INTERMOUNTAIN FRONT RANGE INC: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: INTERMOUNTAIN FRONT RANGE INC (EIN 84-1103606)
Tax period: 2011-01-01 to 2011-12-31
Filed: 2012-11-14
IRS object ID: 201223199349306827
Schema version: 2011v1.3
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule F
Schedule H
Schedule I
Schedule J
Schedule L
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2012-11-14T17:30:19-06:00	Timestamp
Tax Period End Date	2011-12-31	TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	ERNST & YOUNG US LLP	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	TWO NORTH CENTRAL AVENUE STE 2300	AddressLine1
City	PHOENIX	City
State	AZ	State
ZIP Code	85004	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-01-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	841103606	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	EXEMPLA INC FKA LUTHERAN HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
In Care Of Name	% EXEMPLA INC C/O SHARON OWENS	InCareOfName
Name Control	EXEM	NameControl
Phone	3034674430	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	2420 West 26th Ave Suite 100D	AddressLine1
City	Denver	City
State	CO	State
ZIP Code	80211	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	TODD CONKLIN	Name
Title	SVP AND CFO	Title
Date Signed	2012-11-13	DateSigned

Preparer Preparer

Field	Value	IRS element (for citing)
Phone	6023223000	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Field	Value	IRS element (for citing)
Name Of Principal Officer Person	ROBERT LADENBURGER	NameOfPrincipalOfficerPerson
Gross Receipts	665471444	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Organization501c3	X	Organization501c3
Web Site	WWW.EXEMPLA.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1905	YearFormation
State Legal Domicile	CO	StateLegalDomicile
Activity Or Mission Description	THE MISSION OF EXEMPLA, INC. IS TO FOSTER HEALING AND HEALTH FOR THE GREATER DENVER, COLORADO METROPOLITAN SERVICE AREA.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	10	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	9	NbrIndependentVotingMembers
Total Nbr Employees	8548	TotalNbrEmployees
Total Nbr Volunteers	901	TotalNbrVolunteers
Total Gross UBI	292504	TotalGrossUBI
Contributions Grants Prior Year	670723	ContributionsGrantsPriorYear
Contributions Grants Current Year	851145	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	623180351	ProgramServiceRevenuePriorYear
Program Service Revenue CY	632213008	ProgramServiceRevenueCY
Investment Income Prior Year	12605253	InvestmentIncomePriorYear
Investment Income Current Year	8590908	InvestmentIncomeCurrentYear
Other Revenue Prior Year	13396221	OtherRevenuePriorYear
Other Revenue Current Year	20177599	OtherRevenueCurrentYear
Total Revenue Prior Year	649852548	TotalRevenuePriorYear
Total Revenue Current Year	661832660	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	264747	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	757960	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	305103899	SalariesEtcPriorYear
Salaries Etc Current Year	320796735	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	324297104	OtherExpensePriorYear
Other Expenses Current Year	303553068	OtherExpensesCurrentYear
Total Expenses Prior Year	629665750	TotalExpensesPriorYear
Total Expenses Current Year	625107763	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	20186798	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	36724897	RevenuesLessExpensesCY
Total Assets BOY	917736341	TotalAssetsBOY
Total Assets EOY	925782307	TotalAssetsEOY
Total Liabilities BOY	533685454	TotalLiabilitiesBOY
Total Liabilities EOY	521531546	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	384050887	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	404250761	NetAssetsOrFundBalancesEOY
Info In Schedule O Part III	X	InfoInScheduleOPartIII
Mission Description	THE MISSION OF EXEMPLA, INC. IS TO FOSTER HEALING AND HEALTH FOR THE GREATER DENVER, COLORADO METROPOLITAN SERVICE AREA.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	426840978	Expense
Grants	405702	Grants
Revenue	575602621	Revenue
Description	Provision of hospital based healthcare services, including charity care and unreimbursed Medicaid - see description in Schedule O	Description

Activity2 Activity2

Field	Value	IRS element (for citing)
Expense	58224547	Expense
Grants	0	Grants
Revenue	38200903	Revenue
Description	Physician clinics - See detailed descriptions in Schedule O	Description

Activity3 Activity3

Field	Value	IRS element (for citing)
Expense	16561297	Expense
Grants	0	Grants
Revenue	19491812	Revenue
Description	West Pines Behavioral Health - See detailed description in Schedule O	Description

Field	Value	IRS element (for citing)
Total Of Other Program Service Exp	17897568	TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt	352258	TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev	19162513	TotalOfOtherProgramServiceRev
Total Program Service Expense	519524390	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Subject To Proxy Tax	false	SubjectToProxyTax
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	false	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	true	ForeignActivities
More Than5000 K To Organizations	true	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	true	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	true	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	true	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	629	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	8548	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	10	NbrVotingGoverningBodyMembers
Number Independent Voting Members	9	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	true	DelegationOfManagementDuties
Changes To Organizing Docs	true	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	true	LocalChapters
Policies Reference Chapters	true	PoliciesReferenceChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	true	CompensationProcessOther
Investment In Joint Venture	true	InvestmentInJointVenture
Written Policy Or Procedure	true	WrittenPolicyOrProcedure
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Field	Value	IRS element (for citing)
Name Person	EXEMPLA INC CO SHARON OWENS	NamePerson
Telephone Number	3038135280	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	2480 W 26TH AVENUE STE 200B	AddressLine1
City	Denver	City
State	CO	State
ZIP Code	80211	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (44 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee	FormerFormer
KOGER PROPST
DIRECTOR, VICE CHAIR	2.0	X	X	0	0	0
FELIX W COOK SR
DIRECTOR	2.0	X		0	0	0
MICHAEL CHASE MD
DIRECTOR	2.0	X		0	0	0
JOHN V MCDERMOTT
DIRECTOR	2.0	X		0	0	0
KATHRYN A PAUL
DIRECTOR	2.0	X		0	0	0
BRUCE WARING MD
DIRECTOR	2.0	X		0	0	0
SISTER AMY WILLCOTT
DIRECTOR	2.0	X		0	0	0
MICHAEL A SLUBOWSKI
CHAIRMAN	2.0	X	X	0	1304791	10969
MARLA J WILLIAMS
DIRECTOR	2.0	X		0	0	0
SALLY WOOLSEY
DIRECTOR	2.0	X		0	0	0
DAVID HAMM
PRESIDENT & CEO-EGSMC	50.0		X	233552	439836	95182
DAVID C PECORARO
SVP & CIO	25.0		X	0	428616	58070
KATHRYN LOUISE BALLINGER
VP&GENERAL COUNSEL, SECRETARY	50.0		X	768828	0	34536
TODD A CONKLIN
SVP & CFO, TREASURER	25.0		X	364322	316994	87081
LISA S KETTERING
SR VP-CMO (SYSTEM)	50.0		X	167272	0	23882
BAIN FARRIS
PRESIDENT & CEO-ESJH	50.0		X	0	553036	99532
GRANT WICKLUND
PRESIDENT & CEO-ELMC	50.0		X	0	504239	77959
ROBERT LADENBURGER
PRESIDENT & CEO	25.0		X	0	1086761	84694
ROBERT G BILLERBECK
VP-CHIEF MEDICAL OFFICER	50.0			353431	0	28970	X
ELISA WETHERBEE
CHIEF OPERATING OFFICER EPN	50.0			288381	0	41351	X
S ANN EVANS
VP-CHIEF NURSING OFFICER(ELMC)	50.0			238908	0	25635	X
BETH C FORSYTH
VP-CLIN & SUPPORT SVCS (EGSMC)	50.0			280980	0	32924	X
MARGARET CAIN PRICE
VP-OPERATIONS (ELMC)	50.0			245490	0	27965	X
DEBORAH L WELLE POWELL
VP-PAYER STRAT & LEG AFFAIRS	50.0			36104	256889	64476	X
KAREN M SCREMIN
VP-FINANCE (ELMC)	50.0			216781	0	21914	X
EVERETT A DAVIS
VP-FACILITIES DEVELOPMENT	50.0			203232	0	38879	X
BRENDA S CHILMAN
VP-REVENUE CYCLE	50.0			205249	38071	27082	X
SANDRA R CAVANAUGH
VP-COMMUNITY DEVELOPMENT	50.0			187989	0	22271	X
SUSAN E KERSCHEN
VP-CHIEF NURSING OFFCR (EGSMC)	50.0			225019	0	25230	X
JOHN D HIGGINS
VP FINANCE (EGSMC)	50.0			176637	0	27311	X
CAROL J SALZMAN
VP-EXEC DIR FOUNDTN & COMM DEV	50.0			156900	0	31944	X
SCOTT A BARTUSEK DAY
VP-HUMAN RESOURCES (ELMC)	50.0			167822	0	19174	X
BARBARA HELEN DAVIS
VP-PERFORMANCE EXCELLENCE	50.0			143903	0	14156	X
CHRISTINA L JOHNSON
VP-CHIEF CLIN&QLTY OFCR (ELMC)	50.0			351138	0	6462	X
SEAN J GREGORY
VP-STRATEGY & BUSINESS DEV	50.0			276259	0	23308	X
STEPHEN W COBB
CHIEF MEDICAL OFFICER (EPN)	50.0			220704	0	32503	X
MARY L CRUMBAKER
VP-CORP RESP/CHIEF COMP OFCR	50.0			188322	0	13517	X
JEANNE THERESE MCGINNIS
VP-BUS DEV & PHYSICIAN SVCS	50.0			141538	0	26484	X
RODERICK G LAMOND
PHYSICIAN	50.0			818137	0	34951		X
MARK C WATTS
PHYSICIAN	50.0			740934	0	7014		X
KEVIN B MILLER
PHYSICIAN	50.0			699311	0	19943		X
STANLEY D CARSON
PHYSICIAN	50.0			558520	0	14997		X
MARK A AMMONS
PHYSICIAN	50.0			567790	0	15043		X
WILLIAM M MURRAY
CHAIRMAN & SCLHS CEO, FORMER	0.0			0	1848716	23674			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	9223453	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	6777949	TotalReportableCompFrmRltdOrgs
Total Other Compensation	1239083	TotalOtherCompensation
Number Individuals GT100 K	381	NumberIndividualsGT100K
Formers Listed	true	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
M A MORTENSON COMPANY
1621 18th Street Ste 400	DENVER	CO	80202	CONSTRUCTION	12485059
SAUNDERS CONSTRUCTION INC
6950 S JORDAN RD	ENGLEWOOD	CO	80112	CONSTRUCTION	22960081
HL DAVISDAVIS A JOINT VENTURE
1755 BLAKE ST SUITE 400	DENVER	CO	80202	CONSTRUCTION DESIGN	8603270
ARAMARK HEALTHCARE
24863 NETWORK PL	CHICAGO	IL	60673	PROFESSIONAL SERVICE	6060485
HEALTH TRAN LLC DBA BENESCRIPT
8300 E MAPLEWOOD AVE SUITE 100	GREENWOOD VILLAGE	CO	80111	PRESCRIPTION BENEFIT	4466108

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	221	NumberOfContractorsGT100K
Related Organizations	729340	RelatedOrganizations
Government Grants	64219	GovernmentGrants
All Other Contributions	57586	AllOtherContributions
Total Contributions	851145	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT REVENUE	622110	621729632	621437128	292504
OTHER AFFILIATED RENT INCOME	531120	1145855	1145855
PHARMACY SALES	446110	173941	173941
MEANINGFUL USE INCENTIVE	622110	5581476	5581476
ADMIN MISC INCOME	900099	193106	193106

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	3388998	TotalRevenueColumn
Related Or Exempt Function Income	3388998	RelatedOrExemptFunctionIncome

Field	Value	IRS element (for citing)
Total Program Service Revenue	632213008	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	4927135	TotalRevenueColumn
Exclusion	$4,927,135	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	501403	Real

Less Rental Expenses LessRentalExpenses

Field	Value	IRS element (for citing)
Real	568645	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	-67242	Real

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	-67242	TotalRevenueColumn
Exclusion	-$67,242	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	3744185	Securities
Other	127940	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	208352	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	3744185	Securities
Other	-80412	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	3663773	TotalRevenueColumn
Exclusion	$3,663,773	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Field	Value	IRS element (for citing)
Gross Sales Of Inventory	2960791	GrossSalesOfInventory
Cost Of Goods Sold	2861787	CostOfGoodsSold

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	99004	TotalRevenueColumn
Related Or Exempt Function Income	99004	RelatedOrExemptFunctionIncome

Other Revenue Misc OtherRevenueMisc (2 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome
OTHER RENTAL REVENUE	900099	63575	63575
EQUALIZATION	900099	20082262	20082262

Field	Value	IRS element (for citing)
Total Other Revenue	20145837	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	661832660	TotalRevenueColumn
Related Or Exempt Function Income	652165345	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	292504	UnrelatedBusinessRevenue
Exclusion	$8,523,666	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	298258	Total
Program Services	298258	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	405702	Total
Program Services	405702	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	54000	Total
Program Services	54000	ProgramServices

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	6588354	Total
Program Services	5551267	ProgramServices
Management And General	1037087	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	248030104	Total
Program Services	208987159	ProgramServices
Management And General	39042945	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	12817959	Total
Program Services	10800257	ProgramServices
Management And General	2017702	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	35958197	Total
Program Services	30297941	ProgramServices
Management And General	5660256	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	17402121	Total
Program Services	14662816	ProgramServices
Management And General	2739305	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	4359467	Total
Program Services	2891418	ProgramServices
Management And General	1468049	ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	1005954	Total
Management And General	1005954	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	249047	Total
Management And General	249047	ManagementAndGeneral

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	33472607	Total
Program Services	26439978	ProgramServices
Management And General	7032629	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	1353061	Total
Management And General	1353061	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	8579121	Total
Program Services	5326606	ProgramServices
Management And General	3252515	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	6584451	Total
Program Services	288273	ProgramServices
Management And General	6296178	ManagementAndGeneral

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	17472234	Total
Program Services	15395326	ProgramServices
Management And General	2076908	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	546161	Total
Program Services	275164	ProgramServices
Management And General	270997	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	594972	Total
Program Services	444522	ProgramServices
Management And General	150450	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	15813034	Total
Management And General	15813034	ManagementAndGeneral

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	0	Total

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	54541368	Total
Program Services	43572203	ProgramServices
Management And General	10969165	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	4211654	Total
Program Services	369470	ProgramServices
Management And General	3842184	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
MEDICAL SUPPLIES	85730704	85446095	284609
BAD DEBTS	28490248	28490248
EQUIP RENTAL & MAINTENANCE	3432287	3213739	218548
MEDICAID PROVIDER FEE	32124079	32124079

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	4992619	Total
Program Services	4189869	ProgramServices
Management And General	802750	ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	625107763	Total
Program Services	519524390	ProgramServices
Management And General	105583373	ManagementAndGeneral
Fundraising	0	Fundraising

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	696240	BOY
EOY	36838938	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	19903673	BOY
EOY	20000007	EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	81073318	BOY
EOY	78956055	EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	4038962	BOY
EOY	15755574	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	9333216	BOY
EOY	9877289	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	4983886	BOY
EOY	6209225	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	1015109204	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	496450384	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	549742400	BOY
EOY	518658820	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	244208951	BOY
EOY	235899311	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	419118	BOY
EOY	639339	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	3336577	BOY
EOY	2947749	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	917736341	BOY
EOY	925782307	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	90288503	BOY
EOY	85436196	EOY

Grants Payable GrantsPayable

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Deferred Revenue DeferredRevenue

Field	Value	IRS element (for citing)
BOY	1203411	BOY
EOY	1203012	EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

Field	Value	IRS element (for citing)
BOY	1601494	BOY
EOY	1601494	EOY

Escrow Account Liability EscrowAccountLiability

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Loans From Officers Directors LoansFromOfficersDirectors

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

Field	Value	IRS element (for citing)
BOY	22608307	BOY
EOY	21077752	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	417983739	BOY
EOY	412213092	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	533685454	BOY
EOY	521531546	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	383992351	BOY
EOY	404184776	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	58536	BOY
EOY	65985	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	384050887	BOY
EOY	404250761	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	917736341	BOY
EOY	925782307	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	36724897	ReconcilationRevenueExpenses
Reconcilation Other Changes	-16525023	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Total Grassroots Lobbying		TotalGrassrootsLobbying
Total Direct Lobbying		TotalDirectLobbying
Total Lobbying Expenditures		TotalLobbyingExpenditures
Other Exempt Purpose Expenditures		OtherExemptPurposeExpenditures
Total Exempt Purpose Expenditures		TotalExemptPurposeExpenditures
Lobbying Nontaxable		LobbyingNontaxableAmount
Grassroots Nontaxable		GrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non Tx		TotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying Nontx		TotLobbyExpendMnsLobbyingNontx
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	false	GrantsOtherOrganizations
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	true	OtherActivities
Other Activities	$58,476	OtherActivitiesAmount
Total Lobbying Expenditures IIB	58476	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
LOBBYING EXPENDITURES	SCHEDULE C, PART II-B, QUESTION 1I	$58,476 OF OTHER LOBBYING EXPENDITURES INCLUDES PORTIONS OF VARIOUS MEMBERSHIP DUES THAT ARE DESIGNATED AS LOBBYING EXPENSE BY THOSE ORGANIZATIONS IN WHICH EXEMPLA OR EXEMPLA ENTITIES ARE MEMBERS.

Field	Value	IRS element (for citing)
Form990 Schedule C Part IV		Form990ScheduleCPartIV
Form990 Schedule C Part IV		Form990ScheduleCPartIV
Form990 Schedule C Part IV		Form990ScheduleCPartIV
Form990 Schedule C Part IV		Form990ScheduleCPartIV

Schedule D IRS990ScheduleD

Field	Value	IRS element (for citing)
Art Public Exhibition Amts		ArtPublicExhibitionAmts
Held Works Of Art Amts		HeldWorksOfArtAmts
Agent Trustee Etc	false	AgentTrusteeEtc
Current Year Minus3 Years		CurrentYearMinus3Years

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	25464714	OtherCostOrOtherBasis
Book Value	25464714	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	501419922	OtherCostOrOtherBasis
Depreciation	59727241	Depreciation
Book Value	441692681	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	8441517	OtherCostOrOtherBasis
Depreciation	5940049	Depreciation
Book Value	2501468	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	431835816	OtherCostOrOtherBasis
Depreciation	426021371	Depreciation
Book Value	5814445	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	47947235	OtherCostOrOtherBasis
Depreciation	4761723	Depreciation
Book Value	43185512	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	518658820	TotalOfBookValueLandBuildings
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (11 entries)

DescriptionDescription	AmountAmount
DUE TO 3RD PARTY PAYORS	$5,913,622
ACCRUED INTEREST PAYABLE	$3,222,422
OTHER CURRENT LIABILITIES	$43,490
MALPRACTICE LIABILITY	$11,501,956
OTHER LIABILITIES	$2,509,204
PENSION LIABILITIES	$25,297,246
B NOTE PAYABLE TO ESJH	$60,000,000
NOTES PAYABLE TO SCLHS	$271,619,138
ACCRUED INTEREST PAYABLE TO SCLHS	$5,184,105
ACCRUED INTEREST PAYABLE TO ESJH	$23,830,316
CURRENT PAYABLES TO RELATED ORGANIZATIONS	$3,091,593

Field	Value	IRS element (for citing)
Total Of Amounts	412213092	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	SCHEDULE D PART X	Identifier
Return Reference	LIABILITY FOR UNCERTAIN TAX POSITONS	ReturnReference
Explanation	EXEMPLA ACCOUNTS FOR UNCERTAINTY IN TAX POSITIONS IN ACCORDANCE WITH THE ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, WHICH PRESCRIBES CRITERIA FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. MANAGEMENT HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2011 AND 2010. TAX YEARS 2008 THROUGH 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE JURISDICTIONS.	Explanation

Schedule F IRS990ScheduleF

Field	Value	IRS element (for citing)
Grant Records Maintained	true	GrantRecordsMaintained

Accts Actvs Out US Table AcctsActvsOutUSTable

Field	Value	IRS element (for citing)
Region	Sub-Saharan Africa	Region
Type Of Activities Conducted	Program Services	TypeOfActivitiesConducted
Specific Services Provided	HOSPITAL	SpecificServicesProvided
Total Expenditures	46000	TotalExpenditures

Field	Value	IRS element (for citing)
Subtotal Amount Spent	46000	SubtotalAmountSpent
Total Amount Spent	46000	TotalAmountSpent

Grants To Orgs Outside US GrantsToOrgsOutsideUS (2 entries)

RegionRegion	Purpose Of GrantPurposeOfGrant	Amount Of Cash GrantAmountOfCashGrant	Manner Of Cash DisbursementMannerOfCashDisbursement	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance	Method Of ValuationMethodOfValuation
Sub-Saharan Africa	SUPPORT ARUSHA LUTHERAN MEDICAL CENTRE	46000	WIRE TRANSFE
Sub-Saharan Africa	SUPPORT ARUSHA LUTHERAN MEDICAL CENTRE			8000	MED EQUIP	BOOK

Field	Value	IRS element (for citing)
Total Number Of501c3 Orgs	0	TotalNumberOf501c3Orgs
Total Number Of Other Orgs	1	TotalNumberOfOtherOrgs
Transfer To Foreign Corp	false	TransferToForeignCorp
Interest In Foreign Trust	false	InterestInForeignTrust
Own Foreign Corp	false	OwnForeignCorp
Passive Foreign Invest Co	false	PassiveForeignInvestCo
Foreign Partnership	false	ForeignPartnership
Boycott Countries	false	BoycottCountries

Form990 Schedule F Part V Form990ScheduleFPartV

Field	Value	IRS element (for citing)
Identifier	MONITORING OF FUNDS	Identifier
Return Reference	PART I, LINE 2	ReturnReference
Explanation	EXEMPLA PROVIDES ASSISTANCE TO ONLY ONE ORGANIZATION OUTSIDE THE U.S. EXEMPLA OBTAINED AN INITIAL NEEDS ASSESSMENT REPORT FROM THE ORGANIZATION, WHICH ALSO OUTLINED THE COMMITMENT OF EXEMPLA TO PROVIDE SUPPORT TO THE ORGANIZATION BASED ON AN INITIAL SITE VISIT. EXEMPLA MAINTAINS REGULAR CONTACT WITH THE ORGANIZATION, SENDS A TEAM OF CLINICIANS FOR SITE VISITS TO THE ORGANIZASTION EVERY YEAR AND RECEIVES AND REVIEWS THE ORGANIZATION'S ANNUAL REPORT.	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	true	FPGReferenceFreeCare
Pcent200	X	Pcent200
FPG Reference Discounted Care	true	FPGReferenceDiscountedCare
Pcent400	X	Pcent400
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	true	ExpensesExceededBudget
Unable To Provide Care	false	UnableToProvideCare
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	11068741	TotalCommunityBenefitExpense
Net Community Benefit Expense	11068741	NetCommunityBenefitExpense
Percent Of Total Expense	0.01860	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	33729918	TotalCommunityBenefitExpense
Direct Offsetting Revenue	19472752	DirectOffsettingRevenue
Net Community Benefit Expense	14257167	NetCommunityBenefitExpense
Percent Of Total Expense	0.02390	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	44798659	TotalCommunityBenefitExpense
Direct Offsetting Revenue	19472752	DirectOffsettingRevenue
Net Community Benefit Expense	25325908	NetCommunityBenefitExpense
Percent Of Total Expense	0.04250	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	21	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	485756	TotalCommunityBenefitExpense
Net Community Benefit Expense	485756	NetCommunityBenefitExpense
Percent Of Total Expense	0.00080	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	9	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	1347105	TotalCommunityBenefitExpense
Net Community Benefit Expense	1347105	NetCommunityBenefitExpense
Percent Of Total Expense	0.00220	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	14	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	72833848	TotalCommunityBenefitExpense
Direct Offsetting Revenue	43717704	DirectOffsettingRevenue
Net Community Benefit Expense	29116143	NetCommunityBenefitExpense
Percent Of Total Expense	0.04880	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	2	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	120895	TotalCommunityBenefitExpense
Net Community Benefit Expense	120895	NetCommunityBenefitExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	15	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	718234	TotalCommunityBenefitExpense
Net Community Benefit Expense	718234	NetCommunityBenefitExpense
Percent Of Total Expense	0.00120	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	61	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	75505838	TotalCommunityBenefitExpense
Direct Offsetting Revenue	43717704	DirectOffsettingRevenue
Net Community Benefit Expense	31788133	NetCommunityBenefitExpense
Percent Of Total Expense	0.05320	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	63	NumberOfActivitiesOrPrograms
Total Community Benefit Expense	120304497	TotalCommunityBenefitExpense
Direct Offsetting Revenue	63190456	DirectOffsettingRevenue
Net Community Benefit Expense	57114041	NetCommunityBenefitExpense
Percent Of Total Expense	0.09570	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	5	NumberOfActivitiesOrPrograms
Total Community Building Expense	7850	TotalCommunityBuildingExpense
Net Community Building Expense	7850	NetCommunityBuildingExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Building Expense	1235	TotalCommunityBuildingExpense
Net Community Building Expense	1235	NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Total Community Building Expense	2688	TotalCommunityBuildingExpense
Net Community Building Expense	2688	NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	3	NumberOfActivitiesOrPrograms
Total Community Building Expense	134230	TotalCommunityBuildingExpense
Net Community Building Expense	134230	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	10	NumberOfActivitiesOrPrograms
Total Community Building Expense	146003	TotalCommunityBuildingExpense
Net Community Building Expense	146003	NetCommunityBuildingExpense
Percent Of Total Expense	0.00020	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	true	BadDebtExpenseReported
Bad Debt Expense	$11,994,247	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	68671979	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	82414997	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-13743018	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

Field	Value	IRS element (for citing)
Business Name Line1	Lutheran ASC LLC	BusinessNameLine1

Field	Value	IRS element (for citing)
Description Ent Primary Activity	Outpatient Surgery	DescriptionEntPrimaryActivity
Organization Profit Or Ownership	0.59660	OrganizationProfitOrOwnership
Physicans Profit Or Ownership	0.40340	PhysicansProfitOrOwnership

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	2	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (2 entries)

Facility NumberFacilityNumber	Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Licensed HospitalLicensedHospital
EXEMPLA LUTHERAN MEDICAL CENTER
1	8300 W 38TH AVE	WHEAT RIDGE	CO	80211	X
EXEMPLA GOOD SAMARITAN MEDICAL CENTER
2	200 EXEMPLA CIRCLE	LAFAYETTE	CO	80026	X

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB (2 entries)

Hospital Facility NumberHospitalFacilityNumber	Eligibility Criteria ExplainedEligibilityCriteriaExplained	Uses FPG FreeUsesFPGFree	FPG Free PercentFPGFreePercent	Uses FPG DiscountedUsesFPGDiscounted	FPG Discount PercentFPGDiscountPercent	Explains BasisExplainsBasis	Income LevelIncomeLevel	Asset LevelAssetLevel	Medical IndigencyMedicalIndigency	Insurance StatusInsuranceStatus	Uninsured DiscountUninsuredDiscount	Medicaid MedicareMedicaidMedicare	Explains Application MethodExplainsApplicationMethod	Includes Publicity MeasuresIncludesPublicityMeasures	Posted On WebsitePostedOnWebsite	Available On RequestAvailableOnRequest	Other PublicityOtherPublicity	Actions On NonpaymentActionsOnNonpayment	Collection ActivitiesCollectionActivities	Nondiscrim Emergency Care PolicyNondiscrimEmergencyCarePolicy	Used Other MethodUsedOtherMethod	Amounts Generally BilledAmountsGenerallyBilled	Gross ChargesGrossCharges
EXEMPLA LUTHERAN MEDICAL CENTER
1	true	true	200.	true	400.	true	X	X	X	X	X	X	true	true	X	X	X	true	false	true	X	false	false
EXEMPLA GOOD SAMARITAN MEDICAL CENTER
2	true	true	200.	true	400.	true	X	X	X	X	X	X	true	true	X	X	X	true	false	true	X	false	false

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

Field	Value	IRS element (for citing)
Number Of Other Facilities	43	NumberOfOtherFacilities

Other Facilities OtherFacilities (43 entries)

Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Facility TypeFacilityType
EXEMPLA COLORADO LUTHERAN HOME
7991 W 71st AVE	ARVADA	CO	80004	NURSING HOME
EXEMPLA LUTHERAN HOSPICE AT COLLIER HOSP
3210 LUTHERAN PARKWAY	WHEAT RIDGE	CO	80033	HOSPICE
LUTHERAN CAMPUS ASC
3455 LUTHERAN PKWY 150	WHEAT RIDGE	CO	80033	AMBULATORY SURGERY CENTER
EXEMPLA THORNTON MEDICAL CENTER
3814 EAST 120TH AVENUE	DENVER	CO	80033	PHYSICIAN CLINIC
EXEMPLA DENVER MEDICAL ASSOCIATES
1960 OGDEN ST Suite 120	DENVER	CO	80218	PHYSICIAN CLINIC
EXEMPLA FAMILY PRACTICE SPECIALISTS
3550 LUTEHRAN PARKWAY G-20	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA FAMILY PEDIATRIC & INTERNAL MED
2600 CAMPUS DRIVE SUITE A	LAFAYETTE	CO	80026	PHYSICIAN CLINIC
EXEMPLA NW FAMILY & OCC MED & PHYS THER
12169 Sheridan BLVD	Broomfield	CO	80020	PHYSICIAN CLINIC
EXEMPLA GREEN MT FAM & OCC MED & PHYS TH
12790-A WEST ALAMEDA PARKWAY	LAKEWOOD	CO	80228	PHYSICIAN CLINIC
EXEMPLA COLORADO LUTHERAN APARTMENTS
8001 W 71ST AVE	ARVADA	CO	80004	ASSISTED LIVING RESIDENCE
EXEMPLA LUTHERAN MEDICAL CENTER TCU
8300 W 38TH AVE	WHEAT RIDGE	CO	80033	NURSING HOME
EXEMPLA LUTHERAN SOUTHWEST URGENT CARE
13402 WEST COAL MINE AVE SUITE 110	LITTLETON	CO	80127	PHYSICIAN CLINIC
EXEMPLA WELLMORE FAMILY PRACTICE
7777 WEST 38TH AVE SUITE A-118	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA WHEAT RIDGE OCC MED & PHYS THER
9830 I-70 FRONTAGE ROAD SOUTH	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA BLUESTONE ADVANCED SURGICAL CARE
300 EXEMPLA CIRCLE SUITE 360	LAFAYETTE	CO	80026	PHYSICIAN CLINIC
EXEMPLA COLORADO PINNACLE ORTHO ASSOC
3455 LUTHERAN PARKWAY SUITE 210	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA DENVER NEURO SURGERY & SPINE
1960 OGDEN ST SUITE 530	DENVER	CO	80218	PHYSICIAN CLINIC
EXEMPLA MT STATES UROGYNECOLOGY - ESJH
1960 OGDEN ST SUITE 520	DENVER	CO	80205	PHYSICIAN CLINIC
EXEMPLA LARKRIDGE FAMILY & OCC MED & PT
16570 WASHINGTON STREET	THORNTON	CO	80023	PHYSICIAN CLINIC
EXEMPLA STAPLETON FAMILY & OCC MED
2803 ROSLYN STREET	DENVER	CO	80238	PHYSICIAN CLINIC
EXEMPLA DIABETES & ENDOCRINE SERVICES
3555 LUTHERAN PARKWAY SUITE 180	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA SURGICAL SPECIALISTS
1960 OGDEN ST SUITE 530	DENVER	CO	80205	PHYSICIAN CLINIC
EXEMPLA LUTHERAN MATERNAL FETAL MEDICINE
3655 LUTHERAN PARKWAY SUITE 408	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA PLASTIC RECONSTRUCT & AESTH SURG
3455 LUTHERAN PARKWAY SUITE 220	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA DENVER NEURO SURGERY & SPINE
3455 LUTHERAN PARKWAY SUITE 280	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA INTERNAL MEDICINE OF LAFAYETTE
300 EXEMPLA CIRCLE SUITE 300	LAFAYETTE	CO	80026	PHYSICIAN CLINIC
EXEMPLA FRONT RANGE CARDIAC & THOR SURG
1960 OGDEN ST SUITE 540	DENVER	CO	80205	PHYSICIAN CLINIC
EXEMPLA FIRESTONE FAMILY MEDICINE
8350 WCR 13 SUITE 160	FIRESTONE	CO	80504	PHYSICIAN CLINIC
EXEMPLA URGENT CARE OF WESTMINSTER
7625 WEST 92ND AVENUE	WESTMINSTER	CO	80021	PHYSICIAN CLINIC
EXEMPLA MT STATES UROGYNECOLOGY - WEST
3555 Lutheran pkwy SUITE 406	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA LUTHERAN SW URGENT CARE&OCC MED
13402 WEST COAL MINE AVENUE SUITE	LITTLETON	CO	80127	PHYSICIAN CLINIC
EXEMPLA FOOTHILLS NEUROLOGY ASSOCIATES
300 EXEMPLA CIRCLE SUITE 300	LAFAYETTE	CO	80026	PHYSICIAN CLINIC
EXEMPLA LUTHERAN NEUROLOGY
3550 LUTHERAN PARKWAY WEST SUITE 2	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA OASIS FAMILY MEDICINE
360 S GARFIELD ST Ste 500	DENVER	CO	80209	PHYSICIAN CLINIC
EXEMPLA DIABETES EDUCATION CENTER
3555 LUTHERAN PKWY Suite 180	WHEAT RIDGE	CO	80033	PHYSICIAN CLINIC
EXEMPLA ESSENTIAL WOMENS CARE
1960 OGDEN St SUITE 230	Denver	CO	80218	PHYSICIAN CLINIC
ROCKY MOUNTAIN CV ASSOCIATES UNION
355 Union BLVD Suite 200	Lakewood	CO	80228	PHYSICIAN CLINIC
ROCKY MOUNTAIN CV ASSOCIATES NORTH
8300 Alcott St Suite 300	Westminster	CO	80031	PHYSICIAN CLINIC
ROCKY MOUNTAIN CV ASSOCIATES GSMC
300 EXEMPLA CIRCLE Suite 310	Lafayette	CO	80026	PHYSICIAN CLINIC
ROCKY MOUNTAIN CV ASSOCIATES LMC
3655 Lutheran PKWY Suite 201	Wheat Ridge	CO	80033	PHYSICIAN CLINIC
ROCKY MOUNTAIN CV ASSOCIATES SJD
1960 Ogden St Suite 110	Denver	CO	80218	PHYSICIAN CLINIC
EXEMPLA CAPITOL HILL INTERNAL MEDICINE
1960 OGDEN ST SUITE 120	DENVER	CO	80218	PHYSICIAN CLINIC
EXEMPLA STAPLETON OB-GYN
2807 ROSLYN ST	DENVER	CO	80238	PHYSICIAN CLINIC

Form990 Schedule H Part VI Form990ScheduleHPartVI (14 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
COMMUNITY BENEFIT REPORT	PART I, LINE 6A	COMMUNITY BENEFITS ARE INCLUDED IN A REPORT PREPARED BY EXEMPLA HEALTHCARE.
COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS	PART I, LINE 7G	THE ORGANIZATION INCLUDED AS SUBSIDIZED HEALTH SERVICES $13,233,815 IN LOSSES ATTRIBUTABLE TO PHYSICIAN CLINICS.
BAD DEBT EXPENSE	PART I, LINE 7, COLUMN(F)	BAD DEBT EXPENSE INCLUDED ON PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES IN SCHEDULE H PART I, LINE 7, COLUMN (H) IS $28,490,248.
COSTING METHODOLOGY	PART I, LINE 7	THE COST ACCOUNTING SYSTEM WAS USED AS THE BASIS TO CALCULATE THE AMOUNTS REPORTED AS CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS. THE COST OF SUBSIDIZED SERVICES WAS CALCULATED AS THE NET LOSS OF THE RELEVANT DEPARTMENT USING THE DEPARTMENTAL EXPENSES AND ALLOCATED OVERHEAD EXPENSES, AND THE DEDUCTION RATIO PER THE COST ACCOUNTING SYSTEM. FOR SUBSIDIZED SERVICES, THE COST OF CHARITY, MEDICAID, AND SELF PAY PATIENTS WERE REMOVED IN THE CALCULATION.
COMMUNITY BUILDING ACTIVITIES	PART II	THE COMMUNITY BUILDING ACTIVITIES FOR EXEMPLA GOOD SAMARITAN MEDICAL CENTER (EGSMC) WERE FOCUSED ON "WORKFORCE DEVELOPMENT" AND "COMMUNITY SUPPORT." RECRUITMENT OF PHYSICIANS TO MEDICAL SHORTAGE AREAS WITHIN OUR PRIMARY SERVICE AREA (PSA) CONTRIBUTED TO THE IMPROVEMENT OF HEALTH IN OUR COMMUNITY. WE USE A STANDARD PROCESS FOR DETERMINING THE COMMUNITY NEED OF EACH PHYSICIAN SPECIALTY. SEVERAL CURRENT DATA ELEMENTS AND CONDITIONS ARE CONSIDERED. THE LARGEST PORTION OF OUR COMMUNITY BUILDING FUNDS WAS DESIGNATED FOR THIS PURPOSE SINCE WE DETERMINED A SHORTAGE OF SEVERAL SPECIALTIES WITHIN OUR PSA. "DISASTER READINESS AND PUBLIC HEALTH EMERGENCY TRAININGS" WERE ADDITIONAL FOCUS AREAS WITHIN COMMUNITY BUILDING ACTIVITIES. EXEMPLA GOOD SAMARITAN MEDICAL CENTER (EGSMC) IS TAKING A LEADERSHIP ROLE IN BOULDER COUNTY FOR READINESS TRAINING BEYOND THE REQUIREMENTS OF ACCREDITING BODIES OR GOVERNMENT ENTITIES. FOUR (4) HOSPITALS WITHIN BOULDER COUNTY PARTICIPATE ON A REGULAR BASIS AND BOULDER COUNTY HAS BEEN RECOGNIZED AS ONE OF THE LEADERS IN THE STATE OF COLORADO. THE STAFF FROM EGSMC CONTRIBUTES SIGNIFICANT TIME AND RESOURCES EACH YEAR TO LEAD THE DISASTER READINESS AND PUBLIC HEALTH EMERGENCY ACTIVITIES FOR THE COUNTY AND THE REGION. IN ADDITION TO "WORKFORCE DEVELOPMENT" AND "DISASTER READINESS," EGSMC AND EXEMPLA LUTHERAN MEDICAL CENTER (ELMC) ACTIVELY PARTICIPATE IN "ECONOMIC DEVELOPMENT" IN THE FORM OF DONATIONS TO LOCAL CHAMBERS OF COMMERCE (E.G. LAFAYETTE CHAMBER, BROOMFIELD ECONOMIC DEVELOPMENT COUNCIL, JEFFERSON COUNTY ECONOMIC COUNCIL, BOULDER CHAMBER OF COMMERCE, AND OTHERS) AND "COMMUNITY HEALTH IMPROVEMENT ADVOCACY" FOR OUR COMMUNITY. THE COMMUNITY BUILDING ACTIVITIES SELECTED BY BOTH EXEMPLA GOOD SAMARITAN MEDICAL CENTER AND EXEMPLA LUTHERAN MEDICAL CENTER EACH YEAR PROMOTE THE HEALTH OF THE COMMUNITY IN SIGNIFICANT WAYS.
BAD DEBT EXPENSE COSTING METHODOLOGY AND OTHER INFO	PART III, LINE 4	A COST TO CHARGE RATIO IS USED AS THE METHODOLOGY FOR DETERMINING THE AMOUNTS REPORTED AS COST OF BAD DEBT EXPENSE. FOR ALL SELF-PAY ACCOUNTS, A STANDARD 40% DISCOUNT IS FIRST APPLIED TO CHARGES AS A DEDUCTION OF REVENUE. BAD DEBT EXPENSE IS REFLECTED NET OF DISCOUNTS APPLIED AND PAYMENTS RECEIVED. THE ORGANIZATION DOES NOT INCLUDE IN BAD DEBT EXPENSE ANY AMOUNT THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITALS' CHARITY CARE POLICY. THE FOLLOWING ARE THE RELEVANT PORTIONS OF THE COMPANY'S FOOTNOTE TO THE FINANCIAL STATEMENTS RELATED TO BAD DEBT: INCLUDED IN NET RECEIVABLES IS THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS AND TAKES INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE ASSESSMENTS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE.
COSTING METHODOLOGY FOR MEDICARE COSTS	PART III, LINE 8	INPATIENT AND OUTPATIENT MEDICARE COSTS ARE CALCULATED ON THE COST REPORT. INPATIENT COSTS ARE A PRODUCT OF ROUTINE SERVICE COSTS BASED ON PER DIEMS AND ANCILLARY COSTS BASED ON INPATIENT MEDICARE CHARGES FACTORED BY INPATIENT COST TO CHARGE RATIOS. OUTPATIENT COSTS ARE BASED ON MEDICARE OUTPATIENT CHARGES FACTORED BY OUTPATIENT COST TO CHARGE RATIOS. EXEMPLA, INC. DOES NOT RECOGNIZE THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. DEBT COLLECTION POLICY 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. EXEMPLA, INC 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, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED.
PUBLICIZING THE FINANCIAL ASSISTANCE POLICY	PART V, LINE 13G	EXEMPLA, INC TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. EXEMPLA, INC 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. WE POST FINANCIAL ASSISTANCE INFORMATION IN THE FORM OF A FINANCIAL ASSISTANCE BROCHURE IN EMERGENCY AND ADMISSIONS AREAS, ON BILLINGS INVOICES, IN VARIOUS AREAS AROUND THE HOSPITAL AND CLINIC SITES AND ON THE HOSPITAL WEBSITE. THE BROCHURE EXPLAINS OUR FINANCIAL ASSISTANCE POLICY AND HOW IT IS ADMINISTERED. THIS COVERS ELIGIBILITY, STEPS TO FOLLOW TO DETERMINE IF A PATIENT QUALIFIES FOR ASSISTANCE, TYPICAL CHARGES A PATIENT MAY EXPECT FOR ROUTINE PROCEDURES, AND ASSISTANCE AVAILABLE BASED ON A PATIENT'S INCOME LEVEL. WE PROVIDE THESE MATERIALS AND EDUCATION WHEN PATIENTS ARE DISCHARGED, AND INCLUDE INFORMATION IN BILLING STATEMENTS, INCLUDING PHONE NUMBERS AND OTHER METHODS TO CONTACT US WITH QUESTIONS. WE ENSURE THAT OUR FINANCIAL COUNSELORS, ADMISSION EMPLOYEES, SOCIAL WORKERS AND OTHER EMPLOYEES UNDERSTAND OUR POLICIES TO BE ABLE TO ASSIST PATIENTS IN THE MOST APPROPRIATE WAY. WE ALSO PROVIDE THE DETAILED FINANCIAL ASSISTANCE POLICY TO INDIVIDUALS UPON REQUEST AND POST THE POLICY TO OUR WEBSITE TO ENSURE THE ENTIRE COMMUNITY HAS ACCESS TO SUCH INFORMATION. AMOUNTS BILLED TO UNINSURED INDIVIDUALS PART V, LINE 19D EACH FACILITY (EXEMPLA GOOD SAMARITAN MEDICAL CENTER AND EXEMPLA LUTHERAN MEDICAL CENTER) AUTOMATICALLY APPLIES A 40% DISCOUNT FOR ANY PATIENT WITHOUT INSURANCE. IF AN INDIVIDUAL QUALIFIES FOR FINANCIAL ASSISTANCE AND HAS INCOME BELOW 200% OF THE FEDERAL POVERTY GUIDELINES, THE FULL ACCOUNT BALANCE IS ADJUSTED TO ZERO. IF INCOME IS BETWEEN 200% AND 400% OF THE FEDERAL POVERTY GUIDELINES OR IS DETERMINED TO BE MEDICALLY INDIGENT EVEN IF THEIR INCOME IS ABOVE 400% OF THE FEDERAL POVERTY GUIDELINES, A MODEST PATIENT FINANCIAL RESPONSIBILITY IS DETERMINED FOLLOWING A COPAY GRID. THE GRID TAKES INTO CONSIDERATION INCOME AND FAMILY SIZE, AND IS DESIGNED TO RESULT IN AN AMOUNT THAT IS LOWER THAN THE LOWEST COMMERCIAL PAYER RATES.
NEEDS ASSESSMENT	PART VI, LINE 2	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. EXEMPLA GOOD SAMARITAN MEDICAL CENTER AND EXEMPLA LUTHERAN MEDICAL CENTER HAVE REGULARLY PARTICIPATED IN NEEDS ASSESSMENTS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN 2009, AND OTHER SURVEYS WILL BE CONDUCTED ON A REGULAR BASIS. THIS ASSESSMENT STUDIES A DEFINED COMMUNITY SERVED BY THSE HOSPITALS AND IS DONE BY PARTNERING WITH LOCAL GOVERNMENT AND SOCIAL AGENCIES; COMBINING EFFORTS WITH OTHER LOCAL HOSPITALS AND HEALTH CARE ORGANIZATIONS; AND CONDUCTING SURVEYS AND ASSESSMENTS WITH THE ASSISTANCE OF OUTSIDE CONSULTANTS. 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. TO ADDRESS RATES OF ILLNESS IN THE COMMUNITY, BOTH EXEMPLA GOOD SAMARITAN MEDICAL CENTER AND EXEMPLA LUTHERAN MEDICAL CENTER HAVE A MULTITUDE OF PROGRAMS IN PLACE THROUGH ITS DIABETES CENTER, CANCER CENTER AND NEUROVASCULAR CENTER AT ELMC AND THROUGH COMMUNITY OUTREACH. A VARIETY OF CLASSES ARE OFFERED ON WEIGHT MANAGEMENT AND SUPPORT GROUPS FOR CANCER PATIENTS. WE ALSO ROUTINELY OFFER COMMUNITY HEALTH AND SAFETY CLINICS, SKIN CANCER SCREENINGS, BREAST CANCER SURVIVORSHIP PROGRAMS, CLASSES FOR PROSPECTIVE PARENTS AND DIABETES MANAGEMENT CLASSES, TO NAME A FEW. EXEMPLA GOOD SAMARITAN MEDICAL CENTER AND EXEMPLA LUTHERAN MEDICAL CENTER ALSO RECOGNIZE THE ESSENTIAL NEED TO ENHANCE AND IMPROVE MEDICAL OUTCOMES, QUALITY AND SERVICES. IN RESPONSE, A BEST IN THE NATION STRATEGY AND PROGRAM WAS IMPLEMENTED. THE OBJECTIVES OF THE PROGRAM ARE TO BE THE BEST IN THE NATION IN PREDEFINED QUALITY, SERVICE AND COST INDICATORS. THE QUALITY INDICATORS ARE IN ALIGNMENT WITH MAJOR PUBLICLY COMPARABLE DATABASES INCLUDING THE COLORADO HEALTH AND HOSPITAL ASSOCIATION AND CENTERS FOR MEDICARE AND MEDICAID SERVICES. COLLECTIVELY WITH ITS 534 LICENSED BEDS AT ELMC AND EGSMC, EXEMPLA SERVED THE COMMUNITY WITH 28,705 INPATIENT ADMISSIONS AND 112,328 EMERGENCY ROOM (ER) VISITS. COMPREHENSIVE MEDICAL SERVICES INCLUDE, BUT ARE NOT LIMITED TO, CARDIOLOGY, ONCOLOGY, ORTHOPEDIC, WOMEN AND FAMILY, PEDIATRICS, EMERGENCY AND TRAUMA, NEONATAL INTENSIVE CARE, NEUROLOGY, NEUROSURGERY, OB/GYN, GENERAL SURGICAL AND MEDICAL, PRIMARY CARE, INTERNAL MEDICINE, BEHAVIORAL HEALTH, HOSPICE CARE AND INTEGRATIVE HEALTH SERVICES.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE	PART VI, LINE 3	EXEMPLA, INC TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. EXEMPLA, INC 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 HOSPITAL AND CLINIC SITES AND ON THE HOSPITAL WEBSITE. WE PROVIDE WRITTEN MATERIALS TO PATIENTS THAT DETAIL OUR FINANCIAL ASSISTANCE POLICY AND HOW IT IS ADMINISTERED. THIS COVERS ELIGIBILITY, STEPS TO FOLLOW TO DETERMINE IF A PATIENT QUALIFIES FOR ASSISTANCE, TYPICAL CHARGES A PATIENT MAY EXPECT FOR ROUTINE PROCEDURES, AND ASSISTANCE AVAILABLE BASED ON A PATIENT'S INCOME LEVEL. WE PROVIDE MATERIALS AND EDUCATION WHEN PATIENTS ARE DISCHARGED, AND INCLUDE INFORMATION IN BILLING STATEMENTS, INCLUDING PHONE NUMBERS AND OTHER METHODS TO CONTACT US WITH QUESTIONS. WE ENSURE THAT OUR FINANCIAL COUNSELORS, ADMISSION EMPLOYEES, SOCIAL WORKERS AND OTHER EMPLOYEES UNDERSTAND OUR POLICIES TO BE ABLE TO ASSIST PATIENTS IN THE MOST APPROPRIATE WAY. WE ALSO PROVIDE PAYMENT PLAN OPTIONS TO OUR PATIENTS. THIS HELPS PATIENTS MEET THEIR FINANCIAL OBLIGATIONS IN A REASONABLE AND DIGNIFIED MANNER BASED ON THEIR ABILITY TO PAY, AND ALLOWS THEM TO CONTINUE TO ENSURE THE ONGOING WELFARE OF THEIR FAMILIES. THIS IS DONE IN ACCORDANCE WITH OUR CORE VALUE OF RESPECT.
COMMUNITY INFORMATION	PART VI, LINE 4	THE COMMUNITY SERVED BY EXEMPLA, INC. IS A CONTINUUM OF MUNICIPALITIES AND SECTIONS OF MUNICIPALITIES WITHIN THE GREATER DENVER METRO AREA, EXTENDING FROM THE CENTRAL WEST METRO DENVER CITIES OF LAKEWOOD AND EVERGREEN TO LONGMONT, THE MOST NORTHWEST MUNICIPALITY IN THE METRO DENVER AREA (EXCLUDING THE CITY OF BOULDER PROPER). WHILE THERE ARE SOME MOUNTAIN AND RURAL AREAS OVER THIS COMMUNITY EXPANSE, MOST OF THE COMMUNITY SERVED IS SUBURBAN AND URBAN AREAS. THE POPULATION OF THE ENTIRE COMMUNITY SERVED IS 1,066,000 AS OF YEAR 2010. THIS AREA REPRESENTS A LITTLE LESS THAN 40% OF THE WHOLE DENVER METRO AREA. HOWEVER THE COMMUNITY SERVED CAN BE SEPARATED INTO THREE MORE HOMOGENEOUS AREAS OF WEST CENTRAL METRO DENVER (LAKEWOOD, EVERGREEN, WHEAT RIDGE, GOLDEN, ARVADA AND A NORTHWEST PORTION OF THE CITY OF DENVER), NORTHWEST ADAMS COUNTY (WESTMINSTER-EAST, THORNTON, NORTHGLENN, FEDERAL HEIGHTS AND BRIGHTON), AND EAST BOULDER COUNTY (LOUISVILLE, LAFAYETTE, BROOMFIELD, WESTMINSTER-WEST, AND LONGMONT). THE WEST CENTRAL METRO DENVER AREA IS THE MOST POPULATED AREA. IT IS THE OLDEST AREA WITH LESS PERCENTAGE OF CHILDREN, A HIGHER PERCENTAGE OF SENIORS, AND HIGHER MEDIAN AGE. IT IS ALSO THE AREA WITH THE HIGHEST PERCENTAGE OF HOUSEHOLDS BELOW THE POVERTY LEVEL INFLUENCED IN PART BY THE HIGH PERCENTAGE OF SENIORS. - AVERAGE INCOME IS $78,000 AND 14% OF HOUSEHOLDS ARE BELOW THE POVERTY LEVEL. - UNEMPLOYED IN THIS AREA ACCOUNTS FOR 8.6% OF THE POPULATION AND 14% OF THE POPULATION IS AGE 65 OR OLDER. MORBIDITY (PERCENT OF ADULTS REPORTING FAIR OR POOR HEALTH) IS 10% OF THE POPULATION IN THIS COUNTY. ADULT SMOKING IS 18% OF THE POPULATION; ADULT OBESITY (PERCENT OF ADULTS THAT REPORTED A BMI OF GREATER THAN OR EQUAL TO 30) IS 18%; EXCESSIVE DRINKING (INCLUDING BINGE DRINKING) IS 19% OF THE POPULATION IN THIS COUNTY. THIS COUNTY REPORTS 66% OF THE POPULATION RECEIVING A MAMMOGRAPHY SCREENING (PERCENT OF FEMALE MEDICARE ENROLLEES). THE NORTHWEST ADAMS COUNTY IS A YOUNGER AREA WITH A HIGHER PERCENTAGE OF CHILDREN, A LOWER PERCENTAGE OF SENIORS AND A LOWER MEDIAN AGE. THE AREA HAS THE LOWEST AVERAGE INCOME AND THE HIGHEST UNEMPLOYMENT, PERCENTAGE THAT ARE NOT HIGH SCHOOL GRADUATES, AND HISPANIC PERCENTAGE. - AVERAGE INCOME IS $75,000 AND 11% OF HOUSEHOLDS ARE BELOW THE POVERTY LEVEL. - UNEMPLOYED IN THIS AREA ACCOUNTS FOR 11% OF THE POPULATION AND 8% OF THE POPULATION IS AGE 65 OR OLDER. MORBIDITY (PERCENT OF ADULTS REPORTING FAIR OR POOR HEALTH) IS 18% OF THE POPULATION IN THIS COUNTY, HIGHER THAN THE OTHER COUNTIES LISTED HERE. ADULT SMOKING IS 22% OF THE POPULATION; ADULT OBESITY (PERCENT OF ADULTS THAT REPORTED A BMI OF GREATER THAN OR EQUAL TO 30) IS 24%; EXCESSIVE DRINKING (INCLUDING BINGE DRINKING) IS 19% OF THE POPULATION IN THIS COUNTY. THESE HEALTH FACTORS ARE ALL HIGHER THAN THE OTHER COUNTIES REPORTED HERE. THIS COUNTY REPORTS 58% OF THE POPULATION RECEIVING A MAMMOGRAPHY SCREENING (PERCENT OF FEMALE MEDICARE ENROLLEES). THE EAST BOULDER COUNTY AND ASSOCIATED AREAS HAS AN AGE BREAKOUT MOST SIMILAR TO THE DENVER METRO AREA AS A WHOLE (MEDIAN AGE 37). IT HAS THE HIGHEST AVERAGE INCOME, LOWEST UNEMPLOYMENT, HIGHEST EDUCATION LEVELS AND LOWEST PERCENTAGE OF MINORITIES. - AVERAGE INCOME IS $93,000 AND 11% OF HOUSEHOLDS ARE BELOW THE POVERTY LEVEL. - UNEMPLOYED IN THIS AREA ACCOUNTS FOR 7.1% OF THE POPULATION AND 9% OF THE POPULATION IS AGE 65 OR OLDER. MORBIDITY (PERCENT OF ADULTS REPORTING FAIR OR POOR HEALTH) IS 9% OF THE POPULATION IN THIS COUNTY. ADULT SMOKING IS 13% OF THE POPULATION; ADULT OBESITY (PERCENT OF ADULTS THAT REPORTED A BMI OF GREATER THAN OR EQUAL TO 30) IS 13%; EXCESSIVE DRINKING (INCLUDING BINGE DRINKING) IS 18% OF THE POPULATION IN THIS COUNTY. THIS COUNTY REPORTS A HIGHER MAMMOGRAPHY SCREENING THAN THE OTHER COUNTIES, WITH 70% OF THE POPULATION RECEIVING A MAMMOGRAPHY SCREENING (PERCENT OF FEMALE MEDICARE ENROLLEES). BESIDES THE EXEMPLA INC. HOSPITALS, EXEMPLA LUTHERAN MEDICAL CENTER, WHEAT RIDGE AND EXEMPLA GOOD SAMARITAN, LAFAYETTE THERE ARE FOUR OTHER NOT-FOR-PROFIT HOSPITALS IN THE COMMUNITY: - ST. ANTHONY NORTH HOSPITAL-CENTURA HEALTH, WESTMINSTER - ST. ANTHONY WEST HOSPITAL-CENTURA HEALTH, LAKEWOOD - AVISTA ADVENTIST HOSPITAL-CENTURA HEALTH, LOUISVILLE - LONGMONT UNITED HOSPITAL, LONGMONT THERE IS ALSO ONE FOR-PROFIT HOSPITAL, NORTH SUBURBAN MEDICAL CENTER-HEALTHONE, THORNTON.
PROMOTION OF COMMUNITY HEALTH	PART VI, LINE 5	WE EXTEND OUR CARE BEYOND OUR HOSPITALS' WALLS IN ORDER TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR COMMUNITY ACTIVITIES DEMONSTRATE THIS COMMITMENT. OUR COMMUNITY ACTIVITIES AT EXEMPLA LUTHERAN MEDICAL CENTER INCLUDE A VARIETY OF CLASSES ON WEIGHT MANAGEMENT AND SUPPORT GROUPS FOR CANCER PATIENTS. ELMC ALSO ROUTINELY OFFERS COMMUNITY HEALTH AND SAFETY CLINICS, SKIN CANCER SCREENINGS, BREAST CANCER SURVIVORSHIP PROGRAMS, CLASSES FOR PROSPECTIVE PARENTS AND DIABETES MANAGEMENT CLASSES, TO NAME A FEW. EXEMPLA GOOD SAMARITAN MEDICAL CENTER'S HEALTH & HEALING CENTER CONDUCTS HEART HEALTH SCREENINGS IN THE COMMUNITY INCLUDING CHOLESTEROL SCREENING AND BLOOD PRESSURE SCREENINGS SEVERAL TIMES THROUGHOUT THE YEAR. WE ALSO PROMOTE HEALTH AND WELLNESS FOR OUR EMPLOYEES THROUGH PROGRAMS SUCH AS POUND POUNDERS TO PROMOTE WEIGHT LOSS. WE ALSO PROVIDE PRESENTATIONS TO COMMUNITY GROUPS ON SUBJECTS SUCH AS BALANCE, EXERCISE AND STRETCHING. WELLNESS QUEST CLASSES LED BY EGSMC PHYSICIANS ARE HELD IN THE COMMUNITY FOR PREVENTIVE-CARE EDUCATION AND INDIVIDUAL RESPONSIBILITY FOR HEALTH PROMOTION. WE HAVE PARTNERED WITH SUCH ORGANIZATIONS AS THE LAFAYETTE SENIOR CENTER, THE LAFAYETTE RECREATION CENTER AND OTHER COMMUNITY ORGANIZATIONS PROVIDING SERVICES TO OUR COMMUNITY. EGSMC ALSO PROVIDES HEALTH SCREENINGS FOR EMPLOYEES OF BOULDER VALLEY SCHOOL DISTRICT AND SCREENINGS AT EVENTS SEVERAL TIMES THROUGHOUT THE YEAR TO RESIDENTS OF BROOMFIELD, LAFAYETTE AND OTHERS IN THE SURROUNDING AREAS. WE ARE AN IMPORTANT PART OF OUR COMMUNITY AND SERVE IN MANY WAYS, FROM DELIVERING CORE HEALTH CARE TO PREVENTIVE CARE TO SUPPORT OF OTHER CIVIC GROUPS. IN 2011, WE PROVIDED COMMUNITY BENEFIT TOTALING $57,260,044, INCLUDING TRADITIONAL CHARITY CARE AND THE UNPAID COST OF MEDICAID. OUR BOARD OF DIRECTORS REPRESENTS MEDICAL AND BUSINESS PROFESSIONALS, AND ALL PROVIDE HOURS OF SERVICE IN SUPPORT OF OUR HOSPITAL. THEY ARE DEEPLY INVOLVED IN OUR NEEDS ASSESSMENT PROCESS, BUILDING PROGRAMS AND SERVICES, AND COMMUNITY OUTREACH TO ENSURE THAT PEOPLE KNOW ABOUT SERVICES AVAILABLE TO THEM THROUGH OUR HOSPITAL. WHEN EXEMPLA, INC. HAS EXCESS REVENUE OVER OPERATING EXPENSES, WE USE THOSE FUNDS TO OBTAIN CURRENT HEALTH CARE TECHNOLOGIES AND EQUIPMENT, IMPROVE PATIENT CARE, PROVIDE MEDICAL TRAINING EDUCATION AND RESEARCH, AND TO EXPAND ACCESS TO POINTS OF CARE. THESE INVESTMENTS ENSURE WE'LL BE HERE TO CARE FOR FUTURE GENERATIONS. WE ALSO SUPPORT OUR EMPLOYEES IN VOLUNTEERING FOR COMMUNITY ORGANIZATIONS, INCLUDING SERVING ON COMMUNITY BOARDS, AND PROVIDE OPPORTUNITIES FOR THEM TO SUPPORT CAUSES THROUGH HOSPITAL EVENTS SUCH AS CANCER, HEART DISEASE, AMERICAN HEART ASSOCIATION, RACE FOR THE CURE, MARCH OF DIMES AND EPILEPSY FUNDRAISING DRIVES. WE ARE GOOD CITIZENS AND PARTNER WITH OTHER ORGANIZATIONS AND AGENCIES TO SUPPORT A THRIVING COMMUNITY, SUCH AS THE JEFFERSON COUNTY HEALTH DEPARTMENT, LIVEWELL COLORADO, THE METRO COMMUNITY PROVIDER NETWORK, MENTAL HEALTH PARTNERS OF BOULDER, MEALS ON WHEELS (BROOMFIELD & BOULDER COUNTIES), BROOMFIELD HEALTH & HUMAN SERVICES AND OTHER AGENCIES IN A SIX-COUNTY AREA. COMMUNITY BENEFITS PROVIDED IN 2011 THROUGHOUT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS) TOTALED $220.5 MILLION. AS PART OF SCLHS, WE PROMOTE THE SHARED MISSION THAT "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." WE ARE COMMITTED TO LIVING AND DEMONSTRATING OUR CORE VALUES OF EXCELLENCE, RESPECT, RESPONSE TO NEED, STEWARDSHIP AND WHOLENESS. SCLHS SUPPORTS ITS HOSPITALS BY PROVIDING GUIDANCE, OVERSIGHT, AND RESOURCES TO HELP THEM ACCOMPLISH INITIATIVES THAT IMPROVE HEALTH IN ALL OUR COMMUNITIES. THIS INCLUDES COORDINATING COMMUNITY BENEFIT PROCESSES, PROVIDING GUIDANCE WITH COMMUNITY NEEDS ASSESSMENTS, AND ESTABLISHING CONSISTENT FINANCIAL ASSISTANCE AND CHARITY CARE POLICIES AND PROCEDURES. OTHER WAYS SCLHS BENEFITS ITS HOSPITALS INCLUDE QUALITY IMPROVEMENT AND PERFORMANCE EXCELLENCE INITIATIVES; SYSTEM-WIDE IT IMPLEMENTATION AND INFRASTRUCTURE; STRATEGIC AND OPERATIONS DIRECTION AND OVERSIGHT; SUPPLY CHAIN MANAGEMENT AND PURCHASING; BENEFITS ADMINISTRATION (INCLUDING A WELLNESS PROGRAM FREE TO EMPLOYEES THAT PROMOTES THEIR HEALTH AND WELL-BEING); RISK MANAGEMENT; DISASTER PLANNING AND CRISIS ASSISTANCE. BY SHARING THE WORK ACROSS OUR SYSTEM WE ARE ABLE TO LIGHTEN THE BURDEN FOR ALL IN ORDER TO FULFILL OUR MISSION OF IMPROVING HEALTH IN OUR COMMUNITIES. SCLHS IMPROVES OVERALL HEALTH IN OUR COMMUNITIES BY PROVIDING INFRASTRUCTURE TO SUPPORT AND SUSTAIN FOUR CLINICS FOR THE UNINSURED IN KANSAS AND COLORADO. THE SCLHS CLINICS FOR THE UNINSURED ARE OFTEN THE ONLY SAFETY NET CLINIC IN THEIR COMMUNITY AND PROVIDE VALUABLE SERVICES FOR THOSE WHO ARE MOST VULNERABLE. EACH HOSPITAL IS SUPPORTED BY A FOUNDATION TO ACCESS AND OPTIMIZE LOCAL PHILANTHROPIC ORGANIZATIONS AND INDIVIDUALS. THESE FOUNDATIONS RAISE FUNDS THROUGH OUTREACH, SPECIAL EVENTS, AND BUILDING DONOR RELATIONS THROUGHOUT THEIR COMMUNITY TO SUPPORT THE NEEDS OF THE HOSPITAL.
AFFILIATED HEALTH CARE SYSTEM	PART VI, LINE 6	EXEMPLA, INC. IS A CONTROLLED ENTITY OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS). SCLHS AND ITS AFFILIATED ENTITIES HAVE A COMMON CALLING AND MISSION "TO REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE." EXEMPLA, INC. PROMOTES THE HEALTH OF THE COMMUNITY BY DELIVERING DIRECT HIGH QUALITY HEALTHCARE SERVICES THAT ARE RESPONSIVE TO THE NEEDS OF ITS PATIENTS AND THEIR FAMILIES. SCLHS SUPPORTS THE EFFORTS OF THE HOSPITAL THROUGH STRATEGIC DIRECTION AND OPERATING OVERSIGHT. SCLHS SUPPLIES OVERHEAD SUPPORT SERVICES TO EXEMPLA, INC. INCLUDING INFORMATION TECHNOLOGY SERVICES, CENTRAL CASH MANAGEMENT AND INVESTMENT, RISK MANAGEMENT AND INSURANCE AND QUALITY IMPROVEMENT LEADERSHIP.
STATE FILING OF COMMUNITY BENEFIT REPORT	PART VI, LINE 7	THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM FILES A COMMUNITY BENEFIT REPORT IN FOUR STATES: CALIFORNIA, COLORADO, KANSAS AND MONTANA.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable (6 entries)

Address Line1AddressUS/AddressLine1	Address Line2AddressUS/AddressLine2	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant
COLORADO SYMPHONY ASSOCIATION
1000 14TH ST	NUMBER 15	DENVER	CO	80202	840511458	501(C)(3)	10000	SYMPHONY SPONSORSHIP
METRO COMMUNITY PROVIDER NETWORK
3701 S Broadway		ENGLEWOOD	CO	80113	742477108	501(C)(3)	50000	SUPORT FOR ESTES STREET COMMUNITY HEALTH CLINIC
SPECIAL TRANSIT
4880 PEARL STREET		BOULDER	CO	80301	840777296	501(C)(3)	10000	ENSURING ACCESS TO HEALTH CARE PROGRAM
AMERICAN HEART ASSOCIATION
South West Affiliate-Accts Rec PO B		Des Moines	IA	50340	135613797	501(C)(3)	45000	HEART DISEASE AND STROKE PROGRAM
DENVER MUSEUM OF NATURE AND SCIENCE
2001 COLORADO BLVD		DENVER	CO	80205	840518447	501(C)(3)	50000	OPERATING & PROGRAM SUPPORT
DENVER METRO CHAMBER OF COMMERCE
1445 MARKET STREET		DENVER	CO	80202	840186760	501(C)(3)	7500	HEALTH CARE POLICY LUNCHEON

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	6	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	0	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	FREE PRESCRIPTION DRUGS FOR INDIGENT PATIENTS	TypeOfGrant
Amount Of Non Cash Assistance	405702	AmountOfNonCashAssistance
Method Of Valuation	BOOK	MethodOfValuation
Description Of Non Cash Assistance	PRESCRIPTION DRUGS	DescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV

Field	Value	IRS element (for citing)
Identifier	DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS	Identifier
Return Reference	PART 1, QUESTION 2	ReturnReference
Explanation	THE ORGANIZATION KEEPS RECORDS TO SUPPORT THE AMOUNTS PROVIDED OR REASONS FOR SUCH SUPPORT. SUPPORT IS NOT CONSIDERED GRANTS, BUT RATHER MISCELLANEOUS DONATIONS AND SPONSORSHIPS. ELIGIBILITY FOR FUNDING IS DETERMINED ON AN INDIVIDUAL BASIS, CONSIDERING THE USE OF THE FUNDS AND HOW THE USE RELATES TO EXEMPLA'S MISSION.	Explanation

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Idemnification Gross Up Payments	X	IdemnificationGrossUpPayments
Club Dues Or Fees	X	ClubDuesOrFees
Written Policy Re T And E Expenses	true	WrittenPolicyReTAndEExpenses
Substantiation Required	true	SubstantiationRequired
Severance Payment	true	SeverancePayment
Supplemental Nonqual Retire Plan	true	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	true	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (35 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
DAVID HAMM
95534	333780	0	84637	138018	21419	23260	61734	0	10188	256812	511758	138018	0
DAVID C PECORARO
0	330346	0	81212	0	17058	0	47451	0	10619	0	486686	0	0
KATHRYN LOUISE BALLINGER
314897	0	139314	0	314617	0	24060	0	10476	0	803364	0	0	0
ROBERT G BILLERBECK
302952	0	40165	0	10314	0	16396	0	12574	0	382401	0	0	0
ELISA WETHERBEE
232859	0	55485	0	37	0	22484	0	18867	0	329732	0	0	0
S ANN EVANS
210547	0	27877	0	484	0	18543	0	7092	0	264543	0	0	0
BETH C FORSYTH
219152	0	56252	0	5576	0	22763	0	10161	0	313904	0	0	0
MARGARET CAIN PRICE
216994	0	28496	0	0	0	15754	0	12211	0	273455	0	0	0
DEBORAH L WELLE POWELL
8093	252819	28011	0	0	4070	19015	44100	0	1361	55119	302350	0	0
KAREN M SCREMIN
191363	0	25418	0	0	0	13570	0	8344	0	238695	0	0	0
EVERETT A DAVIS
174754	0	22619	0	5859	0	20491	0	18388	0	242111	0	0	0
BRENDA S CHILMAN
173128	37817	25571	0	6550	254	13588	7404	5000	1090	223837	46565	0	0
TODD A CONKLIN
138558	306694	196725	0	29039	10300	15063	55893	3920	12205	383305	385092	0	0
SANDRA R CAVANAUGH
163494	0	21685	0	2810	0	16478	0	5793	0	210260	0	0	0
SUSAN E KERSCHEN
195685	0	25967	0	3367	0	13085	0	12145	0	250249	0	0	0
LISA S KETTERING
116384	0	41474	0	9414	0	17519	0	6363	0	191154	0	0	0
WILLIAM M MURRAY
0	425764	0	0	0	1422952	0	19147	0	4527	0	1872390	0	0
RODERICK G LAMOND
818100	0	0	0	37	0	16396	0	18555	0	853088	0	0	0
JOHN D HIGGINS
156617	0	19998	0	22	0	12506	0	14805	0	203948	0	0	0
CAROL J SALZMAN
138701	0	18199	0	0	0	13725	0	18219	0	188844	0	0	0
SCOTT A BARTUSEK DAY
141414	0	17021	0	9387	0	12476	0	6698	0	186996	0	0	0
BARBARA HELEN DAVIS
123304	0	16377	0	4222	0	8564	0	5592	0	158059	0	0	0
BAIN FARRIS
0	428580	0	105122	0	19334	0	88843	0	10689	0	652568	0	0
GRANT WICKLUND
0	388425	0	97200	0	18614	0	62642	0	15317	0	582198	0	0
ROBERT LADENBURGER
0	607673	0	144615	0	334473	0	73845	0	10849	0	1171455	0	0
MARK C WATTS
740897	0	0	0	37	0	0	0	7014	0	747948	0	0	0
KEVIN B MILLER
544377	0	106220	0	48714	0	4900	0	15043	0	719254	0	0	0
STANLEY D CARSON
525322	0	33161	0	37	0	4900	0	10097	0	573517	0	0	0
MARK A AMMONS
524992	0	42761	0	37	0	0	0	15043	0	582833	0	0	0
CHRISTINA L JOHNSON
332450	0	18688	0	0	0	4900	0	1562	0	357600	0	0	0
SEAN J GREGORY
255548	0	0	0	20711	0	4900	0	18408	0	299567	0	0	0
STEPHEN W COBB
206226	0	14441	0	37	0	17532	0	14971	0	253207	0	0	0
MARY L CRUMBAKER
172571	0	9487	0	6264	0	6882	0	6635	0	201839	0	0	0
JEANNE THERESE MCGINNIS
125622	0	15916	0	0	0	8325	0	18159	0	168022	0	0	0
MICHAEL A SLUBOWSKI
0	913849	0	200000	0	190942	0	0	0	10969	0	1315760	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (6 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
TAX INDEMNIFICATION AND GROSS UP PAYMENTS	SCH J, PART I, QUESTION 1A	20 INDIVIDUALS RECEIVED GROSS UP PAYMENTS FOR GIFTS OR OTHER ITEMS THAT WERE TAXABLE TO THE INDIVIDUAL IN THEIR W-2'S. THESE TOTALED $1,190 IN THE AGGREGATE.
SOCIAL CLUB DUES	SCH J, PART I, QUESTION 1A	SOCIAL CLUB DUES WERE PAID BY EXEMPLA ON BEHALF OF TODD A CONKLIN IN THE AMOUNT OF $518 DURING 2011, AND WAS INCLUDED AS TAXABLE INCOME TO MR. CONKLIN. COMPENSATION OF THE ORGANIZATION'S CEO SCHEDULE J, PART I, QUESTION 3 THE ORGANIZATION'S CEO IS COMPENSATED BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS), A RELATED ORGANIZATION. SCLHS USED ALL OF THE METHODS DESCRIBED IN SCHEDULE J, PART I TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO.
SEVERANCE AND CHANGE OF CONTROL PAYMENTS	SCHEDULE J, PART I, QUESTION 4A	A CHANGE OF CONTROL PAYMENT WAS MADE TO KATHRYN BALLINGER IN THE AMOUNT OF $314,580 IN 2011. SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) PERIODICALLY INCURS SEVERANCE PAYMENTS RELATED TO FORMER EMPLOYEES. A SEVERANCE PAYMENT WAS MADE TO WILLIAM M. MURRAY IN THE AMOUNT OF $150,051 IN 2011.
SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS	SCHEDULE J, PART I QUESTION 4B	EXEMPLA HAS A 457(F) SUPPLEMENTAL NONQUALIFIED DEFERED COMPENSATION PLAN, IN WHICH CERTAIN KEY OFFICERS PARTICIPATE. DAVID HAMM RECEIVED A DISTRIBUTION FROM THE PLAN DURING 2011 IN THE AMOUNT OF $138,018. FURTHER, OTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR IRS IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. ON THE ADVICE OF COUNSEL, SCLHS HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2011 WERE: ROBERT W. LADENBURGER-$116,293 MICHAEL A. SLUBOWSKI-$38,668 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: WILLIAM M MURRAY-$1,258,479
INCENTIVE PLANS	SCHEDULE J, PART I, QUESTION 7	THE MANAGEMENT INCENTIVE PLANS ARE BASED ON A COMBINATION OF MEASURES. MANAGEMENT AND SENIOR LEADERSHIP ARE ELIGIBLE FOR THE INCENTIVE COMPENSATION. PERFORMANCE CATEGORIES ARE MADE UP OF A COMBINATION OF CLINICAL QUALITY MEASURES AND OPERATING INCOME. THE OPERATING INCOME CATEGORY IS GENERALLY RELATED TO THE NET EARNINGS OF THE DIVISION IN WHICH THE INDIVIDUAL WORKS, OR IN THE CASE OF SYSTEM SERVICES SENIOR MANAGEMENT, THE NET EARNINGS OF THE COMPANY.
COMPENSATION OF BOARD MEMBER	SCHEDULE J, PART II	SCLHS CONSISTS OF ELEVEN HOSPITALS AND THREE CLINICS (AFFILIATES) IN FOUR STATES INCLUDING EXEMPLA, INC. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. MICHAEL A. SLUBOWSKI IS PRESIDENT & CHIEF EXECUTIVE OFFICER FOR SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS). HE ALSO SERVES AS A MEMBER OF THE EXEMPLA, INC.'S (EXEMPLA) BOARD AND AS CHAIRMAN. THE COMPENSATION REFLECTED IS THAT OF MR. SLUBOWSKI'S POSITION AS AN SCLHS EXECUTIVE AND NOT AS A MEMBER OF EXEMPLA'S BOARD. WILLIAM M. MURRAY WAS PRESIDENT & CHIEF EXECUTIVE OFFICER FOR SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS). HE ALSO SERVED AS A MEMBER OF THE EXEMPLA, INC.'S (EXEMPLA) BOARD AND AS CHAIRMAN. THE COMPENSATION REFLECTED IS THAT OF MR. MURRAY'S POSITION AS AN SCLHS EXECUTIVE AND NOT AS A MEMBER OF EXEMPLA'S BOARD. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE.

Schedule L IRS990ScheduleL

Form990 Schedule L Part IV Form990ScheduleLPartIV

Name Of Interested Person NameOfInterestedPerson

Field	Value	IRS element (for citing)
Name Person	MIDTOWN INPATIENT MEDICINE LLC	NamePerson

Field	Value	IRS element (for citing)
Relationship	PARTNER / KEY EMPLOYEE	Relationship
Amount Of Transaction	3939484	AmountOfTransaction
Description Of Transaction	HOSPITALIST SVCS AGREEMENT	DescriptionOfTransaction
Sharing Of Revenues	false	SharingOfRevenues

Form990 Schedule L Part V Form990ScheduleLPartV

Field	Value	IRS element (for citing)
Identifier	BUSINESS TRANSACTION RELATIONSHIPS	Identifier
Return Reference	PART IV	ReturnReference
Explanation	LISA KETTERING, A KEY EMPLOYEE, IS A GREATER THAN 5% PARTNER IN MIDTOWN INPATIENT MEDICINE.	Explanation

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (17 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
EXEMPT PURPOSE ACHIEVEMENTS	FORM 990, PART III, QUESTION 4A - 4D	EXEMPLA INC. (EXEMPLA) OPERATES EXEMPLA LUTHERAN MEDICAL CENTER (ELMC), SERVING PRIMARILY WESTERN AND SOUTHERN SUBURBAN AREAS OF METRO DENVER, EXEMPLA GOOD SAMARITAN MEDICAL CENTER (EGSMC), SERVING PRIMARILY BOULDER AND NORTHWEST COUNTIES OF METRO DENVER, AND OTHER AFFILIATED MEDICAL OPERATIONS. THE SYSTEM'S COLLECTIVE PROGRAM SERVICES ACCOMPLISHMENTS INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: MEDICAL SERVICES ARE PROVIDED TO ALL WHO SEEK SERVICE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES IS CRITICAL FOR THE OPERATION AND STABILITY OF EXEMPLA, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH EXEMPLA'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE WILL BE CONSIDERED AND PROVIDED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY EXIST. IN ADDITION, EXEMPLA RECOGNIZES THE ESSENTIAL NEED TO BE EXCEPTIONAL STEWARDS OF MEDICARE, MEDICAID AND COMMUNITY/PRIVATE FUNDING DOLLARS. FOR 2011, EXEMPLA PROVIDED BENEFIT TO THE COMMUNITY AT A COST OF $57,260,044, INCLUDING CHARITY CARE, UNREIMBURSED MEDICAID, OTHER SUBSIDIZED HEALTH SERVICES AND EDUCATION. EXEMPLA ALSO RECOGNIZES THE ESSENTIAL NEED TO ENHANCE AND IMPROVE MEDICAL OUTCOMES, QUALITY AND SERVICES. IN RESPONSE, A BEST IN THE NATION STRATEGY AND PROGRAM WAS IMPLEMENTED. THE OBJECTIVES OF THE PROGRAM ARE TO BE THE BEST IN THE NATION IN PREDEFINED QUALITY, SERVICE AND COST INDICATORS. THE QUALITY INDICATORS ARE IN ALIGNMENT WITH MAJOR PUBLICLY COMPARABLE DATABASES INCLUDING THE COLORADO HEALTH AND HOSPITAL ASSOCIATION AND CENTERS FOR MEDICARE AND MEDICAID SERVICES. COLLECTIVELY WITH ITS 534 LICENSED BEDS AT ELMC AND EGSMC, EXEMPLA SERVED THE COMMUNITY WITH 28,705 INPATIENT ADMISSIONS, 112,328 EMERGENCY ROOM (ER) VISITS AND 281,522 EXEMPLA PHYSICIAN NETWORK (OUTPATIENT CLINICS) ENCOUNTERS. COMPREHENSIVE MEDICAL SERVICES INCLUDE, BUT ARE NOT LIMITED TO, CARDIOLOGY, ONCOLOGY, ORTHOPEDIC, WOMEN AND FAMILY, PEDIATRICS, EMERGENCY AND TRAUMA, NEONATAL INTENSIVE CARE, NEUROLOGY, NEUROSURGERY, OB/GYN, GENERAL SURGICAL AND MEDICAL, PRIMARY CARE, INTERNAL MEDICINE, BEHAVIORAL HEALTH, HOSPICE CARE AND INTEGRATIVE HEALTH SERVICES. A STRONG COMMITMENT TO THE HEALTH OF THE COMMUNITY IS FURTHER EXEMPLIFIED, BUT NOT LIMITED TO, THE FOLLOWING PROGRAMS: EXEMPLA LUTHERAN MEDICAL CENTER WITH ITS 300 LICENSED BEDS, ELMC SERVED THE COMMUNITY WITH 15,647 INPATIENT ADMISSIONS AND 72,644 EMERGENCY ROOM VISITS.
SERVICES AND PROGRAMS	o THE CANCER CENTER AT ELMC INCLUDES ALL STAGES OF CARE INCLUDING	INITIAL DIAGNOSIS; GIVING, MONITORING AND MANAGING MEDICATIONS; PATIENT AND FAMILY EDUCATION. THE CENTER INCLUDES STATE-OF-THE-ART RADIATION ONCOLOGY CENTER, THE INFUSION CENTER, INTERNAL MEDICINE/ONCOLOGY UNIT, REHABILITATION, EDUCATION AND SUPPORT SERVICES. o AT THE HEART AND NEUROVASCULAR CENTER, PATIENTS ARE TREATED BY AN INTERDISCIPLINARY TEAM FOR CARDIAC AND NEUROLOGICAL CARE. PATIENTS DO NOT NEED TO BE TRANSFERRED TO ANOTHER FACILITY. THE CENTER FEATURES ADVANCED IMAGING EQUIPMENT AND NEUROLOGICAL SUITES TO SPEED PATIENTS' CARE. o THE BREAST CARE CENTER ACCREDITED BY THE AMERICAN COLLEGE OF RADIOLOGY, PROVIDES A FULL RANGE OF HIGH-TECH BREAST CARE SERVICES IN ITS NEW SCREENING AND DIAGNOSTIC SUITES INCLUDING DIGITAL MAMMOGRAPHY SCREENINGS AND DIAGNOSTIC SERVICES ULTRASOUND, STEREOTACTIC BIOPSIES, MEDICAL CONSULTATION, EDUCATION, AS WELL AS AN ALTERNATIVE HEALTH CENTER AND EMOTIONAL SUPPORT. o THE WOMEN AND FAMILY CENTER INCLUDES A LEVEL III NEONATAL INTENSIVE CARE UNIT AND COMPREHENSIVE PRENATAL AND PARENTING EDUCATION. THE ANTEPARTUM FAMILY UNIT HELPS PREGNANT WOMEN WHO NEED SPECIALIZED CARE FOR THEMSELVES AND/OR THEIR UNBORN BABIES. SUPPORT FOR THE NEW UNIT HELPS US REACH OUR GOAL TO HELP WOMEN HAVE HEALTHY PREGNANCIES, BIRTHS AND BABIES. o THE DIAGNOSTIC IMAGING CENTER IS ONE OF DENVER'S MOST ADVANCED IMAGING CENTER FEATURING COMPREHENSIVE STATE-OF-THE-ART DIAGNOSTIC IMAGING SERVICES COVERING FOUR BASIC MODALITIES: 40 SLICE CT SCANNER; 3.0 TELSA MRI SYSTEM; ULTRASOUND ROOMS WITH ADJOINED CHANGING ROOMS AND RESTROOMS; AND DIAGNOSTIC (X-RAY) TECHNOLOGY IN ALL-DIGITAL ENVIRONMENT. o THE HUMAN MOTION INSTITUTE (HMI) OFFERS STATE-OF-THE-ART MUSCULOSKELETAL CARE. HMI COMBINES THE MOST ADVANCED MEDICAL TECHNOLOGY WITH A DEDICATED TEAM OF PHYSICIANS AND MEDICAL PROFESSIONALS. THE FOCUS IS ON PREVENTION, ASSESSMENT, TREATMENT AND REHABILITATION OF MUSCULOSKELETAL INJURIES. o THE DIABETES CENTER PROVIDES CERTIFIED DIABETES EDUCATORS THAT OFFER INFORMATION AND COUNSELING SERVICES AS WELL AS MULTIPLE PROGRAMS TO HELP PATIENTS MANAGE DIABETES. o THE EMERGENCY DEPARTMENT IS A 52 BED, FULL SERVICE DEPARTMENT WITH A LEVEL 3 TRAUMA DESIGNATION. SERVICES ARE AVAILABLE 24 HOURS A DAY / 7 DAYS A WEEK AND STAFF IS EQUIPPED TO HANDLE ANY EMERGENCY OR URGENT CARE SITUATION. SERVICES INCLUDED MEDICAL SCREENING, MEDICAL TREATMENT AND REFERRALS FOR PEOPLE OF ALL AGES. o COLLIER HOSPICE CENTER PROVIDES COMPASSIONATE, COMPREHENSIVE, INTERDISCIPLINARY END-OF-LIFE CARE FOR TERMINALLY ILL PATIENTS AND SUPPORT FOR THEIR FAMILIES. PATIENTS ARE SERVED IN THEIR HOMES, IN NURSING HOMES AND IN THE HOSPICE INPATIENT UNIT LOCATED ON ELMC'S CAMPUS. FREE COMMUNITY SERVICES: VOLUNTEER-BASED PRE-HOSPICE SUPPORT, GRIEF SUPPORT GROUPS, GRIEF EDUCATION WORKSHOPS, CAREGIVER SUPPORT GROUPS AND GRIEF SUPPORT FOR YOUNG PEOPLE. o EXEMPLA COLORADO LUTHERAN HOME (CLH) PROVIDES INDEPENDENT AND ASSISTED-LIVING ACCOMMODATIONS FOR OLDER ADULTS AND IS RECOGNIZED AS AN EDEN ALTERNATIVE FACILITY. IT IS AN ELDER-CENTERED COMMUNITY THAT IMBUES DAILY LIFE WITH VARIETY AND SPONTANEITY. CLH IS A SKILLED NURSING FACILITY THAT INCLUDES A SECURED ALZHEIMER'S UNITS FOR PATIENTS NEEDING 24/7 CARE. o EXEMPLA WEST PINES IS A BEHAVIORAL HEALTH FACILITY THAT PROVIDES INPATIENT AND OUTPATIENT PSYCHIATRIC AND RECOVERY SERVICES TO ADULTS AND ADOLESCENTS. THE WEST PINES RECOVERY CENTER OFFERS AN INNOVATIVE TWO-WEEK ADDICTION RECOVERY PROGRAM TO CLIENTS AND THEIR FAMILIES WHO STRUGGLE WITH ADDICTION, OR ADDICTION PLUS MENTAL ILLNESS. AFTER THE TWO-WEEK STAY, CLIENTS RECEIVE INTENSIVE OUTPATIENT ASSISTANCE AND OPTIONAL MEDICATION MANAGEMENT. THE PROGRAM PROVIDES SHORTER STAYS AND LOWER COSTS. o BRIDGES INTEGRATIVE HEALTH AND WELLNESS OFFERS INTEGRATIVE CARE (ACUPUNCTURE, MASSAGE, HEALING TOUCH, PULMONARY REHABILITATION, PHYSICAL THERAPY AND CARDIAC REHABILITATION). o THE EXEMPLA LUTHERAN MEDICAL CENTER FOUNDATION WAS ESTABLISHED IN 2007, IN RESPONSE TO DONOR DEMAND FOR A FOUNDATION EXCLUSIVELY DEDICATED TO THE CURRENT AND FUTURE NEEDS OF ELMC. AT ITS CORE, THE FOUNDATION HAS A COMMITMENT AND DEDICATION TO PROVIDING FOR THE EVOLVING HEALTH CARE NEEDS OF OUR COMMUNITY, WHETHER THAT IS UPDATING FACILITIES, ADDING NEW TECHNOLOGIES, OR DEVELOPING INNOVATIVE NEW PARTNERSHIPS AND SERVICES. o ESTES STREET COMMUNITY CLINIC IS A PARTNERSHIP BETWEEN ELMC, THE JEFFCO ACTION CENTER AND METRO COMMUNITY PROVIDER NETWORK. THE CLINIC SERVES HOMELESS AND LOW-INCOME CHILDREN AND ADULTS WITHOUT INSURANCE. IT PROVIDES ACUTE AND PREVENTIVE CARE, IMMUNIZATIONS AND WELL-CHILD AND WELL-WOMEN CHECKUPS. o ELMC PROVIDES COMPREHENSIVE EDUCATION PROGRAMS WITH OPPORTUNITIES FOR ALL AGES. THROUGH EDUCATION, RELIABLE HEALTH INFORMATION AND SUPPORT, THE PROGRAM PARTNERS WITH DOCTORS AND OTHER HEALTH CARE EXPERTS TO IMPROVE COMMUNITY HEALTH. EXEMPLA GOOD SAMARITAN MEDICAL CENTER WITH ITS 234 LICENSED BEDS, EGSMC SERVED THE COMMUNITY WITH 13,058 INPATIENT ADMISSIONS AND 39,684 EMERGENCY ROOM VISITS. SERVICES AND PROGRAMS o CARDIAC AND VASCULAR SERVICES INCLUDES THE CARDIAC CALCIUM SCORE FOR DETECTING HEART DISEASE RISK. o EMERGENCY AND TRAUMA SERVICES INCLUDES A LEVEL III TRAUMA CENTER, INCLUDING STROKE AND TELEMEDICINE. o BONE AND JOINT INSTITUTE INCLUDES A COMPREHENSIVE TREATMENT OF ALL JOINT INJURIES AND REPLACEMENT. FULL SERVICE PHYSICAL THERAPY IS ALSO AVAILABLE. o NEUROSCIENCES: IN 2009, GOOD SAMARITAN MEDICAL CENTER ADDED TWO BREAKTHROUGH NEUROSCIENCE TECHNOLOGIES - THE INFRARED 800TM AND THE OPMI PENTERO - FOR TREATMENT OF STROKES, ANEURYSMS, BRAIN TUMORS AND OTHER CONDITIONS. IN 2010, THE HOSPITAL EMPLOYED A STROKE FELLOWSHIP-TRAINED PHYSICIAN AND HAS CREATED A STROKE CENTER. o OTOLARYNGOLOGY INCLUDES BALLOON SINUPLASTY. o WOMEN AND FAMILY CENTER INCLUDES A LEVEL II NEONATAL INTENSIVE CARE AND COMPREHENSIVE PRENATAL AND PARENTING EDUCATION. SUPPORT FOR THE UNIT HELPS US REACH OUR GOAL TO HELP WOMEN HAVE HEALTHY PREGNANCIES, BIRTHS AND BABIES. EGSMC ALSO IS THE FIRST HOSPITAL TO RECEIVE THE BABY-FRIENDLY DESIGNATION IN COLORADO. o INPATIENT AND OUTPATIENT SURGICAL SERVICES INCLUDES A BONE & JOINT INSTITUTE. o NEUROSURGERY, INCLUDING O-ARM TECHNOLOGY FOR COMPLEX NEUROSURGICAL CASES AND THE OPMI PENTEROMICROSCOPE, A STATE OF THE ART IMPROVEMENT IN INTRA-OPERATIVE VISUALIZATION FOR BRAIN TUMORS AND ANEURYSMS, THE ONLY ONE OF ITS KIND IN THE REGION. o INTERVENTIONAL AND DIAGNOSTIC RADIOLOGY INCLUDING A 64-SLICE CT SCANNER. OTHER SERVICES INCLUDE MRI, ULTRASOUND AND DIAGNOSTIC IMAGING. o EGSMC'S HEALTH & HEALING CENTER OFFERS INPATIENT AND OUTPATIENT INTEGRATIVE CARE (ACUPUNCTURE, MASSAGE, HEALING TOUCH, PULMONARY REHABILITATION, PHYSICAL THERAPY AND CARDIAC REHABILITATION). o THE EXEMPLA GOOD SAMARIAN MEDICAL CENTER FOUNDATION WAS ESTABLISHED IN 2005 TO FUND THE CURRENT AND FUTURE NEEDS OF EGSMC. AT ITS CORE, THE FOUNDATION HAS A COMMITMENT AND DEDICATION TO PROVIDING FOR THE EVOLVING HEALTH CARE NEEDS OF OUR COMMUNITY, WHETHER IT IS UPDATING FACILITIES, ADDING NEW TECHNOLOGIES, OR DEVELOPING INNOVATIVE NEW PARTNERSHIPS AND SERVICES. o EGSMC PROVIDES WELLNESS QUEST, A COMPREHENSIVE EDUCATION PROGRAM WITH OPPORTUNITIES FOR ALL AGES. THROUGH EDUCATION, RELIABLE HEALTH INFORMATION AND SUPPORT, THE PROGRAM PARTNERS WITH DOCTORS, OTHER HEALTH CARE EXPERTS AND SCHOOLS TO IMPROVE COMMUNITY HEALTH. o EGSMC WORKS CLOSELY WITH CLINICA CAMPESINA, A LAFAYETTE-BASED, FEDERALLY-QUALIFIED CLINIC FOR INDIGENT AND LOW INCOME INDIVIDUALS IN BOULDER COUNTY, PROVIDING ASSISTANCE TO FAMILIES IN NEED. o EGSMC PARTICIPATES IN THE CRAYONS TO CALCULATORS PROGRAM ANNUALLY TO ASSIST FAMILIES IN NEED WITH NECESSARY SCHOOL SUPPLIES, INCLUDING BACKPACKS. o EGSMC'S BABY'S FIRST RIDE PROGRAM IS A SERVICE OFFERED TO ALL FAMILIES DELIVERING AT OUR HOSPITAL. PARENTS ARE TAUGHT THE PROPER WAY TO INSTALL AND USE A CAR SEAT TO ENSURE THEIR BABY'S FIRST RIDE IS A SAFE ONE. o THE EGSMC FOUNDATION STRIVES TO BE THE OPEN DOOR FOR THOSE IN OUR COMMUNITY WHO ARE AS PASSIONATELY COMMITTED TO THE EXEMPLA GOOD SAMARITAN MEDICAL CENTER'S VISION AS WE ARE. THROUGH THE FOUNDATION, DONORS WILL BE ABLE TO HELP EXEMPLA GOOD SAMARITAN MEDICAL CENTER REMAIN A UNIQUE HEALING ENVIRONMENT IN THIS COMMUNITY, USE THE MOST ADVANCED MEDICAL TECHNOLOGY, USE THE BEST PRACTICES IN CLINICAL CARE ANYWHERE, AND BE A GOOD SAMARITAN TO THOSE WHO NEED US MOST. EXEMPLA PHYSICIAN NETWORK 2011 VOLUME - 281,522 VISITS SERVICES o 15 FAMILY PRACTICE, OCCUPATIONAL MEDICINE AND PHYSICAL THERAPY CLINICS PROVIDE TOP-QUALITY PRIMARY CARE AND THE BEST TREATMENT OPTIONS FOR PHYSICAL AND WORKPLACE INJURIES. o 21 SPECIALTY CLINICS INCLUDE CARDIOLOGY, CARDIOVASCULAR SURGERY, JOINT AND SPORTS MEDICINE, NEUROLOGY AND NEUROSURGERY, MATERNAL FETAL MEDICINE, OB/GYN, UROGYNECOLOGY, DIABETES AND ENDOCRINE CARE, AND PLASTIC RECONSTRUCTIVE AND AESTHETIC SURGERY. o 2 URGENT CARE CLINICS - EXEMPLA LUTHERAN SOUTHWEST AND EXEMPLA WESTMINSTER PROVIDE CARE FOR MINOR INJURIES AND ILLNESSES.
BOND ISSUANCES	PART IV, QUESTION 24	DURING 2010, ALL TAX-EXEMPT BONDS, WITH THE EXCEPTION OF BONDS ISSUED PRIOR TO DECEMBER 31, 2002, WERE TRANSFERRED TO SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM'S (SCLHS) MASTER TRUST INDENTURE. FURTHER, ALL EXISTING FIXED RATE DEBT OF EXEMPLA, INC. WAS REFINANCED UNDER THE SCLHS MASTER TRUST INDENTURE DURING 2010. AS EXEMPLA, INC. HAS NO OUTSTANDING TAX-EXEMPT BONDS ISSUED AFTER DECEMBER 31, 2002, EXEMPLA IS NOT REQUIRED TO COMPLETE SCHEDULE K. ALL DISCLOSURES FOR THE BONDS THAT ARE WITHIN SCLHS'S MASTER TRUST INDENTURE ARE INCLUDED IN THE SCLHS FORM 990. DELEGATION OF BOARD AUTHORITY TO AN EXECUTIVE COMMITTEE FORM 990, PART VI, QUESTION 1A PURSUANT TO THE BYLAWS, THE EXECUTIVE COMMITTEE OF THE ORGANIZATION HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE DOES NOT CONFLICT WITH THE ARTICLES OF INCORPORATION, THE BYLAWS OR THE POLICIES OR EXPRESSED WISHES OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL REPORT ALL MATTERS ACTED UPON TO THE BOARD AT THE BOARD'S NEXT MEETING. THE EXECUTIVE COMMITTEE CONSISTS OF AT LEAST THREE MEMBERS, ALL OF WHOM SHALL BE MEMBERS OF THE BOARD OF DIRECTORS, AND INCLUDE THE CHAIRPERSON OF THE BOARD, THE PRESIDENT/CEO AND OTHERS AS DESIGNATED BY THE CHAIRPERSON. DELEGATION OF CONTROL OVER MANAGEMENT DUTIES FORM 990, PART VI, QUESTION 3 IN JUNE 2008, EXEMPLA, INC., AS MANAGER OF EXEMPLA SAINT JOSEPH HOSPITAL, ENTERED INTO A MANAGEMENT AGREEMENT WITH INSIGHT ONCOLOGY FOR THE MANAGEMENT OF THE HOSPITAL'S COMPREHENSIVE CANCER CENTER SERVICES. IN DECEMBER 2008, LUTHERAN CAMPUS ASC, LLC, LOCATED ON THE ELMC CAMPUS, OF WHICH EXEMPLA PARTNERS, LLC IS A MEMBER, ENTERED INTO AN AGREEMENT WITH PINNACLE III, LLC FOR THE MANAGEMENT OF THE COMPANY. CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, Part VI, QUESTION 4 EFFECTIVE OCTOBER 1, 2012, SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS) AND COMMUNITY FIRST FOUNDATION AGREED TO AMEND AND RESTATE THE BYLAWS OF EXEMPLA. UNDER THE AMENDMENTS, COMMUNITY FIRST FOUNDATION'S INTEREST IN THE JOINT OPERATING AGREEMENT AND OTHER RIGHTS OF COMMUNITY FIRST FOUNDATION RELATED TO EXEMPLA WERE TERMINATED. IN RETURN, SCLHS COMMITTECD TO PROVIDE $275 MILLION TO COMMUNITY FIRST FOUNDATION OVER A PERIOD OF 20 YEARS. THE BOARD OF DIRECTORS OF EXEMPLA WILL CONTINUE TO CONSIST OF 10 MEMBERS, 9 OF WHICH ARE APPOINTED BY SCLHS AND 1 OF WHICH IS APPOINTED BY COMMUNITY FIRST FOUNDATION.
MEMBERS OR STOCKHOLDERS	FORM 990, PART VI, QUESTION 6	THE ORGANIZATION HAS TWO MEMBERS: COMMUNITY FIRST FOUNDATION (CFF) AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS)
ELECTION OF MEMBERS OF GOVERNING BODY	FORM 990, PART VI, QUESTION 7A	CFF APPOINTS 5 OF THE DIRECTORS AND SCLHS APPOINTS 5.
DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL	FORM 990, PART VI, QUESTION 7B	BOTH MEMBERS (COMMUNITY FIRST FOUNDATION AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, SCLHS) HAVE CERTAIN RESERVE POWERS TO APPROVE CHANGES TO THE BYLAWS REGARDING APPOINTMENT OF BOARD MEMBERS. SCLHS ALSO HAS EXTENSIVE RESERVE POWERS OVER ANY CHANGE IN MISSION, CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS, ACQUISITION OF ASSETS, INCURRENCE OF DEBT, MERGER OR DISSOLUTION, APPROVAL OF STRATEGIC PLANS AND BUDGETS, AND APPOINTMENT OF AUDITORS.
990 REVIEW PROCESS	FORM 990, PART VI, QUESTION 11A	ALL 990 REPORTING WAS REVIEWED INTERNALLY WITH SENIOR MANAGEMENT. ALL QUESTIONS AND CHANGES PROPOSED WERE ADDRESSED PRIOR TO FILING FORM 990. A DRAFT 990 WAS PROVIDED TO THE MEMBERS OF THE FINANCE COMMITTEE AND OF THE BOARD FOR REVIEW. A COMPLETE COPY OF THE FINAL FORM 990 WAS THEN PROVIDED ELECTRONICALLY TO EACH VOTING MEMBER OF THE EXEMPLA BOARD OF DIRECTORS PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE.
MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY	FORM 990, PART VI, QUESTION 12C	THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES ITS CONFLICT OF INTEREST POLICY BY PROVIDING EDUCATION AND TRAINING FOR EACH OF ITS EMPLOYEES, STAFF, OFFICERS AND DIRECTORS, AS WELL AS HAVING EACH OF THESE INDIVIDUALS COMPLETE A CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS TO DISCLOSE ANY POTENTIAL CONFLICT ISSUES. THESE STATEMENTS ARE CAREFULLY REVIEWED BY THE LEGAL DEPARTMENT. WHEN A CONFLICT IS IDENTIFIED, THE LEGAL DEPARTMENT COMPILES ALL REPORTED CONFLICTS, AND EVALUATES THE DISCLOSURES FOR ACTUAL CONFLICTS. A REPORT IS PROVIDED TO ORGANIZATION'S PRESIDENT/CEO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. THOSE WITH IDENTIFIED CONFLICTS OF INTEREST MUST RECUSE THEMSELVES FROM ANY MEETING DURING THE DISCUSSION AND VOTE THEREOF.
PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEES	FORM 990, PART VI, QUESTION 15A & 15B	COMPENSATION FOR THE CEO IS PAID BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, A RELATED NON-PROFIT ORGANIZATION. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS PAID BY EITHER EXEMPLA, INC. OR SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM. WHEN REVIEWING AND SETTING COMPENSATION FOR 'DISQUALIFIED PERSONS', EXEMPLA'S PROCESS INCLUDES: THE COMPENSATION COMMITTEE OF THE BOARD IS CHARGED WITH THE RESPONSIBILITY FOR SETTING THE OVERALL COMPENSATION PHILOSOPHY AND FOR EVALUATING THE TOTAL COMPENSATION PROGRAMS FOR DISQUALIFIED PERSONS. THE BOARD MEMBERS ARE INDEPENDENT MEMBERS AND IN THESE DISCUSSIONS THE CEO RECUSES HIMSELF FROM THE DISCUSSIONS AROUND HIS OWN COMPENSATION. THE COMMITTEE OBTAINS VALID, COMPARABLE MARKET DATA (FROM INDEPENDENTLY PUBLISHED SOURCES) FOR COMPARABLE POSITIONS AND FROM FORM 990 FILINGS. THIS COMMITTEE ENGAGES THE SERVICES OF AN INDEPENDENT EXPERT IN EXECUTIVE COMPENSATION TO REVIEW THE MARKET DATA AND PROVIDE AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PROGRAM. FOR THE PAST SEVERAL YEARS, THE INDEPENDENT FIRM HAS BEEN WATSON WYATT. WATSON WYATT VALIDATES THE PROCESS USED BY MANAGEMENT FOR IDENTIFYING 'DISQUALIFIED PERSONS' AND THEN CONDUCTS A COMPARABILITY STUDY/ANALYSIS OF PAY AT SIMILAR TYPES AND SIZES OF ORGANIZATIONS AND REVIEWS BASE SALARY, INCENTIVE (OR OVER-BASE PROGRAMS), BENEFITS, RETIREMENT PLANS AND PERQUISITES. WATSON WYATT REVIEWS THE FINDINGS WITH THE BOARD COMMITTEE AND MINUTES ARE PREPARED AND SHARED WITH ALL THE VOTING BOARD MEMBERS EACH YEAR THAT DOCUMENTS THE DISCUSSION AND ANY ACTIONS THAT MAY HAVE BEEN TAKEN. A COPY OF A FORMAL OPINION LETTER PREPARED BY WATSON WYATT FOLLOWING THE DISCUSSION WITH THE COMPENSATION COMMITTEE IS PROVIDED TO THE BOARD CHAIR AND SHARED WITH THE FULL BOARD. THIS PROCESS IS UNDERTAKEN EACH YEAR. SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES, INCLUDING EXEMPLA. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT COMPENSATION CONSULTANT, 3) FORM 990 OF OTHER ORGANIZATIONS, 4) WRITTEN EMPLOYMENT CONTRACTS, 5) COMPENSATION SURVEYS AND STUDIES, 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. THE ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.) IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY AT THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS.
AVAILABILITY OF GOVERNING DOCS, CONFLICT OF INTEREST POLICY, FINANCIALS	FORM 990, PART VI, QUESTION 19	GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND RELATED DOCUMENTS ARE PROVIDED UPON REQUEST AS DEEMED APPROPRIATE.
INDEPENDENT CONTRACTORS	PART VII, SECTION B, QUESTION 2 AND PART V, LINES 1A-1B	EXEMPLA, INC., AS THE PARENT COMPANY/MANAGER OF OTHER ENTITIES, INCLUDING ST JOSEPH HOSPITAL, MAKES ALL VENDOR PAYMENTS FOR THOSE ENTITIES. THE DOLLAR AMOUNTS AND TOTAL NUMBER OF PAYMENTS TO INDEPENDENT CONTRACTORS REFLECTED IN THIS RETURN ARE THE COMBINED PAYMENTS FOR EXPENDITURES OF ALL SUCH ENTITIES.
OTHER CHANGES IN NET ASSETS	PART XI, LINE 5	OTHER CHANGES IN NET ASSETS: CONTRIBUTIONS TO RELATED ORGANIZATIONS (620,000) UNREALIZED Loss - NET (7,009,852) CHANGE IN FUNDED STATUS OF PENSION (6,339,284) CHANGE IN INVESTMENT IN SYSTEM (4,201,997) CHANGE IN PROF AND GEN LIABILITY TRUST 1,629,352 OTHER 16,757 TOTAL (16,525,024)
STATEMENT OF CONTROLLED FOREIGN CORPORATION		EXEMPLA, INC. PARTICIPATION CORPORATION EIN: 84-1103606 FOR THE TAX YEAR ENDED DECEMBER 31, 2011 THIS STATEMENT IS BEING FILED PURSUANT TO TREAS. REG. 1.6038-2(J)(3). EXEMPLA, INC.'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:MICHAEL A SLUBOWSKI TITLE:CHAIRMAN HOURS:50
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:DAVID C PECORARO TITLE:SVP & CIO HOURS:25
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:TODD A CONKLIN TITLE:SVP & CFO, TREASURER HOURS:25
HOURS DEVOTED FOR RELATED ORGANIZATION	FORM 990 PART VII	NAME:ROBERT LADENBURGER TITLE:PRESIDENT & CEO HOURS:25

Schedule R IRS990ScheduleR

Form990 Schedule R Part I Form990ScheduleRPartI (3 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Total IncomeTotalIncome	EOY AssetsEOYAssets	Business Name Line1DirectControllingEntityName/BusinessNameLine1
EXEMPLA PARTNERS LLC
8300 W 38TH AVE	WHEAT RIDGE	CO	80033	020749530	JT VENTURE IN	CO	43024	1118606	EXEMPLA INC
Lutheran Health Partners LLC
8300 W 38TH AVE	WHEAT RIDGE	CO	80033	841103606	HC IMPROVEMEN	CO	100000	158744	EXEMPLA PART
EXEMPLA GOOD SAMARITAN MEDICAL CTR LLC
200 EXEMPLA CIRCLE	LAFAYETTE	CO	80026	431982139	HEALTHCARE	CO	238186941	358267455	EXEMPLA INC

Form990 Schedule R Part II Form990ScheduleRPartII (28 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
SISTERS OF CHARITY LEAVENWORTH HLTH SYST
2420 W 26TH AVE SUITE 100D	DENVER	CO	80211	237379161	SUPPORT MMBRS	KS	501(C)(3)	11B-TYPE II	NA	false
CARITAS CLINICS INC
818 NORTH 7TH STREET	LEAVENWORTH	KS	66048	481009910	CLINIC SVCS	KS	501(C)(3)	3	SCLHS	true
MARIAN CLINIC INC
1001 SW GARFIELD	TOPEKA	KS	66604	481046905	CLINIC SVCS	KS	501(C)(3)	3	SCLHS	true
MARILLAC CLINIC INC
2333 N 6TH STREET	GRAND JUNCTION	CO	81501	841085822	CLINIC SVCS	CO	501(C)(3)	3	SCLHS	true
PROVIDENCE MEDICAL CENTER
8929 PARALLEL PARKWAY	KANSAS CITY	KS	66112	480784446	HEALTHCARE	KS	501(C)(3)	3	SCLHS	true
ST JOHN HOSPITAL INC
3500 SOUTH FOURTH STREET	LEAVENWORTH	KS	66048	480543768	HEALTHCARE	KS	501(C)(3)	3	PMC	true
BETHANY COMMUNITY PLAZA INC
15 NORTH 12TH STREET	KANSAS CITY	KS	66102	481207407	HEALTHCARE	KS	501(C)(3)	3	PMC	true
PROVIDENCEST JOHN FOUNDATION INC
8929 PARALLEL PARKWAY	KANSAS CITY	KS	66112	480925688	SUPPORT 501C3	KS	501(C)(3)	7	PMC	true
ST FRANCIS HEALTH CENTER INC
1700 SW 7TH STREET	TOPEKA	KS	66606	480547719	HEALTHCARE	KS	501(C)(3)	3	SCLHS	true
ST FRANCIS HEALTH CENTER FOUNDATION
1700 SW 7TH STREET	TOPEKA	KS	66606	481092520	SUPPORT 501C3	KS	501(C)(3)	11A-TYPE I	SFHC	true
ST MARYS HOSPITAL & MEDICAL CENTER INC
2635 N 7TH STREET	GRAND JUNCTION	CO	81502	840425720	HEALTHCARE	CO	501(C)(3)	3	SCLHS	true
ST MARYS HOSPITAL FOUNDATION
2635 N 7TH STREET	GRAND JUNCTION	CO	81502	237001007	SUPPORT 501C3	CO	501(C)(3)	11A-TYPE I	SMHMC	true
SAINT JOSEPH HOSPITAL FOUNDATION
1835 FRANKLIN STREET	DENVER	CO	80218	840735096	SUPPORT 501C3	CO	501(C)(3)	11A-TYPE I	SJH	true
HOLY ROSARY HEALTHCARE
2600 WILSON	MILES CITY	MT	59301	810231792	HEALTHCARE	MT	501(C)(3)	3	SCLHS	true
HOLY ROSARY HEALTHCARE FOUNDATION INC
2600 WILSON	MILES CITY	MT	59301	202270238	SUPPORT 501C3	MT	501(C)(3)	11A-TYPE I	HRHC	true
ST VINCENT HEALTHCARE
1233 NORTH 30TH	BILLINGS	MT	59101	810232124	HEALTHCARE	MT	501(C)(3)	3	SCLHS	true
ST VINCENT HEALTHCARE FOUNDATION
PO BOX 35200	BILLINGS	MT	59107	810468034	SUPPORT 501C3	MT	501(C)(3)	7	SVHC	true
NORTHWEST RESEARCH & EDUCATION INSTITUTE
315 NORTH 25TH STREET	BILLINGS	MT	59101	201343024	COMM HLTH RES	MT	501(C)(3)	9	SVHC	true
ST JAMES HEALTHCARE
400 SOUTH CLARK STREET	BUTTE	MT	59701	810231785	HEALTHCARE	MT	501(C)(3)	3	SCLHS	true
ST JAMES HEALTHCARE FOUNDATION
400 SOUTH CLARK STREET	BUTTE	MT	59701	651202190	SUPPORT 501C3	MT	501(C)(3)	11A-TYPE I	SJHC	true
SAINT JOHNS HEALTH CENTER
2121 SANTA MONICA BLVD	SANTA MONICA	CA	90404	951684082	HEALTHCARE	CA	501(C)(3)	3	SCLHS	true
JOHN WAYNE CANCER INSTITUTE
2000 SANTA MONICA BLVD	SANTA MONICA	CA	90404	954291515	CANCER R&D	CA	501(C)(3)	4	SJHHC	true
SAINT JOHNS HOSPITAL & HLTH CENTER FNDTN
2121 SANTA MONICA BLVD	SANTA MONICA	CA	90404	956100079	SUPPORT 501C3	CA	501(C)(3)	11A-TYPE I	SJHHC	true
EXEMPLA LUTHERAN MEDICAL CENTER FNDTN
2480 W 26TH AVESUITE 360B	DENVER	CO	80211	208846152	SUPPORT 501C3	CO	501(C)(3)	7	EXEMPLA INC	true
EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN
200 EXEMPLA CIRCLE	LAFAYETTE	CO	80026	841649162	SUPPORT 501C3	CO	501(C)(3)	7	EXEMPLA INC	true
LUTH MED CNTR PRO&GEN LIAB SELF-INS TRST
2480 W 26TH AVE SUITE 360B	DENVER	CO	80211	742571584	INSURANCE	CO	501(C)(3)	11A-TYPE I	EXEMPLA INC	true
SAINT JOSEPH HOSPITAL
1835 FRANKLIN STREET	DENVER	CO	80218	840417134	HEALTHCARE	CO	501(C)(3)	3	SCLHS	true
MOUNT ST VINCENT HOME INC
4159 LOWELL BOULEVARD	DENVER	CO	80211	840405260	RESIDENT CARE	CO	501(C)3	11A-TYPE I	SCLHS	true

Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Predominant Income TypePredominantIncomeType	Disproportionate AllocationsDisproportionateAllocations	Code VCodeVAmount	General Or Managing PartnerGeneralOrManagingPartner	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership
PAVILION IMAGING LLC
750 WELLINGTON	GRAND JUNCTION	CO	81501	030516198	RADIOLOGY	CO	NA	N/A	false	$0	false
GRAND VALLEY SURGICAL CENTER LLC
710 WELLINGTON	GRAND JUNCTION	CO	81501	841505075	OP SURGERY	CO	NA	N/A	false	$0	false
SAN JUAN CANCER CENTER LLC
600 SOUTH 5TH STREET	MONTROSE	CO	81401	202856331	OP CANCER	CO	NA	N/A	false		false
BILLINGS MRI CENTER LLC
1041 NORTH 29TH STREET	BILLINGS	MT	59101	810450943	MRI-PET SCAN	MT	NA	N/A	false		false
LUTHERAN CAMPUS ASC LLC
3455 LUTHRN PKW SUITE 150	WHEATRIDGE	CO	800336028	020749532	OP SURGERY	CO	EXEMPLA PTNRS	Related	false		false	546756	2624805	0.59660
COLORADO SURGICAL VENTURES LLC
30 S WACKER DR SUITE 2302	CHICAGO	IL	60605	208038915	OP SURGERY	CO	NA	N/A	false	$0	false
COLORADO SURGICAL HOSPITAL LLC
30 S WACKER DR SUITE 2302	CHICAGO	IL	60605	208038977	OP SURGERY	CO	NA	N/A	false	$0	false

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Type Of EntityTypeOfEntity	Address Line1AddressForeign/AddressLine1	CityAddressForeign/City	Province Or StateAddressForeign/ProvinceOrState	CountryAddressForeign/Country	Postal CodeAddressForeign/PostalCode	Legal Domicile Foreign CountryLegalDomicileForeignCountry
CARITAS INC AND SUBSIDIARIES
9801 RENNER BOULEVARD SUITE 100	LENEXA	KS	66219	480941069	OTHER MEDICAL	KS	C CORP
LEAVEN INSURANCE COMPANY LTD
				980370522	INSURANCE			23 LIME TREE BAY AVE PO BOX 1051	GEORGETOWN	GRAND CAYMAN	CJ	KY1-1102	CJ

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	true	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	true	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	true	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	true	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	true	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	false	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	true	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	false	PerformOfServicesByOtherOrgs
Sharing Of Facilities	true	SharingOfFacilities
Sharing Of Paid Employees	true	SharingOfPaidEmployees
Reimbursement Paid To Other Org	true	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	true	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	false	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (16 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
SAINT JOSEPH HOSPITAL
N	177695324	ACCRUAL
SAINT JOSEPH HOSPITAL
M	4201997	CHANGE IN INVES
SAINT JOSEPH HOSPITAL
K	36258773	ACCRUAL
SAINT JOSEPH HOSPITAL
R	20082262	ACCRUAL
SAINT JOSEPH HOSPITAL
E	60000000	AMOUNT LOANED
EXEMPLA LUTHERAN MEDICAL CENTER FOUNDATION
N	223933	ACCRUAL
EXEMPLA GOOD SAMARITAN MEDICAL CTR FOUNDATION
N	232865	ACCRUAL
EXEMPLA GOOD SAMARITAN MEDICAL CTR FOUNDATION
O	208616	ACCRUAL
EXEMPLA GOOD SAMARITAN MEDICAL CTR FOUNDATION
C	75534	ACCRUAL
LUTHERAN CAMPUS ASC LLC
D	2885747	AMT GUARANTEED
SAINT JOSEPH HOSPITAL
P	115828054	ACCRUAL
LUTH MED CNTR PROF & GEN LIAB SELF-INS TRUST
P	1629352	ACCRUAL
LUTH MED CNTR PROF & GEN LIAB SELF-INS TRUST
D	576374	ACCRUAL
SAINT JOSEPH HOSPITAL
D	10983242	ACCRUAL
SAINT JOSEPH HOSPITAL
O	5889610	ACCRUAL
EXEMPLA LUTHERAN MEDICAL CENTER FOUNDATION
C	644376	ACCRUAL

Form990 Schedule R Part VII Form990ScheduleRPartVII

Field	Value	IRS element (for citing)
Identifier	METHOD TO DETERMINE VALUE OF SCHEDULE R TRANSACTIONS	Identifier
Return Reference	SCHEDULE R, PART V, LINE 2 COLUMN D	ReturnReference
Explanation	THE ORGANIZATION USED THE AMOUNT RECOGNIZED ON THE BOOKS AND RECORDS OF THE ORGANIZATION OF CASH RECEIVED OR PROVIDED, ADJUSTED TO THE ACCRUAL BASIS, TO DETERMINE THE VALUE OF SCHEDULE R TRANSACTIONS, WHICH APPROXIMATES FAIR VALUE.	Explanation