2017-11-15T15:46:54-06:00 2016-12-31 990 2016-01-01 431735565 SAINT LUKE'S HOSPITAL OF CHILLICOTHE SAIN 6606461480 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 JANET BUCKMAN CHIEF FINANCIAL OFFICER 6606461480 2017-11-15 8.33.29.132 2017-11-15 15:46:09 CS P BADB30EAA8EA72076E123892A93B1AB4C1559E32 BADB30EAA8EA72076E123892A93B1AB4C1559E32 2016 2017-02-10 21:41:12Z HEDRICK MEDICAL CENTER STEVEN SCHIEBER 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 54010522 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 2003 MO CRITICAL ACCESS HOSPITAL 11 8 377 45 0 0 59616 59300 47669194 53424267 365270 526955 0 0 48094080 54010522 19294 27372 0 0 20531379 21759995 0 0 70541 25009249 26533150 45559922 48320517 2534158 5690005 40604438 47635246 5679115 6751749 34925323 40883497 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 41918631 27372 53424267 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 FINANCIAL ASSISTANCE 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. 41918631 1 1 0 1 0 0 0 0 0 0 1 1 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 0 0 0 1 32 0 1 377 1 0 0 0 0 0 0 0 0 0 0 X 11 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X THE ORGANIZATION 6606461480 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 X MICHAEL PALMER DIRECTOR-CHAIRMAN 1.00 X X 0 0 0 DON SIPES DIRECTOR-PRESIDENT 1.00 50.00 X X 0 399715 65369 DARREL RINEHART DIRECTOR 1.00 X 0 0 0 ROLLIE STADLMAN DIRECTOR-VICE CHAIRMAN 1.00 X X 0 0 0 DELOS CLOW DIRECTOR & EMPLOYED PHYSIC 40.00 X 275891 0 33306 JANE NEAL DIRECTOR 1.00 X 0 0 0 CYNTHIA CHRISTENSEN DIRECTOR-TREASURER 1.00 50.00 X X 0 300948 55043 BETTY PRESTON-STEELE DIRECTOR-SECRETARY 1.00 X X 0 0 0 CAROL SLOAN DIRECTOR 1.00 X 0 0 0 DONALD METRY DIRECTOR 1.00 X 0 0 0 JOHN MARCOLLA DIRECTOR 1.00 X 0 0 0 TERRY PLASTER ASSIST SECR & EMPLOYEE 40.00 X 49908 0 13043 JANET BUCKMAN CFO 40.00 X 207848 0 19600 CATHERINE HAMILTON CNO 40.00 X 142159 0 28137 STEVEN SCHIEBER CEO 40.00 X 172245 0 42125 CHRISTOPHER HULETT PHYSICIAN 40.00 X 324521 0 35252 GREGORY MILLER PHYSICIAN 40.00 X 342172 0 36254 YULIA PENISTON PHYSICIAN 40.00 X 267516 0 37265 JAMES PEPPERS PHYSICIAN 40.00 X 275858 0 37074 ANDREA HUFFORD PHYSICIAN 40.00 X 330329 0 35622 MATT WENZEL FORMER CEO 40.00 X 0 358637 63389 2388447 1059300 501479 23 1 1 0 EMS LLC 920 MAIN STREET SUITE 300 KANSAS CITY MO 64105 ER PHYSICIANS 1867088 HAVE A NICE DAY ANESTHESIA ASSOCIATES 2106 WOODCREST CHILLICOTHE MO 64601 ANESTHESIA SERVICES 875880 CPSI PO BOX 850309 6600 WALL ST MOBILE AL 36685 SOFTWARE SERVICES 442812 DAVID E ROSS CONSTRUCTION CO 10201 E 75TH ST RAYTOWN MO 64138 CONSTRUCTION SERVICES 438780 SHARED MEDICAL SERVICES PO BOX 330 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MEDICAL SERVICES 310450 11 24387 34913 59300 NET PATIENT REVENUE 622110 52333230 52333230 PHARMACY 622110 813665 813665 277372 277372 53424267 526955 526955 54010522 53424267 0 526955 X 27372 27372 984261 309197 675064 16005809 15038121 912935 54753 718249 648802 67132 2315 2937407 2653393 274548 9466 1114269 1006531 104147 3591 118728 118728 67219 67219 7702290 6974559 727675 56 5228 1286 3942 1012258 913445 98453 360 244902 199089 45813 2575519 2211316 364203 70110 51762 18348 77823 11607 66216 1061785 877482 184303 473398 305471 167927 MEDICAL SUPPLIES 4778227 4769693 8534 BAD DEBTS 4610477 4610477 SHARED SERVICES-SLHS 3600000 1239003 2360997 DUES & SUBSCRIPTIONS 112583 47497 65086 22603 22528 75 48320517 41918631 6331345 70541 9870748 10730349 871480 873286 5805277 6349679 874640 890730 353710 398271 11993563 6905861 5316578 5087702 13401854 18115207 2629244 2684413 65076 38382 1415831 2467227 40604438 47635246 2128356 2735460 3550759 4016289 5679115 6751749 X 34784173 40784416 141150 99081 34925323 40883497 40604438 47635246 X 5690005 275214 -7045 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 22549 0 0 0 22549 0 PART II-B, LINE 1: LINE F - PORTION OF DUES PAID TO VARIOUS HOSPITAL AND MEDICAL ASSOCIATIONS USED TOWARD LOBBYING ACTIVITIES. 1 158106 25692 132414 290042 12662 277380 10048691 5521710 4526981 1496724 1345797 150927 5087702 STATE STREET INVESTMENTS 2684413 F 2684413 DUE FROM AFFILIATES 468185 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 99081 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 1085961 LONG-TERM DEPOSITS 814000 2467227 PAYABLES TO AFFILIATES 1306984 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 2709305 4016289 X 49675259 275214 275214 49400045 4610477 4610477 54010522 43710041 0 43710041 4610476 4610476 48320517 PART X, LINE 2: THE MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAX ON ITS RELATED INCOME PURSUANT TO SECTION 501(A) OF THE CODE. MANAGEMENT IS NOT AWARE OF ANY UNCERTAINTIES IN INCOME TAX POSITIONS. THE YEARS ENDED DECEMBER 31, 2016, 2015, 2014, AND 2013, REMAIN SUBJECT TO EXAMINATION FOR BOTH FEDERAL AND STATE PURPOSES. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH REVENUE FOR BOOKS; INCLUDED IN EXPENSES FOR TAX 4,610,477. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH REVENUE FOR BOOKS; INCLUDED IN EXPENSES FOR TAX 4,610,477. ROUNDING -1. 1 1 X 1 X 133.000000000000 1 X 1 1 0 0 469258 469258 0.01070 6819878 5285622 1534256 0.03510 7289136 5285622 2003514 0.04580 3407 3407 0.00010 67478 67478 0.00150 6012391 4627317 1385074 0.03170 27221 500 26721 0.00060 6110497 4627817 1482680 0.03390 13399633 9913439 3486194 0.07970 818 818 0.00000 856 856 0.00000 1674 1674 0.00000 0 4610477 20585659 20452743 132916 X 1 1 1 1 HEDRICK MEDICAL CENTER 2799 N WASHINGTON CHILLICOTHE MO 64601 422-18 X X X X HEDRICK MEDICAL CENTER 1 0 0 1 X X X X X X X X 15 1 0 0 1 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1 15 1 WWW.SAINTLUKESHEALTHSYSTEM.ORG 0 1 X 133.000000000000 200.000000000000 X X 1 1 X X X 1 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X WWW.SAINTLUKESHEALTHSYSTEM.ORG X WWW.SAINTLUKESHEALTHSYSTEM.ORG X X X X X X 1 X 0 X X X 1 X 0 0 HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 5: AN EFFORT TO UNDERSTAND AND CREATE A HEALTHIER COMMUNITY REQUIRES COLLABORATION AND INPUT FROM MANY COMMUNITY STAKEHOLDERS. THROUGH DATA RESEARCH AND KEY CONVERSATIONS IN THE LIVINGSTON COUNTY COMMUNITY, THIS CHNA PULLS TOGETHER COMMUNITY FINDINGS AND ADDRESSES TOP HEALTH PRIORITIES TO HELP IMPROVE COMMUNITY HEALTH OVER THE NEXT THREE YEARS. TO PREPARE THE CHNA, BOTH PRIMARY SOURCES AND SECONDARY DATA WERE COMPILED AND ANALYZED. THE CHNA TEAM CONDUCTED MULTIPLE INTERVIEWS WITH HOSPITAL LEADERSHIP AND COMMUNITY STAKEHOLDERS TO BETTER UNDERSTAND THE NEEDS IN THE COMMUNITY. THE KEY CONTRIBUTORS INCLUDE: EXECUTIVE LEADERS OF HEDRICK MEDICAL CENTER LIVINGSTON COUNTY HEALTH CENTER HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 11: ALONG WITH THE SPECIFIC PROGRAMS DETAILED BELOW, HEDRICK MEDICAL CENTER WILL CONTINUE TO MEET COMMUNITY NEEDS BY PROVIDING CHILLICOTHE AND SURROUNDING COMMUNITIES WITH A BROAD RANGE OF ESSENTIAL HEALTH CARE SERVICES.1. IMPROVED ACCESS TO CARE:BECAUSE OF ITS ALL-INCLUSIVE NATURE, HEALTH CARE ACCESS IS IDENTIFIED AS THE OVERARCHING HEALTH NEED WITHIN HEDRICK MEDICAL CENTER'S COMMUNITY.HEDRICK MEDICAL CENTER WILL CONTINUE TO ACCEPT MISSOURI MEDICAID. FOLLOWING THE IMPLEMENTATION OF THE PATIENT PROTECTION AND AFFORDABLE CARE ACT (PPACA), THE STATE OF MISSOURI CHOSE NOT TO EXPAND THEIR MEDICAID PROGRAM AS OUTLINED IN THE LAW. SAINT LUKE'S HEALTH SYSTEM WILL CONTINUE TO ADVOCATE ON KEY HEALTH POLICY ISSUES AT THE STATE AND NATIONAL LEVEL, INCLUDING MEDICAID REFORM, ACCESS TO CARE, AND HEALTH CARE FINANCING FOR THE LOW-INCOME POPULATION.HEDRICK MEDICAL CENTER OPENED A NEW FACILITY IN FEBRUARY OF 2014. THE NEW HOSPITAL FACILITY HAS ALLOWED HMC TO PROVIDE EXPANDED SERVICES FOR PATIENTS AND ATTRACT NEW HEALTH CARE PROFESSIONALS TO THE COMMUNITY.HEDRICK MEDICAL CENTER HAS WORKED TO CONNECT PATIENTS WITH THE REGION'S MOST RESPECTED AND HIGHLY TRAINED PHYSICIANS. AS A MEMBER OF SAINT LUKE'S HEALTH SYSTEM, HEDRICK MEDICAL CENTER HAS THE ABILITY TO CONNECT LOCAL PATIENTS WITH A RANGE OF HIGHLY TRAINED PHYSICIAN SPECIALISTS. HMC HAS ALSO RECENTLY ENHANCED ACCESS TO HEALTH CARE SERVICES FOR OUR COMMUNITY BY OPENING A WEEKEND CLINIC THAT PROVIDES PRIMARY CARE SERVICES ON SATURDAYS AND SUNDAYS.2. INCREASED ACCESS TO PHYSICAL ACTIVITY AND NUTRITION:ADULT OBESITY IS BECOMING AN EPIDEMIC IN THE U.S. AND INCREASES THE RISK FOR COUNTLESS HEALTH CONDITIONS. OBESITY IS AN ENERGY IMBALANCE DUE TO A LACK OF PHYSICAL ACTIVITY COMBINED WITH A POOR DIET. OBESITY CAN ULTIMATELY LEAD TO THE FOLLOWING: CORONARY HEART DISEASE, TYPE 2 DIABETES, CANCER, HYPERTENSION, STROKE, GALL BLADDER DISORDERS, RESPIRATORY PROBLEMS, AND OSTEOARTHRITIS.HEDRICK MEDICAL CENTER IS ENGAGED IN SEVERAL COMMUNITY HEALTH PROGRAMS AIMED AT ADDRESSING OBESITY. - HMC IS CURRENTLY IN THE PROCESS OF BUILDING A HEALING GARDEN ON CAMPUS, WHICH WILL INCLUDE WALKING PATHS OPEN TO ALL COMMUNITY MEMBERS. - STAFF AT HEDRICK MEDICAL CENTER HOLDS AN ANNUAL FOOD DRIVE FOR COMMUNITY MEMBERS IN NEED OF HEALTHY FOOD. - HMC OFFERS FREE SPORTS PHYSICALS TO HIGH SCHOOL ATHLETES IN THE COMMUNITY.GOING FORWARD, HEDRICK MEDICAL CENTER WILL CONTINUE TO PARTICIPATE IN THESE PROGRAMS IN AN EFFORT TO IMPROVE OVERALL COMMUNITY HEALTH INCLUDING IMPROVED ACCESS TO PHYSICAL ACTIVITY AND NUTRITION.3. BEHAVIORAL HEALTH CARE:LIVINGSTON COUNTY IS SIGNIFICANTLY LACKING IN MENTAL HEALTH PROVIDERS FOR THEIR COMMUNITY COMPARED TO THE STATE OF MISSOURI. MENTAL HEALTH PROVIDERS INCLUDE; PSYCHIATRISTS, CLINICAL PSYCHOLOGISTS, CLINICAL SOCIAL WORKERS, PSYCHIATRIC NURSE SPECIALISTS, AND MARRIAGE/FAMILY THERAPISTS WHO MEET CERTAIN QUALIFICATIONS AND CERTIFICATIONS.HEDRICK MEDICAL CENTER CURRENTLY EMPLOYS A PSYCHIATRIC MENTAL HEALTH CLINICAL NURSE SPECIALIST (PMHCNS) WHO COMES TO HEDRICK ONCE A WEEK VIA THE TELE-HEALTH PROGRAM TO TREAT PATIENTS WITH MENTAL HEALTH NEEDS. IN ADDITION TO THE WEEKLY VISITS THE SPECIALIST IS ALSO CREATING SPECIFIC DAYS TO SEE NEW PATIENTS ONLY. HEDRICK ALSO PROVIDES A MENTAL HEALTH EVALUATION FOR PATIENTS WHO PRESENT THEMSELVES TO THE EMERGENCY DEPARTMENT WITH PSYCHOLOGICAL CONCERNS OR SELF-INFLICTED INJURIES.HEDRICK MEDICAL CENTER WILL CONTINUE TO OFFER A RANGE OF MENTAL HEALTH SERVICES, INCLUDING SPECIALIST AND TELE-HEALTH SERVICES.THERE ARE NO NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT ARE NOT BEING ADDRESSED.THE COMMUNITY BENEFIT COORDINATOR MEETS WITH THE EXECUTIVE TEAM AT THE HOSPITAL TO ENSURE THAT THE PROGRAMS IDENTIFIED IN THE IMPLEMENTATION PLAN ARE ACTIVE AND CONTINUE TO MEET THE SIGNIFICANT NEEDS IDENTIFIED IN THE IMPLEMENTATION PLAN. HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 23: DURING 2017, AS A RESULT OF OUR INTERNAL REVIEW PROCESSES, WE DISCOVERED AN INADVERTENT ERROR IN THE HOSPITAL'S AGB CALCULATION. THE ERROR RESULTED FROM THE TECHNICAL COMPLEXITIES OF THE AGB CALCULATION. THE ERROR AFFECTED 1 INDIVIDUAL AND RESULTED IN A TOTAL ADDITIONAL $95 OF FINANCIAL ASSISTANCE FOR THE 2016 CARE. AFTER THE ERROR WAS DISCOVERED, THE HOSPITAL PROMPTLY CORRECTED THE CALCULATION OF AGB AND AWARDED THE ADDITIONAL FINANCIAL ASSISTANCE TO THE ELIGIBLE PERSON. PART V, SECTION B, LINE 9 AS PERMITTED BY IRS TRANSITION RULES, THE ORGANIZATION ADOPTED ITS IMPLEMENTATION STRATEGY BY MAY 15, 2016 AND THEREFORE IS DEEMED TO SATISFY THE REQUIREMENT TO ADOPT THE STRATEGY IN THE SAME YEAR THE CHNA WAS COMPLETED AND WIDELY AVAILABLE, 2015. PART V, SECTION B, LINE 3I THE ORGANIZATION'S MOST RECENT CHNA WAS PREPARED IN 2015, WHICH WAS PRIOR TO THE FINAL 501(R) REGULATIONS. THE REQUIREMENT TO REPORT THE IMPACT OF ANY ACTIONS TAKEN TO ADDRESS THE SIGNIFICANT HEALTH NEEDS IDENTIFIED IN THE HOSPITAL FACILITY'S PRIOR CHNA WAS NOT SPECIFICALLY ADDRESSED IN THE ORGANIZATION'S 2015 CHNA SINCE IT WAS PREPARED USING THE PROPOSED REGULATIONS, WHICH DID NOT INCLUDE THIS REQUIREMENT. THE IMPACT OF ANY ACTIONS TAKEN WILL BE ADDRESSED IN ALL FUTURE CHNA REPORTS. PART V, SECTION B, LINE 20D THE HOSPITAL IS NOT REQUIRED TO MAKE PRESUMPTIVE ELIGIBILITY DETERMINATIONS BEFORE ENGAGING IN ECAS BECAUSE IT MAKES REASONABLE EFFORTS TO DETERMINE FAP-ELIGIBILITY BASED ON NOTIFICATION AND PROCESSING OF APPLICATIONS, AS PERMITTED BY 1.501(R)-6(C)(3) AND INDICATED IN THE RESPONSES TO QUESTIONS 20A-20C. 2 1 - HEDRICK FAMILY CARE 2791 N WASHINGTON CHILLICOTHE MO 64601 RURAL HEALTH CLINIC 2 - HMC REHAB 2799 N WASHINGTON CHILLICOTHE MO 64601 RURAL REHABILITATION 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, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 4,610,477. PART II, COMMUNITY BUILDING ACTIVITIES: 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. 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: FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: SEE ATTACHED FINANCIALS, PAGE 8, NOTE A, ITEM 2.THE AMOUNT OF BAD DEBT REPORTED IN THIS FORM 990 IS CONSISTENT WITH FINANCIAL STATEMENTS. PART III, LINE 9B: THE DEBT COLLECTION POLICY AND PROCEDURES PROHIBIT ANY COLLECTION EFFORTS FOR THE PORTION OF THE PATIENT ACCOUNT BALANCE THAT QUALIFIES FOR FINANCIAL ASSISTANCE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. FOR ANY REMAINING BALANCES DUE, THE SAME COLLECTION POLICY AND PROCEDURES ARE APPLIED EQUALLY TO ALL PATIENT TYPES. 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 FINANCIAL ASSISTANCE, PATIENT BILLING AND COLLECTION. 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, INFORMATION UPON CHECK-IN LOCATED IN THE ADMITTING PATIENTPACKETS, ON OUR B-131 RELEASE TO TREAT FORMS SIGNED BY ALL PATIENTS REQUESTING SERVICES, VISITS WITH INPATIENTS BY SOCIAL WORKER TEAMS, AND FOLLOW-UP CALLS TO PATIENTS AFTER DISCHARGE. FINANCIAL ASSISTANCE APPLICATIONS OR MEDICAID APPLICATIONS ARE REQUESTED ON ALL UNINSUREDINPATIENTS PRIOR TO DISCHARGE.THE HOSPITAL ALSO CONTRACTS WITH ELIGIBILITY ENROLLMENT COMPANIES TO SCREEN ALL UNINSURED PATIENTS, ANY PATIENTS IDENTIFIED BY OUR SOCIAL WORKER OR CASE MANAGEMENT TEAMS, AND ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR MEDICAID OR OTHER GOVERNMENT COVERAGE. THE ELIGIBILITY ENROLLMENT SERVICE ALSO PROVIDES PATIENTS WITH INFORMATION ON FINANCIAL ASSISTANCE. PART VI, LINE 4: HEDRICK MEDICAL CENTER IS LOCATED IN CHILLICOTHE, MISSOURI. THE HOSPITAL IS WITHIN A 90 MILE DRIVE OF THE KANSAS CITY METROPOLITAN AREA. THE CITY OF CHILLICOTHE POPULATION IS 9,515, WHILE LIVINGSTON COUNTY (THE COUNTY WHERE THE HOSPITAL IS LOCATED) POPULATION IS 14,241. THE AGE GROUP 18 TO 44 MAKES UP THE LARGEST PORTION OF THE POPULATION AT 34% OR 4,838 PEOPLE FOLLOWED BY THE AGE GROUP 45 TO 64 AT 25% OR 3,609 PEOPLE. THE SMALLEST AGE GROUP IS 65 AND UP AT 20% OF THE POPULATION OR 2,810PEOPLE. PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSISTS OF 10 AREA HOSPITALS, 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. 0 0 0 0 0 0 0 1 0 DON SIPES DIRECTOR-PRESIDENT 0 278040 0 77101 0 44574 0 43838 0 21531 0 465084 0 21653 DELOS CLOW DIRECTOR & EMPLOYED PHYSIC 273321 0 0 0 2570 0 13250 0 20056 0 309197 0 0 0 CYNTHIA CHRISTENSEN DIRECTOR-TREASURER 0 210183 0 58113 0 32652 0 42632 0 12411 0 355991 0 20400 JANET BUCKMAN CFO 181878 0 25172 0 798 0 9489 0 10111 0 227448 0 0 0 CATHERINE HAMILTON CNO 123819 0 17630 0 710 0 3692 0 24445 0 170296 0 0 0 STEVEN SCHIEBER CEO 170088 0 0 0 2157 0 21000 0 21125 0 214370 0 0 0 CHRISTOPHER HULETT PHYSICIAN 324206 0 0 0 315 0 10600 0 24652 0 359773 0 0 0 GREGORY MILLER PHYSICIAN 341457 0 0 0 715 0 11925 0 24329 0 378426 0 0 0 YULIA PENISTON PHYSICIAN 266840 0 0 0 676 0 11925 0 25340 0 304781 0 0 0 JAMES PEPPERS PHYSICIAN 275073 0 0 0 785 0 10600 0 26474 0 312932 0 0 0 ANDREA HUFFORD PHYSICIAN 328895 0 0 0 1434 0 10600 0 25022 0 365951 0 0 0 MATT WENZEL FORMER CEO 0 275179 0 64554 0 18904 0 35800 0 27589 0 422026 0 15672 PART I, LINE 7 THE ORGANIZATION HAS ADOPTED A MANAGEMENT INCENTIVE COMPENSATION PLAN FOR CERTAIN MEMBERS OF SENIOR AND MIDDLE MANAGEMENT TO PROMOTE EFFECTIVE MANAGEMENT OF OPERATIONS, QUALITY OF CARE AND SERVICE, AND OPTIMAL USE OF RESOURCES. THE INCENTIVES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY CONTINGENT ON ACHIEVING QUALITY, PATIENT SATISFACTION, EMPLOYEE RETENTION, FINANCIAL AND OTHER OPERATIONAL PERFORMANCE TARGETS ESTABLISHED BY THE BOARD'S COMPENSATION COMMITTEE ON AN ANNUAL BASIS. INCENTIVE AWARDS ARE PAID AT THE DISCRETION OF THE BOARD OF DIRECTORS AND DO NOT ACCRUE TO THE BENEFIT OF THE INDIVIDUALS UNTIL AFTER FINANCIAL RESULTS HAVE BEEN DETERMINED FOR THE CALENDAR YEAR. THIS INCENTIVE COMPENSATION IS EVALUATED AS PART OF THE REVIEW OF MARKET COMPETITIVE DATA AND REASONABLENESS OF OVERALL COMPENSATION AND BENEFITS. SCHEDULE J, PART II DON SIPES AND CYNTHIA CHRISTENSEN 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. MATT WENZEL, FORMER CEO RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. COMPENSATION REPORTED FOR BOARD MEMBERS IS FOR SERVICES AS EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED FOR SERVICES PROVIDED AS DIRECTORS OF THE ORGANIZATION. SHERRY STIRLING FAMILY MEMBER OF TERRY PLASTER, OFFICER 45663 EMPLOYEE COMPENSATION AND BENEFITS PROVIDED BY REPORTING ORGANIZATION 0 FORM 990, PART VI, SECTION A, LINE 2 DON SIPES AND CYNTHIA CHRISTENSEN HAVE A BUSINESS RELATIONSHIP BECAUSE DON SIPES IS AN OFFICER AND CYNTHIA CHRISTENSEN IS A HIGHEST COMPENSATED EMPLOYEE OF THE SOLE CORPORATE MEMBER, SAINT LUKE'S HEALTH SYSTEM, A 501(C)(3) ORGANIZATION. 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, APPOINTMENT & REMOVAL OF DIRECTORS AND THE CEO, DEBT, BUDGETS, CAPITAL EXPENDITURES, POLICIES APPLICABLE TO THE ORGANIZATION, AND STRATEGIC OPERATING DECISIONS. AS PART OF AN INTEGRATED HEALTH SYSTEM, THE SOLE MEMBER ALSO PROVIDES VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO THE ORGANIZATION. FORM 990, PART VI, SECTION B, LINE 11B 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. A SUMMARY OF KEY 990 INFORMATION IS PRESENTED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS AND THE 990 DRAFT IS MADE AVAILABLE TO THE COMMITTEE FOR REVIEW. THE 990 IS PROVIDED TO THE ORGANIZATION'S BOARD MEMBERS BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C THE FILING ORGANIZATION HAS A COMPREHENSIVE WRITTEN CONFLICT OF INTEREST POLICY 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. A REPORT IS PROVIDED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 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 AND CFO. 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 COMPENSATION PHILOSOPHY AND ANALYZES MARKET COMPETITIVENESS (IN TOTAL AND BY EACH COMPENSATION AND BENEFIT 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. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION AND AMENDMENTS THERETO ARE MADE AVAILABLE TO THE PUBLIC THROUGH THE MO SECRETARY OF STATE. THE ORGANIZATION'S FINANCIAL STATEMENTE ARE ATTACHED TO THIS RETURN. THE ORGANIZATION'S OTHER GOVERNING DOCUMENTS AND CONFLICTS OF INTEREST POLICY ARE NOT MADE AVAILABLE TO THE PUBLIC. FORM 990, PART VII DON SIPES AND CYNTHIA CHRISTENSEN 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. MATT WENZEL, FORMER CEO RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. COMPENSATION REPORTED FOR BOARD MEMBERS IS FOR SERVICES AS EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED FOR SERVICES PROVIDED AS DIRECTORS OF THE ORGANIZATION. FORM 990, PART IX, LINE 11G PHYSICIAN REMUNERATION: PROGRAM SERVICE EXPENSES 3,158,927. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,158,927. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 549,129. MANAGEMENT AND GENERAL EXPENSES 349,126. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 898,255. OTHER SERVICES: PROGRAM SERVICE EXPENSES 2,286,514. MANAGEMENT AND GENERAL EXPENSES 57,519. FUNDRAISING EXPENSES 56. TOTAL EXPENSES 2,344,089. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 979,989. MANAGEMENT AND GENERAL EXPENSES 321,030. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,301,019. FORM 990, PART XI, LINE 9: PENSION SETTLEMENT/LIABILITY TRANSFER TO SLHS 35,025. CHANGE IN INTEREST IN ASSETS OF FOUNDATION - SFAS 136 -42,069. ROUNDING -1. ST LUKE'S HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S HEALTH SYSTEM 901 E 104TH ST KANSAS CITY MO 64131 431747502 HEALTH SYSTEM KS 501(C)(3) 509A3 - TYPE III, FI 0 SAINT LUKE'S NORTH HOSPITAL 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 PHYSICIAN GROUP INC 901 E 104TH ST KANSAS CITY MO 64131 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 ST LUKE'S 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 901 E 104TH ST KANSAS CITY MO 64131 440546280 HEALTH CARE MO 501(C)(3) 170B1AVI SAINT LUKE'S HEALTH SYSTEM 0 MIDWEST EAR INSTITUTE INC 4320 WORNALL ROAD STE 420 KANSAS CITY MO 64111 480905027 HEALTH CARE KS 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKES CUSHING HOSPITAL 711 MARSHALL LEAVENWORTH KS 66048 480543792 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S CARE 901 E 104TH ST KANSAS CITY MO 64131 260185090 HEALTH CARE MO 501(C)(3) 509(A)(3) - TYPE II 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 624 WESTPORT ROAD KANSAS CITY MO 64111 272716128 POST-SECONDARY NURSING EDUCATION MO 501(C)(3) 170B1AII ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKE'S PHYSICIAN GROUP I LLC 4330 WORNALL RD SUITE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 ADVANCED UROLOGIC ASSOCIATES INC 901 E 104TH ST KANSAS CITY MO 64131 454725529 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 ROCKHILL ORTHOPAEDIC SPECIALISTS INC 901 E 104TH ST KANSAS CITY MO 64131 453851008 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 THE BISHOP SPENCER PLACE 4301 MADISON AVENUE KANSAS CITY MO 64111 431139083 RETIREMENT COMMUNITY MO 501(C)(3) 509(A)(2) SAINT LUKE'S HEALTH SYSTEM 0 WINDSOR CARE INCORPORATED 4301 MADISON AVENUE KANSAS CITY MO 64111 205284328 HEALTH CARE MO 501(C)(3) 509(A)(2) SAINT LUKE'S HEALTH SYSTEM 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL RD STE 714 KANSAS CITY MO 64111 431357824 OWN & OPERATE MEDICAL OFFICE BUILDING MO N/A ST LUKES SURGICENTER-LEE'S SUMMIT LLC 11221 ROE AVE STE 230 OVERLAND PARK KS 66211 470853481 HEALTH CARE MO N/A SAINT LUKES SOUTH SURGERY CENTER LLC 11221 ROE AVE STE 230 OVERLAND PARK KS 66211 201721929 HEALTH CARE KS N/A SAINT LUKE'S -GI DIAGNOSTICS LLC 4321 WASHINGTON SUITE 5700 KANSAS CITY MO 64111 274142549 HEALTH CARE MO N/A KANSAS CITY ORTHOPAEDIC INSTITUTE LLC 3651 COLLEGE BLVD LEAWOOD KS 66211 481197295 HEALTH CARE KS N/A SAINT LUKE'S RADIATION THERAPY-LIBERTY LLC 901 E 104TH ST KANSAS CITY MO 64131 473793070 HEALTH CARE MO N/A SAINT LUKE'S HEALTH SYSTEM RISK RETENTION GROUP 901 E 104TH ST KANSAS CITY MO 64131 371471890 INSURANCE SC N/A C 0 ST LUKE'S HEALTH VENTURES INC 901 E 104TH ST KANSAS CITY MO 64131 431278476 ACCOUNTING MO N/A C 0 MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL ROAD STE 714 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A C 0 VENTURE FINANCIAL SERVICES INC 9500 E 63RD STREET STE 202 RAYTOWN MO 64133 431605740 COLLECTIONS MO N/A C 0 SAINT LUKE'S HEALTH SYSTEM INSURANCE LTD 113 SOUTH CHURCH STREET GEORGETOWN CJ CAPTIVE CJ N/A C 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 SCHEDULE R, PART V, ITEM 1, TRANSACTIONS WITH RELATED ORGANIZATIONS 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.