2016-11-15T10:20:50-06:00 2015-12-31 990 2015-01-01 431735565 SAINT LUKE'S HOSPITAL OF CHILLICOTHE SAIN 6606461480 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 JANET BUCKMAN CHIEF FINANCIAL OFFICER 6606461480 2016-11-15 2015 2017-02-10 21:41:12Z HEDRICK MEDICAL CENTER STEVEN SCHIEBER 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 48094080 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 2003 MO CRITICAL ACCESS HOSPITAL 11 8 372 46 0 0 19189 59616 47563346 47669194 294060 365270 0 0 47876595 48094080 21102 19294 0 0 19611580 20531379 0 0 67089 23962420 25009249 43595102 45559922 4281493 2534158 35990206 40604438 3181191 5679115 32809015 34925323 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 39767340 19294 47669194 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. 39767340 1 1 0 1 0 0 0 0 0 0 1 1 0 0 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 31 0 1 372 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/INTERIM CEO 1.00 50.00 X X 0 622712 41838 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 293972 0 31735 JANE NEAL DIRECTOR 1.00 X 0 0 0 CYNTHIA CHRISTENSEN DIRECTOR-TREASURER 1.00 50.00 X X 0 282394 53577 JASON GAULT DIRECTOR & EMPLOYED PHYSIC-END 2015 40.00 X 322352 0 8245 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 50993 0 12487 MATT WENZEL CEO - ENDING 8/2015 40.00 X 188037 104022 53771 JANET BUCKMAN CFO 40.00 X 203950 0 19197 CATHERINE HAMILTON CNO 40.00 X 125826 0 26025 STEVEN SCHIEBER CEO - BEGINNING 9/2015 40.00 X 46368 90250 25119 CHRISTOPHER HULETT PHYSICIAN 40.00 X 353023 0 33585 GREGORY MILLER PHYSICIAN 40.00 X 362489 0 34696 YULIA PENISTON PHYSICIAN 40.00 X 275886 0 36554 JAMES PEPPERS PHYSICIAN 40.00 X 263310 0 33799 ANDREA HUFFORD PHYSICIAN 40.00 X 319378 0 36332 2805584 1099378 446960 22 0 1 0 EMS LLC 920 MAIN STREET SUITE 300 KANSAS CITY MO 64105 ER PHYSICIANS 2108963 HAVE A NICE DAY ANESTHESIA ASSOCIATES 2106 WOODCREST CHILLICOTHE MO 64601 ANESTHESIA SERVICES 955377 CPSI PO BOX 850309 6600 WALL ST MOBILE AL 36685 SOFTWARE SERVICES 517097 SHARED MEDICAL SERVICES PO BOX 330 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MEDICAL SERVICES 292250 GE HEALTHCARE P O BOX 96483 CHICAGO IL 60693 SERVICE CONTRACT 152237 6 21875 37741 59616 NET PATIENT REVENUE 622110 46455311 46455311 PHARMACY 622110 846235 846235 EHR MEANINGFUL USE FDS 622110 102463 102463 265185 265185 47669194 365270 365270 48094080 47669194 0 365270 X 19294 19294 1377502 656304 721198 14760091 13884414 823169 52508 725064 653316 69389 2359 2612895 2354393 250054 8448 1055827 951370 101043 3414 42845 42845 7353603 6672208 681395 11606 1419 10187 948209 810121 137728 360 148215 141319 6896 2556739 2206228 350511 91514 64998 26516 64880 13104 51776 1178013 974019 203994 439423 327859 111564 MEDICAL SUPPLIES 4541187 4535166 6021 BAD DEBTS 4274475 4274475 SHARED SERVICES-SLHS 2808128 760754 2047374 DUES & SUBSCRIPTIONS 101095 39017 62078 449317 427562 21755 45559922 39767340 5725493 67089 6641225 9870748 869883 871480 6138118 5805277 711351 874640 308354 353710 11200498 5883920 6048027 5316578 10468322 13401854 2606299 2629244 71385 65076 2127242 1415831 35990206 40604438 2516956 2128356 664235 3550759 3181191 5679115 X 32697240 34784173 111775 141150 32809015 34925323 35990206 40604438 X 2534158 -385641 -32209 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 7129 0 0 0 7129 0 PART II-B, LINE 1: LINE F - PORTION OF DUES PAID TO VARIOUS HOSPITAL AND MEDICAL ASSOCIATIONS USED TOWARD LOBBYING ACTIVITIES. 1 158106 17787 140319 88842 5645 83197 9588310 4595212 4993098 1365240 1265276 99964 5316578 STATE STREET INVESTMENTS 2629244 F 2629244 PAYABLES TO AFFILIATES 270798 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 3279961 3550759 X 43368676 -385641 -385641 43754317 4339763 4339763 48094080 41220159 0 41220159 4339763 4339763 45559922 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, 2015, 2014, 2013, AND 2012, 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 4,274,475. PENSION SETTLEMENT EXP NET WITH REV FOR BOOKS; INCLUDED IN EXP FOR TAX 65,288. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH REVENUE FOR BOOKS; INCLUDED IN EXPENSES FOR TAX 4,274,475. PENSION SETTLEMENT EXP NET WITH REV FOR BOOKS; INCLUDED IN EXP FOR TAX 65,288. 1 1 X 1 X 133.000000000000 1 X 1 1 0 0 441727 441727 0.01070 6733185 3930369 2802816 0.06790 7174912 3930369 3244543 0.07860 13337 13337 0.00030 95358 95358 0.00230 5519342 4677255 842087 0.02040 19155 840 18315 0.00040 5647192 4678095 969097 0.02340 12822104 8608464 4213640 0.10200 1509 1509 0.00000 52 52 0.00000 1561 1561 0 4274475 19237678 19416216 -178538 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 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 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. HEDRICK MEDICAL CENTER 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. HEDRICK MEDICAL CENTER 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 WIDELY AVAILABLE, 2015. 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 $ 4,274,475. 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: IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE ACCOUNT IS ADJUSTED ACCORDINGLY. ANY REMAINING BALANCE IS 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: SEE RESPONSE TO PART V, LINE 16I. 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. 1 0 0 0 0 0 0 1 0 DON SIPES DIRECTOR-PRESIDENT/INTERIM CEO 0 271642 0 60644 0 290426 0 21200 0 20638 0 664550 0 263905 DELOS CLOW DIRECTOR & EMPLOYED PHYSIC 289802 0 0 0 4170 0 13250 0 18485 0 325707 0 0 0 CYNTHIA CHRISTENSEN DIRECTOR-TREASURER 0 204499 0 45708 0 32187 0 42008 0 11569 0 335971 0 20000 JASON GAULT DIRECTOR & EMPLOYED PHYSIC-END 2015 228664 0 0 0 93688 0 4632 0 3613 0 330597 0 0 0 MATT WENZEL CEO - ENDING 8/2015 126567 103409 43893 0 17577 613 23663 4247 16532 9329 228232 117598 15200 0 JANET BUCKMAN CFO 183176 0 19655 0 1119 0 9300 0 9897 0 223147 0 0 0 CATHERINE HAMILTON CNO 125182 0 0 0 644 0 3274 0 22751 0 151851 0 0 0 STEVEN SCHIEBER CEO - BEGINNING 9/2015 45985 89883 0 0 383 367 1906 3710 6215 13288 54489 107248 0 0 CHRISTOPHER HULETT PHYSICIAN 351079 0 1692 0 252 0 10600 0 22985 0 386608 0 0 0 GREGORY MILLER PHYSICIAN 360091 0 1692 0 706 0 11925 0 22771 0 397185 0 0 0 YULIA PENISTON PHYSICIAN 275246 0 0 0 640 0 10600 0 25954 0 312440 0 0 0 JAMES PEPPERS PHYSICIAN 260833 0 1692 0 785 0 10600 0 23199 0 297109 0 0 0 ANDREA HUFFORD PHYSICIAN 293207 0 0 0 26171 0 10600 0 25732 0 355710 0 0 0 PART I, LINE 4A SEVERANCE PAYMENT: JASON GAULT - $92,615 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 & STEVEN SCHIEBER RECEIVED COMPENSATION FOR SERVICES RENDERED TO THE FILING AND RELATED ORGANIZATIONS. COMPENSATION REPORTED FOR BOARD MEMBERS IS FOR SERVICES AS EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED. DON SIPES COMPENSATION INCLUDES PAYOUT OF PREVIOUSLY DEFERRED COMPENSATION. 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 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. 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 & STEVEN SCHIEBER RECEIVED COMPENSATION FOR SERVICES RENDERED TO THE FILING AND RELATED ORGANIZATIONS. COMPENSATION REPORTED FOR BOARD MEMBERS IS FOR SERVICES AS EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED. FORM 990, PART IX, LINE 11G PHYSICIAN REMUNERATION: PROGRAM SERVICE EXPENSES 3,211,216. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,211,216. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 673,676. MANAGEMENT AND GENERAL EXPENSES 198,536. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 872,212. OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,966,267. MANAGEMENT AND GENERAL EXPENSES 205,193. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,171,460. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 821,049. MANAGEMENT AND GENERAL EXPENSES 277,666. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,098,715. FORM 990, PART XI, LINE 9: PENSION SETTLEMENT/LIABILITY TRANSFER TO SLHS -61,584. CHANGE IN INTEREST IN ASSETS OF FOUNDATION - SFAS 136 29,375. 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 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 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 SAINT LUKE'S HEALTH SYSTEM 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 SLCC INC 4330 WORNALL RD SUITE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SLNC INC 901 E 104TH ST KANSAS CITY MO 64131 451470888 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 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 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 INSURANCE 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.