2011-04-11T16:37:23-05:00 2010-05-31 EIDE BAILLY LLP 401N 31ST ST SUITE 1120 PO BOX 7112 BILLINGS MT 591037112 990 2009-06-01 810233121 St Peter's Hospital STPE 4064442100 2475 Broadway Helena MT 59601 John Solheim 4064442100 2011-04-06 1 Steve Markovich 4068962400 2011-04-06 2009 2016-02-24 21:20:13Z John Solheim 2475 Broadway Helena MT 59601 230314992 0 X www.stpetes.org X 1883 MT Provide exceptional and compassionate health care. 16 12 1209 96 656405 0 1126166 882438 123827055 134569173 -8388520 3656103 105821 81866 116670522 139189580 0 0 56762259 59650206 0 400647 63176745 69810304 119939004 129460510 -3268482 9729070 204080475 216324765 74372259 74218407 129708216 142106358 St Peter's Hospital partners with our patients, community, and medical staff to provide exceptional and compassionate health care. 1 1 104835153 133912768 St. Peter's Hospital is a 122-bed acute care hospital facility serving residents of Lewis and Clark County and portions of Jefferson, Broadwater, Meagher and Powell Counties. St. Peter's is the sole facility in the primary service area. During the year ended May 31, 2010 the hospital provided a total of $14,113,378 in community benefit. Of this total of $2,572,693 was for medical services to individuals who were determined unable to purchase such services under the hospital's charity care policy. In addition to free care and/or subsidized care, care is also provided at below cost rates to persons covered by governmental programs. The total operating loss for providing care to Medicaid patients was $2,226,052. The hospital provided $8,851,223 in subsidized health services during the year, including acute patient care for medical, surgical, pediatric and behavioral health patients, outpatient pharmacy, pulmonary rehab, dialysis, clinical nutrition, anti coag, and hospitalists services, physician clinics and in-home nursing and oxygen services.The hospital operates several physician clinics, employing 38 physicians. Without the hospital's assistance, Lewis and Clark County would be without many needed medical and surgical specialties. Physicians in the specialties of Family Practice, Internal Medicine, Neurology, Rheumatology, Gastroenterology, ENT, Cardiology, Radiation and Medical Oncology had approximately 150,000 patient encounters. 104835153 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 1 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 1 1 0 0 1 126 0 1 1209 1 1 1 0 0 0 0 0 0 0 0 16 12 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X John Green CFO 4064442100 2475 Broadway Helena MT 59601 Tom Harlen 1.00 X X 0 0 0 Peter Johnson 1.00 X X 0 0 0 Patty Nelson 1.00 X X 0 0 0 Candace Cain 1.00 X X 0 0 0 John Solheim 40.00 X X 448060 0 51787 Rick Hayes 1.00 X X 0 0 0 John Green 40.00 X 206993 0 30584 Dr Thomas Weiner 40.00 X 1222214 0 46962 Dr David Lechner 40.00 X 168470 0 25344 Kate McIvor 1.00 X 0 0 0 Mary Sheehy-Moe 1.00 X 0 0 0 John Flink 1.00 X 0 0 0 Dr John Michelotti 1.00 X 0 0 0 Rt Rev C Franklin Brookhard Jr 1.00 X 0 0 0 Mathew Rude 1.00 X 0 0 0 Andrew O'Neill 1.00 X 0 0 0 Dr Jack McMahon 5.00 X 20000 0 0 Dr Michael Lee 40.00 X 545613 0 27158 Dr John Ribic 40.00 X 499458 0 16993 Dr Carla Kingsley 40.00 X 464172 0 26608 Dr Michael Dixon 40.00 X 509976 0 31886 Dr Scott Pargot 40.00 X 516272 0 27774 4601228 0 285096 55 0 1 0 Dick Anderson Construction 3424 Highway 12 E Helena MT 59601 General Contractor 2113734 Horizon Mental Health Management PO Box 840839 Dallas TX 75284 Management Services 1320699 Capital Medical Anesthesia PO Box 5179 Helena MT 59601 Anesthesia Services 636626 Medical Information Technology Meditech Circle Westwood MA 02090 Software Support 490100 Arup Laboratories 500 Chipeta Way Salt Lake City UT 84108 Lab Testing Services 487155 18 771238 111200 882438 NET PATIENT SERVICE RE 622110 82112423 82112423 PHARMACY 446110 49565616 49565616 Income from joint vent 900099 1463238 1463238 CAFETERIA 722210 562569 553033 9536 Other services 900099 546667 546667 318660 218458 100202 134569173 1144802 1144802 201762 124008 190798 53106 10964 70902 81866 81866 93392009 800 90667189 214319 2724820 -213519 2511301 2511301 139189580 133912768 656405 3737969 2268002 1377665 890337 45751102 36190480 9255398 305224 2529145 1997948 522489 8708 5977147 2465404 3490916 20827 3124810 3080644 31437 12729 1337519 1337519 323413 43957 279456 59414 59414 20700 20700 343286 343286 6283486 5402253 881233 237520 228814 8706 1494687 705677 770422 18588 1059727 1059727 3372254 1806630 1556084 9540 235576 117666 113145 4765 158575 132218 25358 999 2251530 2251530 9084994 6005771 3079223 2076845 1860157 216688 Medical Supplies, other 32239254 31835319 393374 10561 Bad Debt Expense 7393637 7393637 Bed Tax 1065318 1065318 Miscellaneous 721276 721276 Other Taxes 51293 7073 44220 129460510 104835153 24224710 400647 9669091 13010037 16507252 17824816 2498732 3039728 2451497 2574744 159292497 64054479 99458931 95238018 58345362 65080629 14665528 19094926 484082 461867 204080475 216324765 12156976 10376622 50038140 47537585 12177143 16304200 74372259 74218407 X 120676800 130700567 2808649 3752011 6222767 7653780 129708216 142106358 204080475 216324765 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 500 0 0 1 200 0 1 20000 20700 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Hired consultant to provide lobbying services in connection with governmental affairs representation to ensure hospital, community, and employee interests and needs are represented. 7514363 1405761 928225 155497 9692852 9393554 630667 -2297705 212153 7514363 0.00000 0.79000 0.21000 0 1 1 1104574 1104574 91027808 19060057 71967751 65072376 43787560 21284816 2087739 1206862 880877 95238018 Investment in Joint Ventures 7901681 F Interest in St. Peter's Foundation 11193245 F 19094926 Estimated Third-Party Settlements 1459191 LIABILITY FOR PENSION BENEFITS 14845009 16304200 139189580 129460510 9729070 3277976 -608904 2669072 12398142 139090198 243904 243904 138846294 343286 343286 139189580 129361128 243904 243904 129117224 343286 343286 129460510 Part V, Line 4: Description of Intended Use of Endowment Funds: Endowment funds are restricted for support of hospital programs and services and for capital purchases and improvements in accordance with board policies and/or donor restrictions. Part X: Description of Uncertain Tax Positions Under FIN 48: The Organization undergoes an annual analysis of its various tax positions for all entities, assessing the likelihood of those positions being upheld upon examination with relevant tax authorities. As of May 31, 2010 and 2009, the unrecognized tax benefit is zero. Part XI, Line 8 - Other Adjustments: MINIMUM PENSION LIABILITY ADJUSTMENT: -2983278. Change in permanently and temporarily net assets of Foundation: 2374374. Part XII, Line 2d - Other Adjustments: Rental Expenses recorded in expenses for financial statements: 243904. Part XII, Line 4b - Other Adjustments: Investment expenses netted with investment earnings in financial statements: 343286. Part XIII, Line 2d - Other Adjustments: Rental Expenses recorded in expenses for financial statements: 243904. Part XIII, Line 4b - Other Adjustments: Investment expenses netted with investment earnings in financial statements: 343286. 1 1 X 1 X 1 X 1 1 0 1 1 3074263 501570 2572693 0.01990 7126033 4899981 2226052 0.01720 10200296 5401551 4798745 0.03710 372478 5273 367205 0.00280 77635 480 77155 0.00060 40296360 31445137 8851223 0.06840 19050 19050 0.00010 40765523 31450890 9314633 0.07190 50965819 36852441 14113378 0.10900 79614 79614 0.00060 79614 79614 0.00060 1 3638273 40380852 46196066 -5815214 X 1 1 Helena Surgicenter LLC Surgery Center 0.51980 0.09150 0.05290 St Peter's Hospital

2475 Broadway Helena MT 59601

X X X physician clinics & Urgent Care Services Hospice and Homelink of St Peter's Hosp

201 South California Helena MT 59601

Hospice and Home Health APEX of St Peter's Hospital

201 South California Helena MT 59601

Home Oxygen Services Part I, Line 7: Charity Care, Unreimbursed Medicaid and Subsidized Health Services are converted to cost using the cost to charge ratio derived from the Hospital's cost allocation system. The cost allocation system addresses all patient segments. The costs are estimated by allocating departmental costs based on direct costs less any other operating revenue then an allocation of benefits, depreciation and other overhead costs. Community health improvement services, health professions education and cash and in-kind contributions is derived from the CBISA program. Part I, Line 7g: Subsidized health services includes $26,686,080 of costs attributable to a physician clinic. Part I, Line 7f: The amount of bad debt expense removed from the denominator of the calculations was $7,393,637. Part III, Line 4: Bad debt expense is calculated at cost using a cost of charge ratio derived from the organization's cost allocation system. Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year.Financial statement footnote:Patient receivables are uncollateralized patient and third-party payor obligations. The Organization charges interest at 10 percent per annum on past due accounts after 90 days. Payments of patient receivables are allocated to the specific claims identified on the remittance advice or, if unspecified, are applied to the earliest unpaid claim. The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Part III, Line 8: These expenses represent an overall shortfall of the direct Medicare patient population. The costs themselves are therefore a community benefit as the community would not receive these services if we did not provide them. Medicare allowable costs of care are based on the Medicare cost report. The Medicare cost report is completed based on the rules and regulations set forth by CMS. Part III, Line 9b: St. Peter's Hospital recognizes its responsibility to render necessary health care services to all persons in need of such care, regardless of race, creed, color or economic circumstances. St. Peter's Hospital recognizes that payment for services rendered is due and payable at the time of service. The hospital accepts insurance assignments and some other approved arrangements for delayed payment. Financial assistance is available for all qualified patients. Patients not covered by insurance or unable to pay in full for services rendered must contact the appropriate Patient Account Representative who will assist the patient and/or family in determining if he/she qualifies for patient assistance. Part V: The organization also has the following types of facilities other than those required to be licensed as healthcare facilities in the state of Montana: 5 clinics providing the following services- The Broadway location including Family Practice, Ears/Nose/Throat, Internal Medicine, Urology, Rheumotology, Lab, Xray, Pharmacy and Infusion Services. - Maria Dean location- Ears/Nose/Throat and Audiology - Maria Dean location for Gastro Services - Maria Dean location for Cardiology Services - North Montana Avenue location included Family Practice, Internal Medicine, X-Ray and Lab Services - Cancer Treatment Center included Medical Oncology and Radiation Therapy Physicians. Form 990, Schedule H, Part I, Line 6b:The organization's community benefit report can be found on our website and is published twice a year in the local daily newspaper. Part VI, Line 2: St. Peter's Hospital conducts a Community Survey every two years. The Community Survey is performed by an independent contractor that selects an adequate sample size for the area. The homes of St. Peter's Hospital employees are excluded from the survey. The survey includes questions related to evaluating the community's experience and ability to access Healthcare. The survey helps to identify specialty areas of concern. The results of the surveys are reviewed by the Senior Management team as well as the Board to identify the areas of focus. Part VI, Line 3: St. Peter's Hospital posts its charity care policy on its web site as well as (1) at the Admitting Desk, Emergency Room and Cashier areas in which eligible patients are likely to be present; (2) we offer a summary of our policy and application to self pay patients with contact information to patients as part of the intake process; (3) provide a copy of financial assistance contact information to patients with discharge materials; (4) Financial counselors discuss with patients expecting to owe more than $500 the availability of patient assistance and various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. Part VI, Line 4: St. Peter's Hospital is a 122-bed acute care Hospital Facility serving residents of Lewis and Clark County and portions of Jefferson, Broadwater, Meagher and Powell Counties. St. Peter's is the sole facility in the primary services area. The hospital financial payor mix consisted of 6% self pay patients, 6.9% of Medicaid patients and 43.9% Medicare patients. Approximately 14% of the population is age 65 and older. The average per capita income is $20,123 and approximately 8.4% of the population is below the federal poverty level. The nearest hospital in the area is approximately 35 miles from St. Peter's campus. Part VI, Line 5: St. Peter's Hospital made $79,614 of cash and in-kind donations to a variety of organizations within the community. This includes but is not limited to Montana Chamber Foundation, Helena High School Boys Basketball for a new athletic field scoreboard, CR Anderson Middle School for its honor student program, Angel Fund to purchase clothing and school supplies for youth, Military Museum, Carroll College Athletics with emergency services at events, Carroll College Nursing Department with medical supplies needed for learning labs, Exploration Works with medical supplies needed for student science experiments, United Way to assist low-income and homeless residents with basic needs, Spirit of Service Campaign by providing supplies and volunteers to help elderly residents and others with special needs improve their homes and yards, Kay McKenna Youth Foundation to provide safe summer youth activities, Archie Bray Foundation, Downtown Helena and Big Brothers and Sisters. The donations were made to assist these Community Sponsors in their various programs. Part VI, Line 6: St. Peter's Hospital is the sole acute care provider in the primary service area made up of Lewis & Clark County and the northern portion of Jefferson County. There is a population of approximately 68,000. Out-migration is generally limited to tertiary services not available at St. Peter's Hospital including cardiac surgery and neo-natal care. St. Peter's Hospital provides care to all patients regardless of their ability to pay. St. Peter's Hospital maintains charges as one of the lowest Hospitals within the State depending on the services being provided. St. Peter's Hospital sponsors several wellness screenings, health fairs and educational lectures, classes, and events throughout the year to promote better living, nutrition and good health. Continuing education is also provided to the members of the medical community on an on-going basis. In addition, St. Peter's Hospital had 14,037 volunteer hours from the community assisting in a variety of roles within the organization. X X X 1 1 X X X X X 0 0 0 1 0 0 0 0 0 John Solheim 356109 0 69114 0 22837 0 14700 0 37087 0 499847 0 0 0 John Green 170862 0 21609 0 14522 0 12822 0 26952 0 246767 0 0 0 Dr Thomas Weiner 1219979 0 0 0 2235 0 14700 0 32262 0 1269176 0 0 0 Dr David Lechner 157916 0 10000 0 554 0 10602 0 15598 0 194670 0 0 0 Dr Michael Lee 495023 0 50000 0 590 0 14700 0 13393 0 573706 0 0 0 Dr John Ribic 498055 0 0 0 1403 0 14700 0 4040 0 518198 0 0 0 Dr Carla Kingsley 463224 0 0 0 948 0 14700 0 12252 0 491124 0 0 0 Dr Michael Dixon 509976 0 0 0 0 0 14700 0 17531 0 542207 0 0 0 Dr Scott Pargot 516272 0 0 0 0 0 14700 0 13419 0 544391 0 0 0 Part I, Line 1a CEO receives reimbursement for membership dues paid to a social club, an annual community support allowance and a car allowance. The CEO is taxed on the personal mileage that he uses. All amounts are reported as taxable compensation. Part I, Line 5 Four physicians listed in Part VI, Section A receive compensation based on relative value units (RVU's) that take into consideration patient complexity and volume. The organization uses a third party to set the RVU levels by specialty. Montana Facility Finance Authority 810302402 61204JBR4 2004-05-01 29748183 To fund expansion and renovation of existing Hospital facility. 0 0 Montana Facility Finance Authority 810302402 61204JBY9 2007-03-01 22826511 To fund new Medical Office Building and Women and Children's Unit Bed Wing. 0 0 29748183 2213912 422346 27111925 2008 0 0 1 1 22826511 574461 7154609 353863 14743608 2009 1 0 1 1 0 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0 0.00000 0.00290 0.00290 1 0 0 0 0 1 0 0 0 0 0 0 0 New West Healthcare Services Mr. Solheim is Hospital representative on the New West Board 5573623 Hospital pays health insurance premiums to New West. 0 Lisa McMahon Family relationship with board member 45727 Wages paid as an employee. 0 Form 990, Part III, line 2 New Program Services During Fiscal 2010, St. Peter's Hospital opened three new Operating Room Suites to provide exemplary care and education to the patient and their family concerning surgical procedures, anesthesia, recovery and pain management. A state-of-the-art, automated intelligent lab system was installed in St. Peter's Clinical Laboratory to provide quick, accurate turn around time for testing with smaller samples and handle the community's growing demand for routine blood work. The Dimension Vista 1500 Intelligent Lab System from Siemens Healthcare Diagnostics has best-in-class technologies on one smart workstation. Cancer Treatment Center received re-accreditation with commendation by The Commission on Cancer of the American College of Surgeons. Hospital and clinics were re-accredited by the Joint Commission. Offered monthly Quit for Life tobacco cessation classes in conjunction with Montana Quit Line. Free classes offered to staff and their family members. New community services: Free sports physicals offered to middle and high school students by physicians Youth grief support group formed and counselors in schools following community tragedy Road to Recovery program begun to provide free transportation to cancer patients Cues Club classes formed to help youth develop social skills Free screening mammograms offered to uninsured, low-income women. Swine flu precautions and education given to community. The Behavioral Health Unit was opened in May of 2009 and 2010 was the first full year that the Unit was open. The inpatient hospitalization program involves stabilizing the crisis that led to hospitalization, providing a thorough evaluation, developing an individualized treatment plan, and coordinating care in a warm, supportive, and secure environment that provides 24-hour nursing care. Our program known as the Women's Health Institute and the Breast Program was developed creating a collaborative organization of medical staff dedicated to developing and promoting coordinated multi-disciplinary clinical programs tied to important women's health issues. Breast care navigator hired to consult with individuals diagnosed with cancer. New physicians Recruited for : Urology, Cardiology, Family Practice, Emergency Medicine, Orthopedics, Spine Surgery, Neurology, Anesthesiology, Hospitalist, Internal Medicine, Audiology, and General Surgeon. We selected a new Radiology Group for the organization. We implemented a Medical Staff Pay for Call program to provide emergency services to the community. We participated in the Vigilant Guard Emergency exercise providing a multi-county drill to evaluate the community's ability to respond to a mass disaster such as a major earthquake. In February of 2010, St. Peter's Hospital invested in a limited liability company to build a new Health Club enhancing the community's accessibility to a state of the art wellness facility. The facility is treated as a corporation for federal and state income tax purposes. Form 990, Part III, line 3 Changes in Program Services Changes to services: The Sleep Center received Accreditation. St. Peter's Hospital implemented a Tobacco Free Campus in the Fall of 2009. This program was adopted to provide a healthier patient and employee experience. Form 990, Part VI, Section A, line 7a One board member shall be the Bishop of the Episcopal Diocese of Montana or his designee in accordance with Hospital by-laws. Form 990, Part VI, Section B, line 11 A rough draft of the Form 990 is reviewed by the CEO and CFO as well as the Finance Committee prior to full board approval of the final Form 990 prior to filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers all board members, officers, senior administration and key employees. Board identifies potential conflicts and determines if voting on related items would be a conflict of interest If a conflict is determined to exist, the conflicted individual is excluded from voting on the conflicted item. Form 990, Part VI, Section B, line 15 An independent compensation consultant performs a review of salaries and benefits using data from comparable healthcare facilities. A report is prepared and presented to the Executive Committee of the Board of Directors, which uses the report to determine officer and senior management compensation. The information is then reviewed with the Board of Directors. The annual process was performed during 2010. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are made available to the public upon request. Form 990, Schedule R, Part V Transactions with related organizations are determined as follows: Part V, Line 2 (1) Amounts eliminated for financial statement purposes. (2) Salaries and benefits paid for employees based on fiscal year. (3), (4) and (5) Amounts are not above the threshold using general ledger activity. (6) Cash capital contributions made during the fiscal year. Schedule K, Part I, Bond A, CUSIP#'s for Series 2004 Bond Listing of all CUSIP#'s associated with bond issuance 61204J BR4, 61204J AX2, 61204J AY0, 61204J AZ7, 61204J BA1, 61204J BB9, 61204J BC7, 61204J BD5, 61204J BE3, 61204J BF0, 61204J BG8, 61204J BH6, 612047J BL7 Schedule K, Part I, Bond A, CUSIP#'s for Series 2007 Bond Listing of all CUSIP#'s associated with bond issuance 61204J BY9, 61204J BS2, 61204J BTO, 61204J BU7, 61204J BV5, 61204J BW3 St Peters Hospital Foundation 2475 BROADWAY Helena MT 59601 810392270 Raise funds to support St. Peter's Hospital MT 501(c)(3) 11a N/A Helena SurgiCenter LLC 2440 Winne Ave Helena MT 59601 810513385 Surgery Center MT N/A Related 744809 82878 0 0 Peak Health LLC C/O St Peters Hospital 2475 Boradwa Helena MT 59601 271863807 Health Club MT N/A C 0.65000 Peak Health Realty C/O St Peters Hospital 2475 Boradwa Helena MT 59601 272492966 Rental Property MT N/A C 0.65000 Peak Health Helena LLC C/O St Peters Hospital 2475 Boradwa Helena MT 59601 272493096 Health Club MT N/A C 0.65000 0 1 1 0 0 0 0 0 1 0 0 1 0 1 1 1 0 1 St Peters Hospital Foundation C 771238 St Peters Hospital Foundation N 305224 Helena SurgiCenter LLC I 0 Helena SurgiCenter O 0 Helena SurgiCenter P 0 Peak Health LLC B 2283495