2012-08-15T10:48:39-05:00 2011-09-30 BERBERICH TRAHAN & CO PA 3630 SW BURLINGAME ROAD TOPEKA KS 666112050 990 2010-10-01 480543789 STORMONT-VAIL HEALTHCARE INC STOR 7853546000 1500 SW 10TH STREET TOPEKA KS 666041353 KEVIN J HAN 7853546000 2012-08-14 1 CHERYL G HAYWARD 7852343427 2010 2016-02-24 21:20:13Z KEVIN J HAN 1500 SW 10TH STREET TOPEKA KS 666041353 516840918 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. 16 14 4442 540 0 31921 619223 518666 479320375 509975162 4350279 4865737 787469 845140 485077346 516204705 0 0 0 0 277911626 294024917 0 0 0 189846855 189861294 467758481 483886211 17318865 32318494 450834298 486242743 267374369 314771451 183459929 171471292 X WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY 0 0 471154415 511372574 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, 2011, 20,136 INPATIENTS, 60,942 EMERGENCY ROOM PATIENTS, 2,069 NEWBORNS, AND OVER 493 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 $ 9,819,269SHORTFALL OF MEDICARE PAYMENTS AT COST $ 49,586,161 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 REGION'S 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 56,400 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 28 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 REGIONS 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 352,912 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 FREE PROSTATE CANCER SCREENING CLINIC WAS PROVIDED AT THE COTTON-O'NEIL CANCER CENTER 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 471154415 1 1 0 1 0 0 0 0 1 1 1 0 0 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 1 255 0 1 4442 1 1 1 0 0 0 0 0 0 0 0 0 0 X 16 14 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 MAYNARD OLIVERIUS 60.00 X X 990200 0 171069 STEVEN WATKINS MD 60.00 X X 752338 0 93162 S KENNETH ALEXANDERIII X 0 0 0 PAMELA JOHNSON BETTS X 0 0 0 C RICHARD BONEBRAKEMD X 0 0 0 GARY B FLEENOR X X 0 0 0 JOHN B DICUS X 0 0 0 ROBERT WHEELER X X 0 0 0 JAMES HAINES X 0 0 0 PATRICIA PRESSMAN PHD X 0 0 0 SUEANN V SCHULTZ X 0 0 0 NANCY J PERRY X X 0 0 0 JAMES SCHMANK X 0 0 0 ANDREW J JETTER X 0 0 0 JAMES PARRISH X 0 0 0 RICHARD WIENCKOWSKI X 0 0 0 DAVID CUNNINGHAM 50.00 X 251905 0 47131 CAROL WHEELER 50.00 X 384052 0 130910 BERNIE BECKER 50.00 X 324831 0 127474 KENT PALMBERG MD 60.00 X 715896 0 345867 DEBRA YOCUM 50.00 X 303958 0 50322 JANET STANEK 55.00 X 461253 0 91858 CAROL PERRY 50.00 X 344825 0 82303 KEVIN HAN 60.00 X 240573 0 71384 ROBERT O'NEIL MD 10.00 X 125627 0 1479 ERIC VOTH MD 60.00 X 400099 0 52016 DOUGLAS ROSE MD 60.00 X 345739 0 137568 KEVIN DISHMAN MD 60.00 X 750870 0 34621 MATTHEW WILLS MD 60.00 X 1497795 0 20189 SHAWN MOORE MD 60.00 X 1497711 0 18450 MICHAEL MCCOY MD 60.00 X 772163 0 36861 CHU CHI CHENMD 60.00 X 978651 0 4462 SANJAY MISRA MD 60.00 X 1091667 0 0 VERNON LONG 0.00 X 289232 0 64379 12519385 0 1581505 318 1 1 0 RADIOLOGY & NUCLEAR MEDICINE LLC 823 MULVANE SUITE 1 TOPEKA KS 66606 RADIOLOGY PHYSICIAN SERVICES 1975247 ANESTHESIA ASSOCIATES 823 MULVANE SUITE 2A TOPEKA KS 66606 ANESTHESIA PHYSICIAN SERVICES 1840228 ETHEL LOUISE BJORGAARD 615 S TOPEKA BLVD TOPEKA KS 66603 LEGAL SERVICES 1541514 LABORATORY CORP OF AMERICA PO BOX 12140 BURLINGTON NC 27216 LABORATORY TESTING PROVIDER 1060846 PERINATAL CONSULTANTS 900 SW ROBINSON TOPEKA KS 66614 PHYSICIAN SERVICES 746000 22 80448 438218 308613 518666 NET PATIENT SERVICE RE 621300 505100014 505100014 NUTRITIONAL SERVICES 621300 2124607 2124607 EDUCATION SERVICES/SCH 611600 1770500 1770500 LIFELINE 621300 445689 445689 MEDICAL RECORDS 519100 173535 173535 360817 360817 509975162 3099802 3099802 845140 845140 845140 845140 560527 1841621 192004 444209 368523 1397412 1765935 1397412 368523 516204705 511372574 0 4313465 7838924 3765347 4073577 229823830 229136464 687366 12616211 12494545 121666 29042386 29030930 11456 14703566 14391002 312564 2801867 2508578 293289 169700 169700 129067 129067 15661675 15274430 387245 1213310 1213310 2422156 2096677 325479 6908050 6841750 66300 7232290 7225290 7000 121008 121008 8089400 8078108 11292 19492969 19476788 16181 3782435 1066208 2716227 SUPPLIES 82872503 82870185 2318 PROVISION FOR UNCOLLECT 19588588 19588588 OTHER EXPENSES 12331546 8633768 3697778 REPAIR & MAINTENANCE 6817169 6815111 2058 CONTRIBUTION TO S-V FOU 180000 180000 47561 47561 483886211 471154415 12731796 0 4872802 6097475 55902142 72328936 67353289 74917091 4472770 5088446 3496464 3686374 386392910 201253993 190764266 185138917 64483475 82918308 56332801 53651647 3156289 2415549 450834298 486242743 50470055 58576399 137940000 135870000 4194964 5944140 74769350 114380912 267374369 314771451 X 182697109 170670374 629961 668059 132859 132859 183459929 171471292 450834298 486242743 X 32318494 -44307131 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 OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: 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 2010 IS 24.42% AND 15.2% RESPECTIVELY AND THE AMOUNT IS $ 20,229. OCCASIONALLY, THE CEO WILL SPEAK TO LEGISLATORS REGARDING BILLS THAT WOULD AFFECT THE ORGANIZATION OR HEALTHCARE INDUSTRY. 239410 5014 244424 239400 10 239410 235668 3732 239400 0.54360 0.45640 0 0 10895182 10895182 232890950 99936206 132954744 140740785 101317787 39422998 1865993 1865993 185138917 53571 F 53598076 F 53651647 RESERVE FOR THIRD-PARTY PAYORS 4088606 ACCRUED PENSION PAYABLE 110163807 CONDITIONAL ASSET RETIREMENT OBLIGATION 74459 DUE TO RELATED PARTIES 54040 114380912 516204705 483886211 32318494 -5962075 -38345056 -44307131 -11988637 512357507 -5962075 2243944 -3718131 516075638 129067 129067 516204705 524346144 40926511 40926511 483419633 129067 337511 466578 483886211 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, 2011 AND 2010 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 1,725,640. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS -40,015,373. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES -188,114. TAX AMORTIZATION GREATER THAN BOOK 337,511. INTEREST RATE SWAP 706,418. LOSS ON EXTINGUISHMENT OF DEBT -911,138. PART XII, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED AFFILIATE NET INCOME 1,725,640. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES -188,114. INTEREST RATE SWAP 706,418. PART XIII, LINE 2D - OTHER ADJUSTMENTS: CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS 40,015,373. LOSS ON EXTINGUISHMENT OF DEBT 911,138. PART XIII, LINE 4B - OTHER ADJUSTMENTS: TAX AMORTIZATION GREATER THAN BOOK 337,511. 1 1 1 X 1 X 1 1 1 0 1 1 8088302 8088302 0.01740 59007922 37669378 21338544 0.04600 67096224 37669378 29426846 0.06340 839619 9265 830354 0.00180 3839107 1680425 2158682 0.00460 914632 604425 310207 0.00070 182036 182036 0.00040 5775394 2294115 3481279 0.00750 72871618 39963493 32908125 0.07090 0 9819269 0 153658779 203244940 -49586161 X 1 0 1 1 STORMONT-VAIL HEALTHCARE

1500 SW 10TH STREET TOPEKA KS 66604

X X X STORMONT-VAIL HEALTHCARE 1 28 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 PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 19588586. 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. X X X X 0 1 0 0 0 1 0 0 0 MAYNARD OLIVERIUS 670120 0 303090 0 16990 0 162405 0 8664 0 1161269 0 0 0 STEVEN WATKINS MD 663757 0 84898 0 3683 0 84831 0 8331 0 845500 0 0 0 DAVID CUNNINGHAM 199087 0 50920 0 1898 0 35516 0 11615 0 299036 0 0 0 CAROL WHEELER 286483 0 93160 0 4409 0 122816 0 8094 0 514962 0 0 0 BERNIE BECKER 257225 0 64403 0 3203 0 119703 0 7771 0 452305 0 0 0 KENT PALMBERG MD 537611 0 169799 0 8486 0 337501 0 8366 0 1061763 0 0 0 DEBRA YOCUM 240723 0 61247 0 1988 0 45816 0 4506 0 354280 0 0 0 JANET STANEK 355224 0 99290 0 6739 0 80030 0 11828 0 553111 0 0 0 CAROL PERRY 274099 0 68284 0 2442 0 76208 0 6095 0 427128 0 0 0 KEVIN HAN 228305 0 9927 0 2341 0 63482 0 7902 0 311957 0 0 0 ERIC VOTH MD 339932 0 58141 0 2026 0 39937 0 12079 0 452115 0 0 0 DOUGLAS ROSE MD 319712 0 23878 0 2149 0 132658 0 4910 0 483307 0 0 0 KEVIN DISHMAN MD 700709 0 49603 0 558 0 22365 0 12256 0 785491 0 0 0 MATTHEW WILLS MD 1496955 0 0 0 840 0 7600 0 12589 0 1517984 0 0 0 SHAWN MOORE MD 1496955 0 0 0 756 0 5861 0 12589 0 1516161 0 0 0 MICHAEL MCCOY MD 723553 0 44927 0 3683 0 28530 0 8331 0 809024 0 0 0 CHU CHI CHENMD 974341 0 0 0 4310 0 0 0 4462 0 983113 0 0 0 SANJAY MISRA MD 1091667 0 0 0 0 0 0 0 0 0 1091667 0 0 0 VERNON LONG 211915 0 75655 0 1662 0 61946 0 2433 0 353611 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 53519801 18107157 689770 1048000 30220000 2009 1 1 1 1 27950075 27677500 272575 2008 1 0 1 1 61193490 50325531 863086 10004873 1 0 0 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 0.00000 0.00000 0.00000 1 0 0 0 0 1 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 X MEDICAL EQUIPMENT 5 191128 FMV X COMPUTER EQUIPMENT 2 57291 FMV X OTHER EQUIPMENT 2 60194 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 LOSSES ON INVESTMENTS: -5,962,075. EQUITY IN NET INCOME OF CONSOLIDATED AFFILIATES 1,725,640. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS -40,015,373. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES -188,114. TAX AMORTIZATION GREATER THAN BOOK 337,511. INTEREST RATE SWAP 706,418. LOSS ON EXTINGUISHMENT OF DEBT -911,138. TOTAL TO FORM 990, PART XI, LINE 5: -44,307,131. 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 UNIVERSITY OF ARKANSAS GENETICS COTTON O'NEIL CANCER CENTER BAKER UNIVERSITY NURSING MULTIPLE BARTON CO COMMUNITY COLLEGE PARAMEDIC MULTIPLE CLARKSON COLLEGE PA PEDIATRICCARE COFFEY COUNTY HOSPITAL NURSING MULTIPLE COLBY COMMUNITY COLLEGE PT REHAB SERVICES COMMUNITY HEALTH SYSTEM-ONAGA NURSING MULTIPLE COMMUNITY HEALTH SYSTEMS-ST. MARYS NURSING MULTIPLE CREIGHTON UNIVERSITY PHARMACY PHARMACY EMPORIA STATE UNIVERSITYNURSING MEDICAL ARTS CLINIC-EMPORIA FORT HAYS NURSING NURSING MULTIPLE HOLTON COMMUNITY HOSPITAL NURSING PATIENT CARE SERVICES INSTITUTE OF MIDWIFERY MIDWIFERY STUDENTS BIRTHPLACE KANSAS CITY KS COMM COLLEGE PT/OT REHAB SERVICES KANSAS STATE UNIVERSITY KINESIOLOGY HEART CENTER KANSAS STATE UNIVERSITY SPEECH THERAPY REHAB SERVICES UNIVERSITY OF KANSAS EXERCISE SCIENCE HEART CENTER UNIVERSITY OF KANSAS NURSING PATIENT CARE SERVICES UNIVERSITY OF KANSAS OT PATIENT CARE SERVICES UNIVERSITY OF KANSAS PHARMACY PHARMACY UNIVERSITY OF KANSAS PT ASSISTANTS REHAB SERVICES UNIVERSITY OF KANSAS SOCIAL WORK BEHAVIORAL HEALTH MIDLAND LUTHERAN COLLEGE NURSING PATIENT CARE SERVICES 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 NEBRASKA MEDICAL CENTER MEDICAL TECHNOLOGY LABORATORY NEWMAN UNIVERSITY OTA REHAB SERVICES PRONERVE SURGERY ROCKHURST UNIVERSITY PT/OT REHABILITATION SERVICES ST. LOUIS UNIVERSITY PA COTTON-O'NEIL CLINICS ST. LOUIS UNIVERSITY NURSING PATIENT CARE SERVICES UNIVERSITY OF SOUTHERN INDIANA NURSING PATIENT CARE SERVICES TEXAS WESLEYAN UNIVERSITY CRNA SURGERY USD #501 HIGH SCHOOL MULTIPLE WASHBURN UNIVERSITY COMMUNICATIONS MARKETING/FOUNDATION 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 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 WICHITA STATE UNIVERSITY PT ASSISTANTS REHABILITATION SERVICE 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 376338 1531022 0 0 0.51000 URISH MEDICAL PLAZA LLC 1500 SW 10TH TOPEKA KS 66604 480782848 REAL ESTATE KS STORMONT-VAIL INC RELATED 44172 922272 0 0 STORMONT-VAIL INC 901 GARFIELD TOPEKA KS 66606 480782848 RETAIL PHARMACY KS STORMONT-VAIL HEALTHCARE INC C 1523554 14119332 1.00000 DECHAIRO HOSPITAL INC 1500 SW 10TH ST TOPEKA KS 66604 480788844 REAL ESTATE KS STORMONT-VAIL INC C 326312 1.00000 CENTURY HEALTH SOLUTIONS INC 2951 SW WOODSIDE DR TOPEKA KS 66614 481206397 INSURANCE MANAGEMENT OPERATIONS KS STORMONT-VAIL INC C -400762 225672 1.00000 UAT INC 1500 SW 10TH ST TOPEKA KS 66604 480907989 MEDICAL BILLINGS PRACTICE KS STORMONT-VAIL HEALTHCARE INC C -44591 59440 1.00000 KOSM INC 1500 SW 10TH ST TOPEKA KS 66604 480807000 MEDICAL BILLINGS PRACTICE KS STORMONT-VAIL HEALTHCARE INC C 67410 107262 1.00000 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 STORMONT-VAIL FOUNDATION B 180000 STORMONT-VAIL FOUNDATION R 278800 STORMONT-VAIL HEALTHCARE AUXILIARY C 155297 STORMONT-VAIL HEALTHCARE AUXILIARY P 233115 STORMONT-VAIL INC N 1095661 STORMONT-VAIL FOUNDATION N 334222