2011-08-15T15:37:03-05:00 2010-09-30 Berberich Trahan & Co PA 3630 SW Burlingame Road Topeka KS 666112050 990 2009-10-01 480543789 Stormont-Vail HealthCare Inc STOR 7853546000 1500 SW 10TH Street Topeka KS 666041353 Kevin J Han 7853546000 2011-08-15 1 Cheryl G Hayward 7852343427 2009 2016-02-24 21:20:13Z KEVIN J HAN 1500 SW 10TH Street Topeka KS 666041353 541598856 0 X WWW.STORMONTVAIL.ORG X 1894 KS STORMONT-VAIL'S MISSION IS "WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY" BY PROVIDING QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. 15 13 4496 500 0 42279 1263988 619223 438218249 479320375 -9500318 4350279 919668 787469 430901587 485077346 0 0 251639740 277911626 0 0 176358729 189846855 427998469 467758481 2903118 17318865 435156254 450834298 249155419 267374369 186000835 183459929 WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY 0 0 456222718 479226666 Stormont-Vail HealthCare, Inc. (Medical Center) provides quality medical health care regardless of race, creed, sex, national origin, handicap, age, or ability to pay. For the year ended September 30, 2010 19,070 inpatients, 55,689 emergency room patients, 2,048 newborns, and 480 neonatal intensive care babies were served. Although reimbursement for services rendered is critical to the operation and stability of the Medical Center, it is recognized that not all individuals possess the ability to purchase essential medical services. The Medical Center's mission is to serve the community with respect to providing health care services and health care education regardless of ability to pay. As part of this mission, the Medical Center provides care to persons covered by Medicare and Medicaid patients. Following are some of the benefits provided at reduced rates for the fiscal year:In addition to the charity care provided, the Medical Center also provided service to patients that resulted in uncollectible amounts as follows:Bad Debt Expense at Cost $ 10,935,615Shortfall of Medicare Payments at Cost $ 70,954,044 The Medical Center also provides other health care services and programs for the benefit of the community, free or at reduced rates. Examples of these include: Subsidy of nursing education, medical education, and allied health education Operating the region's only Level III Neonatal Intensive Care Unit (NICU) serving a high percentage of medically indigent patients Operating a Level II Trauma Center serving northeast Kansas Provide support to Lifestar, the air ambulance service in northeast Kansas Support groups are provided for a variety of topics Over 52,000 hours of volunteer time were donated to the Medical Center helping to reduce the cost of providing health care Maintaining the Health Sciences Library that is made available to the public free of charge as a medical resource Stormont Vail employees support the Care Line, which is an emergency fund for patients in financial distress, providing services and supplies on a short-term basis Use of Pozez Education Center facilities for a variety of community groups and programs Donated cash or in-kind gifts to various community organizations Participated in numerous clinical research trials through the Clinical Research Department Stormont-Vail West Behavioral Health Services operates a substance abuse program Developed a Palliative Care program to provide comfort care to patients with chronic conditions Provide support and education for patients with diabetes through the Diabetes Learning Center. Stormont-Vail is a regional network of 27 locations in northeast Kansas improving access to medical care in several cities that otherwise would not have access, particularly on weekends Maternal Fetal Medicine program provided care and access to screenings and genetic counseling for women with at-risk pregnancies. Operated the HealthWise 55 program which provided outreach programs to independent living facilities in Topeka Offered blood pressure clinics at West Ridge Mall as well as outreach blood pressure clinics at six other locations Stormont-Vail provided the regions only perinatologist providing care for high-risk pregnancies Stormont-Vail maintained the Lifeline program, the personal response system Offered online childbirth classes through Stormont-Vails web site Partnered with the March of Dimes for the NICU Family Support Program Stormont-Vail was a Medal of Honor winner for the sixth consecutive year for organ retrieval and tissue conversion The Health Connection program, which provides physician referral and after-hour access to a nurse, received 363,022 calls Provided health information through the Topeka & Shawnee County Public Library's Health Information Neighborhood Partnered with Building Blocks to provide childcare services to staff and the community Stormont-Vail clinical educators participated in the American Health Association's CPR for Family and Friends class to teach others CPR The Trauma Services department provided community education programs on fall prevention Stormont-Vail West Behavioral Health Services participated in a depression screening for the community Partnered in the Kansas Red Ribbon Campaign to promote a healthy, drug-free lifestyle for youth A skin screening clinic for the community was held at the Cotton-O'Neil Cancer Center Sponsored Tour de Dialysis, a 100-mile bike ride to raise awareness and funds for patient needs at the Kansas Dialysis Services Free prostate cancer screening clinic was provided at the Cotton-O'Neil Cancer Center Connect with the community through the organization website, Stormont.org Participated in the Bi-State Stroke Education Consortium Partnered with Health Innovation Network of Kansas, a coalition that grew to 17 hospitals sharing information, education and other needed services The Boy to Man and Girl to Woman communication education programs facilitate conversation between adults and pre-teens about future physical and emotional changes Stormont Vail and its employees donated funds and staff time to the Meals on Wheels program 456222718 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 0 0 1 0 0 0 0 1 1 0 0 1 253 0 1 4496 1 1 1 1 CJ CA BD 0 0 0 0 0 0 0 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEVIN HAN 7853546000 1500 SW 10TH STREET TOPEKA KS 66604 MAYNARD OLIVERIUS 60.00 X X 1007185 0 173692 STEVEN WATKINS MD 60.00 X 1043501 0 84556 S KENNETH ALEXANDERIII X 0 0 0 PAMELA JOHNSON BETTS X 0 0 0 C RICHARD BONEBRAKEMD X 0 0 0 HARRY W CRAIG JR X 0 0 0 GARY B FLEENOR X 0 0 0 JOHN B DICUS X 0 0 0 ROBERT WHEELER X 0 0 0 JAMES HAINES X 0 0 0 PATRICIA PRESSMAN PHD X 0 0 0 FORD W ROSS X 0 0 0 SUEANN V SCHULTZ X X 0 0 0 NANCY J PERRY X X 0 0 0 JAMES SCHMANK X 0 0 0 VERNON LONG 50.00 X 397701 0 137754 DAVID CUNNINGHAM 50.00 X 237153 0 45252 CAROL WHEELER 50.00 X 387368 0 111693 BERNIE BECKER 50.00 X 313036 0 127243 KENT PALMBERG MD 55.00 X 752876 0 336440 DEBRA YOCUM 50.00 X 306765 0 48774 JANET STANEK 55.00 X 433765 0 92100 CAROL PERRY 50.00 X 347125 0 80161 KEVIN HAN 60.00 X 163826 0 42787 MATTHEW WILLS MD 60.00 X 1497721 0 23244 SHAWN MOORE MD 60.00 X 1497803 0 21759 MICHAEL MCCOY MD 60.00 X 926702 0 35980 TEWODROS ADDISSE MD 60.00 X 1076435 0 13157 SANJAY MISRA MD 60.00 X 1380053 0 1240 11769015 0 1375832 291 0 1 0 RADIOLOGY & NUCLEAR MEDICINE 823 MULVANE SUITE 1 TOPEKA KS 66606 X-RAY & OTHER SERVICES 2074612 ANESTHESIA ASSOCIATES 823 MULVANE SUITE 2A TOPEKA KS 66606 CONTRACTED ANESTHESIA SERVICES 1842075 ETHEL LOUISE BJORGAARD 615 S TOPEKA BLVD TOPEKA KS 66603 LEGAL SERVICES 1442611 PERINATAL CONSULTANTS 900 SW ROBINSON TOPEKA KS 66614 MATERNAL & PERINATAL/INFANT SERVICES 746000 KANSAS LITHOTRIPSY 9825 SPECTRUM BUILDING 3 AUSTIN TX 78717 CONTRACTED KIDNEY STONE REMOVAL 543300 12 340000 279223 155989 619223 NET PATIENT SERVICE RE 621300 474958553 474958553 NUTRITIONAL SERVICES 621300 2132673 2132673 EDUCATION SERVICES/SCH 611600 1687205 1687205 MEDICAL RECORDS 519100 139843 139843 MATERNAL FETAL MEDICIN 621300 83120 83120 318981 318981 479320375 2898095 2898095 787469 787469 787469 787469 57964806 8888 56418913 102597 1545893 -93709 1452184 -93709 1545893 485077346 479226666 0 5231457 6679588 2218786 4460802 220478561 220199004 279557 8779004 8724619 54385 27697750 27689842 7908 14276723 14133893 142830 2478721 2097070 381651 97250 97250 127285 127285 12805676 12032868 772808 1016784 1016784 2439049 2262703 176346 5165459 5094159 71300 7030806 7021622 9184 176293 137041 39252 8046410 8023545 22865 20018592 19992489 26103 3357344 1405201 1952143 sUPPLIES 76834898 76833438 1460 PROVISION FOR UNCOLLECT 29301626 29301626 OTHER EXPENSES 14789243 11652074 3137169 REPAIR & MAINTENANCE 5919592 5919592 CONTRIBUTION TO S-V FOU 180000 180000 61827 61827 467758481 456222718 11535763 0 650980 4872802 71716948 55902142 64253104 67353289 4372061 4472770 2479306 3496464 378473605 187709339 193112509 190764266 47602067 64483475 47841185 56332801 3128094 3156289 435156254 450834298 47126940 50470055 140310000 137940000 3727135 4194964 57991344 74769350 249155419 267374369 X 185220929 182697109 647047 629961 132859 132859 186000835 183459929 435156254 450834298 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE KANSAS HOSPITAL ASSOCIATION. THESE ORGANIZATIONS HAVE INFORMED THE TAXPAYER THAT A PORTION OF THEIR DUES ARE ATTRIBUTED TO LOBBYING AND ADVOCACY ACTIVITIES. THAT PERCENTAGE FOR 2009 IS 24.42% AND 15.2% RESPECTIVELY AND THE AMOUNT IS $ 20,017. OCCASIONALLY, THE CEO WILL SPEAK TO LEGISLATORS REGARDING BILLS THAT WOULD AFFECT THE ORGANIZATION OR HEALTHCARE INDUSTRY. 239400 0 10 239410 235668 0 3732 239400 0.00000 0.55490 0.44510 0 0 10885082 10885082 233273631 95979467 137294164 130392825 91729872 38662953 3922067 3922067 190764266 3758346 F 52574455 F 56332801 RESERVE FOR THIRD-PARTY PAYORS 1596286 ACCRUED PENSION PAYABLE 72926135 CONDITIONAL ASSET RETIREMENT OBLIGATION 246929 74769350 485077346 467758481 17318865 3833937 -23693708 -19859771 -2540906 488899614 3833937 115616 3949553 484950061 127285 127285 485077346 491440520 24291853 24291853 467148667 127285 482529 609814 467758481 Part V, Line 4: Description of Intended Use of Endowment Funds: ENDOWMENT FUNDS ARE USED IN ACCORDANCE WITH THE DIRECTION OF THE APPLICABLE DONOR GIFT INSTRUMENT AT THE TIME THE GIFT IS ADDED TO THE FUND. Part X: Description of Uncertain Tax Positions Under FIN 48: AS OF SEPTEMBER 30, 2010 AND 2009 THERE WERE NO UNCERTAIN TAX BENEFITS INDENTIFIED AND RECORDED AS A LIABILITY. Part XI, Line 8 - Other Adjustments: EQUITY IN NET INCOME OF CONSOLIDATED AFFILIATES: 318195. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS: -24291853. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES: -675752. TAX AMORTIZATION GREATER THAN BOOK: 482529. INTEREST RATE SWAP: 473173. Part XII, Line 2d - Other Adjustments: CONSOLIDATED AFFILIATE NET INCOME: 318195. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES: -675752. INTEREST RATE SWAP: 473173. Part XIII, Line 2d - Other Adjustments: CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS: 24291853. Part XIII, Line 4b - Other Adjustments: TAX AMORTIZATION GREATER THAN BOOK: 482529. 1 1 1 X 1 X 1 1 1 0 1 1 6899649 6899649 0.01570 61706140 40400548 21305592 0.04860 68605789 40400548 28205241 0.06430 893237 124260 768977 0.00180 3922501 1975845 1946656 0.00440 11518998 7882192 3636806 0.00830 1627619 1131240 496379 0.00110 193565 193565 0.00040 18155920 11113537 7042383 0.01600 86761709 51514085 35247624 0.08030 0 10935615 0 142371605 213325649 -70954044 X 1 0 STORMONT-VAIL HEALTHCARE

1500 SW 10TH STREET TOPEKA KS 66604

X X X Part III, Line 4: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLE ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED ON AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. STORMONT-VAIL ONLY CHARGES INTEREST ON MEDICAL SERVICE DIVISON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF TO BAD DEBT WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. COSTING METHODOLOGY:THE BAD DEBT EXPENSE WAS CALCULATED BY USING THE ACTUAL BAD DEBT WRITE-OFFS FROM THE HOSPITAL AND THE COST TO CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM FOR OTHER PAYORS MULTIPLIED BY THE BAD DEBT WRITE-OFFS. THE CLINIC BAD DEBTS WERE ESTIMATED AND A COST TO CHARGE RATIO WAS APPLIED TO DETERMINE COST. Part III, Line 8: BOTH THE COST ACCOUNTING AND COST TO CHARGE RATIO METHOD ARE USED. Part VI, Line 6: X X X X 0 1 0 0 0 1 0 0 0 MAYNARD OLIVERIUS 626630 0 363871 0 16684 0 162405 0 11287 0 1180877 0 0 0 STEVEN WATKINS MD 939435 0 100383 0 3683 0 73613 0 10943 0 1128057 0 0 0 VERNON LONG 287802 0 105370 0 4529 0 126992 0 10762 0 535455 0 0 0 DAVID CUNNINGHAM 180865 0 54438 0 1850 0 29455 0 15797 0 282405 0 0 0 CAROL WHEELER 275954 0 107153 0 4261 0 100981 0 10712 0 499061 0 0 0 BERNIE BECKER 233187 0 76825 0 3024 0 113967 0 13276 0 440279 0 0 0 KENT PALMBERG MD 516185 0 231221 0 5470 0 325497 0 10943 0 1089316 0 0 0 DEBRA YOCUM 231665 0 73142 0 1958 0 42551 0 6223 0 355539 0 0 0 JANET STANEK 322123 0 105051 0 6591 0 75948 0 16152 0 525865 0 0 0 CAROL PERRY 262231 0 82817 0 2077 0 69461 0 10700 0 427286 0 0 0 KEVIN HAN 149281 0 13653 0 892 0 32388 0 10399 0 206613 0 0 0 MATTHEW WILLS MD 1496881 0 0 0 840 0 6651 0 16593 0 1520965 0 0 0 SHAWN MOORE MD 1497131 0 0 0 672 0 5166 0 16593 0 1519562 0 0 0 MICHAEL MCCOY MD 866241 0 56778 0 3683 0 25037 0 10943 0 962682 0 0 0 TEWODROS ADDISSE MD 1007829 0 68048 0 558 0 6580 0 6577 0 1089592 0 0 0 SANJAY MISRA MD 1379074 0 0 0 979 0 0 0 1240 0 1381293 0 0 0 Part I, Line 4b: MAYNARD OLIVERIUS $ 161,405. DAVID CUNNINGHAM $ 19,382. BERNARD BECKER $ 81,212. KENT PALMBERG, M.D. $ 278,901. DEBRA YOCUM $ 16,368. JANET STANEK $ 52,104. CAROL PERRY $ 23,143. STEVEN WATKINS, M.D. $ 30,000. Part I, Line 6 CERTAIN EMPLOYEES OF THE ORGANIZATION ARE ELIGIBLE FOR BONUSES UPON ACHIEVEMENT OF VARIOUS PERFORMANCE MEASURES AS OUTLINED IN THE ANNUAL INCENTIVE PLAN. KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BJN9 2007-08-27 1875000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BJP4 2007-08-27 1115000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BJQ2 2007-08-27 4545000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BJR0 2007-08-27 10000000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BJS8 2007-08-27 7515000 HEALTH FACILITIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BJT6 2007-08-27 25000000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKG2 2008-03-31 655000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKH0 2008-03-31 750000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKK3 2008-03-31 18115000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKM9 2008-03-31 130000 HEALTH FACILITIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKN7 2008-03-31 130000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKP2 2008-03-31 130000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKQ0 2008-03-31 155000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKR8 2008-03-31 1320000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKS6 2008-03-31 1380000 HEALTH FACILITIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKT4 2008-03-31 1445000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKU1 2008-03-31 1515000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKV9 2008-03-31 1580000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKW7 2008-03-31 1650000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BKZ0 2008-03-31 5480000 HEALTH FACILITIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLC0 2008-03-31 2280000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLD8 2008-03-31 1940000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLE6 2008-03-31 2055000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLF3 2008-03-31 2160000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLG1 2008-03-31 2295000 HEALTH FACILITIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLH9 2008-03-31 2405000 HEALTH FACILITIES 0 0 KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLJ5 2008-03-31 125000 HEALTH FACILITIES 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X MEDICAL EQUIPMENT 4 124978 FMV X COMPUTER EQUIPMENT 6 27088 FMV X OTHER EQUIPMENT 4 3923 FMV 0 0 0 Form 990, Part VI, Section B, line 11 A DRAFT OF THE RETURN IS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW. ANY CHANGES ARE COMMUNICATED TO THE PAID PREPARER. A COPY OF THE RETURN IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL. WITH THE BOARD'S APPROVAL, THE PAID PREPARER THEN FILES THE RETURN ELECTRONICALLY. Form 990, Part VI, Section B, line 12c THE OFFICERS, DIRECTORS AND KEY EMPLOYEES SUBMIT CONFLICT OF INTEREST STATEMENTS TO THE CHAIRMAN OF THE AUDIT COMMITTEE OF STORMONT-VAIL HEALTHCARE EACH YEAR. THE CHAIRMAN REVIEWS THE RESPONSES AND REPORTS TO THE AUDIT COMMITTEE FOR THEIR REVIEW, ANY APPROPRIATE ACTION IF REQUIRED AND APPROVAL. THE CHAIRMAN ALSO THEN REPORTS THE RESULTS TO THE FULL BOARD OF DIRECTORS. Form 990, Part VI, Section B, line 15 THE PERFORMANCE COMMITTEE OF THE STORMONT-VAIL HEALTHCARE BOARD OF DIRECTORS ENGAGED INTEGRATED HEALTHCARE STRATEGIES, AN EXECUTIVE COMPENSATION CONSULTING FIRM, TO PROVIDE RECOMMENDATIONS REGARDING ALL ASPECTS OF COMPENSATION OF THE ORGANIZATION'S SENIOR LEADERSHIP GROUP, INCLUDING THE PRESIDENT & CEO. THAT ENGAGEMENT INCLUDED THE FOLLOWING COMPONENTS: -REVIEW OF BACKGROUND DATA, INCLUDING INFORMATION ON CURRENT PROGRAM; -COMPILATION OF DATA ON COMPENSATION AND BENEFIT PRACTICES OF COMPARABLE ORGANIZATIONS; -COMPARISON OF BASE SALARIES AT SVHC TO BASE SALARY LEVELS IN THE MARKET; -COMPARISON OF ANNUAL AND LONG-TERM INCENTIVES AT SVHC TO INCENTIVE LEVELS IN THE MARKET; -ANALYSIS OF BENEFITS ON BOTH A QUANTITATIVE AND QUALITATIVE BASIS; -COMPARISON OF SVHC TOTAL COMPENSATION (BASE, INCENTIVE, BENEFITS) TO PEER GROUP TOTAL COMPENSATION; -PREPARATION OF REPORT TO FACILITATE SVHC BOARD DISCUSSION OF THE TOTAL COMPENSATION; AND -RECOMMENDATIONS REGARDING ESTABLISHMENT OF SALARY RANGES FOR SENIOR LEADERSHIP POSITIONS. THE DELIBERATIONS AND DECISIONS OF THE PERFORMANCE COMMITTEE AND THE BOARD OF DIRECTORS ARE DOCUMENTED IN MEETING MINUTES MAINTAINED BY SVHC. Form 990, Part VI, Section C, line 19 STORMONT-VAIL HEALTHCARE, INC. MAKES THEIR FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION AS PART OF THE 990 INFORMATION RETURN. ANY CHANGES TO THE GOVERNING DOCUMENTS ARE INCLUDED WITH THE 990 RETURN. AT THIS TIME, THE HEALTH CENTER DOES NOT MAKE THEIR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. PART XI, LINE 2C NO CHANGE FROM PRIOR YEAR. FORM 990, PART III, LINE 4B, PROGRAM SERVICE ACCOMPLISHMENTS: Name/Location Type of Students Dept/Division University of Arkansas Genetics Cotton O'Neil Cancer Center Atchison Hospital Nursing Patient Care Services Baker University Nursing Multiple Coffey County Hospital Nursing Multiple Colby Community College PT Rehab Services Community Health Systems-St. Marys Nursing Multiple Creighton University Pharmacy Pharmacy Emporia State UniversityNursing Medical Arts Clinic-Emporia Fort Hays Nursing Nursing Multiple Kansas State University Kinesiology Heart Center University of Kansas Nursing Patient Care Services University of Kansas Pharmacy Pharmacy University of Kansas Social Work Behavioral Health University of Kansas Speech Therapy Rehabilitation Services University of Missouri-KC Nursing Cotton-O'Neil Clinics Nebraska Medical Center Medical Technology Laboratory University of Pittsburgh CRNA Surgical Services Pratt Community College Nursing All areas Rockhurst University PT/OT Rehabilitation Services Sabetha Hospital Nursing Staff Patient Care Services St. Louis University PA Cotton-O'Neil Clinics St. Louis University Nursing Patient Care Services Texas Wesleyan University CRNA Surgery USD #501 High School Multiple University of Utah PA Cotton-O'Neil Clinic Washburn University Kinesiology Heart Center Washburn University Health Information Health Information Mgmt. Washburn University Nursing Multiple Washburn University PT Assistants Rehabilitation Services Washburn University Imaging Sciences Medical Imaging Washburn University Radiology (CT) CT Washburn University Social Work SV Behavioral Health Washburn University Ultrasound-Cardio Radiology/Ultrasound Washburn University Ultrasound-Gen Radiology Ultrasound Washburn Institute of Technology LPNs Multiple Washburn Institute of Technology Surg Techs Surgical Services/TSDS Washburn Institute of Technology EMT Patient Care Services Wichita State University Nursing Multiple Wichita State University PA Multiple Wichita State University PT Assistants Rehabilitation Service STORMONT-VAIL FOUNDATION 1500 SW 10TH AVE TOPEKA KS 66604 480980926 GENERATE VOLUNTARY GIFTS TO SUPPORT STORMONT-VAIL HEALTHCARE KS 501(C)(3) 170(B)(1)(A)(VI) STORMONT-VAIL HEALTHCARE STORMONT-VAIL HEALTHCARE AUXILARY 1500 SW 10TH AVE TOPEKA KS 66604 486140517 PROVIDE GIFT SHOP, RESTAURANT AND PROJECTS FOR THE CONVENIENCE OF PATIENTS KS 501(C)(3) 509(A)(3) TYPE I N/A EXCELLENT SURGERY CENTER LLC 1500 SW 10TH TOPEKA KS 66604 260849999 OUTPATIENT SPECIALTY EAR, NOSE, AND THROAT SURGERY CENTER KS N/A RELATED 501457 0 0 URISH MEDICAL PLAZA LLC 1500 SW 10TH TOPEKA KS 66604 480782848 REAL ESTATE KS STORMONT-VAIL INC RELATED 15188 967877 0 0 STORMONT-VAIL INC 901 GARFIELD TOPEKA KS 66606 480782848 RETAIL PHARMACY KS N/A C 1952753 14607579 1.00000 DECHAIRO HOSPITAL INC 1500 SW 10TH ST TOPEKA KS 66604 480788844 REAL ESTATE KS STORMONT-VAIL INC C 389262 1.00000 CENTURY HEALTH SOLUTIONS INC 2951 SW WOODSIDE DR TOPEKA KS 66614 481206397 INSURANCE MANAGEMENT OPERATIONS KS STORMONT-VAIL INC C -217894 263713 1.00000 UAT INC 1500 SW 10TH ST TOPEKA KS 66604 480907989 MEDICAL BILLINGS PRACTICE KS N/A C 42921 119046 1.00000 KOSM INC 1500 SW 10TH ST TOPEKA KS 66604 480807000 MEDICAL BILLINGS PRACTICE KS N/A C 1007534 1059534 1.00000 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 1 0 1 STORMONT-VAIL FOUNDATION B 180000 STORMONT-VAIL FOUNDATION R 428700 STORMONT-VAIL FOUNDATION P 50987 STORMONT-VAIL HEALTHCARE AUXILIARY C 146814 STORMONT-VAIL HEALTHCARE AUXILIARY P 239129 STORMONT-VAIL INC N 1125417 STORMONT-VAIL FOUNDATION N 324469