2014-11-17T10:41:27-06:00 2013-12-31 990 2013-01-01 480543792 SAINT LUKES CUSHING HOSPITAL INC SAIN 9136841100 711 MARSHALL STREET LEAVENWORTH KS 66048 ADELE DUCHARME CEO 9136841100 2014-11-17 2013 2015-11-30 17:44:51Z ADELE DUCHARME 711 MARSHALL STREET LEAVENWORTH KS 66048 37659301 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1930 KS FAITH-BASED, NOT-FOR-PROFIT COMMUNITY HOSPITAL 7 4 382 145 11144 -6146 85996 8070929 31299550 29517152 20100 70849 309 371 31405955 37659301 1508962 1869420 0 0 17272303 15909205 0 0 0 19504113 18757646 38285378 36536271 -6879423 1123030 17112746 21152985 34862681 37844542 -17749935 -16691557 X SAINT LUKE'S CUSHING 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 THE SAINT LUKE'S HEALTH SYSTEM, WE ARE DEDICATED TO ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF THE COMMUNITIES WE SERVE. 0 0 31947942 1869420 29506008 AS A VOLUNTARY, NONPROFIT ORGANIZATION, SAINT LUKE'S CUSHING HOSPITAL IS COMMITTED TO SERVING ALL WHO SEEK OUR SERVICES REGARDLESS OF THEIR SOCIOECONOMIC STATUS. THE HOSPITAL PARTICIPATES IN THE MEDICAID, TRICARE, AND MEDICARE PROGRAMS AND HAS CHARITY CARE POLICIES FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. 31947942 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 1 0 1 382 1 1 1 0 0 0 0 0 0 0 0 0 X 7 4 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 9136841100 711 MARSHALL STREET LEAVENWORTH KS 66048 X JULIE ANDERSON DIRECTOR 1.00 X 0 0 0 MICHAEL CROW DIRECTOR-CHAIRMAN 1.00 X X 0 0 0 CAROL MEYER DIRECTOR-SECRETARY/TREASUR 1.00 50.00 X X 0 295351 40692 RITA SWANN DIRECTOR-VICE CHAIR 1.00 X X 0 0 0 JOHN PETERSON DIRECTOR 1.00 X 0 0 0 DON SIPES DIRECTOR-PRESIDENT 1.00 50.00 X X 0 334800 58828 JULIE MURPHY DIRECTOR & CFO 1.00 50.00 X X 0 252624 46681 ADELE DUCHARME CEO 50.00 X 178838 0 30765 KARIN SUNDBLOM CNO 50.00 X 102119 0 28554 DINH NGUYEN PHARMACIST 40.00 X 114018 0 12473 LINDA ALDERMAN PHARMACIST 40.00 X 107582 0 7039 DAVID GREENE REGISTERED NURSE 40.00 X 104828 0 21420 607385 882775 246452 5 0 1 0 EMERGENCY MEDICAL SERVICES KS LLC 920 MAIN STREET SUITE 300 KANSAS CITY MO 64105 EMERGENCY ROOM PHYSICIANS 1109598 P1 GROUP INC 16210 W 108TH ST LENEXA KS 66219 MAINTENANCE SERVICES 538629 HEARTLAND ANESTHESIA LLC PO BOX 410272 KANSAS CITY MO 64141 ANESTHESIA SERVICES 472376 FAVORITE HEALTHCARE STAFFING INC PO BOX 803356 KANSAS CITY MO 64180 TEMPORARY HELP SERVICES 468520 J E DUNN CONSTRUCTION CO INC 1001 LOCUST KANSAS CITY MO 64106 CONSTRUCTION 396624 11 580 8000000 16500 53849 8070929 NET PATIENT REVENUE 622110 27148783 27148783 EHR MEANINGFUL USE FDS 622110 1450631 1450631 RENTAL REVENUE 531120 431111 431111 REGIONAL LAB 541380 268960 257816 11144 OTHER PROGRAM SERVICES 622110 217667 217667 29517152 62262 62262 371 371 8587 0 8587 8587 8587 37659301 29506008 11144 71220 X 1862520 1862520 6900 6900 340276 340276 12610034 11259913 1350121 404492 338143 66349 1584475 1375318 209157 969928 843307 126621 1055 1055 14500 14500 959 959 5308843 4648367 660476 8668 4402 4266 865215 660094 205121 201145 13289 187856 822514 776524 45990 54780 37339 17441 31165 18979 12186 1056799 924065 132734 1437740 1386698 51042 317253 213686 103567 MEDICAL SUPPLIES 3432941 3430852 2089 BAD DEBT 3059047 3059047 SHARED SERVICES-SLHS 1676000 641598 1034402 SWAP RELATED COSTS 219005 198564 20441 250017 248337 1680 36536271 31947942 4588329 0 1055942 1934903 250073 245731 3576252 3435705 925 0 725293 731481 125567 149695 25464416 14085215 10158003 11379201 66367 449076 583723 253879 570601 2573314 17112746 21152985 2165907 3426489 32696774 34418053 34862681 37844542 X -17850439 -16788495 76146 72580 24358 24358 -17749935 -16691557 17112746 21152985 X 1123030 -64652 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 6614 0 0 0 6614 0 PART II-B, LINE 1: LINE F: PORTION OF DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION USED FOR LOBBYING ACTIVITIES. 100503 5950 321 1000 8836 96938 89386 19100 17 2000 6000 100503 89127 8550 215 1500 7006 89386 76514 21606 307 1000 8300 89127 74358 3277 1121 76514 0.74870 0.25130 1 0 20000 407583 427583 13564492 6725300 6839192 10412461 6613453 3799008 1059880 746462 313418 11379201 OTHER RECEIVABLES 153940 FIN 45 PHYSICIAN GUARANTEE 2260000 DUE FROM AFFILIATES 159374 2573314 PAYABLE TO AFFILIATES 25299334 OTHER NONCURRENT LIABILITIES 38719 RESERVE FOR SELF INSURED RISKS 665000 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS -165000 LONG TERM DEBT TO ST LUKES HEALTH SYSTEM 6320000 FIN 45 PHYSICIAN GUARANTEE 2260000 34418053 PART V, LINE 4: THE INTENDED USE OF ENDOWMENT FUNDS INCLUDES BUT IS NOT LIMITED TO THE GENERAL OPERATIONS OF THE HOSPITAL AND CAPITAL EQUIPMENT PURCHASES FOR THE HOSPITAL. SCHEDULE D, PARTS XI AND XII THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN THE CONSOLIDATED AUDIT OF SAINT LUKE'S HEALTH SYSTEM. 1 1 X 1 X 133.000000000000 1 X 1 1 1 0 0 2148110 2148110 0.06420 4012954 3860600 152354 0.00460 6161064 3860600 2300464 0.06880 42707 42707 0.00130 148144 148144 0.00440 5382494 2755671 2626823 0.07850 21526 21526 0.00060 5594871 2755671 2839200 0.08480 11755935 6616271 5139664 0.15360 2287 2287 0.00010 891 891 0.00000 2658 2658 0.00010 5836 5836 0.00020 0 3059047 6436835 8893236 -2456401 X 1 1 1 1 SAINT LUKES CUSHING HOSPITAL INC 711 MARSHALL STREET LEAVENWORTH KS 66048 H-052-001 X X X SAINT LUKES CUSHING HOSPITAL INC 1 1 X X X X X X X X X 13 1 0 1 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X X X X X X X 0 0 1 1 133.000000000000 1 400.000000000000 1 X X X 1 1 X X X X 1 0 X X X X 1 X 0 0 SAINT LUKES CUSHING HOSPITAL INC PART V, SECTION B, LINE 3: IN-PERSON INTERVIEWS AND OVER-THE-PHONE INTERVIEWS WERE CONDUCTED WITH HOSPITAL EXECUTIVES AND REPRESENTATIVES FROM COMMUNITY ORGANIZATIONS. THE INTERVIEWS WERE FOCUSED ON DISTINGUISHING THE UNMET HEALTHCARE AND PUBLIC HEALTH NEEDS WITHIN THE LEAVENWORTH COUNTY AREA. OUR TEAM GENERATED A SET OF QUESTIONS IN AN EFFORT TO ELICIT ANSWERS FROM COMMUNITY STAKEHOLDERS THAT WOULD IDENTIFY COMMUNITY HEALTH NEEDS IN LEAVENWORTH COUNTY. AFTER INTERVIEWING THE STAKEHOLDERS WE DISCOVERED THAT THERE IS A CONSENSUS AMONG THE GROUP ABOUT THE PERCEIVED HEALTH CARE NEEDS FOR LEAVENWORTH COUNTY. THE ACCESS TO HEALTH CARE WAS IDENTIFIED BY MOST OF THE INTERVIEWEES. ORGANIZATIONS AND GROUPS CONSULTED INCLUDE EXECUTIVE LEADERS, SENIOR NURSING LEADERS AND QUALITY LEADERS OF SAINT LUKE'S CUSHING HOSPITAL, INFORMATICS LEADERS OF SAINT LUKE'S HEALTH SYSTEM, LEAVENWORTH COUNTY HEALTH DEPARTMENT, MUNSON ARMY HEALTH CENTER, AND LEAVENWORTH COUNTY EMERGENCY MEDICAL SERVICES AND HEALTH DEPARTMENT. SAINT LUKES CUSHING HOSPITAL INC PART V, SECTION B, LINE 7: NEEDS NOT BEING ADDRESSED:1. LACK OF URGENT CARE OUTSIDE A HOSPITAL EMERGENCY DEPARTMENT2. LACK OF PUBLIC TRANSPORTATION1. LACK OF URGENT CARETHERE IS A LACK OF URGENT CARE CLINICS IN THE LEAVENWORTH COUNTY AREA. URGENT CARE CLINICS DELIVER AMBULATORY MEDICAL CARE OUTSIDE OF A HOSPITAL EMERGENCY DEPARTMENT, USUALLY ON AN UNSCHEDULED, WALK-IN BASIS. URGENT CARE CENTERS ARE PRIMARILY USED TO TREAT PATIENTS WHO HAVE AN INJURY OR ILLNESS THAT REQUIRES IMMEDIATE CARE BUT IS NOT SERIOUS ENOUGH TO WARRANT A VISIT TO AN EMERGENCY ROOM. UNFORTUNATELY, EMERGENCY DEPARTMENTS ARE OFTEN OVER-UTILIZED BY PATIENTS SEEKING THIS TYPE OF CARE.CURRENTLY, SAINT LUKE'S CUSHING HOSPITAL'S EMERGENCY DEPARTMENT SEES A CONSTANT INFLUX OF INDIVIDUALS WHO COULD HAVE BEEN PROPERLY CARED FOR AT AN URGENT CARE SETTING. CUSHING BELIEVES THAT SAINT JOHN HOSPITAL, SAINT VINCENT CLINIC, AND THE LEAVENWORTH COUNTY HEALTH DEPARTMENT ARE BETTER POSITIONED TO MEET THE COMMUNITY'S NEED FOR A MORE ACCESSIBLE URGENT CARE CLINIC. WITH THE LOCATION OF SAINT LUKE'S CUSHING HOSPITAL CENTERED PRIMARILY IN THE LOWER SOCIOECONOMIC PORTION OF LEAVENWORTH COUNTY, CUSHING CURRENTLY PROVIDES A SUBSTANTIAL AMOUNT OF CHARITY CARE TO THE PUBLIC AND IS CURRENTLY GENERATING A SIGNIFICANT OPERATING LOSS DUE TO THIS. AT THIS TIME THE FOCUS REMAINS ON EXPANDING EXISTING SERVICE LINES.2. LACK OF PUBLIC TRANSPORTATIONCURRENTLY THERE IS NOT A PUBLIC TRANSPORTATION SYSTEM IN OPERATION WITHIN THE LEAVENWORTH COUNTY AREA. IN MOST URBAN AND SEMI-URBAN CITIES, PUBLIC TRANSPORT IS USED TO ENSURE THAT ALL MEMBERS OF SOCIETY ARE ABLE TO TRAVEL INCLUDING: THE YOUNG, THE OLD, THE POOR, THOSE WITH MEDICAL CONDITIONS, AND PEOPLE BANNED FROM DRIVING. PATIENTS WHO RESIDE IN LEAVENWORTH COUNTY WHO ARE WITHOUT INDEPENDENT MOBILITY MUST MAKE TRAVEL ARRANGEMENTS IN ADVANCE. A LACK OF PUBLIC TRANSPORTATION IS A MAJOR BARRIER IMPEDING RESIDENTS FROM ACCESSING HEALTH CARE SERVICES WITHIN THE COMMUNITY.LACK OF PUBLIC TRANSPORTATION IS NOT GENERALLY AN ISSUE HEALTH CARE ORGANIZATIONS CAN DIRECTLY AFFECT, THEREFORE SAINT LUKE'S CUSHING HOSPITAL'S FOCUS WILL REMAIN ON EXPANDING ACCESS TO CARE IN OTHER WAYS. ALONG WITH THE SPECIFIC PROGRAMS DETAILED IN THE PRIORITY NEEDS SECTION OF THIS IMPLEMENTATION PLAN, SAINT LUKE'S CUSHING HOSPITAL WILL CONTINUE TO MEET COMMUNITY NEEDS BY PROVIDING LEAVENWORTH AND SURROUNDING COMMUNITIES WITH A BROAD RANGE OF ESSENTIAL HEALTH CARE SERVICES. SAINT LUKES CUSHING HOSPITAL INC PART V, SECTION B, LINE 14G: THE HOSPITAL FOLLOWS THE SAINT LUKE'S HEALTH SYSTEM POLICIES FOR THE UNINSURED. 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, AND VISITS BY SOCIAL WORKER TEAMS WITH AN INPATIENT AS WELL AS FOLLOW UP CALLS AFTER DISCHARGE. FINANCIAL ASSISTANCE OR MEDICAID APPLICATIONS ARE REQUESTED ON UNINSURED PATIENTS PRIOR TO DISCHARGE.THE HOSPITAL ALSO CONTRACTS WITH ELIGIBILITY ENROLLMENT SERVICE COMPANIES TO SCREEN ALL UNINSURED PATIENTS, ANY PATIENT IDENTIFIED BY A SOCIAL WORKER OR CASE MANAGER AS WELL AS ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR MEDICAID OR OTHER GOVERNMENT COVERAGE. SAINT LUKES CUSHING HOSPITAL INC PART V, SECTION B, LINE 18E: SEE RESPONSE TO LINE 14G. PART V, SECTION B, LINE 6 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 MADE WIDELY AVAILABLE, 2013. PART I, LINE 7: COST OF CHARITY CARE AND UNREIMBURSED HEALTH SERVICES WERE CALCULATED USING THE APPROPRIATE COST TO CHARGE RATIO FROM THE ORGANIZATION'S COST REPORT. PART I, LN 7 COL(F): TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) OF $36,536,271 LESS BAD DEBT EXPENSE OF $3,059,047 EQUALS TOTAL EXPENSE OF $33,477,224 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: SAINT LUKES CUSHING HOSPITAL INC SPONSORS OR PARTICIPATES IN MANY COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF OUR COMMUNITY. ACTIVE PARTICIPATION IN MANY COMMUNITY ORGANIZATIONS INCLUDE LEAVENWORTH COUNTY DEVELOPMENT CORPORATION, CHAMBER OF COMMERCE, ROTARY, KANSAS HEALTHCARE COLLABORATIVE, LEAVENWORTH HEALTH NEEDS TASK FORCE, MILITARY AFFAIRS COUNCIL AND EDUCATION FOUNDATIONS. WE ENCOURAGE OUR EMPLOYEES TO SERVE ON COMMUNITY BOARDS AND VOLUNTEER FOR ACTIVITIES THAT PROMOTE HEALTH IN THE COMMUNITY. PART III, LINE 2, BAD DEBT 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. PART III, LINE 4: FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE (INCLUDING COPAYMENT AND DEDUCTIBLE AMOUNTS FROM PATIENTS), THE SYSTEM ANALYZES CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED. THESE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS AND ARE ADJUSTED AS NEEDED IN FUTURE PERIODS. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WHEN THEY ARE DEEMED UNCOLLECTIBLE.BAD DEBT IS REPORTED CONSISTENT WITH FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO DIRECTLY FROM THE MEDICARE COST REPORT. SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN WHAT IT COSTS TO PROVIDE THE CARE AND SERVICES. WE ACCEPT ALL MEDICARE PATIENTS KNOWING THE COST OF PROVIDING THE CARE MAY EXCEED THE FUNDS WE RECEIVE FROM MEDICARE FOR THE SERVICE. OUR SHORTFALL IS CONSIDERED TO BE COMMUNITY BENEFIT. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS, INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD. PART III, LINE 9B: IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE ACCOUNT IS ADJUSTED ACCORDINGLY. 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: THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, ANNUAL STRATEGIC PLANNING PROCESS. THE HOSPITAL OBTAINS HIDI MARKET DATA AND OTHER OUTPATIENT MARKET DATA. WITH THIS DATA, THE HOSPITAL IDENTIFIES SERVICES RECEIVED BY THE RESIDENTS OF OUR COMMUNITY (DEFINED BY OUR PRIMARY AND SECONDARY SERVICE AREAS). ANY PREDOMINANT SERVICES NOT CURRENTLY OFFERED BY THE HOSPITAL ARE CONSIDERED AT THIS TIME.ANOTHER ELEMENT OF THE COMMUNITY ASSESSMENT CONSISTS OF ONGOING MEETINGS WITH FORT LEAVENWORTH, U.S. PENITENTIARY, AND LANSING STATE CORRECTIONAL FACILITY OFFICIALS. THROUGH FEEDBACK FROM THESE MEETINGS, COMMUNITY NEEDS ARE COMMUNICATED TO THE HOSPITAL AND CONSIDERED. PART VI, LINE 3: SEE RESPONSE TO PART V, LINE 14G. PART VI, LINE 4: SAINT LUKES CUSHING HOSPITAL INC IS LOCATED IN LEAVENWORTH COUNTY, KANSAS, JUST OUTSIDE OF THE KANSAS CITY METROPOLITAN AREA. WE GENERALLY DESCRIBE OUR COMMUNITY AS A 31 ZIP CODE SERVICE AREA. PART VI, LINE 5: THE BOARD OF DIRECTORS CONSISTS OF MEDICAL PROFESSIONALS, BUSINESS PROFESSIONALS AND ACTIVE COMMUNITY MEMBERS NEARLY ALL OF WHOM RESIDE OR PRACTICE IN THE COMMUNITY. THE BOARD IS INVOLVED IN THE PLANNING AND COMMUNITY ASSESSMENT PROCESSES. THE MEDICAL STAFF IS OPEN FOR NEARLY ALL SPECIALTIES AND PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.SAINT LUKES CUSHING HOSPITAL INC DONATES EMERGENCY, LABORATORY, AND RADIOLOGY SERVICES TO PATIENTS OF SAINT VINCENT'S CLINIC, WHICH PROVIDES PRIMARY HEATH CARE SERVICES TO THE UNINSURED POOR OF LEAVENWORTH COUNTY.THE HOSPITAL ALSO PROVIDES SCHOLARSHIPS TO LOCAL STUDENTS INTERESTED IN PURSUING A DEGREE IN HEALTH CARE. IN ADDITION, MANY HOURS ARE DONATED BY STAFF IN ON-THE-JOB EDUCATION OF STUDENTS IN LOCAL COLLEGE HEALTH CARE CURRICULUM. 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. 1 SAINT LUKES MEDICAL GROUP (501C3 AFFILIATE) 6750 ANTIOCH ROAD STE 210 SHAWNEE MISSION KS 66204 431598353 501(C)(3) 1190651 SUPPORT FOR HEALTHCARE NEEDS SAINT LUKES NORTHLAND HOSPITAL CORPORATION (501C3 AFFILIATE) 601 SOUTH 169 HWY SMITHVILLE MO 64089 440565393 501(C)(3) 657626 SUPPORT FOR HEALTHCARE NEEDS 2 SCHOLARSHIPS TO STUDENTS IN HEALTHCARE FIELD 7 6900 PART I, LINE 2: GRANTS ARE PROVIDED TO QUALIFIED CHARITIES FOR GENERAL OPERATIONS AND TO BE USED IN FULFILLING THE EXEMPT PURPOSE OF THE GRANTEE CHARITABLE ORGANIZATION. SUCH GRANTS FURTHER OR SUPPORT A CHARITABLE PURPOSE OF THE ORGANIZATION. 0 0 0 0 0 0 0 1 0 CAROL MEYER DIRECTOR-SECRETARY/TREASUR 0 223000 0 40262 0 32089 0 38240 0 2452 0 336043 0 16442 DON SIPES DIRECTOR-PRESIDENT 0 252783 0 44550 0 37467 0 39677 0 19151 0 393628 0 19889 JULIE MURPHY DIRECTOR & CFO 0 205239 0 28237 0 19148 0 36829 0 9852 0 299305 0 16354 ADELE DUCHARME CEO 173424 0 0 0 5414 0 21800 0 8965 0 209603 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. PART 1, LINE 3 ANNUALLY, THE SAINT LUKE'S HEALTH SYSTEM BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS, DISCUSSES, SETS AND APPROVES COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT EXECUTIVE AND CFO. INDEPENDENT, EXTERNAL DIRECTORS SERVE ON THE COMPENSATION COMMITTEE. AN INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY PROVIDES A WRITTEN REPORT AND REASONABLENESS OPINION. THE CONSULTANT REVIEWS THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY AND ANALYZES MARKET COMPETITIVENESS (IN TOTAL AND BY EACH COMPENSATION AND BENEFIT ELEMENT) FOR THE EXECUTIVES USING APPROPRIATE COMPARABILITY DATA. COMPENSATION COMMITTEE ACTIONS ARE CONTEMPORANEOUSLY DOCUMENTED. THE PROCESS SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE. COMPENSATION FOR OFFICERS NOT REVIEWED BY THE COMPENSATION COMMITTEE IS SET/APPROVED ANNUALLY BY SAINT LUKE'S HEALTH SYSTEM EXECUTIVE MANAGEMENT BASED ON MARKET COMPENSATION SURVEYS AND COMPARABILITY DATA. SCHEDULE J, PART II AND FORM 990, PART VII DON SIPES AND CAROL MEYER DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. JULIE MURPHY RECEIVED COMPENSATION FOR SERVICES RENDERED TO THE FILING ORGANIZATION AND OTHER RELATED ORGANIZATIONS. PART V, LINE 1A, NUMBER REPORTED IN BOX 3 OF FORM 1096 SAINT LUKES CUSHING HOSPITAL INC IS PART OF SAINT LUKE'S HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM. THE MAJORITY OF CUSHING MEMORIAL HOSPITAL VENDORS ARE PAID THROUGH A CENTRALIZED PAYMENT SYSTEM WITH 1099S ISSUED BY THE CENTRALIZED SERVICE ENTITY. FORM 990, PART VI, SECTION A, LINE 2 DON SIPES AND CAROL MEYER HAVE A BUSINESS RELATIONSHIP BECAUSE THEY ARE DIRECTORS, OFFICERS, AND/OR EMPLOYEES OF THE SAME AFFILIATED TAX-EXEMPT ORGANIZATION. DON SIPES AND JULIE MURPHY 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, DEBT, BUDGETS, CAPITAL EXPENDITURES AND STRATEGIC OPERATING DECISIONS. AS PART OF AN INTEGRATED HEALTH SYSTEM, THE SOLE MEMBER ALSO PROVIDES VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO THE ORGANIZATIONS. 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 BEFORE FILING. THE 990 DRAFT WAS ALSO PRESENTED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. 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 OR THE SYSTEM VICE PRESIDENT OF HUMAN RESOURCES REVIEWS COMPLETED QUESTIONNAIRES AND FURTHER INVESTIGATES POSSIBLE CONFLICTS OF INTEREST. A REPORT IS PROVIDED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS AND ANY IDENTIFIED CONFLICT OF INTEREST IS REPORTED TO THE APPLICABLE ENTITY. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE SAINT LUKE'S HEALTH SYSTEM BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS, DISCUSSES, SETS AND APPROVES COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT EXECUTIVE AND CFO. INDEPENDENT, EXTERNAL DIRECTORS SERVE ON THE COMPENSATION COMMITTEE. AN INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY PROVIDES A WRITTEN REPORT AND REASONABLENESS OPINION. THE CONSULTANT REVIEWS THE SYSTEM'S EXECUTIVE COMPENSATION PHILOSOPHY AND ANALYZES MARKET COMPETITIVENESS (IN TOTAL AND BY EACH COMPENSATION AND BENEFIT ELEMENT) FOR THE EXECUTIVES USING APPROPRIATE COMPARABILITY DATA. COMPENSATION COMMITTEE ACTIONS ARE CONTEMPORANEOUSLY DOCUMENTED. THE PROCESS SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE. COMPENSATION FOR OFFICERS NOT REVIEWED BY THE COMPENSATION COMMITTEE IS SET/APPROVED ANNUALLY BY SAINT LUKE'S HEALTH SYSTEM EXECUTIVE MANAGEMENT BASED ON MARKET COMPENSATION SURVEYS AND COMPARABILITY DATA. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S ARTICLES OF INCORPORATION AND AMENDMENTS THERETO ARE MADE AVAILABLE TO THE PUBLIC BY THE FILING OF THOSE DOCUMENTS WITH THE KS SECRETARY OF STATE. ALSO, THE ORGANIZATION IS INCLUDED WITHIN THE COMBINED FINANCIAL STATEMENTS OF SAINT LUKE'S HEALTH SYSTEM INC THAT ARE MADE AVAILABLE TO THE PUBLIC BY THE POSTING OF THOSE DOCUMENTS THROUGH EMMA AND 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 CAROL MEYER DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. JULIE MURPHY RECEIVED COMPENSATION FOR SERVICES RENDERED TO THE FILING ORGANIZATION AND OTHER RELATED ORGANIZATIONS. FORM 990, PART IX, LINE 11G PHYSICIAN REMUNERATION: PROGRAM SERVICE EXPENSES 2,073,296. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,073,296. OTHER SERVICES: PROGRAM SERVICE EXPENSES 175,811. MANAGEMENT AND GENERAL EXPENSES 353,692. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 529,503. TEMPORARY HELP: PROGRAM SERVICE EXPENSES 594,797. MANAGEMENT AND GENERAL EXPENSES 2,357. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 597,154. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 854,321. MANAGEMENT AND GENERAL EXPENSES 217,217. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,071,538. MAINTENANCE AND REPAIRS: PROGRAM SERVICE EXPENSES 950,142. MANAGEMENT AND GENERAL EXPENSES 87,210. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,037,352. FORM 990, PART XI, LINE 9: PENSION LIABILITY TRANSFER TO SLHS -60,754. NET UNREALIZED GAINS ON INVESTMENTS -3,898. CUSHING HOSPITAL PHYSICIAN SERVICES LLC 711 MARSHALL LEAVENWORTH KS 66048 261440016 PHYSICIAN SERVICES-BILLING KS 0 0 CUSHING MEMORIAL HOSPITAL CORPORATION SAINT LUKES HEALTH SYSTEM 901 E 104TH ST KANSAS CITY MO 64131 431747502 HEALTH SYSTEM KS 501(C)(3) 509(A)(3) - TYPE 1 ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 HEALTH CARE MO 501(C)(3) 170B1AIII 0 SAINT LUKES NORTHLAND HOSPITAL CORPORATION 601 SOUTH 169 HWY SMITHVILLE MO 64089 440565393 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 SAINT LUKES SOUTH HOSPITAL INC 12300 METCALF AVE OVERLAND PARK KS 66213 481203262 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 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 INC 0 SAINT LUKES MEDICAL GROUP 6750 ANTIOCH SUITE 210 SHAWNEE MISSION KS 66204 431598353 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 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 LUKES HEALTH SYSTEM HOME CARE AND HOSPICE 3100 BROADWAY SUITE 1000 KANSAS CITY MO 64111 431127200 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 ST LUKES OF TRENTON 701 EAST FIRST TRENTON MO 64683 431707306 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 SAINT LUKES HOSPITAL OF GARNETT 421 SOUTH MAPLE GARNETT KS 66032 742849611 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 CABOT WESTSIDE HEALTH CENTER 901 E 104TH ST KANSAS CITY MO 64131 440546280 HEALTH CARE MO 501(C)(3) 170B1AVI SAINT LUKES HEALTH SYSTEM INC 0 MIDWEST EAR INSTITUTE INC 4200 PENNSYLVANIA SUITE 100 KANSAS CITY MO 64111 480905027 HEALTH CARE KS 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKES HOSPITAL OF CHILLICOTHE 100 CENTRAL STREET CHILLICOTHE MO 64601 431735565 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 SAINT LUKES CARE 901 E 104TH ST KANSAS CITY MO 64131 260185090 HEALTH CARE MO 501(C)(3) 509(A)(3) - TYPE 1 SAINT LUKES HEALTH SYSTEM INC 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 INC 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 ROAD STE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 SLNC INC 4401 WORNALL ROAD KANSAS CITY MO 64111 451470888 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL ROAD SUITE 410 KANSAS CITY MO 64111 431357824 OWN AND OPERATE MEDICAL OFFICE BUILDING MO N/A ST 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 FAMILY ADVOCATES LLC 10918 ELM AVENUE KANSAS CITY MO 64134 202739036 FOSTER CARE MO N/A SAINT LUKES CARDIOLOGY SERVICES LLC 901 E 104TH ST KANSAS CITY MO 64131 263726426 HEALTH CARE MO N/A SAINT LUKES-GI DIAGNOSTICS LLC 4321 WASHINGTON STE 5700 KANSAS CITY MO 64111 274142549 HEALTH CARE MO 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 VENTURES INC 4320 WORNALL ROAD SUITE 410 KANSAS CITY MO 64111 431278476 ACCOUNTING MO N/A C 0 MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL ROAD SUITE 410 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A C 0 VENTURE FINANCIAL SERVICES INC 9500 E 63RD STREET SUITE 202 RAYTOWN MO 64133 431605740 COLLECTIONS MO N/A C 0 0 1 0 0 1 0 0 0 0 1 1 0 0 1 1 1 1 1 1 SCHEDULE R, PART V, LINE 1 SAINT LUKE'S HEALTH SYSTEM (SYSTEM) AND ITS AFFILIATED ENTITIES OPERATE AS A HIGHLY INTEGRATED HEALTH CARE DELIVERY SYSTEM. THE SYSTEM MANAGES AND OPERATES RELATED HOSPITALS AND THEIR AFFILIATES AS A COMMON MISSION ORIENTED HEALTH CARE SYSTEM IN ORDER TO BETTER SERVE THE HEALTH-RELATED NEEDS OF GREATER KANSAS CITY AND SURROUNDING AREAS. AS A RESULT, THERE ARE NUMEROUS INTERCOMPANY INTERACTIONS INCLUDING CENTRALIZED SUPPORT SERVICES AND SHARING OF RESOURCES AND COSTS.