2011-11-15T02:00:52-05:00 2010-12-31 ERNST & YOUNG US LLP 190 CARONDELET PLAZA SUITE 1300 CLAYTON MO 63105 990 2010-01-01 237379161 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC SIST 9138952800 9801 RENNER BOULEVARD LENEXA KS 662199745 LYDIA JUMONVILLE 2011-11-14 3142901000 2010 2016-03-07 17:11:31Z LYDIA W JUMONVILLE 2420 WEST 26TH AVE STE 100-D DENVER CO 80211 101242709 false 0928 X www.sclhealthsystem.org X 1972 KS 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. 13 12 271 0 -8577 0 1093 3100 59732749 72582296 4240595 22559296 5456923 6098017 69431360 101242709 289461 379320 0 0 37882714 40263716 0 0 0 65038561 131032929 103210736 171675965 -33779376 -70433256 825765094 1480585187 776716176 1477109961 49048918 3475226 X 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. false false 59025230 0 15175016 FINANCE, AUDIT AND DEBT SERVICES - ADMINISTERS FINANCING PROGRAM AND REVIEWS THE CAPITAL FORMATION PROGRAM (FOR ELEVEN HOSPITALS AND FOUR CLINICS). IT ALSO OVERSEES THE AUDITS OF ITS RELATED AFFILIATES TO PROVIDE ASSURANCE REGARDING THE EFFECTIVENESS AND EFFICIENCY OF OPERATIONS AND THE RELIABILITY OF FINANCIAL REPORTING. 3668129 0 0 HUMAN RESOURCES - ADMINISTERS PROGRAMS AND OTHER SERVICES TO THE ELEVEN HOSPITALS, FOUR CLINICS AND VARIOUS FOR-PROFIT ENTITIES WHICH ARE AFFILIATES OF SCLHS. PROGRAMS ADMINISTERED INCLUDE EMPLOYEE WELFARE BENEFIT PLANS, RETIREMENT PLANS, AND CERTAIN EXECUTIVE RECRUITING FUNCTIONS. 52827400 0 16551049 INFORMATION SYSTEMS - COORDINATES THE CENTRALIZATION OF MANY OF THE INFORMATION SYSTEMS OF THE HEALTH SYSTEM. CURRENTLY, AN ENTERPRISE RESOURCE PLANNING (ERP) SYSTEM AND A RADIOLOGY INFORMATION SYSTEM (RIS) ARE INSTALLED AND BEING OPERATED. IN ADDITION, A CLINICAL AND PATIENT ADMINISTRATIVE SYSTEM IS BEING INSTALLED THROUGHOUT THE HEALTH SYSTEM. 26630278 38486684 Quality, Risk Management, Communications: 7402412 2465822 Medical Office Building, Denver, CO: 185108 Depreciation: 379320 379320 Grants Related to SCLHS Mission: 34597118 379320 40952506 150117877 true false false true false false false false true true true true true true false false true false false true false false false false false false true true true true false false false false false false false false false false false false false false false true true true false false true 262 0 true 271 true true true true CJ UK CA false false false false false false false false X 13 12 false false false false true true true true true false true true true true true true true true true true false X SHARON OWENSSCL HEALTH SYS 3038135190 2420 W 26TH AVE STE 100-D DENVER CO 80211 X SISTER LYNN CASEY SCL 3.0 X 0 0 0 MICHAEL T DEFREECE 3.0 X X 380 0 0 SISTER KATHERINE FRANCHETT SCL 3.0 X 0 0 0 SISTER MAUREEN HALL SCL 3.0 X X 0 0 0 TERRY HEATH 3.0 X 0 0 0 GORDON HOWIE 3.0 X X 0 0 0 SISTER EILEEN HURLEY SCL 3.0 X 0 0 0 KNUTE KNUDSON 3.0 X 0 0 0 MATTHEW J LAMBERT III MD 3.0 X X 0 0 0 SISTER JOAN SUE MILLER SCL 3.0 X X 0 0 0 MARLON PRIEST MD 3.0 X 626 0 0 DENNIS PURTELL 3.0 X 386 0 0 SISTER LINDA ROTH SCL 3.0 X 0 0 0 KENT RUSSELL 3.0 X 0 0 0 CAROLYN SMELTZER 3.0 X 784 0 0 RON SPERLING 3.0 X 338 0 0 WILLIAM M MURRAY 40.0 X X 1706457 0 169086 LYDIA W JUMONVILLE 40.0 X 294190 0 278 MICHAEL D ROWE 40.0 X 635455 0 21368 EDWARD L BARKER 40.0 X 967328 0 68938 MARK A WILKINSON 40.0 X 136753 0 25841 PAMELA G LOGAN 40.0 X 87763 0 17132 MARY JO GREGORY 40.0 X 1352059 0 116263 ROBERT A BOYSEN 40.0 X 788947 0 85811 MARGARET J BREEN 40.0 X 574096 0 612685 RICHARD T LOPES 40.0 X 588276 0 17185 JILL WILLEN KENNELLY 40.0 X 485416 0 72262 DAVID PECORARO 40.0 X 79343 332998 35001 ROBERT W LADENBURGER 0.0 X 1224099 0 63373 JAMES T PAQUETTE 0.0 X 768909 0 97940 LOURDES J 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195000 3502137 4177114 -620022 121506 3435586 0.54950 0.45050 false false 36793483 36793483 23931206 23559505 371701 1602195 1531681 70514 0 114583162 73889286 40693876 0 0 0 77929574 REAL ESTATE 183070740 F ABSOLUTE RETURN FUNDS 92242505 F CORE HEDGE FUNDS 46873467 F PRIVATE EQUITY 18614198 F 340800910 PROVIDENCE MEDICAL CENTER 15663471 F ST. JOHN HOSPITAL, INC. 1605816 F ST. JAMES HEALTHCARE 14399438 F ST. MARY'S HOSPITAL & MEDICAL 44092693 F SAINT JOHN'S HEALTH CENTER 105000000 F SAINT JOSEPH HOSPITAL 331040000 F 511801418 0 DEFERRED COMP 457 PLAN LIAB 7428054 INTEREST RATE SWAP LIABILITY 13348330 FROZEN DB PLAN 13085319 33861703 FORM 990, SCHEDULE D, PART V, LINE 4 (ENDOWMENT FUNDS) SCLHS HAS A PERMANENT ENDOWMENT IN THE AMOUNT OF $2,000,000. THE EARNINGS FROM THE PERMANENT ENDOWMENT ARE A TERM ENDOWMENT TO BE USED FOR EDUCATION PURPOSES AS DETERMINED BY SCLHS MANAGEMENT. FORM 990, SCHEDULE D, PART X (ASC 740-10 FOOTNOTE DISCLOSURE) SCLHS DID NOT HAVE A DISCLOSURE OF ASC 740-10 - INCOME TAXES IN ITS DECEMBER 31, 2010 AUDITED FINANCIAL STATEMENTS AS IT WAS NOT MATERIAL. Central America and the Caribbean 0 0 Program Services CAPTIVE INSURANCE PREM 19006085 Central America and the Caribbean Investments 123267000 Europe (Including Iceland and Greenland) Investments 2843000 North America Investments 0 0 0 0 0 145116085 145116085 true false true true true false Schedule F, Part I, Line 3 SCLHS' expenditures (premiums paid) for its captive insurance premiums was $19,006,085 net of premium discounts. true CRISTO REY KANSAS CITY SCHOOL 211 W LINWOOD BLVD KANSAS CITY MO 64111 436033728 501(c)(3) 32416 SCHOOL SUPPORT ST VINCENT HEALTHCARE FOUNDATION 1106 N 30TH ST BILLINGS MT 59101 481092520 501(c)(3) 10000 FUNDRAISER SPONSOR ST FRANCIS HEALTH CENTER FOUNDATION 1700 SW 7TH ST TOPEKA KS 66606 480925688 501(c)(3) 10000 FUNDRAISER SPONSOR PROVIDENCE SAINT JOHN FOUNDATION 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 956100079 501(c)(3) 10000 FUNDRAISER SPONSOR SAINT JOHNS HOSPITAL AND HEALTH CENTER FOUNDATION 2121 SANTA MONICA BLVD SANTA MONICA CA 90404 481046905 501(c)(3) 65000 FUNDRAISER SPONSOR AND MOTHER XAVIER ROSS AWARD ST MARYS HOSPITAL FOUNDATION 2635 N 7TH STREET GRAND JUNCTION CO 81502 651202190 501(c)(3) 10000 FUNDRAISER SPONSOR UNIVERSITY OF ST MARY 4100 SOUTH 4TH STREET LEAVENWORTH KS 66048 480547846 501(C)(3) 29500 FUNDRAISER SPONSOR AND SUPPORT LEGENDS OF GRAND VALLEY 248 S 4TH ST GRAND JUNCTION CO 81501 234338654 501(C)(3) 10000 FUNDRAISER SPONSOR AMERICAN RED CROSS 2025 EAST ST NW WASHINGTON DC 20001 530196605 501(C)(3) 33333 HAITI RELIEF SUPPORT CATHOLIC CHARITIES USA PO BOX 17090 BALTIMORE MD 212037090 530196620 501(C)(3) 33333 HAITI RELIEF SUPPORT PARTNERS IN PROGRESS 329 N FAIRFIELD STREET LIGONIER PA 15658 252896636 501(C)(3) 33333 HAITI RELIEF SUPPORT 11 SECONDARY EDUCATION SCHOLARSHIPS 35 63653 Form 990, SCHEDULE I, PART I, LINE 2 (MONITORING OF GRANTS) SCLHS' MISSION DEPARTMENT REQUIRES WRITTEN STATEMENTS THREE TIMES A YEAR REGARDING THE PROGRESS AND STATUS OF THE GRANT. X X X X X true true X X X X X X true true false false false false false false false WILLIAM M MURRAY 910180 0 489328 0 306949 0 157816 0 11270 0 1875543 0 0 0 LYDIA W JUMONVILLE 270273 0 0 0 23917 0 0 0 278 0 294468 0 0 0 MICHAEL D ROWE 328324 0 250906 0 56225 0 18300 0 3068 0 656823 0 0 0 EDWARD L BARKER 453716 0 245899 0 267713 0 53254 0 15684 0 1036266 0 0 0 MARK A WILKINSON 132664 0 0 0 4089 0 11941 0 13900 0 162594 0 0 0 MARY JO GREGORY 717798 0 308171 0 326090 0 105346 0 10917 0 1468322 0 0 0 ROBERT A BOYSEN 376494 0 159066 0 253387 0 74778 0 11033 0 874758 0 0 0 MARGARET J BREEN 272892 0 0 0 301204 0 607543 0 5142 0 1186781 0 0 0 RICHARD T LOPES 199721 0 350775 0 37780 0 14673 0 2512 0 605461 0 0 0 JILL WILLEN KENNELLY 333445 0 66531 0 85440 0 56750 0 15512 0 557678 0 0 0 DAVID PECORARO 76450 229547 0 83044 2893 20407 3977 16105 2010 12909 85330 362012 0 0 ROBERT W LADENBURGER 576408 0 268750 0 378941 0 52613 0 10760 0 1287472 0 0 0 JAMES T PAQUETTE 416920 0 66462 0 285527 0 87072 0 10868 0 866849 0 0 0 LOURDES J LAZATIN 501230 0 100189 0 244601 0 19600 0 7543 0 873163 0 56530 0 IRMA C NAPOLI 289271 0 120067 0 133500 0 33986 0 6351 0 583175 0 0 0 BAIN J FARRIS 425034 0 83164 0 17718 0 63105 0 10699 0 599720 0 0 0 SCHEDULE J SUPPLEMENTAL DISCLOSURES SCHEDULE J, PART I, LINE 1a (CHARTER TRAVEL) DURING 2010, SCLHS UTILIZED A CHARTER AIRCRAFT TO TRANSPORT AN EXECUTIVE TO A MEETING AT ITS AFFILIATE HOSPITAL IN BUTTE, MT. DUE TO SCHEDULE REQUIREMENTS THIS WAS THE ONLY TRANSPORTATION OPTION. ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 1a (TRAVEL FOR COMPANION) SCLHS AND ITS AFFILIATES HAVE ANNUAL RETREATS FOR THEIR BOARDS OF DIRECTORS. THE BOARD MEMBERS AND MANAGEMENT ARE ALLOWED TO BE REIMBURSED IF THEY BRING A SPOUSE OR GUEST TO THESE RETREATS. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2010 WERE: MICHAEL T DEFREECE MARLON PRIEST MD DENNIS PURTELL CAROLYN SMELTZER RON SPERLING LYDIA W JUMONVILLE MARY JO GREGORY ROBERT W LADENBURGER BAIN J FARRIS ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 1a (TAX INDEMNIFICATION AND GROSS-UP PAYMENTS) SCLHS ALLOWS FOR CERTAIN TAX INDEMNIFICATION AND GROSS-UP PAYMENTS IN THE INSTANCES OF RELOCATION AND TEMPORARY HOUSING. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2010 WERE: LYDIA W JUMONVILLE MARY JO GREGORY MARGARET J BREEN ROBERT W LADENBURGER ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 1a (HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE) SCLHS ALLOWS FOR CERTAIN HOUSING PAYMENTS IN THE INSTANCES OF RELOCATION AND TEMPORARY HOUSING. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2010 WERE: LYDIA W JUMONVILLE MARY JO GREGORY MARGARET J BREEN ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 1a (CLUB MEMBERSHIPS) SCLHS HAS CERTAIN CORPORATE CLUB MEMBERSHIPS. PERSONAL USE IS TREATED AS TAXABLE COMENSATION TO THE INDIVIDUAL FOR IRS PURPOSES. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2010 WERE: LOURDES J LAZATIN ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 4a (SEVERANCE PAYMENTS) SCLHS PERIODICALLY INCURS SEVERANCE PAYMENTS RELATED TO FORMER EMPLOYEES. THE AMOUNTS PAID TO LISTED INDIVIDUALS FOR SEVERANCE IN 2010 WERE: MARGARET J BREEN-$43,317 ---------------------------------------------------------------------- SCHEDULE J, PART I, LINE 4b (PAYMENTS FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN) OTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR REGULATORY 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 2010 WERE: WILLIAM M MURRAY-$113,244 EDWARD L BARKER-$106,552 ROBERT A BOYSEN-$96,080 ROBERT W LADENBURGER-$111,377 JAMES T PAQUETTE-$108,797 LOURDS J LAZATIN-$101,512 IRMA C NAPOLI-$45,489 IN ADDITION, VESTED AMOUNTS ARE PAYABLE UPON END OF EMPLOYMENT. THE AMOUNTS WITHDRAWN FOR THIS TYPE OF PAYMENT IN 2010 WERE: MICHAEL D ROWE-$128,351 RICHARD T LOPES-$152,565 ---------------------------------------------------------------------- SCHEDULE J (ADDITIONAL OFFICER AND BOARD DISCLOSURES) THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS' BOARD OF DIRECTORS (BOARD) IS COMPENSATED FOR THAT SERVICE. SCLHS' BOARD COMPENSATION COMMITTEE (COMMITTEE) HAS RETAINED THE SERVICES OF SULLIVAN, COTTER AND ASSOCIATES, INC. (SULLIVAN COTTER), AS INDEPENDENT COMPENSATION ADVISORS. SULLIVAN COTTER IS RESPONSIBLE FOR ADVISING THE COMMITTEE ON ALL MATTERS RELATING TO EXECUTIVE COMPENSATION INCLUDING SUPPORTING THE COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED OFFICERS 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 BY SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. THE SISTERS WHO SERVE AS OFFICERS AND / OR BOARD MEMBERS OF THIS HEALTH SYSTEM ARE MEMBERS OF THE SISTERS OF CHARITY OF LEAVENWORTH (A RELIGIOUS ORDER OF WOMEN). AS MEMBERS OF THIS ORDER, THEY HAVE TAKEN VOWS OF POVERTY AND RECEIVE NO COMPENSATION, EXPENSE ACCOUNT ALLOWANCE, OR CONTRIBUTIONS TO BENEFIT PLANS FOR THEIR SERVICES TO THE HEALTH SYSTEM. HOWEVER, PAYMENT IS MADE DIRECTLY TO THE SISTERS OF CHARITY OF LEAVENWORTH FOR THE SERVICES OF THOSE WHO PERFORM PROFESSIONAL, ADMINISTRATIVE, AND OTHER SUCH SERVICES. ---------------------------------------------------------------------- MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KBB6 2003-12-05 39210000 2/2/1994 REFINANCE+BLDGS+EQUIPMENT false false false CALIFORNIA HEALTH FACILITIES FINANCING AUTHORITY 521643828 13033FQU7 2003-12-05 49755000 2/2/1994 REFINANCE false false false COLORADO HEALTH FACILITIES AUTHORITY 840752932 196474K58 2003-12-05 103035000 2/2/1994&9/9/1992 REFINANCE+BLDGS+ false false false MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KBC4 2006-03-07 35000000 CONSTRUCT/REMODEL HOSPITAL FACILIT false false false 0 0 39210022 0 0 0 270531 0 0 7630591 0 0 2003 true false true true 0 0 49755055 0 0 0 346200 0 0 55 0 0 2003 true false true true 0 0 103035433 0 0 0 714438 0 0 22369995 0 0 2003 true false true true 0 0 35028997 0 0 0 325299 0 0 34703698 0 0 2006 false false true true false true true false true 0.00000 0.00074 0.00074 true false true true false true 0.00000 0.00000 0.00000 true false true true false true 0.00000 0.02937 0.02937 true false true true false true 0.00055 0.03093 0.03148 true true true true MERRILL LYNCH 20. false false false false false true true true MERRILL LYNCH 20. false false false false false true true true MERRILL LYNCH 20. false false false false false true true true DEUTSCHE BANK 25. false false false false false FORM 990, SCHEDULE K, PART I, COLUMN (C), CUSIP # SCHEDULE K DISCLOSES THE COLORADO HEALTH FACILITIES AUTHORITY BONDS, ISSUED 12/05/2003, WITH AN ISSUE PRICE OF $103,035,000. THIS IS DISCLOSED AS ONE LINE ON SCHEDULE K DUE TO ONLY ONE FORM 8038 BEING ISSUED. THAT SAID, THERE ARE ACTUALLY TWO CUSIP NUMBERS, AS FOLLOWS: PER FORM 8038: CUSIP - 196474 K58 / K41 ACTUAL: CUSIP - 196474 K58 and CUSIP - 196474 K41 FORM 990 GENERAL EXPLANATIONS_1 FORM 990 (DEFINITION) SCLHS = SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. ------------------------------------------------------------------------- FORM 990, PART VI (GOVERNANCE, MANAGEMENT, & DISCLOSURE) SECTION A. GOVERNING BODY AND MANAGEMENT 6., 7(A)., AND 7(B). SCLHS DOES HAVE MEMBERS WHO APPOINT THE BOARD OF DIRECTORS OF SCLHS. THE MEMBERS OF SCLHS ARE THE COMMUNITY DIRECTOR AND THOSE PERSONS WHO ARE MEMBERS OF THE COMMUNITY COUNCIL OF THE SISTERS OF CHARITY OF LEAVENWORTH RELIGIOUS COMMUNITY. SECTION B. POLICIES 11(B). SCLHS' GOVERNING BODY, A BOARD OF DIRECTORS, REVIEWS THE FORM 990 BEFORE IT IS FILED WITH THE IRS. THIS PROCESS INVOLVES EACH BOARD MEMBER RECEIVING A DRAFT OF THE FORM 990 AND THE OPPORTUNITY TO REVIEW AND ASK QUESTIONS BEFORE IT IS FILED, THUS ENSURING THAT THE INFORMATION ACCURATELY REFLECTS SCLHS' MISSION, OPERATIONS, COMMUNITY BENEFITS, GOVERNANCE OVERSIGHT, ETC. FURTHER, AND BEFORE THE FORM 990 IS FILED, IT IS REFLECTED IN THE MINUTES OF THE BOARD OF DIRECTORS THAT THEY HAVE REVIEWED THE DOCUMENTS AND INFORMATION, AND THAT THIS REVIEW WAS IN FACT MEANINGFUL. 12(C). SCLHS 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 AND A REPORT PROVIDED TO SCLHS' PRESIDENT/CEO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. IN THE EVENT OF A CONFLICT OF INTEREST WITH AN SCLHS BOARD MEMBER, THE CONFLICT SHALL PROMPTLY BE REPORTED TO THE SCLHS BOARD CHAIR WHO WILL PRESENT THE FACTS TO THE SCLHS GOVERNANCE COMMITTEE FOR EVALUATION AND PRESENTATION TO THE SCLHS BOARD OF DIRECTORS FOR ITS ACTION. 15(A) & 15(B). SCLHS' PROCESS FOR DETERMINING COMPENSATION FOR THE TOP MANAGEMENT, SENIOR LEADERSHIP, IS THE RESPONSIBILITY OF THE SCLHS COMPENSATION COMMITTEE. THIS COMMITTEE IS COMPOSED OF THREE OR MORE MEMBERS WHO ARE NOT CURRENT EMPLOYEES OF SCLHS, OR FORMER EMPLOYEES WITH NO ACTIVE INTEREST IN THE SCLHS' COMPENSATION PROGRAM, INCLUDING AT LEAST TWO MEMBERS OF THE SCLHS BOARD. SCLHS BELIEVES THAT THE INDEPENDENCE OF THESE MEMBERS IS VITAL TO THE INTEGRITY OF THE PROCESS. THE WORK OF THIS COMMITTEE INCLUDES BEING CONSTANTLY AWARE OF THE CURRENT COMPETITIVE MARKET FOR MANAGEMENT AND SENIOR LEADERS, AS WELL AS COMPILING AND MAINTAINING RECORDS OF COMPARABLE COMPENSATION AND BENEFITS DATA, INCLUDING SURVEYS AND OTHER ANALYSES, TO SUPPORT SCLHS' TOTAL COMPENSATION TO EACH INDIVIDUAL. MINUTES ARE KEPT CONTEMPORANEOUSLY FOR EACH MEETING OF THE COMMITTEE. LIKEWISE, THE COMMITTEE IS RESPONSIBLE FOR ENSURING THAT NO "EXCESS BENEFIT" IS CONFERRED ON AN INDIVIDUAL, OR THAT SUCH COMPENSATION DOES NOT CONSTITUTE PROHIBITED INUREMENT. THIS PROCESS IS COMPLETED FOR ALL SENIOR LEADERSHIP, AT THE AFFILIATE AND SYSTEM LEVEL, AND THE COMMITTEE'S RECOMMENDATION IS THEN SUBMITTED TO THE SCLHS BOARD FOR APPROVAL. THE CHARGE OF THIS COMMITTEE ADHERES TO SCLHS' CORE VALUE OF STEWARDSHIP, ENSURING THAT THE MINISTRY'S RESOURCES HELD IN TRUST ARE NOT WASTED OR MISUSED, AND ARE DEPLOYED TO EFFECTIVELY AND EFFICIENTLY ADVANCE THE MISSION. SECTION C. DISCLOSURE 19. SCLHS' GOVERNANCE MANUAL FOR BOARD MEMBERS IS AVAILABLE TO THE PUBLIC ON THE WEBSITE, WWW.GREATBOARDS.ORG. THE MANUAL SETS FORTH THE STANDARDS AND EXPECTATIONS OF EACH BOARD MEMBER INCLUDING THE FIDUCIARY DUTY OF LOYALTY WHICH REQUIRES THAT EACH MEMBER ABIDE BY SCLHS' CONFLICT OF INTEREST POLICY, DISCLOSE ANY ISSUES WHICH MAY PRESENT A CONFLICT, COMPLETE THE ANNUAL DISCLOSURE STATEMENT, REVIEW POLICIES AND PROCEDURES PERTAINING TO CONFLICTS OF INTEREST, AND PROVIDE OVERSIGHT OF SCLHS' RESPONSIBILITY PROGRAM. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ------------------------------------------------------------------------- FORM 990, PART XI (RECONCILIATION OF NET ASSETS) LINE 5: OTHER CHANGES IN NET ASSETS: UNREALIZED GAIN ON INVESTMENTS $26,753,038 UNREALIZED LOSS ON SWAPS (2,421,851) FROZEN DEFINED BENEFIT RETIREMENT PLAN GAIN 5,873,419 EQUITY TRANSFERS FROM RELATED 5,621,780 FAS 158 LOSS ON DEFINED BENEFIT PLANS (9,176,059) SELF-INSURED LIABILITY REDUCTION (1,651,332) RESTRICTED NET ASSET ACTIVITY (139,431) ----------- TOTAL $24,859,564 =========== ------------------------------------------------------------------------- FORM 990, PART XII, LINE 2 (FINANCIAL STATEMENTS & REPORTING) SCLHS HAS AN INDEPENDENT AUDIT COMPLETED AND REPORTED UPON ANNUALLY ON ITS CONSOLIDATED ORGANIZATION. THERE IS NO SEPARATE AUDIT REPORT FOR SCLHS. IN ADDITION, SCLHS' BOARD HAS AN AUDIT COMMITTEE WHICH HAS OVERSIGHT OF THE EXTERNAL AUDIT PROCESS AND RESULTS AS WELL AS SELECTION OF THE INDEPENDENT AUDITORS. CURRENT INDEPENDENT AUDITORS ARE ERNST & YOUNG, LLP. ------------------------------------------------------------------------- FORM 990 GENERAL EXPLANATIONS_2 FORM 926, STATEMENT PURSUANT TO TREASURY REG. SEC. 1.6038B-1(C): APPLICABLE TO ALL IRS FORMS 926 FILED WITH THIS RETURN. 1. TRANSFEROR NAME: SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND U.S. TAXPAYER IDENTIFICATION NUMBER: 23-7379161. 2. TRANSFEREE: A. NAME: VARIOUS, SEE IRS FORMS 926, PART II, LINE 3; TAXPAYER IDENTIFICATION NUMBER: VARIOUS, SEE IRS FORMS 926, PART II, LINE 4; ADDRESS: VARIOUS, SEE IRS FORMS 926, PART II, LINE 5; COUNTRY OF INCORPORATION: VARIOUS, SEE IRS FORMS 926, PART II, LINE 6. B. GENERAL DESCRIPTION OF THE TRANSFER: VARIOUS, GENERALLY CASH, SEE IRS FORMS 926, PART III. 3. CONSIDERATION RECEIVED: SEE AMOUNT ON IRS FORMS 926, PART III. 4. PROPERTY TRANSFERRED, INCLUDING THE ESTIMATED FAIR MARKET VALUE AND ADJUSTED BASIS OF THE PROPERTY: A. ACTIVE BUSINESS PROPERTY: SEE AMOUNT ON IRS FORMS 926, PART III. B. STOCK OR SECURITIES: SEE AMOUNT ON IRS FORMS 926, PART III. I. ACTIVE TRADE OR BUSINESS STOCK. II. APPLICATION OF SPECIAL RULES. C. DEPRECIATED PROPERTY: SEE AMOUNT ON IRS FORMS 926, PART III. D. PROPERTY TO BE LEASED: N/A E. PROPERTY TO BE SOLD: N/A F. TRANSFERS TO FSCS: N/A G. TAINTED PROPERTY: N/A I. INVENTORY, ETC.: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(B); II. INSTALLMENT OBLIGATIONS, ETC.: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(C); III. FOREIGN CURRENCY, ETC: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(D); IV. INTANGIBLE PROPERTY: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(E); V. LEASED PROPERTY: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(F). H. FOREIGN LOSS BRANCH: N/A I. OTHER INTANGIBLES: SEE AMOUNT ON IRS FORMS 926, PART III. 5. TRANSFER OF FOREIGN BRANCH WITH PREVIOUSLY DEDUCTED LOSSES: N/A A. BRANCH OPERATION. B. BRANCH PROPERTY. C. PREVIOUSLY DEDUCTED LOSSES. D. CHARACTER OF GAIN IN ACCORDANCE WITH SEC. 1.367(A)-6T(C)(1). N/A ------------------------------------------------------------------------- FORM 926, STATEMENT PURSUANT TO TREASURY REGS. SEC. 1.351-3T(A) AND SEC. 1.351-3T(B): APPLICABLE TO ALL IRS FORMS 926 WHERE SCLHS IS A SIGNIFICANT TRANSFEROR. BY: SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. EIN: 23-7379161 YEAR ENDED DECEMBER 31, 2010. 1. NAME AND EIN (IF ANY) OF TRANSFEREE CORPORATION(S): SEE FORMS 926, PART II, LINES 3 AND 4. 2. DATE(S) OF THE TRANSFER(S) OF ASSETS: VARIOUS DATES. SEE FORMS 926, PART III. 3. IMMEDIATELY BEFORE THE EXCHANGE, THE PROPERTY TRANSFERRED BY THE TRANSFEROR IN EXCHANGE HAD AN: (A) AGGREGATE FAIR MARKET VALUE OF: SEE FORMS 926, PART III WHERE CASH VALUE EXCHANGED WAS REPORTED. (B) AGGREGATE BASIS OF: SINCE CASH WAS EXCHANGED, BASIS IS EQUAL TO FAIR MARKET VALUE ABOVE. 4. DATE AND CONTROL NUMBER OF ANY PRIVATE LETTER RULING(S) ISSUED BY THE INTERNAL REVENUE SERVICE IN CONNECTION WITH THE SECTION 351 EXCHANGE: NOT APPLICABLE. ------------------------------------------------------------------------- FORM 5471, STATEMENT PURSUANT TO TREASURY REG. SEC. 1.351-3T(B): APPLICABLE TO ALL IRS FORMS 5471 FILED WITH THIS RETURN. BY: VARIOUS, SEE ALL FORMS 5471 FILED WITH THIS RETURN. EIN: VARIOUS, SEE ALL FORMS 5471 FILED WITH THIS RETURN. YEAR ENDED DECEMBER 31, 2010. 1. NAME AND EIN (IF ANY) OF TRANSFEREE CORPORATION(S): SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC.; 23-7379161. 2. DATE(S) OF THE TRANSFER(S) OF ASSETS: VARIOUS DATES. SEE FORMS 5471. 3. IMMEDIATELY BEFORE THE EXCHANGE, THE PROPERTY TRANSFERRED BY THE TRANSFEROR IN EXCHANGE HAD AN: (A) AGGREGATE FAIR MARKET VALUE OF: SEE FORMS 5471 WHERE CASH VALUE EXCHANGED WAS REPORTED. (B) AGGREGATE BASIS OF: SINCE CASH WAS EXCHANGED, BASIS IS EQUAL TO FAIR MARKET VALUE ABOVE. 4. DATE AND CONTROL NUMBER OF ANY PRIVATE LETTER RULING(S) ISSUED BY THE INTERNAL REVENUE SERVICE IN CONNECTION WITH THE SECTION 351 EXCHANGE: NOT APPLICABLE. ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3): SCLHS, A SHAREHOLDER OF THE RIVERVIEW MULTI-SERIES FUND SPC, LTD., IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM RIVERVIEW MULTI-SERIES FUND SPC, LTD. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3). ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II): SCLHS, A SHAREHOLDER OF THE JP MORGAN HEDGE FUND SPC, LTD -ACCESS MAR09 SEGREGATED PORTFOLIO, IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM JP MORGAN HEDGE FUND SPC, LTD -ACCESS MAR09 SEGREGATED PORTFOLIO. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; SCHEDULE E: THE INCOME, WAR PROFITS, AND EXCESS PROFITS TAXES PAID OR ACCRUED BY THE CORPORATION; SCHEDULE G: THE OTHER INFORMATION REGARDING THE CORPORATION. NOTE ALL BOXES ARE MARKED NO BY DEFAULT OF SCLHS' TAX SOFTWARE. ANSWERS MAY NOT BE ACCURATE; SCHEDULE H: THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION; SCHEDULE I: THE SUMMARY OF SHAREHOLDER'S INCOME FROM FOREIGN CORPORATION. SCHEDULE J: THE INFORMATION REGARDING THE ACCUMULATED EARNINGS AND PROFITS (E&P) OF THE CORPORATION; SCHEDULE M: THE INFORMATION REGARDING TRANSACTIONS BETWEEN CONTROLLED FOREIGN CORPORATIONS AND SHAREHOLDERS OR OTHER RELATED PARTIES; AND SCHEDULE O, PART II, SECTIONS B, E AND F: SOCIAL SECURITY NUMBERS OF U.S. DIRECTORS OF THE CORPORATION, INFORMATION REGARDING THE ORGANIZATION OR REORGANIZATION OF THE FOREIGN CORPORATION, AND THE ADDITIONAL INFORMATION. THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II). ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II): SCLHS, A SHAREHOLDER OF THE JP MORGAN HEDGE FUND SPC, LTD -ACCESS JUN09 SEGREGATED PORTFOLIO, IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM JP MORGAN HEDGE FUND SPC, LTD -ACCESS JUN09 SEGREGATED PORTFOLIO. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; SCHEDULE E: THE INCOME, WAR PROFITS, AND EXCESS PROFITS TAXES PAID OR ACCRUED BY THE CORPORATION; SCHEDULE G: THE OTHER INFORMATION REGARDING THE CORPORATION. NOTE ALL BOXES ARE MARKED NO BY DEFAULT OF SCLHS' TAX SOFTWARE. ANSWERS MAY NOT BE ACCURATE; SCHEDULE H: THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION; SCHEDULE I: THE SUMMARY OF SHAREHOLDER'S INCOME FROM FOREIGN CORPORATION. SCHEDULE J: THE INFORMATION REGARDING THE ACCUMULATED EARNINGS AND PROFITS (E&P) OF THE CORPORATION; SCHEDULE M: THE INFORMATION REGARDING TRANSACTIONS BETWEEN CONTROLLED FOREIGN CORPORATIONS AND SHAREHOLDERS OR OTHER RELATED PARTIES; AND SCHEDULE O, PART II, SECTIONS B, E AND F: SOCIAL SECURITY NUMBERS OF U.S. DIRECTORS OF THE CORPORATION, INFORMATION REGARDING THE ORGANIZATION OR REORGANIZATION OF THE FOREIGN CORPORATION, AND THE ADDITIONAL INFORMATION. THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II). ------------------------------------------------------------------------- HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT W LADENBURGER TITLE:CEO EXEMPLA INC DENVER CO HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES T PAQUETTE TITLE:CEO ST VINCENT BILLINGS MT HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LOURDES J LAZATIN TITLE:CEO SAINT JOHN'S SANTA MONICA HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BAIN J FARRIS TITLE:CEO SAINT JOSEPH DENVER CO HOURS:40 CARITAS CLINICS INC 818 NORTH 7TH STREET LEAVENWORTH KS 66048 481009910 CLINIC SVCS KS 501(C)(3) 3 NA MARIAN CLINIC INC 1001 SW GARFIELD TOPEKA KS 66604 481046905 CLINIC SVCS KS 501(C)(3) 3 NA MARILLAC CLINIC INC 2333 N 6TH STREET GRAND JUNCTION CO 81501 841085822 CLINIC SVCS CO 501(C)(3) 3 NA PROVIDENCE MEDICAL CENTER 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 480784446 HEALTHCARE KS 501(C)(3) 3 NA ST JOHN HOSPITAL INC 3500 SOUTH FOURTH STREET LEAVENWORTH KS 66048 480543768 HEALTHCARE KS 501(C)(3) 3 NA BETHANY COMMUNITY PLAZA INC 15 NORTH 12TH STREET KANSAS CITY KS 66102 481207407 HEALTHCARE KS 501(C)(3) 3 NA PROVIDENCEST JOHN FOUNDATION INC 8929 PARALLEL PARKWAY KANSAS CITY KS 661121689 480925688 SUPPORT 501C3 KS 501(C)(3) 7 NA ST FRANCIS HEALTH CENTER INC 1700 SW 7TH STREET TOPEKA KS 66606 480547719 HEALTHCARE KS 501(C)(3) 3 NA ST FRANCIS HEALTH CENTER FOUNDATION 1700 SW 7TH STREET TOPEKA KS 66606 481092520 SUPPORT 501C3 KS 501(C)(3) 11A-TYPE I NA ST MARYS HOSPITAL & MEDICAL CENTER INC 2635 N 7TH STREET GRAND JUNCTION CO 81502 840425720 HEALTHCARE CO 501(C)(3) 3 NA ST MARYS HOSPITAL FOUNDATION 2635 N 7TH STREET GRAND JUNCTION CO 81502 237001007 SUPPORT 501C3 CO 501(C)(3) 11A-TYPE I NA SAINT JOSEPH HOSPITAL FOUNDATION 1835 FRANKLIN STREET DENVER CO 80218 840735096 SUPPORT 501C3 CO 501(C)(3) 11A-TYPE I NA HOLY ROSARY HEALTHCARE 2600 WILSON MILES CITY MT 59301 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