1500 SW 10TH AVE TOPEKA KS 66604 481021165 MEDICAL SERVICES KS 501(C)(3) LINE 7 N/A 0 EXCELLENT SURGERY CENTER LLC 1500 SW 10TH TOPEKA KS 66604 260849999 OUTPATIENT SPECIALTY EAR, NOSE, AND THROAT SURGERY CENTER KS N/A RELATED 429487 1053286 0 0 0.51000 URISH MEDICAL PLAZA LLC 1500 SW 10TH TOPEKA KS 66604 480782848 REAL ESTATE KS STORMONT-VAIL INC RELATED 42185 871436 0 0 0.71667 STORMONT-VAIL INC 901 GARFIELD TOPEKA KS 66606 480782848 RETAIL PHARMACY KS STORMONT-VAIL HEALTHCARE INC C 1870461 16267084 1.00000 DECHAIRO HOSPITAL INC 1500 SW 10TH ST TOPEKA KS 66604 480788844 REAL ESTATE KS STORMONT-VAIL INC C 331398 1.00000 CENTURY HEALTH SOLUTIONS INC 2951 SW WOODSIDE DR TOPEKA KS 66614 481206397 INSURANCE MANAGEMENT OPERATIONS KS STORMONT-VAIL INC C -343213 207101 1.00000 UAT INC 1500 SW 10TH ST TOPEKA KS 66604 480907989 MEDICAL BILLINGS PRACTICE KS STORMONT-VAIL HEALTHCARE INC C 75935 1.00000 KOSM INC 1500 SW 10TH ST TOPEKA KS 66604 480807000 MEDICAL BILLINGS PRACTICE KS STORMONT-VAIL HEALTHCARE INC C 36181 143363 1.00000 0 1 1 0 0 0 1 0 0 0 0 0 1 1 0 1 0 1 STORMONT-VAIL FOUNDATION B 360000 STORMONT-VAIL FOUNDATION R 295800 STORMONT-VAIL HEALTHCARE AUXILIARY C 168535 STORMONT-VAIL HEALTHCARE AUXILIARY P 228844 STORMONT-VAIL INC N 1347107 STORMONT-VAIL FOUNDATION N 322836 STORMONT-VAIL INC G 3420000