2011-11-15T13:00:13-06:00 2010-12-31 990 2010-01-01 431735565 SAINT LUKE'S HOSPITAL OF CHILLICOTHE SAIN 6606461480 100 CENTRAL STREET CHILLICOTHE MO 64601 MATT WENZEL 6606461480 2011-11-15 2010 2016-03-07 17:11:31Z HEDRICK MEDICAL CENTER MATT WENZEL 100 CENTRAL STREET CHILLICOTHE MO 64601 35924468 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1888 MO CRITICAL ACCESS HOSPITAL 12 7 347 54 0 0 210746 127447 33656155 35517977 365658 279044 0 0 34232559 35924468 21290 18896 0 0 15942966 17088667 0 0 0 15912319 17984548 31876575 35092111 2355984 832357 23606278 24338682 3895367 3938870 19710911 20399812 X SAINT LUKE'S HOSPITAL OF CHILLICOTHE IS COMMITTED TO PROVIDING THE HIGHEST LEVEL OF EXCELLENCE IN HEALTH CARE AND HEALTH RELATED SERVICES. 0 0 30483755 18896 35517977 SAINT LUKE'S HOSPITAL OF CHILLICOTHE D/B/A HEDRICK MEDICAL CENTER ("HMC") IS A LICENSED CRITICAL ACCESS HOSPITAL PROVIDING BOTH INPATIENT AND OUTPATIENT SERVICES. HMC IS LOCATED IN CHILLICOTHE (LIVINGSTON COUNTY), MISSOURI, APPROXIMATELY 90 MILES NORTHEAST OF KANSAS CITY. HEDRICK MEDICAL CENTER IS A FAITH-BASED, NOT-FOR-PROFIT COMMUNITY HOSPITAL COMMITTED TO THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE AND HEALTH RELATED SERVICES IN A CARING ENVIRONMENT. AS A MEMBER OF SAINT LUKE'S HEALTH SYSTEM, HMC IS DEDICATED TO ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF THE COMMUNITIES SERVED. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS CHARITY CARE POLICIES FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. IN ADDITION TO THE ACTIVE MEDICAL STAFF, HMC'S SPECIALTY CLINICS HOST MORE THAN 30 VISITING SPECIALISTS.THE HOSPITAL ALSO PROVIDES HEALTH RELATED ACTIVITIES AND SERVICES IN SUPPORT OF THE COMMUNITY, INCLUDING BUT NOT LIMITED TO SOCIAL WORK SERVICES, SPIRITUAL SERVICES, AND COMMUNITY EDUCATION / HEALTH FAIRS. 30483755 1 1 0 1 0 0 0 0 0 1 0 0 0 1 0 1 1 0 0 0 0 0 0 0 0 1 0 1 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 1 38 0 1 347 1 0 0 0 0 0 0 0 0 0 0 X 12 7 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X THE ORGANIZATION 6606461480 100 CENTRAL STREET CHILLICOTHE MO 64601 X MICHAEL PALMER 1.00 X X 0 0 0 DON SIPES 1.00 X X 0 256614 52488 JOHN COOK 1.00 X X 0 0 0 GREGORY W SENSENICH 1.00 X 0 12600 0 DONALD METRY 1.00 X 0 22215 0 JANICE GODDARD 1.00 X 0 0 0 DARREL RINEHART 1.00 X 0 0 0 ROLLIE STADLMAN 1.00 X X 0 0 0 JULIE MURPHY 1.00 X X 0 165937 26589 DELOS CLOW 40.00 X 286765 0 34185 JANE NEAL 1.00 X 0 0 0 CHRISTOPHER E HULETT 1.00 X 0 0 0 TERRY PLASTER 40.00 X 50969 0 12212 DANA ISHMAEL 40.00 X 5148 0 462 BRIAN JOHNSTON 40.00 X 97854 0 18590 JULIE JONES 40.00 X 106554 0 30118 MATT WENZEL 40.00 X 100293 0 24268 JANET BUCKMAN 40.00 X 73349 0 2800 JAMES JOHNSON 40.00 X 79330 0 2380 NARAYANAN MANGALAT 40.00 X 230623 0 26695 WILLIAM BRADE 40.00 X 212899 0 30199 DARIN WARD 40.00 X 211938 0 33208 GREGORY MILLER 40.00 X 285310 0 24478 BRUCE KINNEY 40.00 X 271483 0 27042 DIXIE ALEXANDER 40.00 X 0 0 0 2012515 457366 345714 28 0 1 0 ACUTE CARE INC PO BOX 515 ANKENY IA 50021 ER PHYSICIANS 1433974 CPSI PO BOX 850309 6600 WALL ST MOBILE AL 366850309 SOFTWARE SYSTEM SETUP AND SERVICE 757993 NURSEFINDERS PO BOX 910738 DALLAS TX 75391 TEMP HELP 508384 SHARED MEDICAL SERVICES PO BOX 330 COTTAGE GROVE WI 53527 READS MRI SCANS 265689 MURPHY WATSON BURR 5202 FARAON ST JOSEPH MO 64506 EYE SURGERIES 137500 5 50709 76738 127447 NET PATIENT REVENUE 622110 34623642 34623642 PHYSICIAN SERVICES 622110 421720 421720 PATIENT REHAB SERVICES 622210 193741 193741 278874 278874 35517977 279044 279044 35924468 35517977 0 279044 18896 18896 925276 320950 604326 13001669 12076390 925279 311745 277506 34239 1950883 1736616 214267 899094 800346 98748 38986 38986 52306 52306 5379951 4812891 567060 21579 2562 19017 4225716 4063496 162220 236265 149649 86616 1814575 1723483 91092 156077 87636 68441 81954 48845 33109 792703 774117 18586 511979 339545 172434 BAD DEBTS 2555321 2555321 SHARED SERVICES-SLHS 2000004 646917 1353087 DUES & SUBSCRIPTIONS 75250 36996 38254 MISCELLANEOUS 41882 11593 30289 35092111 30483755 4608356 0 5311464 10141049 9145239 1076122 5242229 7987194 9909 3364 457652 563702 368836 347084 7969703 4347444 2698220 3622259 359914 329902 12815 268006 23606278 24338682 2294726 2815509 1600641 1123361 3895367 3938870 X 19710911 20399812 19710911 20399812 23606278 24338682 X 832357 -143456 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4898 0 0 1 10000 14898 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LINE F - PORTION OF DUES PAID TO VARIOUS HOSPITAL AND MEDICAL ASSOCIATIONS USED TOWARD LOBBYING ACTIVITIES. LINE I - CONTRIBUTION TO "SAVE OUR HOSPITAL COMMITTEE" FOR THE PURPOSE OF SUPPORTING A SALES TAX MEASURE FOR USE IN THE CONSTRUCTION OF A REPLACEMENT HOSPITAL. 1469441 862431 607010 5177627 2763187 2414440 1322635 721826 600809 3622259 PAYABLES TO AFFILIATES 269459 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 853902 1123361 35924468 35092111 832357 -143456 -143456 688901 35767554 0 35767554 156914 156914 35924468 35090586 0 35090586 1525 1525 35092111 PART XI, LINE 8 - OTHER ADJUSTMENTS: RISK RETENTION GROUP SUBSCRIBER SAVINGS ACCOUNT DIVIDEND -101,709. PENSION LIABILITY TRANSFER TO SLHS 11,933. RESTRICTED CONTRIBUTIONS RECORDED IN OTHER CHANGES IN FUND BALANCE -53,681. ROUNDING 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: RISK RETENTION GROUP SUBSCRIBER SAVINGS ACCOUNT DIVIDEND 101,709. RESTRICTED CONTRIBUTIONS RECORDED IN OTHER CHANGES IN FUND BALANCE 53,681. EXPENSES INCLUDED IN OTHER INCOME 1,525. ROUNDING -1. PART XIII, LINE 4B - OTHER ADJUSTMENTS: EXPENSES RECORDED IN OTHER INCOME 1,525. 1 1 X 1 X 133.000000000000 1 X 1 1 1 0 0 2855555 1624383 1231172 0.03780 4259193 3439269 819924 0.02520 7114748 5063652 2051096 0.06300 32920 270 32650 0.00100 216569 500 216069 0.00660 249489 770 248719 0.00760 7364237 5064422 2299815 0.07060 5261 5261 0.00020 5261 5261 0.00020 0 1231665 13794797 13704511 90286 X 1 1 1 1 HEDRICK MEDICAL CENTER

100 CENTRAL ST CHILLICOTHE MO 64601

X X X X NOT REQUIRED 1 1 HEDRICK FAMILY CARE

861 FAIRWAY DRIVE CHILLICOTHE MO 64601

RURAL HEALTH CLINIC PART I, LINE 7: COST OF CHARITY CARE AND UNREIMBURSED HEALTH SERVICES WERE CALCULATED USING THE APPROPRIATE COST TO CHARGE RATIO FROM THE HOSPITAL'S COST REPORT. PART I, L7 COL(F): LINE 7, COLUMN (F): OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) WAS $35,092,111. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $2,555,321. THIS LEFT US WITH A TOTAL EXPENSE OF $32,536,790 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART II: THE ORGANIZATION IS INVOLVED IN SEVERAL COMMUNITY ORGANIZATIONS THAT ARE DEDICATED TO THE IMPROVEMENT OF LIFE IN THE COMMUNITY THROUGH PHYSICAL IMPROVEMENTS AND HOUSING. THE ORGANIZATION HELPS SUPPORT HABITAT FOR HUMANITY THROUGH DONATIONS OF TIME BY EMPLOYEES AND MONETARY NEEDS. MANY OF OUR EMPLOYEES PARTICIPATE IN LOCAL ORGANIZATIONS AND CHURCH GROUPS THAT ARE WORKING TO HELP THE COMMUNITY GROW AND BE BETTER. PART III, LINE 4: BAD DEBT EXPENSE IS REPORTED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT IT ALIGNS WITH GAAP.FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: THE MEDICAL CENTER PROVIDES FOR ACCOUNTS RECEIVABLE THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE BY ESTABLISHING AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THE MEDICAL CENTER ESTIMATES THIS ALLOWANCE BASED ON THE AGING OF ITS ACCOUNTS RECEIVABLE AND ITS HISTORICAL COLLECTION EXPERIENCE FOR EACH TYPE OF PAYOR.COSTING METHODOLOGY: THE RATIO OF PATIENT CARE COST TO CHARGES (FROM MEDICARE COST REPORT) IS APPLIED TO THE BAD DEBT EXPENSE FROM OUR FINANCIAL STATEMENTS TO CALCULATE COST OF BAD DEBT ON LINE 2. DISCOUNTS AND ALLOWANCES ARE ACCOUNTED FOR SEPARATELY FROM BAD DEBT EXPENSE. PART III, LINE 9B: IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE ACCOUNT IS ADJUSTED ACCORDINGLY. ANY REMAINING BALANCE WOULD BE COLLECTED UNDER THE DEBT COLLECTION POLICY. OUR COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. ALTHOUGH WE ARE NOT LEGALLY BOUND BY THE FAIR DEBT COLLECTION PRACTICES ACT, THE PRINCIPLES ADDRESSED ARE GENERALLY FOLLOWED. PART VI, LINE 2: THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, ANNUAL STRATEGIC PLANNING PROCESS. WE INVITE COMMUNITY FEEDBACK. WE ALSO SEND PATIENT SATISFACTION SURVEYS TO OUR PATIENTS TO MEASURE HOW WE ARE MEETING THEIR NEEDS. PART VI, LINE 3: THE HOSPITAL FOLLOWS THE SAINT LUKE'S HEALTH SYSTEM POLICIES FOR THE UNINSURED. IN ADDITION TO THESE POLICIES, THE HOSPITAL PROVIDES EDUCATION ON FINANCIAL ASSISTANCE ELIGIBILITY TO PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES THROUGH MANY SOURCES INCLUDING THE SLHS WEB SITE, INFORMATION ON BILLING STATEMENTS PERTAINING TO POSSIBLE NEED IN PAYING THEIR BILL, INFORMATION UPON CHECK IN LOCATED IN THE ADMITTING PATIENT PACKETS, ON OUR B-131 RELEASE TO TREAT FORMS SIGNED BY ALL PATIENTS REQUESTING SERVICES, AND VISITS BY SOCIAL WORKER TEAMS WHEN AN IN-PATIENT AS WELL AS FOLLOW UP CALLS TO PATIENTS AFTER DISCHARGE. FINANCIAL ASSISTANCE APPLICATIONS OR MEDICAID APPLICATIONS ARE REQUESTED ON ALL UNINSURED INPATIENTS PRIOR TO DISCHARGE. THE HOSPITAL ALSO CONTRACTS WITH HUMAN ARC, AN ELIGIBILITY ENROLLMENT SERVICE COMPANY THAT SCREENS ALL UNINSURED PATIENTS WITH A BALANCE OVER $2,000, ANY PATIENT IDENTIFIED BY A SOCIAL WORKER AS WELL AS ON ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR POSSIBLE MEDICAID OR OTHER GOVERNMENT COVERAGE. PART VI, LINE 4: HEDRICK MEDICAL CENTER IS LOCATED IN CHILLICOTHE, MISSOURI. THE HOSPITAL IS WITHIN AN 80 MILE DRIVE OF THE KANSAS CITY METROPOLITAN AREA. THE CITY OF CHILLICOTHE POPULATION IS 8,968, WHILE LIVINGSTON COUNTY ( THE COUNTY THE HOSPITAL IS LOCATED) IS POPULATION 14,558. THE MEDIAN AGE IS 39.7 AND MEDIAN HOSEHOLD INCOME IS $32,793. PERSONS 65 YEARS OLD AND OVER MAKE UP 19% OF THE POPULATION WITH 23% OF THE POPULATION UNDER 18 YEARS OF AGE. PART VI, LINE 7: THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSISTS OF 11 AREA HOSPITALS AND SEVERAL PRIMARY AND SPECIALTY CARE PRACTICES, AND PROVIDES A RANGE OF INPATIENT, OUTPATIENT, AND HOME CARE SERVICES. FOUNDED AS A FAITH-BASED, NOT-FOR-PROFIT ORGANIZATION, OUR MISSION INCLUDES A COMMITMENT TO THE HIGHEST LEVELS OF EXCELLENCE IN HEALTH CARE AND THE ADVANCEMENT OF MEDICAL RESEARCH AND EDUCATION. THE HEALTH SYSTEM IS AN ALIGNED ORGANIZATION IN WHICH THE PHYSICIANS AND HOSPITALS ASSUME RESPONSIBILITY FOR ENHANCING THE PHYSICAL, MENTAL, AND SPIRITUAL HEALTH OF PEOPLE IN THE METROPOLITAN KANSAS CITY AREA AND THE SURROUNDING REGION. 1 YMCA 1725 LOCUST STREET CHILLICOTHE MO 64601 431493664 501(C)(3) 12500 DONATION FOR THE YMCA BUILDING FUND AND OTHER CONTRIBUTIONS. 1 0 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE PROVIDED TO QUALIFIED 501(C)(3) CHARITIES. ALL DONEE INFORMATION IS KEPT AS PART OF THE ORGANIZATION'S BOOKS AND RECORDS. 0 0 0 0 0 0 0 1 0 DON SIPES 0 221426 0 50 0 35138 0 32699 0 19789 0 309102 0 18033 JULIE MURPHY 0 152200 0 50 0 13687 0 22375 0 4214 0 192526 0 10353 DELOS CLOW 238264 0 40550 0 7951 0 9800 0 24385 0 320950 0 0 0 NARAYANAN MANGALAT 208927 0 17550 0 4146 0 9250 0 17445 0 257318 0 0 0 WILLIAM BRADE 164919 0 47327 0 653 0 6676 0 23523 0 243098 0 0 0 DARIN WARD 163954 0 47327 0 657 0 8685 0 24523 0 245146 0 0 0 GREGORY MILLER 154302 0 116407 0 14601 0 2450 0 22028 0 309788 0 0 0 BRUCE KINNEY 239011 0 50 0 32422 0 2450 0 24592 0 298525 0 0 0 PART I, LINE 7 EMPLOYED PHYSICIANS ARE ELIGIBLE FOR BONUSES BASED ON PRODUCTIVITY AND OTHER PERFORMANCE MEASURES. SUPPLEMENTAL INFORMATION PART III PART II: DON SIPES AND JULIE MURPHY DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. COMPENSATION PAID TO BOARD MEMBERS IS FOR SERVICES AS EMPLOYEES OF THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED. DELOS CLOW RECRUITMENT LOAN TO PAY TAIL COVERAGE X 28826 3364 0 0 1 3364 SHERRY STIRLING FAMILY MEMBER OF TERRY PLASTER, ASSISTANT SECRETARY 17850 SHERRY STIRLING IS EMPLOYED BY SAINT LUKE'S HOSPITAL OF CHILLICOTHE 0 FORM 990, PART VI, SECTION A, LINE 3 AS PART OF AN INTEGRATED HEALTH SYSTEM, THE ORGANIZATION ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS SAINT LUKE'S HEALTH SYSTEM, A 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY IS ELECTED BY THE SOLE CORPORATE MEMBER. FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS SPECIFIED RESERVE POWERS OVER MAJOR DECISIONS SUCH AS AMENDMENTS TO ARTICLES AND BYLAWS, DEBT, BUDGETS, CAPITAL EXPENDITURES AND STRATEGIC OPERATING DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED JOINTLY BY ACCOUNTING STAFF OF THE ENTITY AND SAINT LUKE'S HEALTH SYSTEM (SYSTEM) TAX STAFF. THE RETURN IS REVIEWED BY THE ENTITY'S CFO OR CEO BEFORE FILING. THE 990 DRAFT WAS ALSO PRESENTED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. THE 990 WAS MADE AVAILABLE TO THE ORGANIZATION'S BOARD MEMBERS FOR VIEWING BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C SAINT LUKE'S HEALTH SYSTEM AND ITS AFFILIATES, INCLUDING THE FILING ORGANIZATION, HAVE COMPREHENSIVE WRITTEN CONFLICT OF INTEREST POLICIES APPLICABLE TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES. ANY ACTUAL, POSSIBLE OR PERCEIVED CONFLICT OF INTEREST IS EXPECTED TO BE HANDLED THROUGH FULL AND TIMELY DISCLOSURE OF ANY SUCH INTEREST, TOGETHER WITH ABSENCE OF PERSUASION IN ANY DISCUSSION AND IN ANY VOTE WHEREIN THE INTEREST IS INVOLVED. DISCLOSURE IS TO BE MADE WHEN THE INTEREST ARISES, AT ANY TIME THE INTEREST BECOMES A MATTER OF GOVERNING BOARD ACTION, AND THEN ANNUALLY THROUGH COMPLETION OF A CONFLICT OF INTEREST QUESTIONNAIRE. THE SYSTEM COMPLIANCE OFFICER OR THE SYSTEM VICE PRESIDENT OF HUMAN RESOURCES REVIEWS COMPLETED QUESTIONNAIRES AND FURTHER INVESTIGATES POSSIBLE CONFLICTS OF INTEREST. A REPORT IS PROVIDED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS AND ANY IDENTIFIED CONFLICT OF INTEREST IS REPORTED TO THE APPLICABLE ENTITY. FORM 990, PART VI, SECTION B, LINE 15A ANNUALLY, THE SAINT LUKE'S HEALTH SYSTEM BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS, DISCUSSES, SETS AND APPROVES COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT EXECUTIVE. INDEPENDENT, EXTERNAL DIRECTORS SERVE ON THE COMPENSATION COMMITTEE. AN INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY PROVIDES A WRITTEN REPORT AND REASONABLENESS OPINION. THE CONSULTANT REVIEWS THE SYSTEM'S EXECUTIVE TOTAL COMPENSATION PHILOSOPHY AND ANALYZES MARKET COMPETITIVENESS (IN TOTAL AND BY EACH COMPENSATION ELEMENT) FOR THE EXECUTIVES USING APPROPRIATE COMPARABILITY DATA. COMPENSATION COMMITTEE ACTIONS ARE CONTEMPORANEOUSLY DOCUMENTED. THE PROCESS SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE. COMPENSATION FOR OFFICERS NOT REVIEWED BY THE COMPENSATION COMMITTEE IS SET/APPROVED ANNUALLY BY SAINT LUKE'S HEALTH SYSTEM EXECUTIVE MANAGEMENT BASED ON MARKET COMPENSATION SURVEYS AND COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. FORM 990, PART VII DON SIPES AND JULIE MURPHY DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. THESE INDIVIDUALS WORKED 40 HOURS OR MORE PER WEEK FOR ALL RELATED ORGANIZATIONS. COMPENSATION PAID TO BOARD MEMBERS IS FOR SERVICES AS EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: RISK RETENTION GROUP SUBSCRIBER SAVINGS ACCOUNT DIVIDEND -101,709. PENSION LIABILITY TRANSFER TO SLHS 11,933. RESTRICTED CONTRIBUTIONS RECORDED IN OTHER CHANGES IN FUND BALANCE -53,681. ROUNDING 1. TOTAL TO FORM 990, PART XI, LINE 5: -143,456. NUMBER REPORTED IN BOX 3 OF FORM 1096 PART V, LINE 1A HEDRICK MEDICAL CENTER (HMC) IS PART OF SAINT LUKE'S HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM. THE MAJORITY OF HMC VENDORS ARE PAID THROUGH A CENTRALIZED PAYMENT SYSTEM WITH 1099S ISSUED BY THE CENTRALIZED SERVICE ENTITY. ST LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 HEALTH CARE MO 501(C)(3) 170B1AIII 0 SAINT LUKE'S HEALTH SYSTEM 10920 ELM AVENUE KANSAS CITY MO 64134 431747502 HEALTH SYSTEM KS 501(C)(3) 509(A)(3) - TYPE 1 ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKE'S NORTHLAND HOSPITAL CORPORATION 601 S 169 HWY SMITHVILLE MO 64089 440545393 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S SOUTH HOSPITAL INC 12300 METCALF AVE OVERLAND PARK KS 66213 481203262 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S EAST HOSPITAL 100 NE SAINT LUKES BLVD LEES SUMMIT MO 64086 562488077 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S MEDICAL GROUP 6750 ANTIOCH STE 210 SHAWNEE MISSION KS 66204 431598353 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 CRITTENTON 10918 ELM AVENUE KANSAS CITY MO 64134 440545808 HEALTH CARE MO 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKE'S HEALTH SYSTEM HOME CARE AND HOSPICE 3100 BROADWAY STE 1000 KANSAS CITY MO 64111 431127200 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S HOSPITAL OF TRENTON 191 IOWA BLVD TRENTON MO 64683 431707306 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S HOSPITAL OF GARNETT 421 SOUTH MAPLE GARNETT KS 66032 742849611 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 CABOT WESTSIDE HEALTH CENTER 2121 SUMMIT KANSAS CITY MO 64108 440546280 HEALTH CARE MO 501(C)(3) 170B1AVI SAINT LUKE'S HEALTH SYSTEM 0 MIDWEST EAR INSTITUTE INC 4200 PENNSYLVANIA STE 100 KANSAS CITY MO 64111 480905027 HEALTH CARE KS 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 0 CUSHING MEMORIAL HOSPITAL CORPORATION 711 MARSHALL LEAVENWORTH KS 66048 480543792 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S CANCER INSTITUTE LLC 4323 WORNALL ROAD PEET KANSAS CITY MO 64111 431933950 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S CARE 10920 ELM AVENUE KANSAS CITY MO 64134 260185090 HEALTH CARE MO 501(C)(3) 509(A)(3) - TYPE 1 SAINT LUKE'S HEALTH SYSTEM 0 MEDICAL PLAZA IMAGING ASSOCIATES LLC 4401 WORNALL ROAD KANSAS CITY MO 64111 431609584 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S COLLEGE OF HEALTH SCIENCES 8320 WARD PARKWAY SUITE 300 KANSAS CITY MO 64114 272716128 POST-SECONDARY NURSING EDUCATION MO 501(C)(3) 170B1AII ST LUKES HOSPITAL OF KANSAS CITY 0 SLCC INC 4330 WORNALL RD SUITE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS APPLYING FOR 501(C)( APPLYING FOR 170B1AI SAINT LUKE'S HEALTH SYSTEM 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL RD STE 410 KANSAS CITY MO 64111 431357824 OWN & OPERATE MEDICAL OFFICE BUILDING MO N/A MEDICAL PARK ASSOCIATES A LP 601 S 169 HWY SMITHVILLE MO 64089 431311049 OWN & OPERATE MEDICAL OFFICE BUILDING MO N/A SAINT LUKE'S SURGICENTER - LEE'S SUMMIT LLC 11221 ROE AVE STE 230 OVERLAND PARK KS 66211 470853481 HEALTH CARE MO N/A SAINT LUKE'S SOUTH SURGICENTER LLC 11221 ROE AVE STE 230 OVERLAND PARK KS 66211 201721929 HEALTH CARE KS N/A FAMILY ADVOCATES LLC 10918 ELM AVENUE KANSAS CITY MO 64134 202739036 FOSTER CARE MO N/A SAINT LUKE'S CARDIOLOGY SERVICES LLC 10920 ELM AVENUE KANSAS CITY MO 64134 263726426 HEALTH CARE MO N/A SAINT LUKE'S -GI DIAGNOSTICS LLC 4321 WASHINGTON SUITE 5700 KANSAS CITY MO 64111 274142549 HEALTH CARE MO N/A SAINT LUKE'S HEALTH SYSTEM RISK RETENTION GROUP 10920 ELM AVENUE KANSAS CITY MO 64134 371471890 INSURANCE SC N/A C ST LUKE'S HEALTH VENTURES INC 4320 WORNALL ROAD STE 410 KANSAS CITY MO 64111 431278476 ACCOUNTING MO N/A C MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL ROAD STE 410 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A C VENTURE FINANCIAL SERVICES INC 9500 E 63RD STREET STE 202 RAYTOWN MO 64133 431605740 COLLECTIONS MO N/A C SPELMAN DEVELOPMENT CORPORATION 601 S 169 HWY SMITHVILLE MO 64089 431296007 HEALTH CARE MO N/A C 0 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 TRANSACTIONS WITH RELATED ORGANIZATIONS SCHEDULE R, PART V, ITEM 1 SAINT LUKE'S HEALTH SYSTEM (SYSTEM) AND ITS AFFILIATED ENTITIES OPERATE AS A HIGHLY INTEGRATED HEALTH CARE DELIVERY SYSTEM. THE SYSTEM MANAGES AND OPERATES RELATED HOSPITALS AND THEIR AFFILIATES AS A COMMON MISSION ORIENTED HEALTH CARE SYSTEM IN ORDER TO BETTER SERVE THE HEALTH-RELATED NEEDS OF GREATER KANSAS CITY AND SURROUNDING AREAS. AS A RESULT, THERE ARE NUMEROUS INTERCOMPANY INTERACTIONS INCLUDING CENTRALIZED SUPPORT SERVICES AND SHARING OF RESOURCES AND COSTS.