2014-02-15T12:09:19-06:00 2013-03-31 450250958 EIDE BAILLY LLP 800 NICOLLET MALL STE 1300 MINNEAPOLIS MN 554027033 990 2012-04-01 810241755 ST JOHN'S LUTHERAN HOSPITAL INC STJO 4062837000 350 LOUISIANA AVENUE LIBBY MT 59923 BRUCE WHITFIELD 4062837000 2014-02-13 1 KIM HUNWARDSEN CPA P00484560 6122536500 2014-02-13 2012 2015-11-30 17:44:51Z BRUCE WHITFIELD 350 LOUISIANA AVENUE LIBBY MT 59923 30867231 0 X WWW.SJLH.ORG X 1952 MT HEALTHCARE SERVICES. 9 7 280 50 0 0 653219 1564175 28124276 28050520 219827 18525 59815 -9659 29057137 29623561 6990 7137 0 0 16380605 16428466 0 0 199806 11789935 10680684 28177530 27116287 879607 2507274 24457269 33993775 4470720 12722982 19986549 21270793 X TO PROVIDE EXCELLENT HEALTH CARE CLOSE TO HOME BY BEING A GREAT PLACE FOR EMPLOYEES TO WORK, PHYSICIANS TO PRACTICE MEDICINE, AND PATIENTS TO RECEIVE CARE. 1 0 21540855 7137 28050520 IN FISCAL YEAR 2013, ST. JOHN'S HOSPITAL PROVIDED SERVICE TO NEARLY 10,605 PATIENTS, MANY OF WHOM ARE UNINSURED/UNDERINSURED AND DO NOT HAVE AN ESTABLISHED PATIENT RELATIONSHIP WITH LOCAL PROVIDERS. THE TOTAL NUMBER OF ADJUSTED PATIENT DAYS AMOUNTED TO 11,509 FOR FISCAL YEAR 2013. THE PROGRAM SERVICES RANGE ANYWHERE FROM ROUTINE INPATIENT SERVICES TO HOME HEALTH TO CARDIAC REHAB, JUST TO NAME A FEW. ALL THESE SERVICES ARE PROVIDED TO A COMMUNITY THAT IS REMOTE IN LOCATION AND OFTEN CONSIDERED UNINSURED OR UNDERINSURED. IN ADDITION, SOME OF THE MAJOR PROGRAMS OFFERED BY THE HOSPITAL INCLUDE EMERGENCY SERVICES, SURGERY, AND PHYSICAL THERAPY. AS A SMALL CRITICAL ACCESS HOSPITAL MORE THAN 90 MILES AWAY FROM THE NEAREST EMERGENCY SERVICES, ST. JOHN'S LUTHERAN HOSPITAL RECOGNIZES THE NEED FOR AROUND THE CLOCK SERVICE AS IT RELATES TO EMERGENCY CARE. THAT IS WHY ST. JOHN'S OPERATES A 24/7 ER DEPARTMENT. DUE TO THE REMOTE LOCATION OF LINCOLN COUNTY, SURGERY IS A VERY IMPORTANT SERVICE FOR THE RESIDENTS OF LINCOLN COUNTY. IT IS NOT PRACTICAL OR ECONOMICAL TO EXPECT THAT PATIENTS MAKE THE 90-MILE TRIP TO KALISPELL FOR THIS SERVICE. THIS IS WHY ST. JOHN'S IS COMMITTED TO PROVIDING SURGICAL SERVICE FOR GENERAL, ORTHOPEDIC, OB/GYN, AND UROLOGY. NEARLY 1,075 SURGERIES WERE PERFORMED AS A RESULT OF THIS SERVICE.PHYSICAL THERAPY SERVICES OFFERED TO RESIDENTS OF LINCOLN COUNTY ENABLE PATIENTS TO RECEIVE SERVICE CLOSE TO HOME WHEN THEY ARE ALREADY STRUGGLING WITH PHYSICAL LIMITATIONS. OUR THERAPY STAFF ARE ABLE TO MAXIMIZE THE PATIENT'S LIMITATIONS FOR THERAPY AND ASSURE THAT THEY ARE ON A WELL-DESIGNED PROGRAM OF RECOVERY. OVER 2,100 PATIENTS WERE CARED FOR IN THIS PROGRAM DURING THE FISCAL YEAR 2013. 21540855 1 1 0 0 0 0 0 0 1 0 1 0 0 1 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 0 0 1 42 0 1 280 1 0 0 0 0 0 0 0 0 0 0 X 9 7 0 1 0 0 0 0 0 1 0 0 0 1 1 1 1 1 1 1 1 0 X GAYL SMITH CONTROLLER 4062837139 350 LOUISIANA AVENUE LIBBY MT 59923 STEVE SORENSON OD 1.00 0.00 X X 0 0 0 JOHN KONZEN 1.00 0.00 X X 0 0 0 SARAH DINNING 1.00 0.00 X X 0 0 0 RUSS BARNES 1.00 0.00 X 0 0 0 KERRY BEASLEY 1.00 0.00 X 0 0 0 KATHY NELSON 1.00 0.00 X 0 0 0 CHARI LUCAS 1.00 0.00 X 0 0 0 BOB CASTANEDA 1.00 0.00 X 0 0 0 JAY MALONEY MD 36.00 0.00 X 205332 0 31148 ANNE CAMBER MD 40.00 0.00 X 269862 0 27780 BRUCE WHITFIELD 40.00 1.00 X 0 0 0 JOHN SCHWARTZ 40.00 1.00 X 0 0 0 STEVEN CHAVEZ 40.00 0.00 X 69759 0 7453 LOREN JACOBSON 40.00 0.00 X 0 0 0 GAYL SMITH 40.00 0.00 X 87611 0 20550 JOSHUA URVATER 40.00 0.00 X 405424 0 17920 MARK SERRA 36.00 0.00 X 287465 0 19499 BRIAN BARSTAD 36.00 0.00 X 241762 0 28126 RAYMOND ZURCHER 36.00 0.00 X 173118 0 16754 NICOLLE BENZ 36.00 0.00 X 151312 0 10939 BILL PATTEN 0.00 0.00 X 218935 0 4072 2110580 0 184241 18 1 1 0 KALISPELL REGIONAL MEDICAL CENTER 310 SUNNYVIEW LANE KALISPELL MT 59901 SOFTWARE SUPPORT/MGMT 710936 CARDINAL HEALTH PHARMACY 21377 NETWORK PLACE CHICAGO IL 60673 MANAGEMENT SERVICES 330652 PAML LLC PO BOX 2720 SPOKANE WA 992204002 LABORATORY SERVICES 121338 3 1481765 82410 1564175 NET PATIENT SERVICE REVENUE 622110 27422777 27422777 OTHER REVENUE 900099 518235 518235 CAFETERIA 722210 93003 93003 AUXILIARY REVENUE 900099 16505 16505 28050520 67670 67670 88361 98020 -9659 -9659 -9659 1096505 1145650 -49145 -49145 -49145 29623561 28050520 0 8866 6719 6719 418 418 719496 719496 542769 542769 11752771 9613466 2021470 117835 418865 353125 61645 4095 2139675 1710808 409027 19840 854890 669603 176784 8503 330652 330652 18534 18534 42950 42950 1983745 1329472 649253 5020 52868 52828 40 384497 261829 112876 9792 283069 151479 131590 232097 194220 37877 2931 2931 81331 81331 1069994 1069994 352284 352284 MEDICAL SUPPLIES 2191361 2179558 11803 BAD DEBTS 1726322 1726322 REPAIRS AND MAINTENANCE 955570 695104 260429 37 LICENSES AND TAXES 176370 26649 149721 796109 678668 82797 34644 27116287 21540855 5375626 199806 1322522 4622598 4582442 4728409 4861 18750 606414 576113 528886 667518 31062577 13244694 9649097 17817883 4842388 2323649 64482 4000 2856177 3234855 24457269 33993775 2371747 5229808 58988 29250 2039985 7463924 4470720 12722982 X 17749152 20197204 1343906 178053 893491 895536 19986549 21270793 24457269 33993775 X 2507274 -110884 -1112146 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 9085 16505 16072 9518 0 372000 603017 975017 6564726 4029699 2535027 10936607 8649788 2286819 12586227 565207 12021020 17817883 INTEREST IN NET ASSETS OF FOUNDATION 1340903 ESTIMATED THIRD-PARTY PAYOR SETTLEMENTS 111588 DEFERRED FINANCING COSTS 1782364 3234855 X 26484983 -1726322 -1726322 28211305 1412256 1412256 29623561 25459907 86014 86014 25373893 1742394 1742394 27116287 PART IV, LINE 1B: THE ASSETS OF ST. JOHN'S HOSPITAL AUXILIARY ARE HELD BY ST. JOHN'S LUTHERAN HOSPITAL. THE AUXILIARY ACCOUNT BALANCES WERE NOT INCLUDED IN THE BALANCE SHEETS AS THEY ARE NOT RECORDED FOR AUDIT PURPOSES. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: THE HOSPITAL IS A MONTANA NONPROFIT CORPORATION AND HAS BEEN RECOGNIZED BY THE INTERNAL REVENUE SERVICE (IRS) AS EXEMPT FROM FEDERAL INCOME TAXES UNDER SECTION 501(C)(3). THE HOSPITAL IS ANNUALLY REQUIRED TO FILE A RETURN OF ORGANIZATION EXEMPT FROM INCOME TAX (FORM 990) WITH THE IRS. IN ADDITION THE HOSPITAL IS SUBJECT TO INCOME TAX ON NET INCOME THAT IS DERIVED FROM BUSINESS ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE. THE ORAGANIZATION FILES AN EXEMPT ORGANIZATION BUSINESS INCOME TAX RETURN (FORM 990T) WITH THE IRS TO REPORT ITS UNRELATED BUSINESS TAXABLE INCOME. THE HOSPITAL BELIEVES THAT IT HAS APPROPRIATE SUPPORT FOR ANY TAX POSITIONS TAKEN AFFECTING ITS ANNUAL FILING REQUIREMENTS, AND AS SUCH, DOES NOT HAVE ANY UNCERTAIN TAX POSITIONS THAT ARE MATERIAL TO THE FINANCIAL STATEMENTS. THE HOSPITAL WOULD RECOGNIZE FUTURE ACCRUED INTEREST AND PENALTIES RELATED TO UNRECOGNIZED TAX BENEFITS AND LIABILITIES IN INCOME TAX EXPENSE IF SUCH INTEREST AND PENALTIES ARE INCURRED. THE HOSPITAL'S FEDERAL FORM 990T FILINGS ARE NO LONGER SUBJECT TO FEDERAL TAX EXAMINATIONS BY TAX AUTHORITIES FOR YEARS BEFORE 2010. PART XI, LINE 2D - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS INCLUDED IN REVENUE ON FINANCIAL STATEMENTS -1,726,322. PART XI, LINE 4B - OTHER ADJUSTMENTS: CONTRIBUTION FROM FOUNDATION RECORDED IN FUND BALANCE ON FINANCIAL STATMENTS 1,481,765. AUXILIARY REVENUE NOT INCLUDED IN FINANCIAL STATEMENTS 16,505. RENTAL EXPENSES RECORDED IN EXPENSES ON FINANCIAL STATEMENTS -86,014. PART XII, LINE 2D - OTHER ADJUSTMENTS: RENTAL EXPENSES RECORDED IN EXPENSES ON FINANCIAL STATEMENTS 86,014. PART XII, LINE 4B - OTHER ADJUSTMENTS: PROVISION FOR BAD DEBTS INCLUDED IN REVENUE ON FINANCIAL STATEMENTS 1,726,322. AUXILIARY EXPENSES NOT INCLUDED IN FINANCIAL STATEMENTS 16,072. 1 1 X 1 X 1 X 1 1 1 0 1 1 388614 388614 0.01430 388614 388614 0.01430 11 2918 74606 5553 69053 0.00250 1 207 277 277 0.00000 2880410 1103488 1776922 0.06550 2 7266 7266 0.00030 14 3125 2962559 1109041 1853518 0.06830 14 3125 3351173 1109041 2242132 0.08260 10146 10146 0.00040 10146 10146 0.00040 0 1726322 67000 7926851 7848367 78484 X 1 1 1 1 ST JOHN'S LUTHERAN HOSPITAL

350 LOUISIANA AVE LIBBY MT 59923

X X X X 2 REHAB, 1 OB/GYN ST JOHN'S LUTHERAN HOSPITAL INC 1 1 X X X X X X X X X 12 1 0 1 X X X X X 0 0 1 1 100.000000000000 1 250.000000000000 1 X X X 1 1 X X 1 0 X X X 1 X 0 1 PART I, LINE 3C: IN ADDITION TO USING INCOME LEVELS FOR DETERMINING ELIGIBILITY UNDER THE FINANCIAL ASSISTANCE POLICY, ST. JOHN'S LUTHERAN HOSPITAL USES ASSET LEVELS AND MEDICAL INDIGENCY. PART I, LINE 7: CHARITY CARE EXPENSE WAS CONVERTED TO COST ON LINE 7A USING THE COST-TO-CHARGE RATIO DERIVED FROM WORKSHEET 2. COMMUNITY HEALTH IMPROVEMENT SERVICES, LINE 7E, HEALTH PROFESSIONS EDUCATION LINE 7F, AND CASH AND IN-KIND CONTRIBUTIONS, LINE 7I, ARE REPORTED BASED ON THE AMOUNTS COMPILED IN THE CBISA REPORT. THE COST FOR SUBSIDIZED HEALTH SERVICES ON LINE 7G WAS DETERMINED USING THE MEDICARE COST REPORT. TOTAL COMMUNITY BENEFIT EXPENSE AS A PERCENTAGE OF TOTAL EXPENSE IS 9.61%. PART I, LINE 7G: COSTS OF $226,863 TO OPERATE A CLINIC WERE INCLUDED IN SUBSIDIZED HEALTH SERVICES REPORTED ON LINE G. PART I, L7 COL(F): THE AMOUNT OF BAD DEBT EXPENSE BACKED OUT OF TOTAL EXPENSES TO DETERMINE THE PERCENTAGE WAS $1,726,322. PART II: ST. JOHN'S LUTHERAN HOSPITAL IS OFFICIALLY DESIGNATED AS A HEALTH PROFESSIONS SHORTAGE AREA. THE COMMUNITY BUILDING WORKFORCE DEVELOPMENT COSTS OF $10,146 INCLUDE RECRUITING EXPENSES AND MOVING EXPENSES FOR ONE PHYSICIAN. PART III, LINE 4: THE ORGANIZATION'S BAD DEBT IS REPORTED AS CHARGES INCURRED DURING THE YEAR.BAD DEBT IS THE UNPAID OBLIGATION FOR CARE PROVIDED TO PATIENTS WHO MAY BE UNABLE OR UNWILLING TO PAY OR WHO DO NOT QUALIFY FOR CHARITY CARE. PRIOR TO ANY ACCOUNT BEING CLASSIFIED AS BAD DEBT, ALL PAYMENTS ARE APPLIED INCLUDING CONTRACTUAL ALLOWANCES AND DISCOUNTS FROM MEDICARE, MEDICAID, AND INSURANCE COMPANIES. ACCOUNTS FROM PATIENTS QUALIFYING FOR CHARITY CARE OR THE SHAREPAY SLIDING SCALE FINANCIAL ASSISTANCE PROGRAM ARE NOT WRITTEN OFF TO BAD DEBT. EVERY EFFORT IS MADE WITH THE PATIENT IN AN ATTEMPT TO COLLECT THE OUTSTANDING BALANCE. PAYMENTS ON ACCOUNTS THAT WERE WRITTEN OFF AS BAD DEBT REDUCES BAD DEBT EXPENSE.ST. JOHN'S LUTHERAN HOSPITAL BUDGETS FOR AND MONITORS THE LEVEL OF CHARITY CARE IT PROVIDES, AND DURING FY 2013 THE ORGANIZATION EXCEEDED ITS BUDGETED AMOUNT FOR CHARITY CARE. THE ORGANIZATION STILL PROVIDED FREE OR DISCOUNTED CARE TO PATIENTS WHO WERE ELIGIBLE. THE ESTIMATED AMOUNT OF THE ORGANIZATION'S BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S CHARITY CARE POLICY IS CALCULATED BASED ON AN ESTIMATE OF CHARITY CARE TO GROSS CHARGES.THE FOOTNOTE TO THE ORGANIZATIONS' FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSES IS LOCATED IN FOOTNOTE 1 ON PAGE 7 OF THE ATTACHED FINANCIAL STATEMENTS. PART III, LINE 8: TOTAL REVENUE RECEIVED FROM MEDICARE IS THE GROSS REIMBURSEMENT PLUS SETTLEMENT. BOTH TOTAL REVENUE RECEIVED FROM MEDICARE AND THE MEDICARE ALLOWABLE COSTS ARE REPORTED FROM THE MEDICARE COST REPORT. PART III, LINE 9B: THERE ARE NO COLLECTION EFFORTS FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR WHO QUALIFY FOR SHAREPAY, A SLIDING SCALE FINANCIAL ASSISTANCE PROGRAM DESIGNED TO MEET THE MEDICAL FINANCIAL OBLIGATIONS OF THE UNINSURED AND UNDERINSURED. ST. JOHN'S LUTHERAN HOSPITAL, INC. PART V, SECTION B, LINE 3: FOCUS GROUPS WERE OPEN TO THE COMMUNITY AND INVITATIONS WERE PUT IN LOCAL PAPERS. THE STEERING COMMITTEE WAS USED TO HELP FACILITATE THESE FOCUS GROUPS. THE ASSESSMENT CONSISTED OF PUBLIC LEADERS, INCLUDING MEMBERS OF OTHER HEALTHCARE ORGANIZATIONS, THE SCHOOL SYSTEM, ATHLETIC CLUBS, LOCAL POLITICIANS, ROTARY, COMMUNITY SERVICE ORGANIZATIONS, ETC. EACH FOCUS GROUP WAS SET FOR SPECIFIC SERVICE GROUPS. ADDITIONALLY, THE MONTANA OFFICE OF RURAL HEALTH WAS CONSULTED DURING THE PROCESS.ST. JOHN'S LUTHERAN HOSPITAL, INC.:PART V, SECTION B, LINE 6A: THE ORGANIZATION'S IMPLEMENTATION STRATEGY MAY BE FOUND AT THE FOLLOWING LINK: HTTP://WWW.SJLH.COM/GETPAGE.PHP?NAME=COMMUNITY_IMPACT&SUB=ABOUT%20US ST. JOHN'S LUTHERAN HOSPITAL, INC. PART V, SECTION B, LINE 7: ASSISTED LIVING FACILITY: AT THIS TIME SJLH IS CONSTRUCTING A REPLACEMENT FACILITY AND DOES NOT HAVE THE BUDGET TO ACQUIRE AND SUPPORT AN ASSISTED LIVING FACILITY. ST. JOHN'S LUTHERAN HOSPITAL, INC. PART V, SECTION B, LINE 14G: A SUMMARY OF THE FINANCIAL ASSISTANCE POLICY IS PROVIDED WITH BILLING INVOICES AND IS POSTED IN THE FACILITY'S EMERGENCY ROOM AND WAITING ROOMS. ST. JOHN'S LUTHERAN HOSPITAL, INC. PART V, SECTION B, LINE 22: ALL INDIVIDUALS ELIGIBLE UNDER THE HOSPITAL FINANCIAL ASSISTANCE POLICY ARE PROVIDED A DISCOUNT FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE. FAP-ELIGIBLE PATIENTS WITHOUT INSURANCE MAY BE CHARGED GROSS CHARGES ON ELECTIVE PROCEDURES. PART VI, LINE 2: A COMPLETE COMMUNITY HEALTH NEEDS ASSESSMENT WAS CONDUCTED AND COMPLETED DURING THE 2012 FISCAL YEAR BY ST. JOHN'S LUTHERAN HOSPITAL IN COOPERATION WITH THE MONTANA OFFICE OF RURAL HEALTH AND THE NATIONAL RURAL HEALTH RESOURCE CENTER. ALL MAJOR MEDICAL ENTITIES IN THE COMMUNITY WERE INVOLVED WITH THE DEVELOPMENT OF THE SURVEY AND DISTRIBUTION OF THE RESULTS. ST. JOHN'S LUTHERAN HOSPITAL IS CURRENTLY WORKING ON A NEW COMMUNITY HEALTH NEEDS ASSESSMENT. PART VI, LINE 3: BROCHURES ARE AVAILABLE AT THE HOSPITAL IN WAITING AREAS. IN ADDITION, THE HOSPITAL EMPLOYS A FULL-TIME TRAINED PATIENT FINANCIAL SERVICES COUNSELOR TO ASSIST PATIENTS IN DETERMINING IF THEY QUALIFY FOR MEDICAID AS WELL AS FREE OR DISCOUNTED CARE. THE COUNSELOR ALSO PROVIDES HANDS-ON ASSISTANCE TO PATIENTS APPLYING FOR OTHER FINANICAL ASSISTANCE SUCH AS CHIP'S, HEATING ASSISTANCE, MEDICAID, AND WIC. APPLICATIONS FOR CHARITY CARE ARE ALSO DISCUSSED AT REGISTRATION AND DISCHARGE AND WITH PATIENTS WHO HAVE BILLS THAT ARE PAST DUE. PART VI, LINE 4: ST. JOHN'S LUTHERAN HOSPITAL IS LOCATED IN LIBBY IN NORTHWESTERN MONTANA, 72 MILES SOUTH OF THE CANADIAN BORDER, 89 MILES NORTHWEST OF KALISPELL, MONTANA, AND 35 MILES EAST OF THE IDAHO BORDER. LIBBY BECAME THE COUNTY SEAT FOR LINCOLN COUNTY IN 1909, THE COUNTY BEING NAMED AFTER PRESIDENT ABRAHAM LINCOLN. HELICOPTER TRANSPORT SERVICES ARE AVAILABLE TO PATIENTS REQUIRING SPECIALIZED CARE IN A LARGER HOSPITAL IN SPOKANE, KALISPELL OR MISSOULA. THE CLOSEST HOSPITAL IS BONNER GENERAL HOSPITAL ABOUT 47 MILES FROM LIBBY IN SANDPOINT, ID. RESIDENTS WITH INCOME BELOW POVERTY LEVEL IN 2012 WAS 20.4% COMPARED TO 14.6% IN THE STATE OF MONTANA. THE MEDIAN HOUSEHOLD INCOME WAS $32,012, WHICH IS SIGNIFICANTLY BELOW THE STATE AVERAGE. PART VI, LINE 5: ST. JOHN'S LUTHERAN HOSPITAL IS A NON-DENOMINATIONAL COMMUNITY HOSPITAL. IT IS A 25 BED ACUTE CARE FACILITY, OF WHICH 3 ARE ICU BEDS, WITH A WIDE RANGE OF SURGICAL SERVICES AND EMERGENCY CARE. ST. JOHN'S LUTHERAN HOSPITAL IS ACTIVELY INVOLVED WITH MANY COMMUNITY PARTNERS TO PROMOTE HEALTH TO THE COMMUNITY. ORGANIZING AND FUNDING A COMMUNITY HEALTH FAIR, PROVIDING DISCOUNTED SERVICES FOR MAMMOGRAPHY, LABORATORY TESTS, AND X-RAYS, PROVIDING SPEAKERS FOR HEALTH LECTURES, AND PROVIDING SUPPORT FOR RECRUITING OF PHYSICIANS ARE JUST A FEW OF THE WAYS ST. JOHN'S HELPS THE COMMUNITY.OUR BOARD OF DIRECTORS IS COMPRISED ENTIRELY OF LOCAL RESIDENTS, ONLY ONE OF WHICH IS AN EMPLOYEE OR CONTRACTOR. TO MEET THE NEEDS OF THE COMMUNITY, THE HOSPITAL EXTENDS MEDICAL STAFF PRIVILEGES TO ALL QUALIFIED, LICENSED PHYSICIANS IN THE COMMUNITY. SURPLUS FUNDS ARE REINVESTED FOR THE REPLACEMENT/ADDITION OF CAPITAL EQUIPMENT AND FACILITY UPKEEP. REPORTS FILED WITH STATES PART VI, LINE 7 MT X X 1 1 X X X 1 0 0 0 0 0 0 0 0 JAY MALONEY MD 174564 0 0 0 30768 0 10554 0 20594 0 236480 0 0 0 ANNE CAMBER MD 213604 0 11720 0 44538 0 12500 0 15280 0 297642 0 0 0 JOSHUA URVATER 374885 0 0 0 30539 0 12500 0 5420 0 423344 0 0 0 MARK SERRA 250430 0 0 0 37035 0 9764 0 9735 0 306964 0 0 0 BRIAN BARSTAD 218882 0 0 0 22880 0 9056 0 19070 0 269888 0 0 0 RAYMOND ZURCHER 147958 0 0 0 25160 0 772 0 15982 0 189872 0 0 0 NICOLLE BENZ 126312 0 25000 0 0 0 0 0 10939 0 162251 0 0 0 BILL PATTEN 22463 0 0 0 196472 0 1752 0 2320 0 223007 0 0 0 PART I, LINE 1A HEALTH CLUB MEMBERSHIP FEES AND SOCIAL CLUB MEMBERSHIP DUES WERE PAID ON BEHALF OF THE CEO AND CFO. AN AUTOMOBILE EXPENSE ALLOWANCE WAS PROVIDED TO THE CEO. ALL SUCH COMPENSATION IS REPORTED AS TAXABLE COMPENSATION. PART I, LINE 4A BILL PATTEN RECEIVED A SEVERANCE PACKAGE OF $170,867.44. NICOLLE BENZ EMPLOYEE PHYSICIAN SIGN-ON AGREEMENT X 25000 18750 0 1 1 18750 FRANK LUCAS SPOUSE OF TRUSTEE 61707 SALARY AND BENEFITS AS AN EMPLOYEE 0 LAURIE MALONEY SPOUSE OF TRUSTEE 57300 SALARY AND BENEFITS AS AN EMPLOYEE 0 JULI HOPFER SISTER OF TRUSTEE 17487 SALARY AND BENEFITS AS AN EMPLOYEE 0 JOSHUA URVATER SPOUSE OF TRUSTEE 406275 SALARY AND BENEFITS AS AN EMPLOYEE 0 NEW PROGRAM SERVICES FORM 990, PART III, LINE 2 A HOSPITALIST PROGRAM WAS MADE AVAILABLE BEGINNING JUNE 2012. FORM 990, PART VI, SECTION A, LINE 3 MANAGEMENT DUTIES WERE DELEGATED TO KALISPELL REGIONAL MEDICAL CENTER. THE FOLLOWING INDIVIDUALS HELD MANAGEMENT POSITIONS DURING THE YEAR: BRUCE WHITFIELD $74,612 JOHN SCHWARTZ $151,785 FORM 990, PART VI, SECTION A, LINE 8B NO COMMITTEE HAS THE AUTHORITY TO ACT ON BEHALF OF THE GOVERNING BODY. FORM 990, PART VI, SECTION B, LINE 11 A DRAFT COPY OF THE FORM 990 WILL BE REVIEWED IN DETAIL BY THE CFO. THE ENTIRE BOARD IS THEN PROVIDED A COPY FOR REVIEW PRIOR TO FILING OF THE FORM 990 RETURN. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION REQUIRES ANNUAL CONFLICT OF INTEREST TRAINING FOR ALL OFFICERS, DIRECTORS, AND KEY EMPLOYEES ALONG WITH AN ANNUAL SUBMISSION OF A CONFLICT OF INTEREST FORM. THE BOARD OVERSEES THE PROCESS AND ANY POTENTIAL CONFLICTS ARE DISCUSSED BY THE BOARD. SHOULD A CONFLICT BE DETERMINED, THE CONFLICTED INDIVIDUAL ABSTAINS FROM VOTING ON THE CONFLICTED ISSUE. FORM 990, PART VI, SECTION B, LINE 15 THE BOARD REVIEWS INDEPENDENT SALARY SURVEYS AND OTHER COMPARABILITY DATA TO DETERMINE FAIR MARKET COMPENSATION AMOUNTS FOR OFFICERS AND KEY EMPLOYEES ON AN ANNUAL BASIS, AND THEN TAKES INTO ACCOUNT LOCAL ECONOMIC FACTORS AND SPECIFIC JOB RESPONSIBILITIES. THE PROCESS IS DOCUMENTED AND THE LAST REVIEW WAS PERFORMED IN 2013. KALISPELL REGIONAL MEDICAL CENTER ALSO HAS A PROCESS IN PLACE FOR DETERMINING COMPENSATION. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND ANNUAL FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. REQUESTS MAY BE IN PERSON, BY E-MAIL, IN WRITING, OR BY TELEPHONE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: CHANGE IN UNRESTRICTED INVESTMENT IN NET ASSETS OF FOUNDATION 52,095. CHANGE IN TEMPORARILY RESTRICTED INVESTMENT IN FOUNDATION -1,165,853. CHANGE IN PERMANENTLY RESTRICED INVESTMENT IN FOUNDATION 2,045. CHANGE IN ST. JOHN'S HOSPITAL AUXILIARY ASSETS -433. ST JOHN'S LUTHERAN HOSPITAL FOUNDATION 350 LOUISIANA AVENUE LIBBY MT 59923 810425832 SUPPORT THE DEVELOPMENT OF ST. JOHN'S LUTHERAN HOSPITAL MT 501(C)(3) LINE 11B, II N/A 0 ST JOHN'S REAL ESTATE CORPORATION 350 LOUISIANA AVENUE LIBBY MT 59923 201538952 SUPPORT THE DEVELOPMENT OF ST. JOHN'S LUTHERAN HOSPITAL MT 501(C)(2) N/A ST JOHN'S LUTHERAN HOSPITAL INC 1 0 0 1 0 0 0 0 0 0 0 0 0 1 1 1 0 0 0 0