2015-11-16T10:33:28-06:00 2014-12-31 990 2014-01-01 431735565 SAINT LUKE'S HOSPITAL OF CHILLICOTHE SAIN 6606461480 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 JANET BUCKMAN CHIEF FINANCIAL OFFICER 6606461480 2015-11-16 2014 2016-03-07 17:11:31Z HEDRICK MEDICAL CENTER STEVEN SCHIEBER 2799 N WASHINGTON STREET CHILLICOTHE MO 64601 47876595 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 2003 MO CRITICAL ACCESS HOSPITAL 11 6 366 69 0 0 175335 19189 41566576 47563346 250726 294060 0 0 41992637 47876595 28204 21102 0 0 18241178 19611580 0 0 35374 21258131 23962420 39527513 43595102 2465124 4281493 33364294 35990206 4925308 3181191 28438986 32809015 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 37519419 21102 47563346 SAINT LUKE'S HOSPITAL OF CHILLICOTHE D/B/A HEDRICK MEDICAL CENTER ("HMC") IS A LICENSED CRITICAL ACCESS HOSPITAL PROVIDING BOTH INPATIENT AND OUTPATIENT SERVICES. HMC IS LOCATED IN CHILLICOTHE (LIVINGSTON COUNTY), MISSOURI, APPROXIMATELY 90 MILES NORTHEAST OF KANSAS CITY. HEDRICK MEDICAL CENTER IS A FAITH-BASED, NOT-FOR-PROFIT COMMUNITY HOSPITAL COMMITTED TO THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE AND HEALTH RELATED SERVICES IN A CARING ENVIRONMENT. AS A MEMBER OF SAINT LUKE'S HEALTH SYSTEM, HMC IS DEDICATED TO ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF THE COMMUNITIES SERVED. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS CHARITY CARE POLICIES FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. IN ADDITION TO THE ACTIVE MEDICAL STAFF, HMC'S SPECIALTY CLINICS HOST MORE THAN 30 VISITING SPECIALISTS.THE HOSPITAL ALSO PROVIDES HEALTH RELATED ACTIVITIES AND SERVICES IN SUPPORT OF THE COMMUNITY, INCLUDING BUT NOT LIMITED TO SOCIAL WORK SERVICES, SPIRITUAL SERVICES, AND COMMUNITY EDUCATION / HEALTH FAIRS. 37519419 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 0 0 0 0 0 0 0 1 0 0 0 1 40 0 1 366 1 0 0 0 0 0 0 0 0 0 0 X 11 6 1 0 1 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 427605 61082 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 283104 0 30808 JANE NEAL DIRECTOR 1.00 X 0 0 0 CYNTHIA CHRISTENSEN DIRECTOR-TREASURER 1.00 50.00 X X 0 286410 45945 JASON GAULT DIRECTOR & EMPLOYED PHYSIC 40.00 X 313222 0 37004 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 9736 7594 0 LINDEN CHAPMAN DIR-THRU 5/2014; EMPLOYEE BEG 6/2014 32.00 X 25422 0 582 TERRY PLASTER ASSIST SECR & EMPLOYEE 40.00 X 48962 0 12091 MATT WENZEL CEO 40.00 X 269039 0 50561 JANET BUCKMAN CFO 40.00 X 190503 0 17893 CATHERINE HAMILTON CNO 40.00 X 119542 0 24393 CHRISTOPHER HULETT PHYSICIAN 40.00 X 246961 0 31593 GREGORY MILLER PHYSICIAN 40.00 X 315929 0 33629 YULIA PENISTON PHYSICIAN 40.00 X 275318 0 32224 JAMES SUCHSLAND PHYSICIAN 40.00 X 199486 0 15420 JAMES PEPPERS PHYSICIAN 40.00 X 247051 0 29628 2544275 721609 422853 19 0 1 0 EMS LLC 920 MAIN STREET SUITE 300 KANSAS CITY MO 64105 ER PHYSICIANS 1853808 GE HEALTHCARE P O BOX 96483 CHICAGO IL 60693 SERVICE CONTRACT 1003527 HAVE A NICE DAY ANESTHESIA ASSOCIATES 2106 WOODCREST CHILLICOTHE MO 64601 ANESTHESIA SERVICES 891660 CPSI PO BOX 850309 6600 WALL ST MOBILE AL 36685 SOFTWARE SERVICES 575062 SHARED MEDICAL SERVICES PO BOX 330 209 LIMESTONE PASS COTTAGE GROVE WI 53527 MEDICAL SERVICES 277900 8 10364 8825 19189 NET PATIENT REVENUE 622110 45970051 45970051 PHARMACY 622110 1145483 1145483 EHR MEANINGFUL USE FDS 622110 157243 157243 290569 290569 47563346 294060 294060 47876595 47563346 0 294060 X 21102 21102 1432860 673874 732983 26003 14127884 13281467 844499 1918 497389 446074 50423 892 2512891 2253636 254746 4509 1040556 933202 105487 1867 91760 91760 6861421 6008127 853294 6435 1463 4972 1338146 957295 380666 185 155753 93093 62660 2497369 2062975 434394 99849 80868 18981 56511 8899 47612 1423129 1140251 282878 338206 227112 111094 BAD DEBTS 4418026 4418026 MEDICAL SUPPLIES 4148827 4146033 2794 SHARED SERVICES-SLHS 2365000 708419 1656581 DUES & SUBSCRIPTIONS 116757 46263 70494 45231 11240 33991 43595102 37519419 6040309 35374 13157191 6641225 867708 869883 5764453 6138118 10439 0 449701 711351 155316 308354 10773236 4725209 3852705 6048027 10468322 8697357 2606299 65441 71385 343983 2127242 33364294 35990206 3545513 2516956 1379795 664235 4925308 3181191 X 28338986 32697240 100000 111775 28438986 32809015 33364294 35990206 X 4281493 155074 -66538 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 17149 0 0 0 17149 0 PART II-B, LINE 1: LINE F - PORTION OF DUES PAID TO VARIOUS HOSPITAL AND MEDICAL ASSOCIATIONS USED TOWARD LOBBYING ACTIVITIES. 0 1 158106 9882 148224 15065 274 14791 9219742 3516248 5703494 1380323 1198805 181518 6048027 STATE STREET INVESTMENTS 2606299 F 2606299 DUE FROM AFFILIATES 31264 BENEFICIAL INTEREST IN NET ASSETS OF FOUNDATION 111775 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 1170203 LONG-TERM DEPOSITS 814000 2127242 PAYABLES TO AFFILIATES 268647 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 395588 664235 X 43556290 155074 155074 43401216 4475379 4475379 47876595 39177076 0 39177076 4418026 4418026 43595102 PART X, LINE 2: THE MEDICAL CENTER IS A NOT-FOR-PROFIT CORPORATIONS 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, 2014, 2013, 2012 AND 2011, REMAIN SUBJECT TO EXAMINATION FOR BOTH FEDERAL AND STATE PURPOSES. PART XI, LINE 4B - OTHER ADJUSTMENTS: RRG SSA DIVIDEND 57,353. BAD DEBT NET WITH REVENUE FOR BOOKS; INCLUDED IN EXPENSES FOR TAX 4,418,026. PART XII, LINE 2D - OTHER ADJUSTMENTS: ROUNDING PART XII, LINE 4B - OTHER ADJUSTMENTS: BAD DEBT NET WITH REVENUE FOR BOOKS; INCLUDED IN EXPENSES FOR TAX 4,418,026. 1 1 X 1 X 133.000000000000 1 X 1 1 1 0 0 808928 808928 0.02060 6594641 6679114 -84473 0.00000 7403569 6679114 724455 0.02060 70642 70642 0.00180 21196 21196 0.00050 4964075 4281474 682601 0.01740 17712 450 17262 0.00040 5073625 4281924 791701 0.02010 12477194 10961038 1516156 0.04070 1503 1503 0.00000 1629 1629 0.00000 3132 3132 0 4418026 18261466 18446104 -184638 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 13 1 0 0 1 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1 13 1 WWW.SAINTLUKESHEALTHSYSTEM.ORG 0 0 1 X 133.000000000000 200.000000000000 X X 1 1 X X 1 X X X X X X X X 1 X 0 X X X X 1 X 0 0 HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 5: KEY COMMUNITY STAKEHOLDERS WERE CONTACTED EITHER IN-PERSON, OVER-THE-PHONE, OR DURING MONTHLY COMMUNITY WELLNESS COMMITTEE MEETINGS WITH HOSPITAL EXECUTIVES AND REPRESENTATIVES FROM COMMUNITY ORGANIZATIONS; THEY INCLUDE:EXECUTIVE LEADERS OF HEDRICK MEDICAL CENTERLIVINGSTON COUNTY HEALTH CENTERLIVINGSTON COUNTY COMMISSIONSALT (SIMPLY ACHIEVING LIFE'S TRIUMPHS) MEN'S HOMELESS SHELTERCHILLICOTHE FIRE DEPARTMENTRSVPYMCAFAMILY SUPPORT DIVISIONNORTH CENTRAL MISSOURI MENTAL HEALTHAREA AGENCY ON AGINGC2000FIRST STEPSSALT/ALCOHOLICS ANONYMOUSPREFERRED FAMILY HEALTHCARE, INC.UNIVERSITY OF MISSOURI EXTENSIONNORTH CENTRAL MISSOURI CHILDREN'S ADVOCACY CENTERCHILLICOTHE CORRECTIONAL CENTERACCESS IICHILLICOTHE HOUSING AUTHORITYPREFERRED FAMILY HEALTHCARESOCIAL SECURITY ADMINISTRATION 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.ADULT OBESITYHEDRICK MEDICAL CENTER IS CURRENTLY UTILIZING THE SERVICES OF AN ENDOCRINOLOGIST AND INCREASING THE AMOUNT OF PATIENTS SEEN THROUGH THE ENDOCRINOLOGY TELE-HEALTH CLINIC. HEDRICK MEDICAL CENTER ALSO OFFERS DIABETES CARE AT THE HEDRICK DIABETES CENTER, WHERE SPECIALISTS PROVIDE THE KNOWLEDGE TO GUIDE PATIENTS THROUGH EACH STEP OF DIABETES TREATMENT.ADULT SMOKINGHEDRICK MEDICAL CENTER TREATS PATIENTS WITH A VARIETY OF HEALTH CONCERNS THAT CAN BE LINKED TO SMOKING.PULMONOLOGY IS A SPECIALTY THAT MANAGES RESPIRATORY CONDITIONS INCLUDING THOSE RELATED TO SMOKING. HEDRICK MEDICAL CENTER OFFERS COMPREHENSIVE PULMONOLOGY SERVICES THAT INCLUDE DIAGNOSIS, TREATMENT, AND EVALUATION. ENHANCED EDUCATION AND RESOURCES ARE ALSO OFFERED TO PATIENTS WITH INCREASED INTEREST IN SMOKING CESSATION, INCLUDING SMOKING CESSATION COUNSELING.LACK OF ACCESS TO MENTAL HEALTH PROVIDERS AND SERVICESHEDRICK 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.CHILDREN IN POVERTYASIDE FROM PROVIDING MEDICAL CARE TO INDIGENT POPULATIONS IN LIVINGSTON COUNTY, HEDRICK MEDICAL CENTER ALSO PROVIDES COMMUNITY HEALTH IMPROVEMENT SERVICES, FINANCIAL AND IN-KIND CONTRIBUTIONS, AND COMMUNITY BENEFIT OPERATIONS. SUCH CONTRIBUTIONS ARE GIVEN TO PROGRAMS LIKE ROTARY SHOES FOR ORPHANS TO PROVIDE ADEQUATE FOOTWEAR FOR THOSE CHILDREN IN NEED OR THE YMCA TO PROVIDE SERVICES FOR CHILDREN SUCH AS BACKPACK BUDDIES.LACK OF PRIMARY CARE ACCESS AND PHYSICIANSA SHORTAGE OF PRIMARY CARE PHYSICIANS IS ALWAYS AN ISSUE IN RURAL AMERICA AND HEDRICK MEDICAL CENTER IS STRIVING TO IMPROVE THE ACCESS FOR COUNTY RESIDENTS. ONE SUCH WAY THAT HEDRICK IS ACHIEVING THIS IS BY INCREASING THE TELE-HEALTH SERVICES OFFERED AS WELL AS THE CAPACITY OF CERTAIN SPECIALTIES IN THE SPECIALTY CLINIC. ALSO, WE ARE EMPLOYING AN E-HOSPITALIST PROGRAM TO PROVIDE E-CONSULTS AND INCREASE THE NUMBER OF PATIENTS THAT WILL HAVE ACCESS TO A PRIMARY CARE PHYSICIAN. HEDRICK IS ALSO CONTINUALLY RECRUITING FAMILY PRACTICE PHYSICIANS AND NURSE PRACTITIONERS TO THE AREA TO PROVIDE INPATIENT CONSULTS. 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, 2014 AND THEREFORE IS DEEMED TO SATISFY THE REQUIREMENT TO ADOPT THE STRATEGY IN THE SAME YEAR THE CHNA WAS COMPLETED AND WIDELY AVAILABLE, 2013. PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 16A WEBSITE: WWW.SAINTLUKESHEALTHSYSTEM.ORG HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 16B WEBSITE: WWW.SAINTLUKESHEALTHSYSTEM.ORG HEDRICK MEDICAL CENTER PART V, SECTION B, LINE 16C WEBSITE: WWW.SAINTLUKESHEALTHSYSTEM.ORG 2 HEDRICK FAMILY CARE 2791 N WASHINGTON CHILLICOTHE MO 64601 RURAL HEALTH CLINIC 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 $ 4,418,026. 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 8,968, WHILE LIVINGSTON COUNTY (THE COUNTY WHERE THE HOSPITAL IS LOCATED) POPULATION IS 14,558. THE MEDIAN AGE IS 39.7 AND MEDIAN HOSEHOLD INCOME IS $32,793. PERSONS 65 YEARS OLD AND OVER MAKE UP 19% OF THE POPULATION WITH 23% OF THE POPULATION UNDER 18 YEARS OF AGE. PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSISTS OF 10 AREA HOSPITALS, 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 DON SIPES DIRECTOR-PRESIDENT 0 266388 0 43570 0 117647 0 41153 0 19929 0 488687 0 19120 DELOS CLOW DIRECTOR & EMPLOYED PHYSIC 235729 0 45000 0 2375 0 13000 0 17808 0 313912 0 0 0 CYNTHIA CHRISTENSEN DIRECTOR-TREASURER 0 201500 0 33920 0 50990 0 41200 0 4745 0 332355 0 19300 JASON GAULT DIRECTOR & EMPLOYED PHYSIC 267311 0 45000 0 911 0 10400 0 26604 0 350226 0 0 0 MATT WENZEL CEO 190387 0 32224 0 46428 0 27372 0 23189 0 319600 0 14000 0 JANET BUCKMAN CFO 171000 0 18586 0 917 0 7756 0 10137 0 208396 0 0 0 CHRISTOPHER HULETT PHYSICIAN 220823 0 26000 0 138 0 9847 0 21746 0 278554 0 0 0 GREGORY MILLER PHYSICIAN 273702 0 31000 0 11227 0 11700 0 21929 0 349558 0 0 0 YULIA PENISTON PHYSICIAN 234653 0 40000 0 665 0 10400 0 21824 0 307542 0 0 0 JAMES SUCHSLAND PHYSICIAN 177956 0 20000 0 1530 0 7979 0 7441 0 214906 0 0 0 JAMES PEPPERS PHYSICIAN 234231 0 12000 0 820 0 5080 0 24548 0 276679 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 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. COMPENSATION REPORTED FOR BOARD MEMBERS IS FOR SERVICES AS EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. BOARD MEMBERS ARE NOT COMPENSATED. 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 4 THE ORGANIZATION AMENDED AND UPDATED SELECTED PROVISIONS OF ITS ARTICLES AND BYLAWS AT THE END OF 2014. THE CHANGES FORMALIZED ADDITIONAL RESERVE POWERS FOR THE SOLE MEMBER, UPDATED BOARD MEMBER QUALIFICATIONS TO BE CONSISTENT WITH SYSTEM STANDARDS, CLARIFIED OBLIGATIONS TO CARRY OUT POLICIES AND ORDERS OF THE SOLE MEMBER, UPDATED AND ALIGNED CEO AUTHORITY AND DUTIES, CLARIFIED MEDICAL STAFF RESPONSIBILITIES TO THE BOARD AS TO PATIENT CARE PROVIDED WITHIN THE HOSPITAL, AND STANDARDIZED CERTAIN PROVISIONS ACROSS SYSTEM HOSPITALS WITH THE GOAL OF BETTER FACILITATING OPERATIONS AS AN ALIGNED AND INTEGRATED HEALTH SYSTEM. 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. THE 990 DRAFT WAS ALSO MADE AVAILABLE TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS PRIOR TO FILING. THE 990 IS 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. 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 3,080,021. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,080,021. SERVICE CONTRACTS: PROGRAM SERVICE EXPENSES 395,915. MANAGEMENT AND GENERAL EXPENSES 183,812. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 579,727. OTHER SERVICES: PROGRAM SERVICE EXPENSES 1,693,677. MANAGEMENT AND GENERAL EXPENSES 389,357. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,083,034. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 838,514. MANAGEMENT AND GENERAL EXPENSES 280,125. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,118,639. FORM 990, PART XI, LINE 9: PENSION SETTLEMENT/LIABILITY TRANSFER TO SLHS -120,960. ROUNDING CHANGE IN INTEREST IN ASSETS OF FOUNDATION - SFAS 136 111,775. RRG SSA DIVIDEND ALLOCATION -57,353. PART V, LINE 1A, NUMBER REPORTED IN BOX 3 OF FORM 1096 HEDRICK MEDICAL CENTER (HMC) IS PART OF SAINT LUKE'S HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM. THE MAJORITY OF HMC VENDORS ARE PAID THROUGH A CENTRALIZED PAYMENT SYSTEM WITH 1099S ISSUED BY THE CENTRALIZED SERVICE ENTITY. ST LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 HEALTH CARE MO 501(C)(3) 170B1AIII 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) 509(A)(3) - TYPE 1 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 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 1 SAINT LUKE'S HEALTH SYSTEM 0 MEDICAL PLAZA IMAGING ASSOCIATES LLC 4401 WORNALL ROAD KANSAS CITY MO 64111 431609584 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKE'S HEALTH SYSTEM 0 SAINT LUKE'S COLLEGE OF HEALTH SCIENCES 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 901 E 104TH ST KANSAS CITY MO 64131 454725529 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 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 1 1 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.