2012-11-15T18:59:37-06:00 2011-12-31 ERNST & YOUNG US LLP 190 CARONDELET PLAZA SUITE 1300 CLAYTON MO 63105 990 2011-01-01 810232124 ST VINCENT HEALTHCARE % MARK W PETESCH STVI 4066577000 1233 NORTH 30TH BILLINGS MT 59101 Ronald Oldfield 2012-11-15 3142901000 2011 2016-02-24 21:20:13Z JAMES T PAQUETTE 1233 NORTH 30TH ST BILLINGS MT 59101 330429537 false 0928 X www.svh-mt.org X 1972 MT WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE. 12 9 2454 389 2110187 -1016220 7880253 3789691 289997965 309537998 7255555 10543304 8345079 5767294 313478852 329638287 1331268 1247660 0 0 149103898 139635912 0 0 0 157811924 177169993 308247090 318053565 5231762 11584722 446637263 447858975 30127606 27309250 416509657 420549725 WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE 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3585703 PART V, LINE 4 ENDOWMENT FUND PURPOSE THE TWO LARGEST ENDOWMENTS ARE DESIGNATED FOR INSURANCE COVERAGE FOR THE WORKING POOR AND NURSE EDUCATION. THE REMAINDER SUPPORT VARIOUS DEPARTMENTS IN THE HOSPITAL AND FOR GREATEST NEED FOR THE HOSPITAL AND FOR PATIENTS. THE ENDOWMENTS ARE HELD BY ST. 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1233 N 30TH BILLINGS MT 59107

X X X X DURABLE MEDICAL EQUI OUTPATIENT PHYS CLIN ST VINCENT HEALTHCARE 1 true true true 400. true X X X X X X true true X X X X X X true false X X X X true X false false 37 INTERNAL MEDICINE ASSOCIATES

2900 12TH AVENUE NORTH SUITE 310 W BILLINGS MT 591017588

AMBULATORY CARE CLINIC INTERNAL MEDICINE AND DIABETES

2019 BROADWATER AVENUE BILLINGS MT 591024810

AMBULATORY CARE CLINIC WEST GRAND FAMILY MEDICINE

2750 GRAND AVENUE BILLINGS MT 591022629

AMBULATORY CARE CLINIC YELLOWSTONE IMAGING AND BREAST CENTER

2900 12TH AVENUE NORTH SUITE 210 W BILLINGS MT 59101

AMBULATORY RADIOLOGY HOME OXYGEN AND MEDICAL EQUIPMENT

1124 16TH STREET WEST BILLINGS MT 591024152

DURABLE MEDICAL EQUIPMENT CARDIOVASCULAR AND THORACIC SURGERY

2900 12TH AVENUE NORTH SUITE 502E BILLINGS MT 591017504

AMBULATORY CARE OF PRE-POST OP CARDIAC, THORACIC, VASCULAR LAUREL MEDICAL CENTER

1035 1ST AVENUE LAUREL MT 590442119

AMBULATORY CARE OUTPATIENT REHABILITATION

2900 12TH AVENUE NORTH BILLINGS MT 59101

OUTPATIENT THERAPIES HEIGHTS FAMILY PRACTICE

32 WICKS LANE BILLINGS MT 59105

AMBULATORY CARE HARDIN MEDICAL CLINIC

16 NORTH MILES AVENUE HARDIN MT 590342356

AMBULATORY CARE VASCULAR CLINIC

2900 12TH AVENUE NORTHSUITE 502E BILLINGS MT 591017504

VASCULAR CLINIC YELLOWSTONE HEART CENTER

2900 12TH AVENUE NORTH SUITE 307W BILLINGS MT 59101

CARDIOLOGY CARE NORTHERN ROCKIES REGIONAL PAIN CENTER

2900 12TH AVENUE NORTH SUITE 401 E BILLINGS MT 591017506

AMBULATORY PAIN MGMT AND CARE SERVICES NEUROSCIENCE CENTER

2900 12TH AVENUE NORTH SUITE 400E BILLINGS MT 591010136

AMBULATORY CARE AND INFUSION SERVICES SVH NEUROSURGERY

2900 12TH AVENUE NORTH SUITE 315 W BILLINGS MT 59101

AMBULATORY PRE AND POST OPERATIVE NEUROSURGICAL CARE CENTER FOR HEALTHY LIVING

2223 MISSION WAY BILLINGS MT 591020160

AMBULATORY CARE OCCUPATIONAL HEALTH

1027 NORTH 27TH STREET BILLINGS MT 591010701

AMBULATORY OCCUPATIONAL HEALTH BROADWATER WALKIN CLINIC

2019 BROADWATER AVENUE BILLINGS MT 591024810

AMBULATORY CARE PHYSICAL MEDICINE CLINIC

2900 12TH AVENUE NORTH SUITE 400 E BILLINGS MT 591010136

PHYSICAL MEDICINE REHAB CANCER THERAPY CLINIC

1041 NORTH 29TH STREET BILLINGS MT 591010700

CANCER THERAPY CARE ELIZABETH SETON PRENATAL CLINIC

1230 NORTH 30TH ST SUITE 100 BILLINGS MT 591010128

PRENATAL CARE SVH GASTROINTESTINAL CLINIC

1144 NORTH 28TH STREET SUITE C BILLINGS MT 59101

GASTROINTESTINAL CARE PEDIATRIC CARDIOLOGY CLINIC

1232 NORTH 30TH STREET SUITE 300 BILLINGS MT 59101

PEDIATRIC CARDIOLOGY CARE MOUNTAIN VIEW CLINIC

10 ROBINSON LANE RED LODGE MT 590680070

AMBULATORY CARE HOME HEALTH SPECIALITIES

2600 WILSON STREET MILES CITY MT 59301

DURABLE MEDICAL EQUIPMENT BEHAVIORAL HEALTH ASSOCIATES

1101 NORTH 27TH STREET SUITE 201 BILLINGS MT 591010100

AMBULATORY PYSCH AND COUNSELING SERVICES WEIGHT MANAGEMENT CLINIC

1101 NORTH 27TH STREET SUITE 101 BILLINGS MT 591010100

AMBULATORY CARE SERVICES RELATED TO WEIGHT LOSS SISTER JOANNA BRUNER CLINIC

720 LINDSAY LANE SUITE A CODY WY 824144103

AMBULATORY CARE BILLINGS CARDIOLOGY

2019 BROADWATER AVENUE BILLINGS MT 591027588

CARDIOLOGY CARE ABSAROKEE MEDICAL CLINIC

55 NORTH MONTANA AVENUE ABSAROKEE MT 590010425

AMBULATORY CARE PHYSICAL THERAPY WEST

14 AVANTA WAY BILLINGS MT 59102

PHYSICAL THERAPY CARE SVH TRAUMATIC BRAIN INJURY

2900 12TH AVE NORTH SUITE 10W BILLINGS MT 291010127

TRAUMATIC BRAIN INJURY CARE SVH NEUROLOGY

1233 NORTH 30 ST BILLINGS MT 591010127

NEUROLOGY CARE RONALD MCDONALD CLINIC

1233 NORTH 30TH STREET BILLINGS MT 591075200

DENTAL AND MEDICAL CARE FOR LOW-INCOME PATIENTS SVH PEDIATRIC SPECIALITY CLINICS

1230 NORTH 30TH STREET SUITE 100 BILLINGS MT 591020128

AMBULATORY CARE MATERNAL FETAL CLINIC

2900 12TH AVENUE NORTH SUITE 130W BILLINGS MT 59101

PERINATOLOGIST CARE BIG HORN BASIN RADIATION ONCOLOGY CENTER

1025 9TH STREET CODY WY 824143441

RADIATION ONCOLOGY CARE SCHEDULE H, PART VI SUPPLEMENTAL INFORMATION PART I, LINE 3C: ELIGIBILITY IS BASED ON FEDERAL POVERTY GUIDELINES. PART I, LINE 6A: NA PART I, LINE 7G: SEVERAL PHYSICIAN CLINICS ARE INCLUDED IN SUBSIDIZED SERVICES. THESE INCLUDE PRIMARY CARE CLINICS IN RURAL AREAS AS WELL AS CLINICS PROVIDING UNDER-REPRESENTED SPECIALTY CARE. TOTAL COSTS INCLUDED ON SCHEDULE H RELATED TO THESE CLINICS AS SUBSIDIZED SERVICES WERE $3,793,704. SUBSIDIDIZED SERVICES ARE EVALUATED FOR INCLUSION USING CHA/VHA GUIDELINES. PART I, LINE 7, COLUMN F: THE AMOUNT OF BAD DEBT EXCLUDED FROM THESE CALCULATONS WAS $22,083,213. PART I, LINE 7: COST ACCOUNTING IS USED TO DETERMINE COMMUNITY BENEFIT EXPENSES FOR SUBSIDIZED HEALTH SERVICES. THE COST ACCOUNTING SYSTEM INCLUDES THE COSTS FROM ALL BUSINESS COMPONENTS TO INCLUDE INPATIENT, OUTPATIENT, EMERGENCY ROOM AND CLINICS, AS WELL AS, ALL PAYOR SEGMENTS. A COST TO CHARGE RATIO WAS USED IN ALL THE OTHER CALCULATIONS AND WAS DERIVED USING THE WORKSHEET 2 METHODOLOGY. PART II: WE EXTEND OUR CARE BEYOND OUR HOSPITAL'S WALLS IN ORDER TO IMPROVE THE HEALTH OF OUR COMMUNITY. In 2011 our community building activities included contributions to non-health related not-for profit organizations; student volunteer mentor program; advocacy related to public health and access to care; Foster Grandparent program; and work with the Healthy by Design Coalition of the Alliance. The Healthy By Design Coalition of the Alliance is the multi-disciplinary community group who provides oversight to prioritizing our community health needs assessment and leading efforts to create and implement our Plan to Improve the Community's Health (PITCH). This collation marked several community health improvement successes during the year as we completed a community health needs assessment and as action plans of the PITCH were implemented. The coalition has developed a recognition program endorsement. THE ENDORSEMENT WAS DEVELOPED AS A WAY OF ESTABLISHING A STANDARD OF EXCELLENCE RELATED TO EVENT PLANNING IN ORDER TO PROMOTE EVENTS IN BILLINGS THAT ARE DESIGNED WITH HEALTH IN MIND. THIS ENDORSEMENT IS DONE THROUGH AN APPLICATION PROCESS AND EACH APPLICATION IS REVIEWED AND EVALUATED BY A TEAM OF EXPERTS. THERE ARE FIVE CRITERIA ADDRESSED WHICH INCLUDE SAFETY; NUTRITION; PHYSICAL ACTIVITY; PREVENTION AND WELLNESS; AND ENVIRONMENTAL STEWARDSHIP. THE PROGRAM HAS BEEN WELL RECEIVED AND RECOGNIZED AT THE MONTANA PUBLIC HEALTH ASSOCIATION ANNUAL MEETING. PARTICIPANTS USING THE PROGRAM TO HELP GUIDE EVENT PLANNING REPORT MAKING HEALTHIER CHOICES RELATED TO MENU SELECTION, INCREASING PHYSICAL ACTIVITY AND PROMOTING SAFETY AT EVENTS. THOUSAND OF AREA RESIDENTS HAVE BEEN IMPACTED BY THIS WORK. THE COALITION APPLIED FOR AND SECURED AN ACHIEVE GRANT FROM THE CDC'S HEALTHY COMMUNITIES PROGRAM IN COLLABORATION WITH THE NATIONAL ASSOCIATION OF COUNTY & CITY HEALTH OFFICIALS, NATIONAL ASSOCIATION OF CHRONIC DISEASE DIRECTORS, NATIONAL RECREATION AND PARK ASSOCIATION, SOCIETY OF PUBLIC HEALTH EDUCATION AND YMCA OF THE USA. THE GRANT WAS AWARDED BASED ON THE SUCCESS OF THE ALLIANCE AND ITS COMMUNITY HEALTH IMPROVEMENT EFFORTS. THE GRANT FOCUSES ON IMPROVING COMMUNITY HEALTH THROUGH POLICY, SYSTEM & ENVIRONMENTAL CHANGE STRATEGIES. We created action plans for this grant that are part of our PITCH. This year we celebrated adoption of a complete streets policy for the City of Billings and worked to improve nutritional offerings in worksites. These target areas tie back to our community needs assessment and to community benefit objectives in our organizational strategic plan. THE WORK OF THIS COALITION HAS BEEN SHARED AT LOCAL, STATE AND NATIONAL PRESENTATIONS INCLUDING THE NATIONAL ASSOCIATION OF COUNTY-CITY HEALTH OFFICIALS ANNUAL MEETING, BILLINGS CITY COUNCIL, THE MONTANA PUBLIC HEALTH ASSOCIATION ANNUAL MEETING, THE MONTANA ASSOCIATION OF PLANNERS ANNUAL MEETING, BILLINGS AVIATION AND TRANSIT COMMISSION, CITY OF BILLINGS PLANNING DEPARTMENT AND PLANNING BOARD, BETTER BILLINGS FOUNDATION, THE CITY OF BILLINGS PARKS AND RECREATION DEPARTMENT AND HEALTHY PLACES ADVISORY COMMITTEE, AND THE CDC'S ACHIEVE COMMUNITIES CONFERENCES. ADDITIONAL COMMUNITY BUILDING ACTIVITIES INCLUDED STATE AND NATIONAL ADVOCACY EFFORTS TARGETED AT HEALTHCARE REFORM AND INCREASING ACCESS TO HEALTHCARE FOR VULNERABLE POPULATIONS. COMMUNITY BUILDING ACTIVITIES ALSO INCLUDE EXPENSES RELATED TO THE FOSTER GRANDPARENT PROGRAM, AIMED AT IMPROVING LITERACY FOR VULNERABLE CHILDREN, WITH SPECIAL OUTREACH TO MARGINALIZED POPULATIONS ON AMERICAN INDIAN RESERVATIONS. PART III, LINE 4: DISCOUNTS AND PAYMENTS APPLIED TO ACCOUNTS REDUCE BAD DEBT EXPENSE. NO METHOD IS USED TO DETERMINE THE AMOUNT THAT COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE, HOWEVER, THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY ALLOWS FINANCIAL ASSISTANCE AWARDS TO BE MADE PRESUMPTIVELY TO INDIVIDUALS WHO HAVE NOT ADEQUATELY COMPLETED THE APPLICATION PROCESS IF THE INDIVIDUAL IS HOMELESS OR IF THE INDIVIDUAL IS NON-RESPONSIVE AND HAS A CREDIT SCORE LESS THAN 600. BAD DEBT EXPENSES INCLUDE ACTUAL WRITE OFFS AND ANY ASSOCIATED ACCRUAL BASED ON ACCOUNTS RECEIVABLE. THE COSTING METHODOLOGY USED TO CALCULATE THE COST OF BAD DEBT INCLUDED ON PART III LINE 2 WAS THE COST TO CHARGE RATIO DERIVED USING THE METHODOLOGY FROM WORKSHEET 2. PART III, LINE 8: THE ORGANIZATION DOES NOT BELIEVE THAT MEDICARE SHORTFALLS SHOULD BE INCUDED AS COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT'S SCHEDULE D PART V, PART VI AND SCHEDULE D-1. PART III, LINE 9B: AN INTEGRAL COMPONENT OF OUR MISSION IS TO BE GOOD FINANCIAL STEWARDS. THIS REQUIRES US TO DETERMINE WHICH PATIENTS ARE IN NEED OF CHARITY CARE AND WHICH ARE ABLE TO CONTRIBUTE SOME PAYMENT FOR CARE RECEIVED. WE MAINTAIN A BALANCE THAT ENABLES US TO CONTINUE TO PROVIDE CHARITY CARE TO THOSE WHO NEED IT MOST, AND TO ENSURE THAT WE MANAGE OUR RESOURCES SO THAT WE CAN CONTINUE TO BE HERE WHEN PEOPLE NEED US MOST. ST. VINCENT HEALTHCARE NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION, DISCHARGE AND IN COMMUNICATION REGARDING PATIENT BILLS. PATIENTS ARE CONTACTED MULTIPLE TIMES ABOUT UNPAID BALANCES PRIOR TO INITIATING ANY COLLECTION ACTION. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION PROCESS, INCLUDING REFERRAL TO A COLLECTION AGENCY, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED. NEEDS ASSESSMENT: AS PART OF OUR CORE VALUE OF RESPONSE TO NEED, WE TAKE STEPS TO DETERMINE WHERE THERE IS THE MOST NEED IN ORDER TO PROVIDE THE GREATEST GOOD. ST. VINCENT HEALTHCARE REGULARLY PARTICIPATED IN NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN 2010, IN COLLABORATION WITH RIVERSTONE HEALTH - THE PUBLIC HEALTH DEPARTMENT - AND BILLINGS CLINIC, THE OTHER NON-PROFIT HOSPITAL IN OUR COMMUNITY. THIS ASSESSMENT STUDIES HEALTH NEEDS IN YELLOWSTONE COUNTY AND WAS CONDUCTED WITH PROFESSIONAL RESEARCH CONSULTANTS THROUGH THE USE OF RANDOM PHONE CALLS TO 400 HOUSEHOLDS IN THE COUNTY AND THROUGH FOCUS GROUPS. RESULTS OF THE SURVEY HAVE BEEN MADE WIDELY AVAILABLE AND COMMUNITY WIDE ACTION PLANS ARE IN DEVELOPMENT. WE ALSO CONTINUOUSLY ASSESS THE NEEDS OF THE COMMUNITY THROUGH CLOSE WORKING RELATIONSHIPS AND PARTNERSHIPS WITH SERVICE AGENCIES IN THE COMMUNITY, AND BY EVALUATING STATE AND COUNTY HEALTH STATISTICS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE: ST. VINCENT HEALTHCARE TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. ST. VINCENT HEALTHCARE HAS A WRITTEN FINANCIAL ASSISTANCE POLICY THAT EXPLAINS ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE AT VARIOUS LEVELS, INCLUDING A 100% DISCOUNT, AND IS BASED ON FEDERAL POVERTY GUIDELINES. WE WORK WITH PATIENTS TO HELP THEM UNDERSTAND THEIR FINANCIAL RESPONSIBILITY FOR CARE RECEIVED, FINANCIAL ASSISTANCE AVAILABLE TO THEM, AND TO ESTABLISH PAYMENT PROGRAMS IN DEMONSTRATION OF OUR CORE VALUE OF RESPECT. AS PART OF OUR RESPONSIBILITY TO EDUCATE, WE INFORM OUR PATIENTS AND THEIR FAMILIES OF THE AVAILABILITY OF ASSISTANCE, INCLUDING GOVERNMENT PROGRAMS. WE COMMUNICATE THIS IN A VARIETY OF WAYS TO ENSURE THAT MESSAGES REACH MULTIPLE AUDIENCES. BEFORE, DURING AND/OR AFTER ADMISSION, WE ENCOURAGE OUR SELF PAY PATIENTS TO VISIT WITH A FINANCIAL COUNSELOR TO DISCUSS QUALIFICATIONS FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WORKS WITH THE PATIENT TO COMPLETE A FINANCIAL ASSISTANCE FORM TO DETERMINE THE LEVEL OF DISCOUNT FOR WHICH THE PATIENT MAY BE ELIGIBLE. WE POST FINANCIAL ASSISTANCE INFORMATION IN EMERGENCY AND ADMISSIONS AREAS, ON BILLINGS INVOICES, IN VARIOUS AREAS AROUND THE ST. VINCENT HEALTHCARE AND CLINIC SITES AND ON THE ST. VINCENT HEALTHCARE WEBSITE. WE PROVIDE WRITTEN MATERIALS TO PATIENTS THAT OUTLINE OUR FINANCIAL ASSISTANCE POLICY AND HOW IT IS ADMINISTERED. THIS COVERS ELIGIBILITY, STEPS TO FOLLOW TO DETERMINE IF A PATI STATE FILING OF COMMUNITY BENEFIT REPORT 990 SCHEDULE H, PART VI CA,KS,MT, true COMMUNITY CRISIS CENTER LLC 704 NORTH 30TH ST BILLINGS MT 59101 203231164 501(C)(3) 142500 FUNDING FOR THE COMMUNITY CRISIS CENTER. IT OPERATES A CRISIS STABILIZATION PROGRAM FOR CITIZENS IN NEED IN BILLINGS. ST VINCENT HEALTHCARE FOUNDATION PO BOX 35200 BILLINGS MT 591075200 810468034 501(c)(3) 1048921 Operations ST VINCENT DE PAUL 2610 MONTANA AVE BILLINGS MT 59101 910879988 501(c)(3) 16239 Rent Utility Assistance BILLINGS AREA CATHOLIC EDUCATION TRUST PO BOX 31158 BILLINGS MT 591071158 816081234 501(c)(3) 10000 STUDENT SCHOLARSHIPS 4 MISSION FUND POLICIES PART I LINE 2 ST VINCENT HEALTHCARE PROVIDES A LIMITED NUMBER OF GRANTS TO IMPROVE THE HEALTH AND WELL-BEING OF THE PEOPLE IN OUR COMMUNITY. GUIDED BY HOSPITAL POLICY, MISSION FUND AWARD PROJECTS MUST: (1) DEMONSTRATE A COMMITTMENT TO THE ST VINCENT HEALTHCARE MISSION, VISION, AND VALUES; (2) MEET CRITERIA FOR INCLUSION IN THE COMMUNITY BENEFIT REPORT; AND (3) DOCUMENT MEASURABLE OUTCOMES THAT DEMONSTRATE THE SUCCESS OF THE PROJECT. PREFERENCE WILL BE GIVEN WHEN THE PROJECT: (1) ADDRESSES CREATIVELY THE UNMET NEEDS OF THE ECONOMICALLY DISADVANTAGED; (2) FORMS COLLABORATIVE PARTNERSHIPS THAT IMPROVE THE HEALTH OF THE COMMUNITY; (3) AIDS A SIGNIFICANT POPULATION OF THE POOR, UNDERSERVED AND/OR UNINSURED; (4) REFLECTS ST VINCENT HEALTHCARE'S ANNUAL AND STRATEGIC GOALS; AND (5) DEMONSTRATE THE POSSIBILITY FOR SUSTAINABILITY BEYOND THE GRANT PERIOD. APPLICATIONS ARE REVIEWED ON AN ANNUAL BASIS BY COMMITTEE. GRANTEES ARE REQUIRED TO PROVIDE A 6-MONTH AND 1-YEAR REPORT TO ST VINCENT HEALTHCARE AND PROVIDE FOR AN ON-SITE VISIT OF THE PROGRAM. AS NOTED IN THE MISSION FUND APPLICATION, IF FUNDS ARE USED OUTSIDE OF PROJECT GUIDELINES THE GRANTEE MAY BE ASKED TO REIMBURSE ST VINCENT HEALTHCARE FOR FUNDS ALREADY DISTRIBUTED FOR THE PROJECT. true true false false false false false true false JAMES T PAQUETTE 0 418351 0 0 0 320176 0 107885 0 15226 0 861638 0 0 STEVE BALLOCK 0 214525 0 0 0 31317 0 18210 0 15742 0 279794 0 0 STEVE SHANDERA 0 153652 0 0 0 104566 0 185119 0 6611 0 449948 0 0 STUART GOODMAN 638244 0 296500 0 0 0 20000 0 14484 0 969228 0 0 0 TIMOTHY DERNBACH 506885 0 0 0 0 0 20000 0 10111 0 536996 0 0 0 JASON FITZGERALD 491391 0 338060 0 0 0 20000 0 10293 0 859744 0 0 0 JOAN THULLBERY 0 153767 0 0 0 1254 0 24018 0 10178 0 189217 0 0 JASON BARKER 0 408132 0 0 0 28965 0 42237 0 10110 0 489444 0 0 Mike Dowdy 0 126738 0 0 0 33454 0 13000 0 11293 0 184485 0 0 ROGER WALLACE 499594 0 0 0 0 0 20000 0 14728 0 534322 0 0 0 Hamad Hai 453167 0 1178 0 7131 0 12500 0 5265 0 479241 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 SEE FORM 990, SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, LINES 15A & B REGARDING THE PROCESS USED BY SCLHS TO DETERMINE EXECUTIVE COMPENSATION WHICH IS RELIED UPON BY THIS ORGANIZATION. FORM 990, SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS THE AMOUNTS PAID FOR SEVERANCE IN 2011 WERE: STEVEN P. SHANDERA-$95,438 FORM 990, SCHEDULE J, PART I, LINE 4B PAYMENTS FROM NONQUALIFIED RETIREMENT PLAN 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 2011 WERE: JAMES T. PAQUETTE-$105,270 STEVEN A. BALLOCK-$9,198 IN ADDITION, VESTED AMOUNTS ARE PAYABLE UPON END OF EMPLOYMENT. THE VESTED AMOUNTS WITHDRAWN, NOT PREVIOUSLY TAXED, FOR THIS TYPE OF PAYMENT IN 2011 WERE: STEVEN P. SHANDERA-$4,468 SCHEDULE J, PART I, LINE 7 (NON-FIXED PAYMENTS) SCLHS HAS MANAGEMENT INCENTIVE PLANS WHICH 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 CARE SITE IN WHICH THE INDIVIDUAL WORKS, OR IN THE CASE OF SCLHS SENIOR MANAGEMENT, THE NET EARNINGS OF SCLHS. FORM 990 PART VII AND SCHEDULE J, PART II THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES INCLUDING ST. VINCENT HEALTHCARE (ST. VINCENT) IN BILLINGS, MONTANA. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. JAMES T. PAQUETTE IS A SYSTEM PROJECT LEADER OF SCLHS IN DENVER, COLORADO. HE FORMERLY SERVED AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF ST. VINCENT HEALTHCARE. THE COMPENSATION REFLECTED IS THAT OF MR. PAQUETTE'S POSITION AS AN SCLHS SYSTEM PROJECT LEADER AND IS NOT RELATED TO ST VINCENT'S. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE. DISCLOSURES FORM 990 PART III, LINE 4D OTHER PROGRAM SERVICES OTHER PROGRAM SERVICES ARE DETAILED IN THE NARRATIVES OF FORM 990 SCHEDULE H. FORM 990, PART VI, SECTION A, LINE 3, DELEGATE CONTROL OVER MANAGEMENT DUTIES ALTHOUGH THESE SERVICES MAY NOT ALL RISE TO THE LEVEL OF MANAGEMENT CONTROL AS DEFINED IN THE 990 INSTRUCTION, WE HAVE IN THE SPIRIT OF FULL TRANSPARENCY PROVIDED THE FOLLOWING DISCLOSURE. AS A MEMBER OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, THIS PROVIDER MAY HAVE INDIVIDUAL AND/OR SYSTEM CONTRACT(S) THAT HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES IN SOME OR ALL OF THE FOLLOWING AREAS: DIETARY AND FOOD SERVICE HOUSEKEEPING SUPPLY CHAIN REVENUE CYCLE SECURITY FORM 990 PART VI, SEC A, LINES 6, 7A & 7B CLASS OF MEMBER, NATURE OF RIGHTS, ELECTION OF BOARD MEMBERS, DECISIONS SUBJECT TO APPROVAL THE SOLE MEMBER AND CONTROLLING MEMBER OF THE ST VINCENT HEALTHCARE (SVH) CORPORATION IS THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC (SCLHS), A KANSAS NON-FOR-PROFIT CORPORATION. SOME OF THE EXCLUSIVE POWERS OF SCLHS INCLUDE: (1) TO APPOINT, AFTER CONSULTATION WITH THE SVH CORPORATE BOARD, THE BOARD OF DIRECTORS OF SVH AND APPOINT MEMBERS OF SCLHS TO THE SVH BOARD OF DIRECTORS; (2) TO REMOVE, WITH OR WITHOUT CAUSE, AFTER CONSULTATION WITH THE SVH CORPORATE BOARD, ANY MEMBER OF THE SVH BOARD OF DIRECTORS; (3) TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE CHIEF EXECUTIVE OFFICER AND THE CHIEF ADMINISTRATIVE OFFICER OF SVH; (4) TO IMPLEMENT CORPORATE GOALS, POLICIES, AND PROCEDURES OF SVH; (5) TO APPROVE FOR SVH THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS, OR THE LEASE, SALE, TRANSFER, ASSUMPTION, OR ENCUMBERING OF SVH ASSETS; (6) TO APPROVE THE MERGER, DISSOLUTION, OR CORPORATE RESTRUCTURING OF SVH; AND (7) TO APPROVE SVH ANNUAL STRATEGIC PLANS AND OPERATING AND CAPITAL BUDGETS. THE SVH BOARD OF DIRECTORS HAVE THE POWERS TO EXERCISE GENERAL MANAGEMENT AND CONTROL OF THE BUSINESS AFFAIRS OF SVH WITH DUE REGARD FOR THE POWERS RESERVED BY SCLHS. THE POWERS OF THE SVH BOARD OF DIRECTORS INCLUDE NOMINATION OF BOARD MEMBERS FOR APPOINTMENT BY SCLHS. FORM 990 PART VI, SEC B, LINE 11B PROCESS FOR REVIEWING FORM 990 DURING THE PREPARATION OF THE RETURN, IT IS REVIEWED BY THE SYSTEM OFFICE AND BY AN INDEPENDENT ACCOUNTING FIRM. THEN THE FORM 990 IS REVIEWED BY THE ST VINCENT BOARD BEFORE THE RETURN IS SUBMITTED TO THE IRS. DUE TO THE TIMING OF BOARD MEETINGS THERE MAY BE CHANGES TO THE FORM 990 THAT ARE COMMUNICATED TO THE BOARD AFTER THEIR REVIEW. FORM 990 PART VI, SEC B, LINE 12C WRITTEN CONFLICT OF INTEREST POLICIES ALL ST VINCENT HEALTHCARE EXECUTIVES, DIRECTORS, AND MANAGERS, BOARD MEMBERS AND BOARD COMMITTEE MEMBERS, MEDICAL EXECUTIVE COMMITTEE (MEC) MEMBERS AND OTHER PHYSICIANS IN DECISION MAKING ROLES OR SERVING ON SVH EXECUTIVE COMMITTEES, COMPLETE A NEW CONFLICT OF INTEREST (COI) DISCLOSURE FORM ANNUALLY. A COPY OF THE POLICY IS DISTRIBUTED ALONG WITH THE COI FORMS. IN THE EVENT OF A CHANGE OF CIRCUMSTANCE, EACH INDIVIDUAL WHO HAS ALREADY SIGNED A COI IS EXPECTED TO NOTIFY THE ORGANIZATION OF THE CHANGE AND UPDATE THE CONFLICT OF INTEREST INFORMATION. THE STATEMENTS ARE REVIEWED AND COI ISSUES ARE ADDRESSED BY THE ORGANIZATION RESPONSIBILITY OFFICER (ORO) AND LEADERSHIP AT THE APPROPRIATE LEVEL: - BOARD BY BOARD CHAIR - PHYSICIANS BY THE MEC PRESIDENT - SVH DIRECTORS AND MANAGERS BY THE SVH ADMINISTRATION - SVH EXECUTIVES BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM THE SIGNED COI FORMS ARE MAINTAINED IN SVH ADMINISTRATION. THE CONFLICT OF INTEREST DISCLOSURE STATEMENTS FOR SVH EXECUTIVES ARE MAINTAINED AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AT THE BEGINNING OF BOARD AND BOARD COMMITTEE MEETINGS, THE QUESTION OF COI IS ASKED OF THOSE IN ATTENDANCE. WHEN AN ACTUAL CONFLICT IS IDENTIFIED, THE INDIVIDUAL ASKS TO BE EXCUSED FROM PARTICIPATING IN THE DISCUSSION AND DECISION-MAKING. FORM 990, PART VI, LINES 15A & B SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACTS -COMPENSATION SURVEYS AND STUDIES -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. FORM 990 PART VI, SEC B, LINE 16B JOINT VENTURE WRITTEN POLICIES AND PROCEDURES ST VINCENT HEALTHCARE MAINTAINS DETAILED RECORDS OF THE JOINT VENTURES IN ADMINISTRATION. ALL FILES ARE SCANNED AND REVIEWED. E&Y PERFORMED A COMPREHENSIVE ANALYSIS OF THE JOINT VENTURES IN 2008. FORM 990 PART VI, SEC C, LINE 19 WRITTEN CONFLICT OF INTEREST POLICY A WRITTEN COPY OF THE GOVERNING DOCUMENTS AND THE CONFLICT OF INTEREST POLICY IS AVAILABLE FROM HOSPITAL ADMINISTRATION. FORM 990 PART XI, LINE 5 RECONCILIATION OF NET ASSETS THE CHANGES IN NET ASSETS SHOWN ON LINE 5 OF PART XI ($-7,544,654) STEM FROM THE UNREALIZED LOSS ON INVESTMENTS THAT WAS NOT RECORDED IN THE TAX RETURN ASSETS SHOWN ON LINE 5 OF PART XI ($-7,544,654) STEM FROM THE UNREALIZED LOSS ON INVESTMENTS THAT WAS NOT RECORDED IN THE TAX RETURN STATEMENT OF CONTROLLED FOREIGN CORPORATION ST. VINCENT HEALTHCARE, PARTICIPATION CORPORATION EIN: 81-0232124 FOR THE TAX YEAR ENDED DECEMBER 31, 2011 THIS STATEMENT IS BEING FILED PURSUANT TO TREAS. REG. 1.6038-2(J)(3). ST. VINCENT HEALTHCARE'S FILING REQUIREMENT FOR FORM 5471 FOR THE CONTROLLED FOREIGN CORPORATIONS LISTED BELOW HAS BEEN SATISFIED BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (FEIN:23-7379161). SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM HAS INCLUDED THE FORM 5471 WITH ITS FORM 990 WHICH WAS FILED ELECTRONICALLY. LEAVEN INSURANCE COMPANY, LTD. 98-0370522 23 LIMETREE BAY AVE., PO BOX 1051 GEORGE TOWN, GRAND CAYMAN KY1-1102 CJ RIVERVIEW MULTI-SERIES FUND SPC, LTD. 510 THORNALL STREET, SUITE 220 EDISON, NJ 08837 AUSTIN CAPITAL SAFE HARBOR OFFSHORE FUND, LTD. PO BOX 31106, 89 NEXUS WAY, 2ND FLOOR CAMANA BAY GEORGE TOWN, GRAND CAYMAN KY1-1205 CJ JP MORGAN HEDGE FUND SPC-ACCESS MAR09 SEGREGATED 98-0680591 %INT'L FUND SVCS LTD, 78 SIR JOHN ROGERSON'S QUAY DUBLIN, IRELAND 2 EI JP MORGAN HEDGE FUND SPC-ACCESS JUN09 SEGREGATED 98-0680582 %INT'L FUND SVCS LTD, 78 SIR JOHN ROGERSON'S QUAY DUBLIN, IRELAND 2 EI HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JASON BARKER TITLE:BOARD ASST. 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