2016-11-15T10:17:30-06:00 2015-12-31 990 2015-01-01 742849611 SAINT LUKES HOSPITAL OF GARNETT INC SAIN 7854483131 421 SOUTH MAPLE BOX 309 GARNETT KS 66032 VICKI MILLS CFO 7854483131 2016-11-15 2015 2017-02-10 21:41:12Z ANDERSON COUNTY HOSPITAL DENNIS HACHENBERG 421 S MAPLE GARNETT KS 66032 23449018 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1997 KS CRITICAL ACCESS HOSPITAL 7 4 282 138 0 0 101978 55831 20627396 23392387 10511 800 0 0 20739885 23449018 9291 7217 0 0 10370932 10937334 0 0 0 10559428 12052878 20939651 22997429 -199766 451589 7396988 6987462 6209086 5383574 1187902 1603888 X ANDERSON COUNTY HOSPITAL 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, WE ARE DEDICATED TO ENHANCING THE PHYSICAL, MENTAL, AND SPIRITUAL HEALTH OF THE COMMUNITIES WE SERVE. 0 0 19689784 7217 23392387 ANDERSON COUNTY HOSPITAL HAS BEEN DESIGNATED BY THE STATE OF KANSAS AND MEDICARE AS A CRITICAL ACCESS HOSPITAL.ALL PROGRAM SERVICE EXPENSES WERE INCURRED IN FURTHERANCE OF OUR MISSION, WHICH IS TO ENSURE HIGH QUALITY HEALTHCARE IN A CARING ENVIRONMENT FOR THE COMMUNITIES WE SERVE. IN 2015, THERE WERE 13,905 PATIENT DAYS, 17,238 RURAL HEALTH CLINIC VISITS, 3,432 EMERGENCY ROOM VISITS, 24,676 OUTPATIENT VISITS AND 943 AMBULANCE CALLS. WE PROVIDED UN-INSURED OR INDIGENT AREA CHILDREN WITH 217 VACCINATIONS.AS A VOLUNTARY, NONPROFIT, RURAL CRITICAL ACCESS HOSPITAL, SAINT LUKE'S HOSPITAL OF GARNETT IS COMMITTED TO SERVING ALL WHO SEEK OUR SERVICES REGARDLESS OF THEIR SOCIOECONOMIC STATUS. THOUGH WE HAVE PROVIDED SUCH CARE THROUGHOUT OUR 64-YEAR HISTORY, OUR COMMITMENT TO THOSE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE HAS GROWN SIGNIFICANTLY IN RECENT YEARS. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS A FINANCIAL ASSISTANCE POLICY FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE.THE HOSPITAL ALSO PROVIDES HEALTH RELATED ACTIVITIES AND SERVICES IN SUPPORT OF THE COMMUNITY INCLUDING PROVIDING AN ANNUAL BREAST CANCER AWARENESS CAMPAIGN AND CLINIC AND COMMUNITY WIDE HEALTH, WEIGHT, FIRST AID AND CPR CLASSES. IN ADDITION, WE PROVIDE A HEALTH CAREERS CLASS AT THE HIGH SCHOOL AND ARE A WORK STUDY SITE FOR HIGH SCHOOL STUDENTS INTERESTED IN HEALTH RELATED CAREERS. 19689784 1 1 0 1 0 0 0 0 0 0 1 0 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 0 0 0 0 0 0 0 1 0 0 0 1 X 0 0 282 1 0 0 0 0 0 0 0 0 0 0 X 7 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X THE ORGANIZATION 7854483131 421 SOUTH MAPLE BOX 309 GARNETT KS 66032 X WILLIAM BARNES BOARD MEMBER 0.25 X 0 0 0 CAROL ASKINS-BELLER VICE CHAIR-BOARD MEMBER 1.00 X X 0 0 0 MACKENZIE PETERSON MD BOD MBR/EMPLD PHYSICIAN 40.00 X 198560 0 33891 DON SIPES SECRETARY-BOARD MEMBER 1.00 50.00 X X 0 622712 41838 CAROL MEYER TREASURER-BOARD MEMBER 1.00 50.00 X X 0 318779 42362 DAVID LYBARGER CHAIR-BOARD MEMBER 1.00 X X 0 0 0 LYNN DAVISON BOARD MEMBER 1.00 X 0 0 0 DENNIS HACHENBERG CEO 40.00 X 255273 0 55369 VICKI MILLS CFO 40.00 X 158779 0 23911 MARGO WILLIAMS CNO 40.00 X 110267 0 17088 WENDY BELCHER PHYSICIAN 40.00 X 152821 0 30594 JANELL JONES PHYSICIAN 40.00 X 185177 0 22909 ROSS KIMBALL PHYSICIAN 40.00 X 201823 0 33396 1262700 941491 301358 7 0 1 0 AUBURN PHARMACY 429 N MAPLE GARNETT KS 66032 CONTRACT PHARMACY 1282401 QUALITY ER CARE LLC 7550 220TH ROAD CHANUTE KS 66720 ER & URGENT CARE COVERAGE 1095000 CPSI 6600 WALL STREET MOBILE AL 36685 COMPUTER SERVICES 219795 BOWES ANESTHESIA 9622 PERRY LANE OVERLAND PARK KS 66212 CRNA SERVICES 196542 CRANSTON J CEDERLIND MD 20030 W 89TH LENEXA KS 66220 PHYSICIAN 130000 7 55091 740 55831 NET PATIENT REVENUE 622110 20633595 20633595 PHARMACY 622110 2074564 2074564 AMBULANCE CONTRACT 621910 510000 510000 MEDICAL CLINIC RENT 531120 58930 58930 115298 115298 23392387 800 800 23449018 23392387 0 800 X 7217 7217 853136 232450 620686 7555020 7064551 490469 358710 298715 59995 1579467 1365766 213701 591001 516922 74079 123618 123618 4131472 3863699 267773 11359 5721 5638 1145726 1035100 110626 375999 307577 68422 1404279 1148027 256252 33709 33709 70895 44348 26547 9356 8010 1346 475598 475598 297940 290416 7524 MEDICAL SUPPLIES 1638356 1636304 2052 SHARED SERVICES-SLHS 1279987 334511 945476 BAD DEBTS 986246 986246 OTHER 68338 34897 33441 22997429 19689784 3307645 0 1409 818 1095377 582930 2069369 2500742 243963 290187 255836 286156 3620816 859553 2522640 2761263 1208394 565366 7396988 6987462 2517269 1533396 3691817 3850178 6209086 5383574 X 1187902 1603888 1187902 1603888 7396988 6987462 X 451589 -35603 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1500 0 0 0 1500 0 PART II-B, LINE 1: LINE F - PORTION OF DUES PAID TO VARIOUS HOSPITAL AND RELATED MEDICAL ASSOCIATIONS USED TOWARD LOBBYING ACTIVITIES. 106110 10720 95390 3094946 573147 2521799 419760 275686 144074 2761263 OTHER RECEIVABLES 195539 DUE FROM SLHS AFFILIATES 23207 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 346620 565366 DUE TO COUNTY BOARD OF TRUSTEES, LESSOR 387334 DUE TO SLHS AFFILIATED ENTITIES 918242 NOTE PAYABLE TO SLHS AFFILIATED ENTITIES 2544602 3850178 X 22462772 0 22462772 986246 986246 23449018 22011182 0 22011182 986247 986247 22997429 PART X, LINE 2: THE HOSPITAL IS A NOT-FOR-PROFIT CORPORATION AS DESCRIBED IN SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE AND IS EXEMPT FROM FEDERAL INCOME TAXES 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, 2015, 2014, 2013, AND 2012, REMAIN SUBJECT TO EXAMINATION FOR BOTH FEDERAL AND STATE PURPOSES. PART XI, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT REPORTED IN NET PATIENT REV FOR BOOKS; REPORTED IN EXPENSES FOR TAX 986,246. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT 986,246. ROUNDING 1. 1 1 X 1 X 133.000000000000 1 X 1 1 0 0 97356 97356 0.00440 1636529 2249202 0 1733885 2249202 97356 0.00440 51598 2997 48601 0.00220 33086 33086 0.00150 7342203 5164448 2177755 0.09890 77237 77237 0.00350 7504124 5167445 2336679 0.10610 9238009 7416647 2434035 0.11050 5948 5948 0.00030 6905 6905 0.00030 13641 13641 0.00060 62885 62885 0.00290 89379 89379 0.00410 0 986246 9767204 11421483 -1654279 X 1 1 1 1 SAINT LUKE'S HOSPITAL OF GARNETT 421 S MAPLE GARNETT KS 66032 H-002-001 X X X SAINT LUKES HOSPITAL OF GARNETT INC 1 0 0 1 X 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 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 0 X X X X X 1 X 0 0 SAINT LUKES HOSPITAL OF GARNETT INC PART V, SECTION B, LINE 5: ANDERSON COUNTY HOSPITAL UNDERTOOK A STRUCTURED APPROACH TO DETERMINE HEALTH NEEDS INCLUDING ANALYSIS OF PUBLIC HEALTH DATA, INTERVIEWS WITH HEALTHCARE PROFESSIONALS AND INPUT FROM COMMUNITY MEMBERS. THE CHNA TEAM CONDUCTED MULTIPLE INTERVIEWS WITH HOSPITAL LEADERSHIP AND COMMUNITY STAKEHOLDERS TO BETTER UNDERSTAND THE NEEDS OF THE COMMUNITY. STAKEHOLDERS WERE CHOSEN TO REPRESENT BROAD INTEREST OF THE COMMUNITY, INCLUDING UNDERSERVED POPULATIONS. STAKEHOLDERS PROVIDED INFORMATION WHICH WAS USED TO HELP IDENTIFY AND PRIORITIZE COMMUNITY NEEDS. KEY CONTRIBUTORS INCLUDED HOSPITAL LEADERSHIP AND INDIVIDUALS FROM THE ANDERSON COUNTY HEALTH DEPARTMENT. SAINT LUKES HOSPITAL OF GARNETT INC PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED THREE MAJOR HEALTH NEEDS:1. IMPROVED ACCESS TO CARE2. INCREASED ACCESS TO PHYSICAL ACTIVITY AND NUTRITION3. BEHAVIORAL HEALTH CARE1. IMPROVED ACCESS TO CAREAFFORDABILITY AND AVAILABILITY ARE KEY FACTORS FOR ACCESS TO CARE. ANDERSON COUNTY HOSPITAL WILL CONTINUE TO ACCEPT KANSAS MEDICAID.ANDERSON COUNTY HOSPITAL OPENED A NEW FACILITY IN JANUARY 2015. THE NEW FACILITY HAS ALLOWED THE HOSPITAL TO PROVIDE EXPANDED SERVICES FOR PATIENTS AND ATTRACT NEW HEALTH CARE PROFESSIONALS TO THE COMMUNITY. AS A MEMBER OF SAINT LUKE'S HEALTH SYSTEM, THE HOSPITAL HAS THE ABILITY TO CONNECT LOCAL PATIENTS WITH A RANGE OF HIGHLY TRAINED PHYSICIAN SPECIALISTS.2.INCREASED ACCESS TO PHYSICAL ACTIVITY AND NUTRITIONTHE HOSPITAL IS ENGAGED N SEVERAL COMMUNITY HEALTH PROGRAMS AIMED AT ADDRESSING THIS NEED: - THE SPRING INTO FITNESS PROGRAM IS A FREE PROGRAM FOR THE CHILDREN OF ANDERSON COUNTY FOCUSING ON HEALTH, EXERCISE, AND NUTRITION. - THE WOMEN IN TRAINING PROGRAM IS AN EIGHT-WEEK TRAINING PROGRAM FOR WOMEN OF ALL AGES. THE PROGRAM OFFERS ONE-ON-ONE SUPPORT FROM FITNESS AND HEALTH EXPERTS. - THE HOSPITAL'S FAMILY HEALTH FESTIVAL IS A FUN FILLED DAY OF HEALTH FOR ANDERSON COUNTY RESIDENTS. COMMUNITY MEMBERS WILL BE ENCOURAGED TO PARTICIPATE IN A FREE EVENT FEATURING HEALTH SCREENINGS AND EDUCATION.GOING FORWARD, THE HOSPITAL WILL CONTINUE TO PARTICIPATE IN THESE PROGRAMS IN AN EFFORT TO IMPROVE OVERALL COMMUNITY HEALTH INCLUDING INCREASED ACCESS TO PHYSICAL ACITIVITY AND NUTRITION. 3. BEHAVIORAL HEALTH CAREPATIENTS IN GARNETT, KS AND THE SURROUNDING AREAS CURRENTLY HAVE ACCESS TO ONSITE PSYCHIATRIC SERVICES AT OUR FAMILY CARE CENTER, AS WELL AS THROUGH THE HOSPITAL'S EHEALTH TELEMEDICINE PROGRAM. THE MENTAL HEALTH TEAM UTILIZED BY THE TELEMEDICINE PROGRAM HAS THE TRAINING AND EXPERTISE TO ADDRESS AND TREAT A WIDE RANGE OF PYSCHIATRIC ISSUES.THE HOSPITAL WILL CONTINUE TO PROVIDE PSYCHIATRIC SERVICES ONSITE AT OUR FAMILY CARE CENTER AS WELL AS THROUGH THE EHEALTH TELEMEDICINE PROGRAM. THE HOSPITAL WILL ALSO CONTINUE TO WORK WITH COMMUNITY PARTNERS SUCH AS THE SOUTHEAST KANSAS MENTAL HEALTH CENTER AND MID-AMERICA NAZARENE TO ADDRESS THE ONGOING MENTAL HEALTH NEEDS OF COMMUNITY MEMBERS.THERE ARE NO NEEDS IDENTIFIED IN THE CHNA THAT ARE NOT BEING ADDRESSED. SAINT LUKES HOSPITAL OF GARNETT INC PART V, SECTION B, LINE 16I: 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 PATIENT PACKETS, 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 UNINSURED INPATIENTS 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 ELIGIBITY ENROLLMENT SERVICE ALSO PROVIDES PATIENTS WITH INFORMAITON ON FINANCIAL ASSISTANCE. SAINT LUKES HOSPITAL OF GARNETT INC PART V, SECTION B, LINE 20E: SEE RESPONSE TO LINE 16I. 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 MADE WIDELY AVAILABLE, 2015. 4 1 - ANDERSON COUNTY LONG TERM CARE UNIT 421 S MAPLE GARNETT KS 66032 LONG TERM CARE NURSING FACILITY 2 - ANDERSON COUNTY HOSPITAL FAMILY CARE CTR 536 W 4TH GARNETT KS 66032 RURAL HEALTH CLINIC 3 - ANDERSON COUNTY HOSPITAL FAMILY CARE CTR 309 N PINE COLONY KS 66015 RURAL HEALTH CLINIC 4 - ANDERSON COUNTY EMS 421 S MAPLE GARNETT KS 66032 AMBULANCE PART I, LINE 3C: THE HOSPITAL USES THE FEDERAL POVERTY GUIDELINES TO DETERMINE ELIGIBILITY.IN ADDITION, MEDICAL INDIGENCY MAY BE DETERMINED ON AN INDIVIDUAL BASIS FOR INCOME ABOVE THE FEDERAL POVERTY LEVEL WHEN A SINGLE ILLNESS OR INJURY CAUSES HARDSHIP. 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 7G: SUBSIDIZED HEALTH SERVICES ARE FOR THE EMERGENCY DEPARTMENT,RURAL HEALTH CLINIC AND AMBULANCE 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 $ 986,246. PART II, COMMUNITY BUILDING ACTIVITIES: ANDERSON COUNTY HOSPITAL'S COMMUNITY BUILDING ACTIVITIES ARE DIVERSE. THE HOSPITAL TAKES THE LEAD IN MANY COMMUNITY ENDEAVORS. WE PROVIDE MEETING SPACE, REFRESHMENTS AND SPEAKERS FOR MANY COMMUNITY PROJECTS AND OTHER CHARITABLE ORGANIZATIONS. WE ASSIST WITH COALITION BUILDING IN OUR COMMUNITY AND BRING TOGETHER OTHER HEALTH AND SOCIAL SERVICES ORGANIZATIONS TO PLAN FOR THE BENEFIT OF THE COMMUNITY. WE PROVIDE OVER $62,000 IN FUNDS FOR WORKFORCE DEVELOPMENT IN THE COMMUNITY INCLUDING EMT, NURSE AID AND MEDICATION AID CLASSES THAT ARE OPEN TO THE COMMUNITY. WE PARTICIPATE IN THE ELEMENTARY AND HIGH SCHOOLS BY OFFERING HEALTH RELATED CLASSES TO ALL AGE GROUPS. WE OFFER HEALTH CAREER ASSISTANCE AND CLASSES TO THE HIGH SCHOOL AND PARTICIPATE IN THE HIGH SCHOOL WORK STUDY PROGRAM WHICH OFFERS STUDENTS AN OPPORTUNITY TO SHADOW IN THE HEALTH CARE WORK ENVIRONMENT. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: SEE PAGE 7, NOTE A, ITEM 2, OF ATTACHED FINANCIAL STATEMENTS.THE AMOUNT OF BAD DEBT REPORTED IN THIS FORM 990 IS CONSISTENT WITH THE FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING THE COST-TO-CHARGE RATIO FROM THE MEDICARE COST REPORT.ANDERSON COUNTY HOSPITAL IS A CRITICAL ACCESS HOSPITAL IN A FEDERALLY DESIGNATED LOW INCOME HEALTH PROFESSIONALS SHORTAGE AREA(HPSA), LOCATED IN THE SECOND LOWEST INCOME COUNTY IN THE STATE OF KANSAS. THE AVERAGE AGE OF OUR INPATIENT POPULATION IS 78 AND THE AVERAGE AGE OF OUR OUTPATIENT POPULATION IS 58. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. WE PROVIDE SERVICES TO THE MOST NEEDY CONSTITUENCIES IN OUR AREA. THESE INCLUDE BOTH MEDICAID AND MEDICARE POPULATIONS. THE LOSS ON MEDICARE SHOULD BE TREATED AS COMMUNITY BENEFIT.ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS, INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD. PART III, LINE 9B: IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE ACCOUNT IS ADJUSTED ACCORDINGLY. WE FOLLOW OUR BILLING AND COLLECTIONS POLICY FOR ANY REMAINING BALANCES. 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. IN ADDITION, ONCE EVERY 3 YEARS, A COMMUNITY HEALTH SURVEY IS DELIVERED TO OVER 4000 HOMES IN THE SERVICE AREA. DETAILED INFORMATION ON HEALTH AND SOCIAL CONCERNS IN THE COMMUNITY AS WELL AS OTHER HEALTH RELATED INFORMATION IS GARNERED FROM THE SURVEYS. THE HOSPITAL ALSO HAS A NUMBER OF COMMUNITY ADVISORY BOARDS REPRESENTING DIFFERENT CONSTITUENCIES THAT MEET AT LEAST ANNUALLY TO ASSIST US IN PLANNING FOR THE HEALTH CARE NEEDS OF THE COMMUNITY. WE PARTICIPATE MONTHLY IN THE COMMUNITY WIDE HEALTH COALITION MADE UP OF OTHER HEALTH PROVIDERS WITHIN OUR AREA. FROM TIME TO TIME WE HAVE COMMUNITY FOCUS GROUPS TO ASSIST US IN UNDERSTANDING THE HEALTHCARE NEEDS IN OUR COMMUNITY. PART VI, LINE 3: ANDERSON COUNTY HOSPITAL INFORMED AND EDUCATED PATIENTS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THE ELIGIBILITY FOR ASSISTANCE BY POSTING SIGNS THROUGHOUT THE FACILITY AND ON HOSPITAL SPECIFIC LITERATURE GIVEN OUT TO EACH PATIENT WHO SEEKS SERVICES AS WELL AS ON OUR PATIENT STATEMENTS. WE COORDINATE IDENTIFICATION OF NEED WITH OUR PHYSICIAN OFFICE AND WITH OTHER ENTITIES WITHIN OUR HEALTH SYSTEM. WE HAVE FINANCIAL AND SOCIAL SERVICE COUNSELORS WHO WORK WITH FAMILIES AND INDIVIDUALS IN NEED. SINCE ANDERSON COUNTY IS A LOW-INCOME HPSA WE UNDERSTAND THAT A LARGE PART OF OUR POPULATION NEEDS ASSISTANCE. PART VI, LINE 4: ANDERSON COUNTY HOSPITAL IS A CRITICAL ACCESS HOSPITAL, LOCATED IN GARNETT, A RURAL COMMUNITY SOUTHWEST OF KANSAS CITY. THE SERVICE AREA ENCOMPASSES ALL OF ANDERSON COUNTY AND PORTIONS OF FRANKLIN, LINN, COFFEY AND ALLEN COUNTIES. THE CURRENT COUNTY POPULATION IS 7992 AND THE EXTENDED SERVICE AREA POPULATION IS 12,000 PEOPLE. THE GARNETT AREA IS MAINLY A FARMING COMMUNITY. THE COUNTY IS FEDERALLY DESIGNATED AS A LOW-INCOME HEALTH PROFESSIONALS SHORTAGE AREA. PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSISTS OF 10 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. 0 0 0 0 0 0 0 1 0 MACKENZIE PETERSON MD BOD MBR/EMPLD PHYSICIAN 177922 0 20200 0 438 0 10246 0 23645 0 232451 0 0 0 DON SIPES SECRETARY-BOARD MEMBER 0 271642 0 60644 0 290426 0 21200 0 20638 0 664550 0 263905 CAROL MEYER TREASURER-BOARD MEMBER 0 231962 0 50965 0 35852 0 39761 0 2601 0 361141 0 17840 DENNIS HACHENBERG CEO 190527 0 41480 0 23266 0 35382 0 19987 0 310642 0 14520 0 VICKI MILLS CFO 141241 0 15427 0 2111 0 12894 0 11017 0 182690 0 0 0 WENDY BELCHER PHYSICIAN 133667 0 18805 0 349 0 7913 0 22681 0 183415 0 0 0 JANELL JONES PHYSICIAN 172635 0 11733 0 809 0 7523 0 15386 0 208086 0 0 0 ROSS KIMBALL PHYSICIAN 189134 0 11492 0 1197 0 8340 0 25056 0 235219 0 0 0 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 SAINT LUKE'S HEALTH SYSTEM 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. PART I, LINE 3 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 SURVEYS AND COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM. SCHEDULE J, PART II DON SIPES AND CAROL MEYER 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. PART V, LINE 1A, NUMBER REPORTED IN BOX 3 OF FORM 1096 THE ORGANIZATION IS PART OF SAINT LUKE'S HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM. THE MAJORITY OF THE ORGANIZATION'S VENDORS ARE PAID THROUGH A CENTRALIZED PAYMENT SYSTEM WITH 1099S ISSUED BY THE CENTRALIZED SERVICE ENTITY. FORM 990, PART VI, SECTION A, LINE 2 DON SIPES AND CAROL MEYER HAVE A BUSINESS RELATIONSHIP BECAUSE THEY ARE DIRECTORS, OFFICERS, AND/OR EMPLOYEES OF THE SAME AFFILIATED TAX-EXEMPT 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 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. A SUMMARY OF KEY 990 INFORMATION WAS PRESENTED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS AND THE 990 DRAFT WAS MADE AVAILABLE TO THE COMMITTEE FOR REVIEW. THE 990 WAS PROVIDED TO THE ORGANIZATION'S BOARD MEMBERS 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 VICE PRESIDENT OF INTERNAL AUDIT REVIEWS COMPLETED QUESTIONNAIRES AND 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 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 SURVEYS AND COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION AND AMENDMENTS THERETO ARE AVAILABLE TO THE PUBLIC THROUGH THE KS SECRETARY OF STATE. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE ATTACHED TO THIS FORM 990. 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 CAROL MEYER 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. FORM 990, PART IX, LINE 11G PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 1,564,111. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,564,111. REPAIRS AND MAINTENANCE SERVICES: PROGRAM SERVICE EXPENSES 243,018. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 243,018. TECHNICAL FEES: PROGRAM SERVICE EXPENSES 332,061. MANAGEMENT AND GENERAL EXPENSES 8,802. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 340,863. CRNA FEES: PROGRAM SERVICE EXPENSES 198,278. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 198,278. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,526,231. MANAGEMENT AND GENERAL EXPENSES 258,971. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,785,202. FORM 990, PART XI, LINE 9: PENSION LIABILITY TRANSFER TO SYSTEM -35,603. ROUNDING RISK RENTENTION GROUP SUBSCRIBER SAVINGS DIVIDEND SAINT LUKES HEALTH SYSTEM INC 901 E 104TH ST KANSAS CITY MO 64131 431747502 HEALTH SYSTEM KS 501(C)(3) 509A3 - TYPE III FIS 0 ST LUKES 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 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 AVENUE 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 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 SAINT LUKE'S HEALTH SYSTEM HOME CARE AND HOSPICE 3100 BROADWAY SUITE 1000 KANSAS CITY MO 64111 431127200 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 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 MEDICAL GROUP 901 E 104TH ST KANSAS CITY MO 64131 431598353 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S HOSPITAL OF CHILLICOTHE 2799 N WASHINGTON CHILLICOTHE MO 64601 431735565 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 MIDWEST EAR INSTITUTE INC 4320 WORNALL ROAD STE 320 KANSAS CITY MO 64111 480905027 HEALTH CARE KS 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 0 CRITTENTON 10918 ELM AVENUE KANSAS CITY MO 64134 440545808 HEALTH CARE MO 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 MEDICAL PLAZA IMAGING ASSOCIATES LLC 4401 WORNALL ROAD KANSAS CITY MO 64111 431609584 HEALTH CARE MO 501C3 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S COLLEGE OF HEALTH SCIENCES 624 WESTPORT RD KANSAS CITY MO 64111 272716128 POST-SECONDARY NURSING EDUCATION MO 501C3 170B1AII SAINT LUKE'S HOSPITAL 0 SLCC INC 4330 WORNALL ROAD SUITE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS 501C3 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SLNC INC 901 E 104TH ST KANSAS CITY MO 64131 451470888 HEALTH CARE KS 501C3 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 ADVANCED UROLOGIC ASSOCIATES INC 901 E 104TH ST KANSAS CITY MO 64131 454725529 HEALTH CARE MO 501C3 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 ROCKHILL ORTHOPAEDIC SPECIALISTS INC 901 E 104TH ST KANSAS CITY MO 64131 453851008 HEALTH CARE MO 501C3 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL RD SUITE 714 KANSAS CITY MO 64111 431357824 OWN & OPERATE MEDICAL OFFICE BUILDING MO N/A ST LUKE'S SURGICENTER-LEE'S SUMMIT LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 470853481 HEALTH CARE MO N/A SAINT LUKE'S SOUTH SURGERY CENTER LLC 11221 ROE AVE SUITE 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 HEALTH SYSTEM RISK RETENTION GROUP 901 E 104TH ST KANSAS CITY MO 64131 371471890 INSURANCE SC N/A 0 ST LUKE'S HEALTH VENTURES INC 901 E 104TH ST KANSAS CITY MO 64131 431278476 ACCOUNTING MO N/A 0 MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL ROAD SUITE 714 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A 0 VENTURE FINANCIAL SERVICES INC 9500 E 63RD ST STE 202 KANSAS CITY MO 64133 431605740 COLLECTIONS MO N/A 0 SAINT LUKE'S HEALTH SYSTEM INSURANCE LTD 113 SOUTH CHURCH ST GEORGETOWN CJ INSURANCE CJ N/A 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 1 1 1 0 0 SCHEDULE R, PART V, LINE 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.