2013-11-15T12:09:55-06:00 2012-12-31 990 2012-01-01 440565393 SAINT LUKES NORTHLAND HOSPITAL CORPORATION SAIN 8165327382 601 SOUTH 169 HIGHWAY SMITHVILLE MO 64089 KEVIN TRIMBLE 8165327382 2013-11-15 2012 2016-03-07 17:11:31Z KEVIN TRIMBLE 601 SOUTH 169 HIGHWAY SMITHVILLE MO 64089 126609851 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1989 MO HOSPITAL 12 10 1022 191 244353 -112840 332673 442617 115467999 126083898 149370 83336 0 0 115950042 126609851 4267171 5385584 0 0 53972125 56899954 0 0 35585 53259612 58944184 111498908 121229722 4451134 5380129 101409607 103119557 56089317 53354175 45320290 49765382 X SAINT LUKE'S NORTHLAND HOSPITAL CORPORATION IS A PART OF SAINT LUKE'S HEALTH SYSTEM, A FAITH BASED, NOT-FOR-PROFIT ALIGNED HEALTH SYSTEM COMMITTED TO THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE AND HEALTH RELATED SERVICES IN A CARING ENVIRONMENT. WE ARE DEDICATED TO ENHANCING THE PHYSICAL, MENTAL, AND SPIRITUAL HEALTH OF THE COMMUNITIES WE SERVE. 0 0 107307963 5385584 125839545 ALL PROGRAM SERVICE EXPENSES WERE INCURRED IN FURTHERANCE OF OUR MISSION, WHICH IS TO ENSURE THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE SERVICES TO ALL PATIENTS IN A CARING ENVIRONMENT. IN 2012, THERE WERE 29,000 PATIENT DAYS AND 1,700 NEWBORN DAYS. IN ADDITION, THE HOSPITAL PROVIDED 86,000 OUTPATIENT AND EMERGENCY SERVICES.AS A VOLUNTARY, NONPROFIT, COMPREHENSIVE ORGANIZATION, SAINT LUKE'S NORTH HOSPITAL IS COMMITTED TO SERVING ALL WHO SEEK OUR SERVICES REGARDLESS OF THEIR SOCIOECONOMIC STATUS. 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.THE BARRY ROAD CAMPUS IS AN 84-BED ACUTE CARE FACILITY LOCATED IN KANSAS CITY, MISSOURI. THE SMITHVILLE CAMPUS PROVIDES URGENT CARE SERVICES TO THE COMMUNITY, AS WELL AS REHABILITATION, MENTAL HEALTH, AND POST-ACUTE CARE SERVICES. BOTH CAMPUSES SERVE THE NORTHERN KANSAS CITY AREA. 107307963 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 0 0 1 X 9 0 1 1022 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 8165327164 601 SOUTH 169 HIGHWAY SMITHVILLE MO 64089 X THOMAS L BROWN 1.00 X X 0 0 0 EUGENE RUIZ 1.00 X X 0 0 0 RAHUL JOSHI 1.00 X 0 0 0 GAYDEN F CARRUTH 1.00 X X 0 0 0 KELLEY M MARTIN 1.00 X 0 0 0 WILLIAM PARKS 1.00 X 0 0 0 GINA LAWSON DO 1.00 40.00 X 0 374473 43497 LORA CHEATUM 1.00 X 0 0 0 MICHAEL SHORT 1.00 X 0 0 0 RYAN MCNELLIS MD 1.00 40.00 X 0 302865 27411 GEORGE RICHTER 1.00 X 0 0 0 TWYLA WILSON 1.00 X 0 0 0 KEVIN TRIMBLE 50.00 X 344569 0 63574 JULIE MURPHY 50.00 X 255699 0 45707 JEFF EYE 50.00 X 193110 0 15619 DON SIPES 5.00 45.00 X 0 339041 55262 DANIEL WEED 40.00 X 495921 0 32729 JENNIFER SVETLECIC 40.00 X 395907 0 29738 VANCE JERNSTROM 40.00 X 361162 0 16566 SALVATORE MICELI 40.00 X 355392 0 31253 MICHAEL WILLIAMSON 40.00 X 459649 0 12580 2861409 1016379 373936 16 0 1 0 P1 GROUP INC 16210 W 108TH ST LENEXA KS 66219 MAINTENANCE 1795320 JE DUNN 929 HOLMES KANSAS CITY MO 64106 CONSTRUCTION & CONST MGMT 1081847 MOBILE CATARACT CARE OF KANSAS CITY LLC 5844 NW BARRY RD SUITE 200 KANSAS CITY MO 64154 MEDICAL SERVICES 963050 AD VIVUM ANESTHESIOLOGY PC 8646 N OREGON AVE KANSAS CITY MO 64154 MEDICAL SERVICES 750000 NORTHLAND WOMENS HEALTHCARE 5844 NW BARRY RD SUITE 310 KANSAS CITY MO 64154 MEDICAL SERVICES 392707 16 288971 8000 145646 442617 NET PATIENT REVENUE 622110 121368848 121368848 EHR MEANINGFUL USE FDS 622110 966975 966975 REGIONAL LAB SERVICES 621500 777052 733588 43464 MEDICAL OFFICE RENT 531120 644372 644372 RENT FROM AFFILIATES 531120 628154 628154 1698497 1497608 200889 126083898 83336 83336 126609851 125839545 244353 83336 5372502 5372502 13082 13082 918279 918279 44425549 42922508 1503041 1736501 1643773 92728 6860798 6438767 422031 2958827 2800828 157999 217307 217307 45000 45000 11367060 9030162 2336898 26540 5500 21040 3208925 2603555 569785 35585 325359 168754 156605 1975235 1896090 79145 112217 93159 19058 104533 77048 27485 2221725 2103040 118685 6921360 6506717 414643 400485 172382 228103 MEDICAL SUPPLIES 13087222 13087222 SHARED SERVICES- SLHS 9610000 3187288 6422712 BAD DEBT 8680516 8680516 OTHER EXPENSES 404768 269138 135630 235932 235932 121229722 107307963 13886174 35585 100594 56335 16140065 21330158 13798385 14456703 1993881 2059908 1500969 1233890 142130102 80659668 63720471 61470434 885039 58605 438961 624394 2831242 1829130 101409607 103119557 6829381 7872947 43896482 42410317 5363454 3070911 56089317 53354175 X 44891122 49462872 429168 302510 45320290 49765382 101409607 103119557 X 5380129 -935037 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 22824 0 0 0 22824 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: LINE F-PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS AND MEDICAL ORGANIZATIONS USED TOWARD LOBBYING ACTIVITIES. 94772 91850 285 76822 110085 100371 68525 416 74540 94772 74120 93625 482 67856 100371 72833 70450 605 69768 74120 95720 48400 1010 72297 72833 1.00000 1 0 2591240 2591240 65121710 37253847 27867863 69696831 39471379 30225452 4720321 3934442 785879 61470434 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 439000 RESERVE SELF INSURED RISKS 409380 OTHER NONCURRENT LIABILITIES 62737 OTHER CURRENT LIABILITIES 677821 PAYABLES TO AFFILIATES 1481973 3070911 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF ENDOWMENT FUNDS INCLUDES BUT IS NOT LIMITED TO MEDICAL STAFF DEVELOPMENT, GENERAL OPERATIONS OF THE HOSPITAL, AND STUDENT SCHOLARSHIPS. THE ASSETS HELD AT THE UNRELATED ORGANIZATION REPRESENTS THE ORGANIZATION'S SHARE OF NET ASSETS AT SPELMAN MEDICAL FOUNDATION PER SFAS 136. SUCH ASSETS ARE REPORTED IN PART X, LINE 15. PART XI, XII, AND XIII, THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN THE CONSOLIDATED AUDIT OF SAINT LUKE'S HEALTH SYSTEM. 1 1 X 1 X 133.000000000000 1 X 1 1 0 0 6966090 6966090 0.06190 17473050 13926419 3546631 0.03150 24439140 13926419 10512721 0.09340 320959 320959 0.00290 29798 29798 0.00030 137479 137479 0.00120 488236 488236 0.00440 24927376 13926419 11000957 0.09780 0 8680516 26610013 34628954 -8018941 X 1 1 2 1 SAINT LUKES NORTHLAND HOSPITAL-BARRY

5830 NW BARRY ROAD KANSAS CITY MO 64154

X X X 2 SAINT LUKES NORTHLAND HOSPITAL-SMV

601 S 169 HIGHWAY SMITHVILLE MO 64089

X X REHABILITATION AND BEHAVIORAL HEALTH SAINT LUKES NORTHLAND HOSPITAL-BARRY 1 1 1 133.000000000000 1 400.000000000000 1 X X X 1 1 X X X 1 0 1 X 0 0 SAINT LUKES NORTHLAND HOSPITAL-SMV 2 1 1 133.000000000000 1 400.000000000000 1 X X X 1 1 X X X 1 0 1 X 0 0 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 $121,229,722 LESS BAD DEBT EXPENSE OF $8,680,516 EQUALS TOTAL EXPENSE OF $112,549,206 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F), PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE (INCLUDING COPAYMENT AND DEDUCTIBLE AMOUNTS FROM PATIENTS), THE SYSTEM ANALYZED CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE SYSTEM 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. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED. THESE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS AND ARE ADJUSTED AS NEEDED IN FUTURE PERIODS. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE.BAD DEBT IS REPORTED CONSISTENT WITH FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO DIRECTLY FROM THE MEDICARE COST REPORT. SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN WHAT IT COSTS TO PROVIDE THE CARE AND SERVICES. WE ACCEPT ALL MEDICARE PATIENTS KNOWING THE COST OF PROVIDING THE CARE MAY EXCEED THE FUNDS WE RECEIVE FROM MEDICARE FOR THE SERVICE. OUR SHORTFALL IS CONSIDERED TO BE COMMUNITY BENEFIT. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS, INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD. 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. 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. SAINT LUKES NORTHLAND HOSPITAL-BARRY 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-INLOCATED 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. SAINT LUKES NORTHLAND HOSPITAL-SMV 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-INLOCATED 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. THE HOSPITAL MEETS WITH STAFF, VOLUNTEERS, PATIENTS, BOARD MEMBERS AND PHYSICIANS. THE FEEDBACK PROVIDED BY THESE GROUPS IS COMMUNICATED TO HOSPITAL MANAGEMENT AND CONSIDERED WHEN DETERMINING THE NEEDS OF THE COMMUNITY.THE HOSPITAL ALSO WORKS WITH THE PATIENT ADVOCATE AND MARKETING DEPARTMENTS TO DETERMINE FEEDBACK RECEIVED FROM THE COMMUNITY REGARDING ITS NEEDS. THIS FEEDBACK IS ALSO COMMUNICATED TO HOSPITAL MANAGEMENT AND EVALUATED DURING THE ANNUAL BUDGET AND STRATEGIC PLANNING PROCESS. PART VI, LINE 3: SEE RESPONSE TO SCHEDULE H, PART V, LINE 14G. PART VI, LINE 4: THE BARRY ROAD CAMPUS IS AN 84-BED ACUTE CARE FACILITY LOCATED IN KANSAS CITY, MISSOURI. THE SMITHVILLE CAMPUS PROVIDES URGENT CARE SERVICES TO THE COMMUNITY, AS WELL AS REHABILITATION, MENTAL HEALTH, AND POST-ACUTE CARE SERVICES. BOTH CAMPUSES SERVE THE NORTHERN KANSAS CITY AREA. PART VI, LINE 5: THE BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROFESSIONALS, ALMOST ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP.MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. 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 SAINT LUKE'S MEDICAL GROUP - AFFILIATED 501(C)(3) 6750 ANTIOCH SUITE 210 SHAWNEE MISSION KS 66204 431598353 501(C)(3) 1852569 OPERATING FUNDS SPELMAN MEDICAL FOUNDATION 5810 NW BARRY ROAD KANSAS CITY MO 64154 431270223 501(C)(3) 21100 CONTRIBUTION SLNC INC - AFFILIATED 501C3 4401 WORNALL ROAD KANSAS CITY MO 64111 271994652 501(C)(3) 175773 OPERATING FUNDS SLCC INC - AFFILIATED 501C3 4330 WORNALL ROAD SUITE 2000 KANSAS CITY MO 64111 271994652 501(C)(3) 2233137 OPERATING FUNDS NORTHLAND HEALTHCARE ACCESS PO BOX 14414 PARKVILLE MO 64152 431578121 501(C)(3) 22500 CONTRIBUTION ST LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 501(C)(3) 1050523 OPERATING FUNDS 6 0 ADVANCED EDUCATION IN MEDICAL FIELD - SCHOLARSHIP 12 12000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SCHOLARSHIPS ARE GIVEN TO HIGH SCHOOL GRADUATES PURSUING ADVANCED EDUCATION IN THE MEDICAL FIELD BASED ON ACADEMICS. GRANTS ARE ALSO PROVIDED TO QUALIFIED 501(C)(3) CHARITIES. ALL DONEE INFORMATION IS KEPT AS PART OF THE HOSPITAL BOOKS AND RECORDS. 0 0 0 0 0 0 0 1 0 GINA LAWSON DO 0 313072 0 60833 0 568 0 20000 0 23497 0 417970 0 0 RYAN MCNELLIS MD 0 215166 0 85660 0 2039 0 11250 0 16161 0 330276 0 0 KEVIN TRIMBLE 249969 0 71297 0 23303 0 40560 0 23014 0 408143 0 14888 0 JULIE MURPHY 198500 0 41219 0 15980 0 36159 0 9548 0 301406 0 12368 0 JEFF EYE 163127 0 28841 0 1142 0 8705 0 6914 0 208729 0 0 0 DON SIPES 0 235195 0 66841 0 37005 0 37870 0 17392 0 394303 0 17999 DANIEL WEED 492934 0 0 0 2987 0 10000 0 22729 0 528650 0 0 0 JENNIFER SVETLECIC 391991 0 2500 0 1416 0 10000 0 19738 0 425645 0 0 0 VANCE JERNSTROM 358701 0 0 0 2461 0 10000 0 6566 0 377728 0 0 0 SALVATORE MICELI 233038 0 120997 0 1357 0 11250 0 20003 0 386645 0 0 0 MICHAEL WILLIAMSON 459216 0 0 0 433 0 5000 0 7580 0 472229 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 GINA LAWSON AND RYAN MCNELLIS DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZTION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR DON SIPES IS FOR SERVICES RENDERED TO THE FILING AND RELATED ORGANIZATIONS. NUMBER REPORTED IN BOX 3 OF FORM 1096 FORM 990, PART V, LINE 1A SAINT LUKE'S NORTHLAND HOSPITAL CORPORATION (SLNH) IS PART OF SAINT LUKE'S HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM. THE MAJORITY OF SLNH VENDORS ARE PAID THROUGH A CENTRALIZED PAYMENT SYSTEM WITH 1099S ISSUED BY THE CENTRALIZED SERVICE ENTITY. 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. THE 990 DRAFT WAS ALSO PRESENTED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS FOR REVIEW. 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 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 EXECUTIVES. 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 SURVEYS AND COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. GINA LAWSON AND RYAN MCNELLIS DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZTION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. REPORTABLE COMPENSATION FROM RELATED ORGANIZATIONS FOR DON SIPES IS FOR SERVICES RENDERED TO THE FILING AND RELATED ORGANIZATIONS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: RISK RETENTION GROUP SSA DIVIDENDS -20,611. PENSION LIABILITY TRANSFER TO SAINT LUKE'S HEALTH SYSTEM -158,185. EQUITY IN AFFILIATES -165,718. CHANGE IN INTEREST IN ASSETS OF THE FOUNDATION - SFAS 136 -141,971. DISSOLUTION OF WHOLLY OWNED SUBSIDIARIES -448,551. RDG -1. JOINT VENTURE FORM 990, PART VI, SECTION B, LINE 16B THE ORGANIZATION HAS PROCEDURES IN PLACE TO ENSURE THE VENTURE OPERATES IN A MANNER CONSISTENT WITH THE ORGANIZATION'S EXEMPT MISSION AND FOR THE VENTURE TO NOT ENGAGE IN POLITICAL CANDIDATE CAMPAIGN ACTIVITY OR OTHER ACTIVITIES THAT WOULD JEOPARDIZE THE ORGANIZATION'S EXEMPTION. TAX EXEMPT BOND LIABILITIES FORM 990, PART X, BALANCE SHEET, LINE 20 THE AMOUNT REPORTED AS TAX-EXEMPT BONDS IS THE PORTION OF SAINT LUKE'S HEALTH SYSTEM BONDS ALLOCATED TO SAINT LUKE'S NORTHLAND HOSPITAL. REQUIRED INFORMATION FOR THE BONDS, INCLUDING SCHEDULE K, IS REPORTED IN THE SAINT LUKE'S HEALTH SYSTEM (EIN: 43-1747502) IRS FORM 990. SLN MEDICAL SPECIALISTS LLC 5830 NW BARRY ROAD KANSAS CITY MO 64154 260178220 PHYSICIAN SERVICES - BILLING MO 4987480 0 SAINT LUKES NORTHLAND HOSPITAL SAINT LUKES 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 LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 HEALTH CARE MO 501(C)(3) 170B1AIII 0 SAINT LUKES SOUTH HOSPITAL INC 12300 METCALF AVE OVERLAND PARK KS 66213 481203262 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES EAST HOSPITAL 100 NE ST LUKES BLVD LEES SUMMIT MO 64086 562488077 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES MEDICAL GROUP 6750 ANTIOCH SUITE 210 SHAWNEE MISSION KS 66204 431598353 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 CRITTENTON 10918 ELM AVE KANSAS CITY MO 64134 440545808 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HOSPITAL 0 SAINT LUKES HEALTH SYSTEM HOME CARE AND HOSPICE 3100 BROADWAY SUITE 1000 KANSAS CITY MO 64111 431127200 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES HOSPITAL OF TRENTON 701 EAST FIRST TRENTON MO 64683 431707306 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES HOSPITAL OF GARNETT 421 SOUTH MAPLE GARNETT KS 66032 742849611 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 CABOT WESTSIDE HEALTH CENTER 2121 SUMMIT KANSAS CITY MO 64108 440546280 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 MIDWEST EAR INSTITUTE INC 4200 PENNSYLVANIA SUITE 100 KANSAS CITY MO 64111 480905027 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HOSPITAL 0 SAINT LUKES HOSPITAL OF CHILLICOTHE 100 CENTRAL STREET CHILLICOTHE MO 64601 431735565 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 CUSHING MEMORIAL HOSPITAL CORP 711 MARSHALL LEAVENWORTH KS 66048 480543792 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES CANCER INSTITUTE LLC 4401 WORNALL RD KANSAS CITY MO 64111 431933950 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES CARE 10920 ELM AVENUE KANSAS CITY MO 64134 260185090 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 MEDICAL PLAZA IMAGING ASSOCIATES LLC 4401 WORNALL ROAD KANSAS CITY MO 64111 431609584 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES COLLEGE OF HEALTH SCIENCES 624 WESTPORT ROAD KANSAS CITY MO 64111 272716128 POST SECONDARY NURSING EDUCATION MO 501(C)(3) 170B1AIII SAINT LUKES HOSPITAL 0 SLCC INC 4330 WORNALL ROAD SUITE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SLNC INC 4401 WORNALL RD KANSAS CITY MO 64111 451470888 HEALTH CARE KS APPLYING FOR 501(C)( APPLYING FOR 170B1AI SAINT LUKES HEALTH SYSTEM 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL RD SUITE 410 KASAS CITY MO 64111 431357824 OWN AND OPERATE MEDICAL OFFICE BUILDING MO N/A MEDICAL PARK ASSOCIATES A LP (DISSOLVED DURING 2012) 601 S 169 HWY SMITHVILLE MO 64089 431311049 OWN AND OPERATE MEDICAL OFFICE BUILDING MO SPELMAN DEVELOPMENT CORP INVESTMENT -55741 0 0 0.08250 ST LUKE'S SURGICENTER-LEE'S SUMMIT LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 470853481 HEALTH CARE MO N/A SAINT LUKE'S SOUTH SURGERY CENTER LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 201721929 HEALTH CARE KS N/A FAMILY ADVOCATES LLC 10918 ELM AVE KASAS CITY MO 64134 202739036 FOSTER CARE MO N/A SAINT LUKE'S CARDIOLOGY SERVICES 10920 ELM AVE KASAS CITY MO 64134 263726426 HEALTH CARE MO N/A SAINT LUKE'S-GI DIAGNOSTICS LLC 4321 WASHINGTON SUITE 5700 KASAS CITY MO 64111 274142549 HEALTH CARE MO N/A SPELMAN DEVELOPMENT CORPORATION (DISSOLVED DURING 2012) 601 S 169 HIGHWAY SMITHVILLE MO 64089 431296007 MEDICAL OFFICE BUILDING RENTALS MO SAINT LUKES NORTHLAND HOSPITAL C -141217 1.00000 0 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 10920 ELM AVENUE KANSAS CITY MO 64134 431278476 ACCOUNTING MO N/A C 0 MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL RD SUITE 410 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A C 0 VENTURE FINANCIAL SERVICES INC 6158 RAYTOWN TRAFFICWAY RAYTOWN MO 64133 431605740 COLLECTIONS MO N/A C 0 0 1 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 MEDICAL PARK ASSOCIATES K 156080 PAID FMV RENT TO MPA FOR OFFICES SPELMAN DEVELOPMENT CORPORATION R 15000 CONTRIBUTION TO EQUITY TRANSACTIONS WITH RELATED ORGANIZATIONS SCHEDULE R, PART V, LINE 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.