2016-11-15T10:27:53-06:00 2015-12-31 990 2015-01-01 431707306 ST LUKES OF TRENTON STLU 6603595621 191 IOWA BLVD TRENTON MO 64683 JANET BUCKMAN CHIEF FINANCIAL OFFICER 6603595621 2016-11-15 2015 2017-02-10 21:41:12Z WRIGHT MEMORIAL HOSPITAL GARY JORDAN 191 IOWA BLVD TRENTON MO 64683 30328020 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1995 MO CRITICAL ACCESS HOSPITAL 10 8 227 22 0 0 50604 150640 29107135 30165717 31105 11663 0 0 29188844 30328020 6201 5899 0 0 11943407 12875318 0 0 71937 16588678 17464907 28538286 30346124 650558 -18104 11868810 13416646 3351541 5021099 8517269 8395547 X WRIGHT MEMORIAL 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 25407636 5899 30165717 SAINT LUKE'S HOSPITAL OF TRENTON OPERATES AN ACUTE CARE HOSPITAL IN RURAL MISSOURI AND IS DESIGNATED BY THE STATE OF MISSOURI AND MEDICARE AS A CRITICAL ACCESS HOSPITAL. THE HOSPITAL IS DEDICATED TO PROVIDING BOTH SERVICES AND LEADERSHIP IN CARING FOR THE NEEDY. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS A FINANCIAL ASSISTANE POLICY FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. THE HOSPITAL ENCOURAGES PHYSICIANS PRACTICING IN SPECIALTY AREAS TO PROVIDE SERVICES TO THE HOSPITAL'S RURAL PATIENTS WHO OTHERWISE WOULD HAVE DIFFICULTY ACCESSING SUCH SPECIALTY SERVICES. THE HOSPITAL CONDUCTS COMMUNITY EDUCATION AND OUTREACH SERVICES INCLUDING FREE SEMINARS FOR HEALTHCARE PROFESSIONALS AND STUDENTS. IN ADDITION, THE HOSPITAL PROVIDED CLINICS, SCREENINGS, SUPPORT GROUPS, SOCIAL WORKS SERVICES AND PARTICIPATED IN CHARITABLE EVENTS AND SPONSORSHIPS. 25407636 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 1 0 0 0 0 0 0 0 0 0 1 0 0 0 1 26 0 1 227 1 0 0 0 0 0 0 0 0 0 0 X 10 8 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X THE ORGANIZATION 6603595621 191 IOWA BLVD TRENTON MO 64683 X DON SIPES PRESIDENT-DIRECTOR 1.00 50.00 X X 0 622712 41838 WENDELL LENHART CHAIRMAN-DIRECTOR 1.00 X X 0 0 0 BEV HOOKER SECRETARY-DIRECTOR 1.00 X X 0 0 0 CHARLES ROBB TREASURER-DIRECTOR 1.00 50.00 X X 0 786858 291922 SCOTT WILSON DIRECTOR 1.00 X 0 0 0 BONITA PRICE DIRECTOR 1.00 X 0 0 0 MACK WOODARD VICE CHAIR-DIRECTOR 1.00 X X 0 0 0 DANETTE RARDON DIRECTOR 1.00 X 0 0 0 TOM WITTEN DIRECTOR 1.00 X 0 0 0 DWIGHT GRIFFIN DIRECTOR 1.00 X 0 0 0 ELAINA HEAD ASSISTANT SECRETARY 40.00 X 55891 0 20691 GARY JORDAN CEO 40.00 X 269285 0 54087 BARBARA BALL CNO 40.00 X 129548 0 24020 JANET BUCKMAN CFO 20.00 20.00 X 0 203950 19197 PAMELA RALLS PHYSICIAN 40.00 X 346279 0 28765 GEORGE GARCIA PHYSICIAN 40.00 X 148418 0 4153 ESGAR GUARIN-NIETO PHYSICIAN 40.00 X 244682 0 5821 AARON HUFFSTUTTER ADV PRACTICE RN 40.00 X 153496 0 21204 JENNIFER BOWE PHYSICIAN 40.00 X 260354 0 28995 1607953 1613520 540693 10 0 1 0 DOCS WHO CARE 1337 SOUTH FOUNTAIN DRIVE OLATHE KS 66061 EMERGENCY DEPT PHYSICIANS 1368746 HAVE A NICE DAY ANESTHESIA ASSOCIATES L 2106 WOODCREST DR CHILLICOTHE MO 64601 ANESTHESIA SERVICES 570000 FAVORITE HEALTHCARE STAFFING PO BOX 803356 KANSAS CITY MO 64180 CONTRACTED PHYSICIANS 211643 JACKSON & COKER LOCUM TENENS PO BOX 277638 ATLANTA GA 30384 CONTRACTED PHYSICIANS 202583 SHARED MEDICAL SERVICES INC PO BOX 330 COTTAGE GROVE WI 53527 MRI PATIENT SERVICES 189350 6 13149 137491 150640 NET PATIENT REVENUE 622110 29432808 29432808 PHARMACY 622110 596934 596934 135975 135975 30165717 11663 11663 30328020 30165717 0 11663 X 5899 5899 553521 553521 9434030 8499727 894420 39883 234510 199575 33998 937 1986374 1690468 287974 7932 666883 567539 96681 2663 11538 11538 60542 60542 5109453 4788478 300960 20015 2471 501 1970 867181 653036 213798 347 259388 165214 94174 3177082 2759467 417615 36598 20131 16307 160 35326 35326 945470 600135 345335 235690 118612 117078 MEDICAL SUPPLIES 2507217 2501710 5507 BAD DEBTS 2232838 2232838 SHARED SERVICES - SLHS 1881824 522370 1359454 102289 81936 20353 30346124 25407636 4866551 71937 2069458 3563533 3902237 4510775 58895 44442 403436 453170 429988 361750 7356201 4588953 2808133 2767248 18750 26857 2177913 1688871 11868810 13416646 1578212 2081907 1773329 2939192 3351541 5021099 X 8152581 8098852 364688 296695 8517269 8395547 11868810 13416646 X -18104 -103618 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 21325 0 0 0 21325 0 PART II-B, LINE 1: LINE F - PORTION OF DUES PAID TO VARIOUS HOSPITAL AND RELATED MEDICAL ASSOCIATIONS USED TOWARD LOBBYING ACTIVITIES. 56611 5210 61821 50271 7495 1155 56611 1 106053 20518 85535 5003396 2898423 2104973 2246752 1670012 576740 2767248 BENEFICIAL INTEREST IN NET ASSETS OF WMH FOUNDATION 296694 DUE FROM AFFILIATES 27883 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 1286411 OTHER RECEIVABLES 77883 1688871 DUE TO CHARITABLE TRUST 1370359 DUE TO AFFILIATES 150221 ESTIMATED THIRD-PARTY PAYOR SETTLEMENT 1418612 2939192 X 27919923 0 27919923 2408097 2408097 30328020 28075519 0 28075519 2270605 2270605 30346124 PART V, LINE 4: THE INTENDED USE OF ENDOWMENT FUNDS INCLUDES BUT IS NOT LIMITED TO THE GENERAL OPERATIONS OF THE HOSPITAL, CAPITAL EQUIPMENT PURCHASES FOR THE HOSPITAL, AND LOCAL HOME CARE AND HOSPICE SERVICES. THE ASSETS HELD AT THE UNRELATED ORGANIZATION REPRESENT THE ORGANIZATION'S BENEFICIAL INTEREST IN THE NET ASSETS AT WRIGHT MEMORIAL HOSPITAL FOUNDATION. SUCH ASSETS ARE REPORTED IN PART X, LINE 15. 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 NET WITH REVENUE FOR BOOKS; INCLUDED IN EXPENSES FOR TAX 2,232,838. PENSION SETTLEMENT EXP IN OTHER INCOME FOR BOOKS 37,767. CONTRIBUTION REVENUE INCLUDED IN OTHER CHANGES IN FUN BALANCE FOR BOOKS 137,491. ROUNDING 1. PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH REVENUE FOR BOOKS; INCLUDED IN EXPENSES FOR TAX 2,232,838. PENSION SETTLEMENT EXP IN OTHER INCOME FOR BOOKS 37,767. 1 1 X 1 X 133.000000000000 1 X 1 1 0 0 302012 302012 0.01070 4431375 4336360 95015 0.00340 4733387 4336360 397027 0.01410 131 131 0.00000 9539503 7461686 2077817 0.07390 5398 5398 0.00020 9545032 7461686 2083346 0.07410 14278419 11798046 2480373 0.08820 0 2232838 13606105 13805799 -199694 X 1 1 1 1 WRIGHT MEMORIAL HOSPITAL 191 IOWA BLVD TRENTON MO 64683 413-19 X X X X ST LUKES OF TRENTON 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 ST LUKES OF TRENTON PART V, SECTION B, LINE 5: MULTIPLE INTERVIEWS WERE CONDUCTED WITH HOSPITAL LEADERSHIP AND COMMUNITY STAKEHOLDERS TO BETTER UNDERSTAND THE NEEDS IN THE COMMUNITY. STAKEHOLDERS WERE CHOSEN TO REPRESENT BROAD INTERESTS OF THE COMMUNITY, INCLUDING UNDERSERVED POPULATIONS. STAKEHOLDERS PROVIDED INFORMATION, WHICH WAS USED TO HELP IDENTIFY AND PRIORITIZE COMMUNITY NEEDS. KEY CONTRIBUTORS WERE HOSPITAL LEADERSHIP AND INDIVIDUALS FROM THE GRUNDY COUNTY HEALTH DEPARTMENT. ST LUKES OF TRENTON PART V, SECTION B, LINE 11: THE COMMUNITY HEALTH NEEDS ASSESSMENT IDENTIFIED FOUR PRIORITY HEALTH NEEDS:1. IMPROVED ACCESS TO CARE:THE HOSPITAL WILL CONTINUE TO ACCEPT MISSOURI MEDICAID. THE HOSPITAL IS A MEMBER OF SAINT LUKE'S HEALTH SYSTEM. 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.THE HOSPITAL OPENED A NEW FACILITY IN 2011. THE NEW HOSPITAL FACILITY HAS ALLOWED THE HOSPITAL TO PROVIDE EXPANDED SERVICES FOR PATIENTS AND ATTRACT NEW HEALTH CARE PROFESSIONALS TO THE COMMUNITY.THE HOSPITAL HAS WORKED TO CONNECT PATIENTS WITH THE REGION'S MOST RESPECTED AND HIGHLY TRAINED PHYSICIANS. 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. THE HOSPITAL HAS ALSO RECENTLY ENHANCED ACCESS TO HEALTH CARE SERVICES FOR THE COMMUNITY BY OPENING A WEEKEND CLINIC THAT PROVIDES PRIMARY CARE SERVICES ON SATURDAYS AND SUNDAYS. 2. INCREASED ACCESS TO PHYSICAL ACTIVITY AND NUTRITION:THE HOSPITAL OFFERS NUTRITION COUNSELING THROUGH AN ON-SITE DIETITIAN, PROVIDING EDUCATION ON NUTRITION AND HEALTHY EATING STRATEGIES TO COMMUNITY MEMBERS YEAR ROUND. THE HOSPITAL WORKS TO PROVIDE HEALTHY MEAL OPTIONS FOR EMPLOYEES, PATIENTS, AND VISITORS FROM THE COMMUNITY, AND ENCOURAGES EMPLOYEE PARTICIPATION IN WEIGHT LOSS AND WELLNESS CHALLENGES THROUGHOUT THE YEAR.THE HOSPITAL IS ENGAGED IN SEVERAL COMMUNITY HEALTH PROGRAMS AIMED AT ADDRESSING OBESITY. THE HOSPITAL CONTINUES TO SUPPORT COMMUNITY RECREATIONAL EVENTS SUCH AS THE ANNUAL WRIGHT MEMORIAL HOSPITAL FOUNDATION 10K/5K RACE. IT ALSO WORKS TO SUPPORT RECREATIONAL ORGANIZATIONS SUCH AS THE GREEN HILLS RECREATION ASSOCIATION AND THE TRENTON PARKS SYSTEM.GOING FORWARD, THE HOSPITAL 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:TRENTON RESIDENTS HAVE ACCESS TO BEHAVIORAL HEALTH CARE THROUGH THE HOSPITAL'S EHEALTH TELEMEDICINE PROGRAM. THE MENTAL HEALTH TEAM UTILIZED BY THE TELEMEDICINE PROGRAM HAS THE TRAINING AND EXPERTISE TO ADDRESS ISSUES SUCH AS: DEPRESSION; STRESS; LIFE TRANSITIONS; FAMILY PROBLEMS; CRISIS; GRIEF AND LOSS; MENTAL ILLNESS; TRAUMA-RELATED ISSUES; ANXIETY/PANIC DISORDERS; AND DUAL-DIAGNOSIS TREATMENT.THE HOSPITAL WILL CONTINUE TO OFFER A RANGE OF BEHAVIORAL HEALTH SERVICES, INCLUDING SPECIALIST AND TELEHEALTH SERVICES. THE HOSPITAL WILL ALSO CONTINUE TO WORK WITH COMMUNITY PARTNERS SUCH AS THE GRUNDY COUNTY HEALTH DEPARTMENT TO ADDRESS THIS ONGOING NEED.4. SMOKING CESSATION:THE HOSPITAL IS A NON-SMOKING CAMPUS. THE HOSPITAL SUPPORTS COMMUNITY EFFORTS TO CREATE NON-SMOKING INITIATIVES IN PUBLIC PLACES. THE HOSPITAL IS WORKING TO INTEGRATE SMOKING CESSATION PROGRAMS INTO PATIENT CARE, AND WORK TOWARD BETTER OUTCOMES FOR ALL SMOKING RELATED DISEASES.THERE ARE NO NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT THAT ARE NOT BEING ADDRESSED. ST LUKES OF TRENTON 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 ELIGIBILITY ENROLLMENT SERVICE ALSO PROVIDES PATIENTS WITH INFORMATION ON FINANCIAL ASSISTANCE. ST LUKES OF TRENTON 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. 1 1 - WRIGHT MEMORIAL PHYSICIANS GROUP 189 IOWA BLVD TRENTON MO 64683 RURAL HEALTH CLINIC PART I, LINE 7: COST OF CHARITY CARE AND UNREIMBURSED HEALTH SERVICES WERE CALCULATED USING THE APPROPRIATE COST TO CHARGE RATIO. 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 $ 2,232,838. PART II, COMMUNITY BUILDING ACTIVITIES: OUR HOSPITAL SPONSORS OR PARTICIPATES IN MANY COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEATH OF OUR COMMUNITY. THE HOSPITAL PARTICIPATES IN EDUCATIONAL OFFERINGS AND SPONSORS MULTIPLE COMMUNITY EVENTS TO BENEFIT VARIOUS COMMUNITY ORGANIZATIONS. WE ALSO ENCOURAGE OUR EMPLOYEES TO SERVE ON COMMUNITY BOARDS AND VOLUNTEER FOR ACTIVITIES THAT PROMOTE HEALTH IN THE COMMUNITY. 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: SEE PAGE 8, NOTE A, SECTION 2 OF THE ATTACHED FINANCIALS STATEMENTS.BAD DEBT IS REPORTED IN THIS FORM 990 CONSISTENT WITH FINANCIAL STATEMENTS. 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: IN ADDITION TO ITS CHNA, THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, ANNUAL STRATEGIC PLANNING PROCESS. THE HOSPITAL MEETS WITH STAFF, VOLUNTEERS, PATIENTS, BOARD MEMBERS AND PHYSICIANS. THE HOSPITAL ALSO WORKS WITH THE PATIENT ADVOCATE AND MARKETING DEPARTMENTS TO DETERMINE FEEDBACK RECEIVED FROM THE COMMUNITY REGARDING ITS NEEDS. THE FEEDBACK PROVIDED BY THESE GROUPS IS COMMUNICATED TO HOSPITAL MANAGEMENT AND CONSIDERED WHEN DETERMINING THE NEEDS OF THE COMMUNITY. PART VI, LINE 3: SEE RESPONSE TO SCHEDULE H, PART V, LINE 16I. PART VI, LINE 4: WRIGHT MEMORIAL HOSPITAL IS LOCATED IN GRUNDY COUNTY, MISSOURI IN THE NORTHWEST AREA OF MISSOURI. THE HOSPITAL'S PRIMARY SERVICE AREA IS THE IMMEDIATE COUNTY AND ALL CONTIGUOUS SURROUNDING COUNTIES. PART VI, LINE 5: THE BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROFESSIONALS, ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA, PLUS TWO REPRESENTATIVES OF SAINT LUKE'S HEALTH SYSTEM. MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. 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 1 0 0 0 0 0 1 0 DON SIPES PRESIDENT-DIRECTOR 0 271642 0 60644 0 290426 0 21200 0 20638 0 664550 0 263905 CHARLES ROBB TREASURER-DIRECTOR 0 520664 0 144099 0 122095 0 262023 0 29899 0 1078780 0 100882 GARY JORDAN CEO 204395 0 45023 0 19867 0 26997 0 27090 0 323372 0 15760 0 BARBARA BALL CNO 128563 0 0 0 985 0 5985 0 18035 0 153568 0 0 0 JANET BUCKMAN CFO 0 183176 0 19655 0 1119 0 9300 0 9897 0 223147 0 0 PAMELA RALLS PHYSICIAN 345726 0 0 0 553 0 10600 0 18165 0 375044 0 0 0 GEORGE GARCIA PHYSICIAN 148220 0 0 0 198 0 2980 0 1173 0 152571 0 0 0 ESGAR GUARIN-NIETO PHYSICIAN 244053 0 0 0 629 0 1878 0 3943 0 250503 0 0 0 AARON HUFFSTUTTER ADV PRACTICE RN 136789 0 0 0 16707 0 5948 0 15256 0 174700 0 0 0 JENNIFER BOWE PHYSICIAN 259444 0 0 0 910 0 10471 0 18524 0 289349 0 0 0 PART I, LINE 4B 457(F) PLAN PARTICIPANT AND AMOUNT INCLUDED IN COLUMN C FOR THE PLAN: CHARLES ROBB - $135,093 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. 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 DATA. PART II DON SIPES AND CHARLES ROBB 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. JANET BUCKMAN RECEIVED COMPENSATION FOR SERVICES RENDERED TO THE FILING AND RELATED ORGANIZATIONS. DON SIPES COMPENSATION INCLUDES PAYOUT OF PREVIOUSLY DEFERRED COMPENSATION. AARON HUFFSTUTTER HIGHLY COMPENSATED EMPLOYEE BUYOUT OF NON-COMPETE X 75000 44442 0 0 1 44442 0 FORM 990, PART VI, SECTION A, LINE 2 DANETTE RARDON, BONITA PRICE, AND DWIGHT GRIFFIN HAVE A BUSINESS RELATIONSHIP. DON SIPES AND CHARLES ROBB 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 DATA. 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 STATEMENTS 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, COLUMN E DON SIPES AND CHARLES ROBB 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. JANET BUCKMAN RECEIVED COMPENSATION FOR SERVICES RENDERED TO THE FILING AND RELATED ORGANIZATIONS. DON SIPES COMPENSATION INCLUDES PAYOUT OF PREVIOUSLY DEFERRED COMPENSATION. FORM 990, PART IX, LINE 11G PURCHASED SERVICES & OTHER: PROGRAM SERVICE EXPENSES 2,326,665. MANAGEMENT AND GENERAL EXPENSES 290,267. FUNDRAISING EXPENSES 20,015. TOTAL EXPENSES 2,636,947. REPAIRS & MAINTENANCE: PROGRAM SERVICE EXPENSES 181,480. MANAGEMENT AND GENERAL EXPENSES 10,693. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 192,173. PHYSICIAN FEES: PROGRAM SERVICE EXPENSES 2,280,333. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,280,333. FORM 990, PART XI, LINE 9: CHANGE IN NET ASSETS AT WMH FOUNDATION - SFAS 136 69,498. PENSION SETTLEMENT/LIABILITY TRANSFER TO SLHS -35,625. RESTRICTED NET ASSETS ADJUSTED FOR CONTRIBUTION FROM WMH FOUNDATION -137,491. SAINT LUKES HEALTH SYSTEM 901 E 104TH ST KANSAS CITY MO 64131 431747502 HEALTH SYSTEM KS 501(C)(3) 509A3 - TYPE III, FI 0 ST LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES NORTHLAND HOSPITAL CORPORATION 601 SOUTH 169 HIGHWAY SMITHVILLE MO 64089 440565393 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES SOUTH HOSPITAL INC 12300 METCALF AVENUE OVERLAND PARK KS 66213 481203262 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES EAST HOSPITAL 100 NE SAINT LUKES BLVD LEES SUMMIT MO 64086 562488077 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES MEDICAL GROUP 901 E 104TH ST KANSAS CITY MO 64131 431598353 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 CRITTENTON 10918 ELM AVE KANSAS CITY MO 64134 440545808 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES HEALTH SYSTEM HOMECARE AND HOSPICE 3100 BROADWAY SUITE 1000 KANSAS CITY MO 64111 431127200 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES HOSPITAL OF GARNETT 421 SOUTH MAPLE GARNETT KS 66032 742849611 HEALTH CARE KS 501(C)(3) 170B1AVI SAINT LUKES HEALTH SYSTEM 0 CABOT WESTSIDE HEALTH CENTER 901 E 104TH ST KANSAS CITY MO 64131 440546280 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 MIDWEST EAR INSTITUTEINC 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 HOSPITAL OF CHILLICOTHE 2799 N WASHINGTON CHILLICOTHE MO 64601 431735565 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES CUSHING HOSPITAL 711 MARSHALL LEAVENWORTH KS 66048 480543792 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES CARE 901 E 104TH ST KANSAS CITY MO 64131 260185090 HEALTH CARE MO 501(C)(3) 509(A)(3) - TYPE II SAINT LUKES HEALTH SYSTEM 0 MEDICAL PLAZA IMAGING ASSOCIATES LLC 4401 WORNALL ROAD KANSAS CITY MO 64111 431609584 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES 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 STE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SLNC INC 901 E 104TH ST KANSAS CITY MO 64131 451470888 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 ADVANCED UROLOGIC ASSOCIATES INC 901 E 104TH ST KANSAS CITY MO 64131 454725529 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 ROCKHILL ORTHOPAEDIC SPECIALISTS INC 901 E 104TH ST KANSAS CITY MO 64131 453851008 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL ROAD SUITE 714 KANSAS CITY MO 64111 431357824 OWN & OPERATE MEDICAL OFFICE BUILDING MO N/A SAINT LUKES SURGICENTER-LEES SUMMIT LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 470853481 HEALTH CARE MO N/A SAINT LUKES SOUTH SURGERY CENTER LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 201721929 HEALTH CARE KS N/A SAINT LUKES - GI DIAGNOSTICS LLC 4321 WASHINGTON STE 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 LUKES HEALTH SYSTEM RISK RETENTION GROUP 901 E 104TH ST KANSAS CITY MO 64131 371471890 INSURANCE SC N/A C 0 ST LUKES HEALTH VENTURESINC 901 E 104TH ST KANSAS CITY MO 64131 431278476 ACCOUNTING MO N/A C 0 MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL ROAD SUITE 714 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A C 0 VENTURE FINANCIAL SERVICES INC 9500 E 63RD ST STE 202 KANSAS CITY MO 64133 431605740 COLLECTIONS MO N/A C 0 SAINT LUKES HEALTH SYSTEM INSURANCE LTD 113 SOUTH CHURCH STREET GEORGETOWN CJ INSURANCE CJ N/A C 0 0 0 0 0 0 0 0 0 0 0 0 1 1 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.