2014-07-23T12:25:06-05:00 2013-09-30 481066439 BERBERICH TRAHAN & CO PA 3630 SW BURLINGAME ROAD TOPEKA KS 666112050 990 2012-10-01 480543789 STORMONT-VAIL HEALTHCARE INC STOR 7853546000 1500 SW 10TH AVENUE TOPEKA KS 666041353 KEVIN J HAN 7853546000 2014-07-21 1 CHERYL G HAYWARD P00016097 7852343427 2014-07-21 2012 2015-11-30 17:44:51Z KEVIN J HAN 1500 SW 10TH AVENUE TOPEKA KS 666041353 633545948 0 X WWW.STORMONTVAIL.ORG X 1894 KS STORMONT-VAIL'S MISSION IS "WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY" BY PROVIDING QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. 15 13 4970 639 0 21164 556438 430397 554101812 515883852 20878532 331606 899423 466788 576436205 517112643 0 0 0 0 321871961 313985036 0 0 0 204146186 182337931 526018147 496322967 50418058 20789676 554200087 565232540 340105644 282723434 214094443 282509106 X WORKING TOGETHER TO IMPROVE THE HEALTH OF OUR COMMUNITY 0 0 453261659 515883852 STORMONT-VAIL HEALTHCARE, INC. (MEDICAL CENTER) PROVIDES QUALITY MEDICAL HEALTH CARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. FOR THE YEAR ENDED SEPTEMBER 30, 2013, 19,744 INPATIENTS, 63,737 EMERGENCY ROOM PATIENTS, 1,889 NEWBORNS, AND 438 NEONATAL INTENSIVE CARE BABIES WERE SERVED. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF THE MEDICAL CENTER, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THE MEDICAL CENTER'S MISSION IS TO SERVE THE COMMUNITY WITH RESPECT TO PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION REGARDLESS OF ABILITY TO PAY. AS PART OF THIS MISSION, THE MEDICAL CENTER PROVIDES CARE TO PERSONS COVERED BY MEDICARE AND MEDICAID PATIENTS. FOLLOWING ARE SOME OF THE BENEFITS PROVIDED AT REDUCED RATES FOR THE FISCAL YEAR:IN ADDITION TO THE CHARITY CARE PROVIDED, THE MEDICAL CENTER ALSO PROVIDED SERVICE TO PATIENTS THAT RESULTED IN UNCOLLECTIBLE AMOUNTS AS FOLLOWS:BAD DEBT EXPENSE AT COST $11,715,093SHORTFALL OF MEDICARE PAYMENTS AT COST $47,711,210SHORTFALL OF MEDICAID PAYMENTS AT COST $18,486,096 THE MEDICAL CENTER ALSO PROVIDES OTHER HEALTH CARE SERVICES AND PROGRAMS FOR THE BENEFIT OF THE COMMUNITY, FREE OR AT REDUCED RATES. EXAMPLES OF THESE INCLUDE:- SUBSIDY OF NURSING EDUCATION, MEDICAL EDUCATION, AND ALLIED HEALTH EDUCATION- OPERATING THE REGION'S ONLY LEVEL III NEONATAL INTENSIVE CARE UNIT (NICU) SERVING A HIGH PERCENTAGE OF MEDICALLY INDIGENT PATIENTS- OPERATING A LEVEL II TRAUMA CENTER SERVING NORTHEAST KANSAS- PROVIDE SUPPORT TO LIFESTAR, THE AIR AMBULANCE SERVICE IN NORTHEAST KANSAS- ORGANIZED SUPPORT GROUPS FOR A VARIETY OF TOPICS- APPROXIMATELY 49,000 HOURS OF VOLUNTEER TIME WERE DONATED TO THE MEDICAL CENTER HELPING TO REDUCE THE COST OF PROVIDING HEALTH CARE- MAINTAINING THE HEALTH SCIENCES LIBRARY THAT IS MADE AVAILABLE TO THE PUBLIC FREE OF CHARGE AS A MEDICAL RESOURCE - STORMONT-VAIL EMPLOYEES SUPPORT THE CARE LINE, WHICH IS AN EMERGENCY FUND FOR PATIENTS IN FINANCIAL DISTRESS, PROVIDING SERVICES AND SUPPLIES ON A SHORT-TERM BASIS- USE OF POZEZ EDUCATION CENTER FACILITIES FOR A VARIETY OF COMMUNITY GROUPS AND PROGRAMS- DONATED CASH GIFTS TO VARIOUS COMMUNITY ORGANIZATIONS- PARTICIPATED IN NUMEROUS CLINICAL RESEARCH TRIALS THROUGH THE CLINICAL RESEARCH DEPARTMENT- STORMONT-VAIL WEST BEHAVIORAL HEALTH SERVICES OPERATES A SUBSTANCE ABUSE PROGRAM- OPERATED A PALLIATIVE CARE PROGRAM TO PROVIDE COMFORT CARE TO PATIENTS WITH CHRONIC CONDITIONS- PROVIDE SUPPORT AND EDUCATION FOR PATIENTS WITH DIABETES THROUGH THE DIABETES LEARNING CENTER.- STORMONT-VAIL IS A REGIONAL NETWORK OF 32 LOCATIONS IN NORTHEAST KANSAS IMPROVING ACCESS TO MEDICAL CARE IN SEVERAL CITIES THAT OTHERWISE WOULD NOT HAVE ACCESS, PARTICULARLY ON WEEKENDS- MATERNAL FETAL MEDICINE PROGRAM PROVIDED CARE AND ACCESS TO SCREENINGS AND GENETIC COUNSELING FOR WOMEN WITH AT-RISK PREGNANCIES.- OPERATED THE HEALTHWISE 55 PROGRAM WHICH PROVIDED OUTREACH PROGRAMS TO INDEPENDENT LIVING FACILITIES IN TOPEKA- OFFERED BLOOD PRESSURE CLINICS AT WEST RIDGE MALL AS WELL AS OUTREACH BLOOD PRESSURE CLINICS AT SIX OTHER LOCATIONS- STORMONT-VAIL PROVIDED THE REGION'S ONLY PERINATOLOGIST PROVIDING CARE FOR HIGH-RISK PREGNANCIES- STORMONT-VAIL MAINTAINED THE LIFELINE PROGRAM, THE PERSONAL RESPONSE SYSTEM- OFFERED ONLINE CHILDBIRTH CLASSES THROUGH STORMONT-VAIL'S WEB SITE- PARTNERED WITH THE MARCH OF DIMES FOR THE NICU FAMILY SUPPORT PROGRAM- STORMONT-VAIL WAS A MEDAL OF HONOR WINNER FOR ORGAN RETRIEVAL AND TISSUE CONVERSION- THE HEALTH CONNECTION PROGRAM, WHICH PROVIDES PHYSICIAN REFERRAL AND AFTER-HOUR ACCESS TO A NURSE, RECEIVED 464,192 CALLS- PROVIDED HEALTH INFORMATION THROUGH THE TOPEKA & SHAWNEE COUNTY PUBLIC LIBRARY'S HEALTH INFORMATION NEIGHBORHOOD- PARTNERED WITH BUILDING BLOCKS TO PROVIDE CHILDCARE SERVICES TO STAFF AND THE COMMUNITY- STORMONT-VAIL CLINICAL EDUCATORS PARTICIPATED IN THE AMERICAN HEALTH ASSOCIATION'S CPR FOR FAMILY AND FRIENDS CLASS TO TEACH OTHERS CPR- THE TRAUMA SERVICES DEPARTMENT PROVIDED COMMUNITY EDUCATION PROGRAMS ON FALL PREVENTION- STORMONT-VAIL WEST BEHAVIORAL HEALTH SERVICES PARTICIPATED IN A DEPRESSION SCREENING FOR THE COMMUNITY- PARTNERED IN THE KANSAS RED RIBBON CAMPAIGN TO PROMOTE A HEALTHY, DRUG-FREE LIFESTYLE FOR YOUTH- A SKIN SCREENING CLINIC FOR THE COMMUNITY WAS HELD AT THE COTTON-O'NEIL CANCER CENTER- SPONSORED TOUR DE DIALYSIS, A 100-MILE BIKE RIDE TO RAISE AWARENESS AND FUNDS FOR PATIENT NEEDS AT THE KANSAS DIALYSIS SERVICES- CONNECT WITH THE COMMUNITY THROUGH THE ORGANIZATION WEBSITE, STORMONT.ORG- PARTICIPATED IN THE BI-STATE STROKE EDUCATION CONSORTIUM- PARTNERED WITH HEALTH INNOVATION NETWORK OF KANSAS, A COALITION THAT GREW TO 19 HOSPITALS SHARING INFORMATION, EDUCATION AND OTHER NEEDED SERVICES- THE BOY TO MAN AND GIRL TO WOMAN COMMUNICATION EDUCATION PROGRAMS FACILITATE CONVERSATION BETWEEN ADULTS AND PRE-TEENS ABOUT FUTURE PHYSICAL AND EMOTIONAL CHANGES- STORMONT VAIL AND ITS EMPLOYEES DONATED FUNDS AND STAFF TIME TO THE MEALS ON WHEELS PROGRAM AND THE UNITED WAY- DEVELOPING PATIENT CENTER MEDICAL HOME CONCEPT TO IMPROVE CARE WITH THE FOCUS ON PREVENTION AND WELLNESS- WORK WITH OTHERS IN THE COMMUNITY TO IMPROVE SAFETY NET SERVICES FOR UNDER INSURED AND UNINSURED- COLLABORATED WITH SABETHA COMMUNITY HOSPITAL TO ESTABLISH IROBOT PROJECT TO ALLOW SABETHA PHYSICIANS TO COMMUNICATE WITH STORMONT-VAIL PHYSICIANS ON PATIENT CAREIN ADDITION TO THESE COMMUNITY CONTRIBUTIONS, STORMONT-VAIL PROVIDED SUPERVISED CLINICAL EXPERIENCE FOR 1,027 STUDENTS AND 145,865 HOURS TO THE FOLLOWING ENTITIES:NAME/LOCATION TYPE OF STUDENTS DEPT/DIVISIONBAKER UNIVERSITY NURSING MULTIPLEBALL STATE UNIVERSITY NURSING MULTIPLEBARTON CO COMMUNITY COLLEGE PARAMEDIC MULTIPLEBENEDICTINE COLLEGE NURSING MULTIPLECOFFEY COUNTY HOSPITAL NURSING MULTIPLECOLBY COMMUNITY COLLEGE PT REHAB SERVICESCOMMUNITY HEALTH SYSTEM-ONAGA NURSING MULTIPLECREIGHTON UNIVERSITY PHARMACY PHARMACY EMPORIA STATE UNIVERSITY NURSING MEDICAL ARTS CLINIC-EMPORIAFORT HAYS MRI IMAGING SERVICESFORT HAYS NURSING NURSING MULTIPLEFRONTIER SCHOOL OF MIDWIFERY NURSING THE BIRTHPLACEHIAWATHA COMMUNITY HOSPITAL NURSING PATIENT CARE SERVICESHIGHLAND COMMUNITY COLLEGE NURSING MULTIPLEKANSAS STATE UNIVERSITY DIETICIANS NUTRITIONAL SERVICESKANSAS STATE UNIVERSITY HUMAN ECOLOGY PATIENT CARE SERVICESUNIVERSITY OF KANSAS NURSING PATIENT CARE SERVICESUNIVERSITY OF KANSAS PHARMACY PHARMACYUNIVERSITY OF KANSAS SOCIAL WORK BEHAVIORAL HEALTHUNIVERSITY OF MINNESOTA ADMIN INTERN ADMINISTRATION UNIVERSITY OF MISSOURI-KC NURSING COTTON-O'NEIL CLINICSNEBRASKA MEDICAL CENTER/WU MEDICAL TECHNOLOGIST LABORATORYNEMAHA VALLEY COMM HOSPITAL NURSING PATIENT CARE SERVICESNEOSHO COMMUNITY COLLEGE NURSING PATIENT CARE SERVICESNEWMAN REGIONAL HEALTH NURSING ALL AREASTEXAS WESLEYAN UNIVERSITY CRNA SURGERYUSD #501 HIGH SCHOOL MULTIPLEWALDEN UNIVERSITY NURSING PATIENT CARE SERVICESWASHBURN UNIVERSITY CRIMINAL JUSTICE SECURITYWASHBURN UNIVERSITY KINESIOLOGY HEART CENTERWASHBURN UNIVERSITY HEALTH INFORMATION HEALTH INFORMATION MGMT.WASHBURN UNIVERSITY NURSING MULTIPLEWASHBURN UNIVERSITY OT REHABILITATION SERVICESWASHBURN UNIVERSITY PT ASSISTANTS REHABILITATION SERVICESWASHBURN UNIVERSITY IMAGING SCIENCES MEDICAL IMAGINGWASHBURN UNIVERSITY RADIATION THERAPY CANCER CENTERWASHBURN UNIVERSITY RESP THERAPY PULMONARY CAREWASHBURN UNIVERSITY SOCIAL WORK SV BEHAVIORAL HEALTHWASHBURN UNIVERSITY ULTRASOUND-CARDIO RADIOLOGY/ULTRASOUNDWASHBURN UNIVERSITY ULTRASOUND-GEN RADIOLOGY ULTRASOUNDWASHBURN INSTITUTE OF TECH LPNS MULTIPLEWASHBURN INSTITUTE OF TECH SURG TECHS SURGICAL SERVICES/TSDSWASHBURN INSTITUTE OF TECH EMT PATIENT CARE SERVICESWICHITA STATE UNIVERSITY NURSING MULTIPLEWICHITA STATE UNIVERSITY PA MULTIPLEWICHITA STATE UNIVERSITY PT ASSISTANTS REHAB SERVICES 453261659 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 1 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 1 1 1 0 0 1 264 0 1 4970 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 0 0 0 1 1 0 0 1 1 1 1 1 1 1 1 0 X KEVIN HAN 7853546000 1500 SW 10TH STREET TOPEKA KS 66604 STEVEN WATKINS MD 60.00 X 859432 0 70445 S KENNETH ALEXANDERIII 0.00 X 0 0 0 PAMELA JOHNSON-BETTS 0.00 X 0 0 0 C RICHARD BONEBRAKEMD 0.00 X 0 0 0 GARY B FLEENOR 0.00 X 0 0 0 JOHN B DICUS 0.00 X 0 0 0 RANDALL L PETERSON 50.00 X X 398165 0 163647 JAMES HAINES 0.00 X X 0 0 0 PATRICIA PRESSMAN PHD 0.00 X 0 0 0 SUEANN V SCHULTZ 0.00 X 0 0 0 NANCY J PERRY 0.00 X X 0 0 0 JAMES SCHMANK 0.00 X 0 0 0 ANDREW J JETTER 0.00 X 0 0 0 JAMES PARRISH 0.00 X 0 0 0 RICHARD WIENCKOWSKI 0.00 X 0 0 0 ROBERT O'NEIL MD 10.00 X 147716 0 1432 ERIC VOTH MD 60.00 X 353899 0 77949 DOUGLAS ROSE MD 50.00 X 428991 0 167652 KEVIN DISHMAN MD 60.00 X 902390 0 22824 LAMBERT WU MD 60.00 X 674002 0 20178 DAVID CUNNINGHAM 50.00 X 275387 0 74092 CAROL WHEELER 50.00 X 438838 0 209588 BERNIE BECKER 50.00 X 368200 0 165691 KENT PALMBERG MD 50.00 X 790037 0 416232 DEBRA YOCUM 50.00 X 356474 0 91648 JANET STANEK 50.00 X 509547 0 129432 CAROL PERRY 50.00 X 386938 0 149236 KEVIN HAN 50.00 X 397805 0 202879 MICHAEL KONGS 50.00 X 163769 0 28505 MATTHEW WILLS MD 60.00 X 2266512 0 34528 TEWODRO ADDISSE MD 60.00 X 1012162 0 32911 DAVID LUTES MD 60.00 X 918203 0 51321 CHU CHI CHENMD 60.00 X 1415228 0 42462 PETER TUTUSKA MD 60.00 X 955500 0 68103 MAYNARD OLIVERIUS 50.00 X 1760488 0 5627 15779683 0 2226382 352 1 1 0 ANESTHESIA ASSOCIATES 823 MULVANE SUITE 2A TOPEKA KS 66606 ANESTHESIA PHYSICIAN SERVICES 1939366 PROBASCO & ASSOCIATES PA 615 S TOPEKA BLVD TOPEKA KS 66603 COLLECTION AGENCY 1490273 PERINATAL CONSULTANTS 900 SW ROBINSON TOPEKA KS 66614 PHYSICIAN SERVICES 746000 TOPEKA PATHOLOGY GROUP 1000 W 10TH ST TOPEKA KS 66604 PATHOLOGY SERVICES 543757 TOPEKA EARS NOSE & THROAT PA 920 SW LANE ST STE 200 TOPEKA KS 66606 PHYSICIAN SERVICES 275800 12 278162 152235 290109 430397 NET PATIENT SERVICE REVENUE 621300 510154044 510154044 NUTRITIONAL SERVICES 621300 2179082 2179082 EDUCATION SERVICES/SCHOOL OF NURS 611600 2167412 2167412 PHARMACY 621300 438469 438469 LIFELINE 621300 433790 433790 511055 511055 515883852 791176 791176 466788 0 466788 466788 466788 115779487 194248 116020478 412827 -240991 -218579 -459570 -459570 517112643 515883852 0 798394 9357010 4972455 4384555 247916503 232090031 15826472 7379509 7144148 235361 33234895 29596635 3638260 16097119 14333891 1763228 2938966 939 2938027 162325 162325 187927 187927 17315402 15759756 1555646 827684 3101 824583 3073819 2007366 1066453 8760428 7452400 1308028 7782053 7629698 152355 251373 242817 8556 6849254 6849254 19720192 19720192 5105101 2357792 2747309 SUPPLIES 85621308 84771030 850278 REPAIR & MAINTENANCE 7622976 7276806 346170 NUTRITION & FOOD SERVIC 2160775 821095 1339680 CONTRIBUTION TO S-V FOU 420000 420000 13538348 9812253 3726095 496322967 453261659 43061308 0 6029203 90388835 92574769 8269095 75923316 75615981 5802499 5114532 4343928 5676443 421127116 224226668 193296075 196900448 118429539 125231593 55369328 53021631 2431430 5013982 554200087 565232540 62243012 62074619 144490000 141430000 4554153 3894894 128818479 75323921 340105644 282723434 X 213263622 281653583 697962 722664 132859 132859 214094443 282509106 554200087 565232540 X 20789676 7845886 39779101 X X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 1 0 1 0 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: THE HOSPITAL IS A MEMBER OF THE AMERICAN HOSPITAL ASSOCIATION AND THE KANSAS HOSPITAL ASSOCIATION. THESE ORGANIZATIONS HAVE INFORMED THE TAXPAYER THAT A PORTION OF THEIR DUES ARE ATTRIBUTED TO LOBBYING AND ADVOCACY ACTIVITIES. THAT PERCENTAGE FOR 2012 IS 14.9%. OCCASIONALLY, THE CEO WILL SPEAK TO LEGISLATORS REGARDING BILLS THAT WOULD AFFECT THE ORGANIZATION OR HEALTHCARE INDUSTRY. 254042 -5029 249013 244424 9618 254042 239410 5014 244424 239400 10 239410 235668 3732 239400 0.00000 0.53350 0.46650 0 0 15431914 15431914 247740764 110089164 137651600 157954438 114137504 43816934 196900448 18779144 F MORGAN CREEK FUND, LTD CLASS A 39,673 SHARES HELD 34242487 F 53021631 RESERVE FOR THIRD-PARTY PAYORS 2527462 ACCRUED PENSION PAYABLE 72770104 DUE TO RELATED PARTIES 26355 75323921 X 564701409 7845886 39930807 47776693 516924716 187927 187927 517112643 496286746 151706 151706 496135040 187927 187927 496322967 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE USED IN ACCORDANCE WITH THE DIRECTION OF THE APPLICABLE DONOR GIFT INSTRUMENT AT THE TIME THE GIFT IS ADDED TO THE FUND. DESCRIPTION OF UNCERTAIN TAX POSITIONS UNDER FIN 48: PART X, LINE 2: AS OF SEPTEMBER 30, 2013 AND 2012 THERE WERE NO UNCERTAIN TAX BENEFITS INDENTIFIED AND RECORDED AS A LIABILITY. PART XI, LINE 2D - OTHER ADJUSTMENTS: CONSOLIDATED AFFILIATE NET INCOME 290,181. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES -283,177. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS 39,923,803. PART XII, LINE 2D - OTHER ADJUSTMENTS: BOOK AMORTIZATION GREATER THAN TAX 151,706. 1 1 1 X 1 X 1 1 0 1 1 8171760 8171760 0.01650 57649354 39163258 18486096 0.03720 65821114 39163258 26657856 0.05370 686197 221004 465193 0.00090 3474312 2039163 1435149 0.00290 2121995 1350944 771051 0.00160 3784282 2675415 1108867 0.00220 22450 22450 0.00000 10089236 6286526 3802710 0.00760 75910350 45449784 30460566 0.06130 0 11715093 0 180904173 228615383 -47711210 X 1 1 1 1 STORMONT-VAIL HEALTHCARE

1500 SW 10TH STREET TOPEKA KS 66604

X X X STORMONT-VAIL HEALTHCARE 1 1 X X X X X X X X X 12 1 1 1 X X X X X X X X X X 0 0 1 1 150.000000000000 1 400.000000000000 1 X X X X 1 1 X 1 0 X X X 1 X 0 0 32 CANCER CENTER

1414 SW 8TH AVENUE TOPEKA KS 66606

CANCER CENTER HEART CENTER

929 MULVANE TOPEKA KS 66606

CARDIOLOGY OFFICE FAMILY PRACTICE

901 GARFIELD TOPEKA KS 66606

FAMILY PRACTICE PHYSICIAN OFFICES COTTON O'NEIL PHYSICIAN CLINICS

823 MULVANE TOPEKA KS 66606

VARIOUS PHYSICIAN OFFICES STORMONT VAIL WEST

3707 SW 6TH STREET TOPEKA KS 66606

PSYCHIATRIC COTTON O'NEIL GI CENTER

720 LANE TOPEKA KS 66606

GI CLINIC ORTHOPEDICS KOSM

909 SW MULVANE TOPEKA KS 66604

ORTHOPEDIC PHYSICIAN OFFICE EMPORIA CLINIC

1301 SW 12TH STREET EMPORIA KS 66801

PHYSICIAN OFFICES 6TH & FRAZIER

3520 SW 6TH STREET TOPEKA KS 66606

PHYSICIAN OFFICES REHABILTATION SERVICES

4019 SW 10TH AVE TOPEKA KS 66606

REHABILITATION THERAPY CROCO CLINIC

2909 SE WALNUT DR TOPEKA KS 66605

PHYSICIAN OFFICES PEDIATRICARE

4100 SW 15TH STREET TOPEKA KS 66604

PEDIATRICS PHYSICIAN OFFICE STORMONT VAIL SLEEP CENTER

920 SW WASHBURN TOPEKA KS 66606

SLEEP CENTER URISH CLINIC

6725 SW 29TH STREET TOPEKA KS 66614

PHYSICIAN OFFICES DERMATOLOGY CLINIC

6650 MISSION VALLEY DRIVE TOPEKA KS 66614

PHYSICIAN OFFICES WAMEGO CLINIC

1704 COMMERCIAL CIRCLE WAMEGO KS 66547

PHYSICIAN OFFICES CARBONDALE CLINIC

211 EAST MAIN CARBONDALE KS 66614

PHYSICIAN OFFICES OSAGE CITY CLINIC

131 WEST MARKET OSAGE CITY KS 66523

PHYSICIAN OFFICES OSKALOOSA CLINIC

209 W JEFFERSON OSKALOOSA KS 66066

PHYSICIAN OFFICES NORTH TOPEKA CLINIC

1130 N KANSAS AVENUE TOPEKA KS 66608

PHYSICIAN OFFICES LAWRENCE CLINIC

330 ARKANSAS LAWRENCE KS 66044

PHYSICIAN OFFICES ROSSVILLE CLINIC

423 MAIN ROSSVILLE KS 66533

PHYSICIAN OFFICES MERIDEN CLINIC

407 E WYANDOTTE MERIDEN KS 66512

PHYSICIAN OFFICES OCCUPATIONAL MEDICINE

1504 SW 8TH STREET TOPEKA KS 66606

WORKERS COMP PHYSICIAN OFFICE LEBO CLINIC

118 W 4TH LEBO KS 66856

PHYSICIAN OFFICES ALMA CLINIC

701 MISSOURI ALMA KS 66401

PHYSICIAN OFFICES CARDIAC THORACIC SURGEONS

830 MULVANE TOPEKA KS 66606

PHYSICIAN OFFICES MEDICAL ASSOCIATES OF MANHATTAN

1133 COLLEGE AVE STE E-110 MANHATTAN KS 66502

PHYSICIAN OFFICES MRI OF KANSAS

631 SW MULVANE TOPEKA KS 66606

MRI CENTER LYNDON CLINIC

715 WASHINGTON ST STE B LYNDON KS 66451

PHYSICIAN OFFICES EXCELLENT SURGERY CENTER

920 SW LANE TOPEKA KS 66606

SURGICAL FACILITY STORMONT VAIL SINGLE DAY SURGERY

823 MULVANE TOPEKA KS 66606

SURGICAL FACILITY PART III, LINE 4: THE FILING ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT THAT IT ALIGNS WITH THE GUIDELINES SET FORTH BY GAAP. PATIENT RECEIVABLES DUE DIRECTLY FROM THE PATIENTS ARE CARRIED AT THE ORIGINAL CHARGE FOR THE SERVICE PROVIDED LESS AMOUNTS COVERED BY THIRD-PARTY PAYORS AND LESS AN ESTIMATED ALLOWANCE FOR DOUBTFUL RECEIVABLES BASED ON A REVIEW OF ALL OUTSTANDING AMOUNTS ON A MONTHLY BASIS. MANAGEMENT DETERMINES THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BY IDENTIFYING TROUBLED ACCOUNTS, BY HISTORICAL EXPERIENCE APPLIED ON AN AGING OF ACCOUNTS AND BY CONSIDERING THE PATIENT'S FINANCIAL HISTORY, CREDIT HISTORY AND CURRENT ECONOMIC CONDITIONS. STORMONT-VAIL ONLY CHARGES INTEREST ON MEDICAL SERVICE DIVISON PATIENT RECEIVABLES. PATIENT RECEIVABLES ARE WRITTEN OFF TO BAD DEBT WHEN DEEMED UNCOLLECTIBLE. RECOVERIES OF RECEIVABLES PREVIOUSLY WRITTEN OFF ARE RECORDED AS A REDUCTION OF BAD DEBT EXPENSE WHEN RECEIVED. COSTING METHODOLOGY:THE BAD DEBT EXPENSE WAS CALCULATED BY USING THE ACTUAL BAD DEBT WRITE-OFFS FROM THE HOSPITAL AND THE COST TO CHARGE RATIO FROM THE COST ACCOUNTING SYSTEM FOR OTHER PAYORS MULTIPLIED BY THE BAD DEBT WRITE-OFFS. THE CLINIC BAD DEBTS WERE ESTIMATED AND A COST TO CHARGE RATIO WAS APPLIED TO DETERMINE COST. PART III, LINE 8: BOTH THE COST ACCOUNTING AND COST TO CHARGE RATIO METHOD ARE USED. STORMONT-VAIL HEALTHCARE PART V, SECTION B, LINE 1J: THE SHAWNEE COUNTY HEALTH NEEDS ASSESSMENT IDENTIFIED 14 HEALTH ISSUES THE HEALTHCARE COMMUNITY SHOULD ADDRESS. THE FINAL REPORT HAS A DETAILED ANALYSIS OF EACH ISSUE THAT INCLUDES:-DATA SOURCES-SHAWNEE COUNTY'S CURRENT PERFORMANCE-DISCUSSION OF THE ISSUE AND BARRIERS TO OVERCOME-HEALTHY PEOPLE 2020 NATION TARGETS STORMONT-VAIL HEALTHCARE PART V, SECTION B, LINE 3: PURPOSE AND SCOPE OF THE CHNA- TO IDENTIFY AND PRIORITIZE TOP HEALTH NEEDS IN SHAWNEE COUNTY.- COLLABORATE WITH LOCAL HEALTH CARE EXPERTS AND COMMUNITY STAKEHOLDERS TO COLLECT AND ANALYZE DATA TO IDENTIFY THE TOP COMMUNITY HEALTH ISSUES IN SHAWNEE COUNTY.INPUT AND DATA SOURCES FOR THE CHNAQUANTITATIVE PUBLIC HEALTH DATA FOR SHAWNEE COUNTY ARE AVAILABLE THROUGH THE KANSAS HEALTH MATTERS WEBSITE. A COMMUNITY SURVEY, WIDELY DISSEMINATED VIA EMAIL, PROVIDED ADDITIONAL QUANTITATIVE DATA. QUALITATIVE DATA WERE OBTAINED FROM THREE FOCUS GROUPS AND A SURVEY OF LOCAL PUBLIC HEALTH EXPERTS.QUANTITATIVE DATA SOURCES- KANSAS HEALTH MATTERS IS A ONE STOP SOURCE OF NON-BIASED DATA AND INFORMATION ABOUT COMMUNITY HEALTH IN KANSAS. IT IS INTENDED TO HELP HOSPITALS, HEALTH DEPARTMENTS, POLICY MAKERS AND COMMUNITY PLANNERS LEARN ABOUT ISSUES, IDENTIFY IMPROVEMENTS AND COLLABORATE FOR POSITIVE CHANGE. THIS VALUABLE RESOURCE WAS DEVELOPED BY THE KANSAS PARTNERSHIP FOR IMPROVING COMMUNITY HEALTH.USING KANSAS HEALTH MATTERS, THE TASK FORCE WAS ABLE TO COMPARE SHAWNEE COUNTY TO THE STATEWIDE AVERAGE ON 103 HEALTH INDICATORS. ALSO AVAILABLE ON THIS WEBSITE IS A 'COMMUNITY HEALTH NEEDS ASSESSMENT TOOLBOX' AND HYPERLINKS TO PROMISING PRACTICES REGARDING COMMUNITY HEALTH.- THE HEALTHY SHAWNEE COUNTY COMMUNITY PERCEPTION SURVEY WAS AVAILABLE ON-LINE FROM JULY 16 THROUGH AUGUST 31, 2012. THIS SURVEY TOOK 48 HEALTH INDICATORS FROM THE KANSAS HEALTH MATTERS WEBSITE AND ASKED PARTICIPANTS TO IDENTIFY THE LEVEL OF ATTENTION NEEDED FOR THOSE INDICATORS ON A 1-5 LIKERT SCALE (1 = MUCH LESS ATTENTION, 5 = MUCH MORE ATTENTION. 548 COMMUNITY AND 229 ORGANIZATION MEMBERS COMPLETED THE SURVEY. THE SURVEY RESULTS WERE ANALYZED BY BIOSTATISTICS AND EVALUATION SERVICES AND TRAINING (BEST) CENTER, UNIVERSITY OF NORTH TEXAS HEALTH SCIENCE CENTER, SCHOOL OF PUBLIC HEALTH.QUALITATIVE DATA SOURCES- INSIGHT INTO SHAWNEE COUNTY'S HEALTH-RELATED NEEDS WAS ALSO PROVIDED BY THREE FOCUS GROUPS. EACH GROUP HAD A DIFFERENT SET OF PARTICIPANTS, HEALTH CARE PROFESSIONALS, SOCIAL SERVICE PROFESSIONALS AND NEIGHBORHOOD LEADERS. THESE FOCUS GROUPS WERE FACILITATED BY VIRDEN AND ASSOCIATES OF KANSAS CITY AND CONDUCTED AUGUST 15 AND 16, 2012 AT THE TOPEKA-SHAWNEE COUNTY PUBLIC LIBRARY. FOCUS GROUP PARTICIPANTSHEALTHCARE PROFESSIONALS, AUGUST 15, 2012 AT 6:30 P.M., REPRESENTATIVES FROM:SELECT SPECIALTY HOSPITALWASHBURN RURAL SCHOOL NURSECOTTON-O'NEIL EXPRESSCAREHEALTH CONNECTIONS (ASK-A-NURSE)KANSAS REHAB HOSPITALSTORMONT-VAIL BEHAVIORAL SERVICESALDERSGATE VILLAGEMARIAN CLINIC, MEDICAL DIRECTORSTORMONT-VAIL EMERGENCY DEPARTMENTMARIAN CLINIC, PATIENT CARE DIRECTORST. FRANCIS EMERGENCY DEPARTMENTSHAWNEE COUNTY HEALTH AGENCY, MEDICAL DIRECTORBAKER SCHOOL OF NURSINGWASHBURN UNIVERSITY, DIRECTOR STUDENT HEALTHWASHBURN SCHOOL OF NURSING, COMMUNITY HEALTH NURSESOCIAL SERVICE AGENCIES, AUGUST 16, 2012 AT NOON, REPRESENTATIVE FROM:UNITED WAY OF GREATER TOPEKAHEALTH ACCESSAMERICAN RED CROSSHOUSING AND CREDIT COUNSELINGCATHOLIC CHARITIESBREAKTHROUGH HOUSEFAMILY SERVICE AND GUIDANCELET'S HELPTOPEKA COMMUNITY FOUNDATIONSHAWNEE COUNTY DEPARTMENT OF CORRECTIONSDOORSTEPMIDLAND CAREMEALS ON WHEELSBREWSTER PLACEVALEO BEHAVIORAL HEALTHSTORMONT-VAIL CASE MANAGERTOPEKA ASSOCIATION FOR RETARDED CITIZENSTOPEKA NEIGHBORHOOD ASSOCIATIONS/COMMUNITY VOLUNTEERS, AUGUST 16, 2012 6:30 P.M., REPRESENTATIVES FROM:COLLEGE HILL NEIGHBORHOODQUINTON HEIGHTS NEIGHBORHOODGREATER AUBURNDALE NEIGHBORHOODROLLING MEADOWS NEIGHBORHOODSOUTHERN HILLS NEIGHBORHOODOAKLAND NEIGHBORHOODELMHURST NEIGHBORHOODSTORMONT-VAIL COMMUNITY ADVISORY COUNCILCOMMUNITY VOLUNTEERS - 3-EIGHT COMMUNITY STAKEHOLDERS WITH PUBLIC HEALTH EXPERTISE WERE SENT AN E-MAIL SURVEY. THE QUESTIONS WERE OPENED ENDED IN ORDER TO COLLECT A BROADER BASE OF ANALYSIS - BASED UPON THE INSIGHT OF THE PARTICIPANTS. THE EXPERTS WERE DRAWN FROM A POOL OF COMMUNITY EXPERTISE THAT DEFINES PUBLIC HEALTH BROADLY. RESPONDING TO THE SURVEY WERE:-DAVID BECK, BREWSTER PLACE RETIREMENT COMMUNITY-DONA BOOE, KANSAS CHILDREN'S SERVICE LEAGUE-DEBBIE GUILBAULT, POSITIVE CONNECTIONS, INC.-CATHY HARDING, KANSAS ASSOCIATION FOR THE MEDICALLY UNDERSERVED-JOHN HOMLISH, COMMUNITY ACTION-MIRIAM KREHBIEL, UNITED WAY OF GREATER TOPEKA-LEE LEINWETTER, D.O., SHAWNEE COUNTY HEALTH AGENCY-MAX WILSON, RETIRED NON-PROFIT EXECUTIVE DIRECTORADDITIONAL INPUT WAS ALSO PROVIDED BY THE ASSESSMENT ADVISORY COMMITTEE. THE MEMBERS ARE LISTED IN THE NEXT SECTION. STORMONT-VAIL HEALTHCARE PART V, SECTION B, LINE 4: THE LEAD ENTITY IN THIS COMMUNITY HEALTH NEEDS ASSESSMENT WAS THE HEALTHY SHAWNEE COUNTY TASK FORCE, COMPRISED OF STORMONT-VAIL HEALTHCARE, ST. FRANCIS HEALTH CENTER AND THE SHAWNEE COUNTY HEALTH AGENCY. THE TASK FORCE HAD AN ASSESSMENT ADVISORY COMMITTEE TO PROVIDE DIRECTION AND FEEDBACK DURING THIS PROCESS:-HEALTHY SHAWNEE COUNTY TASK FORCE -SHAWNEE COUNTY HEALTH AGENCY ALLISON ALEJOS, DIRECTOR BOB HEDBERG, GRANTS & SPECIAL PROJECTS OFFICER -ST. FRANCIS HEALTH CENTER MARY HOMAN, DIRECTOR, MISSION & ETHICS PAULA ELLIS, DIRECTOR COMMUNITY BENEFIT, ACO AND PATIENT CENTERED MEDICAL HOME DEVELOPMENT -STORMONT-VAIL HEALTHCARE THOMAS LUELLEN, DIRECTOR OF PLANNING & DECISION SUPPORT-HEALTHY SHAWNEE COUNTY ASSESSMENT ADVISORY COMMITTEE PAMELA BETTS, 501 FOUNDATION KARILY TAYLOR, MARIAN CLINIC DONA BOOE, KANSAS CHILDREN'S SERVICE LEAGUE GARRY CUSHINBERRY, COREFIRST BANK JOHN HOMLISH, COMMUNITY ACTION NANCY JOHNSON, COMMUNITY RESOURCES COUNCIL MAX WILSON, COMMUNITY VOLUNTEER JOCELYN LYONS, JAYHAWK AREA ON AGING MIRIAM KREHBIEL, UNITED WAY OF GREATER TOPEKA REV. T.D. HICKS, ANTIOCH BAPTIST CHURCH STORMONT-VAIL HEALTHCARE PART V, SECTION B, LINE 5C: CHNA AVAILABLE AT THESE WEBSITES HTTPS://WWW.STORMONTVAIL.ORG HTTP://WWW.STFRANCIS.ORG HTTP://SHAWNEEHEALTH.ORG/DOCUMENTCENTER/VIEW/160WITH THE COMPLETION OF THE DATA COLLECTION/ANALYSIS AND SELECTION OF PRIORITIES, THE NEXT STEP IN THE PROCESS WAS DOCUMENTING AND COMMUNICATING THE RESULTS. IN ADDITION TO MAKING THE CHNA AVAILABLE ON EACH ORGANIZATION'S WEBSITE, THE FINAL REPORT WAS ALSO COMMUNICATED VIA:-DISTRIBUTE REPORT TO ASSESSMENT ADVISORY COUNCIL MEMBERS-DISTRIBUTE REPORT TO FOCUS GROUP PARTICIPANTS-PRESENTATIONS TO HOSPITAL LEADERSHIP AND BOARDS (LISTED BELOW)-PRESENT TO HEARTLAND HEALTHY NEIGHBORHOOD ADVISORY COUNCIL-MARCH COUNTY COMMISSION MEETING PRESENTATION STORMONT-VAIL PRESENTATIONS OF THE SHAWNEE COUNTY COMMUNITY HEALTH NEEDS ASSESSMENTDATE GROUP NUMBER OF ATTENDEES12/18/12 STORMONT-VAIL OPERATING COMMITTEE 141/17/13 STORMONT-VAIL AUXILIARY 451/31/13 SAFETY NET CLINIC SUMMIT 252/19/13 STORMONT-VAIL COMMUNITY ADVISORY COUNCIL 223/5/13 SHAWNEE COUNTY HEALTH CLINIC BOARD OF DIRECTORS 253/21/13 SHAWNEE COUNTY COMMISSIONERS 253/21/13 STORMONT-VAIL ALL MANAGEMENT COUNCIL 1254/5/13 LEADERSHIP GREATER TOPEKA, CLASS OF 2013 654/8/13 HEARTLAND HEALTHY NEIGHBORHOOD 214/25/13 KANSAS HEALTH INSTITUTE CHNA WORKSHOP 287/24/13 TOPEKA BUSINESS LEADERS - FAT WEDNESDAY 159/9/13 HEARTLAND HEALTHY NEIGHBORHOOD 28 STORMONT-VAIL HEALTHCARE PART V, SECTION B, LINE 6I: FOR THE IMPLEMENTATION PHASE OF THE CHNA, STORMONT-VAIL, ST, FRANCIS AND THE SHAWNEE COUNTY HEALTH AGENCY SOLICITED THE ASSISTANCE OF HEARTLAND HEALTHY NEIGHBORHOODS (HHN). HHN IS A GRASS ROOTS ORGANIZATION REPRESENTING OVER 40 LOCAL COMMUNITY AND SOCIAL SERVICE ORGANIZATIONS THAT DIRECTLY OR INDIRECTLY ADDRESS HEALTH CARE PROBLEMS IN THE COMMUNITY.TO ADDRESS THE 14 ISSUES IDENTIFIED IN THE CHNA, THE HHN GROUP FURTHER CATEGORIZED THEM INTO THREE MAJOR HEALTH PRIORITIES:IMPROVED ACCESS TO CARE, TO TRANSPORTATION AND TO HEALTH KNOWLEDGEHEALTHY EATING, ACTIVE LIVINGHEALTHY BABIESSTORMONT-VAIL COMMUNITY HEALTH IMPROVEMENT EFFORTS ARE BUILT UPON THESE THREE PRIORITY AREAS.STORMONT-VAIL'S IMPLEMENTATION STRATEGY TO ADDRESS EACH OF THE COMMUNITY HEALTH NEEDS IDENTIFIED THROUGH THE CHNA WAS INCORPORATED INTO THE FY14 STRATEGIC PLAN. STORMONT-VAIL HEALTHCARE PART V, SECTION B, LINE 7: THE SHAWNEE COUNTY CHNA IDENTIFIED 14 COMMUNITY HEALTH PRIORITIES. THE TOP COMMUNITY HEALTH ISSUES IDENTIFIED WERE:-ADULTS WHO ARE OVERWEIGHT OR OBESE-ADULTS NOT CONSUING FRUITS AND VEGETABLES FIVE OR MORE TIMES PER DAY-ADULTS PARTICIPATING IN RECOMMENDED LEVEL OF PHYSICAL ACTIVITY-ADULT CIGARETTE SMOKING-ADULTS WHO REPORTED THEIR MENTAL HEALTH WAS NOT GOOD ON 14 OR MORE DAY DURING THE PAST 30 DAYS-BIRTHS OCCURING TO TEENS AGES 15-19 YEARS OLD-ADULTS WITH DIAGNOSED DIABETES-ADULTS WITH AND AT-RISK FOR HEART DISEASE AND STROKE-INFANT MORTALITY-INFANTS FULLY IMMUNIZED AT 24-MONTHS-CHILDREN WITHOUT ADEQUATE ORAL HEALTHCARE-ACCESS TO HEALTH SERVICES-KNOWLEDGE OF AVAILABLE HEALTH/SOCIAL SERVICES-TRANSPORTATION CONNECTING PERSONS TO SERVICES AND RECREATIONFOR IMPLEMENTATION PURPOSES THESE 14 ISSUES WERE FURTHER CATEGORIZED INTO THREE MAJOR HEALTH PRIORITIES:IMPROVED ACCESS TO CARE, TO TRANSPORTATION AND TO HEALTH KNOWLEDGE -ACCESS FOR MEDICALLY UNDERSERVED POPULATIONS -TRANSPORTATION TO/KNOWLEDGE OF AVAILABLE SERVICES -POOR MENTAL HEALTH -DIABETES, HEART DISEASE/STROKEHEALTHY EATING, ACTIVE LIVING -OVERWEIGHT/OBESE -EAT FRUIT/VEGETABLES 5 TIMES DAILY -PARTICIPATE IN RECOMMENDED LEVEL OF PHYSICAL ACTIVITYHEALTHY BABIES -INFANT MORTALITY -TEEN BIRTHS -IMMUNIZED INFANTS -CIGARETTE SMOKING BY PREGNANT WOMENSTORMONT-VAIL COMMUNITY HEALTH IMPROVEMENT EFFORTS IS BUILT UPON THESE THREE PRIORITY AREAS.EACH OF THE HEALTH NEEDS IDENTIFIED IN THE SHAWNEE COUNTY CHNA IS IMPORTANT AND NUMEROUS PARTNERS THROUGHOUT THE COMMUNITY ARE ADDRESSING THESE NEEDS THROUGH INNOVATIVE PROGRAMS AND INITIATIVES. THE STORMONT-VAIL COMMUNITY HEALTH IMPROVEMENT PLAN WILL ONLY ADDRESS THE PRIORITY AREAS LISTED ABOVE IN ORDER TO ALLOCATE APPROPRIATE TIME AND RESOURCES TO SUCCESSFUL TACTICS AND ACTIONS.AREAS IDENTIFIED, BUT NOT SPECIFICALLY ADDRESSED INCLUDE:- ADULT CIGARETTE SMOKING (OTHER THAN PREGNANT WOMEN)- CHILDREN WITHOUT ADEQUATE ORAL HEALTHWHILE THE CHIP WILL NOT FOCUS DIRECTLY ON THESE ISSUES, ALL 3 WILL BE INDIRECTLY ADDRESSED BY THE EFFORTS TO INCREASE ACCESS TO CARE AND HEALTH KNOWLEDGE. STORMONT-VAIL HEALTHCARE PART V, SECTION B, LINE 14G: FOR PATIENTS EXPRESSING THE INABILITY TO PAY, THEY ARE PROVIDED WITH CUSTOMER SERVICE PHONE NUMBERS ON THE WEBSITE, PATIENT STATEMENTS, PATIENT HANDBOOKS, AND BROCHURES GIVEN TO ALL INPATIENTS AND OUTPATIENTS. X X X X 0 1 0 0 0 1 0 0 0 STEVEN WATKINS MD 734190 0 119698 0 5544 0 61192 0 9253 0 929877 0 0 0 RANDALL L PETERSON 395380 0 0 0 2785 0 157991 0 5656 0 561812 0 0 0 ERIC VOTH MD 268209 0 83719 0 1971 0 62311 0 15638 0 431848 0 0 0 DOUGLAS ROSE MD 331587 0 93750 0 3654 0 163043 0 4609 0 596643 0 0 0 KEVIN DISHMAN MD 781908 0 119222 0 1260 0 6766 0 16058 0 925214 0 0 0 LAMBERT WU MD 607529 0 65633 0 840 0 4120 0 16058 0 694180 0 0 0 DAVID CUNNINGHAM 202355 0 70857 0 2175 0 58606 0 15486 0 349479 0 0 0 CAROL WHEELER 307255 0 126896 0 4687 0 200718 0 8870 0 648426 0 0 0 BERNIE BECKER 271163 0 92710 0 4327 0 156879 0 8812 0 533891 0 0 0 KENT PALMBERG MD 537570 0 243319 0 9148 0 406979 0 9253 0 1206269 0 0 0 DEBRA YOCUM 268571 0 85484 0 2419 0 87166 0 4482 0 448122 0 0 0 JANET STANEK 348935 0 151981 0 8631 0 113653 0 15779 0 638979 0 0 0 CAROL PERRY 281466 0 102961 0 2511 0 133847 0 15389 0 536174 0 0 0 KEVIN HAN 319127 0 75049 0 3629 0 202248 0 631 0 600684 0 0 0 MICHAEL KONGS 148040 0 15225 0 504 0 13130 0 15375 0 192274 0 0 0 MATTHEW WILLS MD 2193449 0 71803 0 1260 0 18470 0 16058 0 2301040 0 0 0 TEWODRO ADDISSE MD 925000 0 86373 0 789 0 28033 0 4878 0 1045073 0 0 0 DAVID LUTES MD 839267 0 77004 0 1932 0 46386 0 4935 0 969524 0 0 0 CHU CHI CHENMD 1307416 0 97144 0 10668 0 37527 0 4935 0 1457690 0 0 0 PETER TUTUSKA MD 874884 0 77004 0 3612 0 58850 0 9253 0 1023603 0 0 0 MAYNARD OLIVERIUS 599490 0 1151304 0 9694 0 1000 0 4627 0 1766115 0 0 0 PART I, LINE 4B RANDALL PETERSON $ 157,991. DAVID CUNNINGHAM $ 37,201. BERNARD BECKER $ 96,743. KENT PALMBERG, M.D. $ 344,919. DEBRA YOCUM $ 46,160. JANET STANEK $ 62,500. CAROL PERRY $ 25,137. KEVIN HAN $ 113,339. ERIC VOTH, M.D. $ 1,653. DOUGLAS ROSE, M.D. $ 114,076. KEVIN DISHMAN, M.D. $ 4,510. PART I, LINE 6 CERTAIN EMPLOYEES OF THE ORGANIZATION ARE ELIGIBLE FOR BONUSES UPON ACHIEVEMENT OF VARIOUS PERFORMANCE MEASURES AS OUTLINED IN THE ANNUAL INCENTIVE PLAN. SUPPLEMENTAL INFORMATION PART III SCHEDULE J, PART II, LINE 21, COLUMN (II): INCLUDES A DEFERRED COMPENSATION PAYOUT THAT WAS PAID UPON RETIREMENT AND WAS REPORTED ON THE W-2. A KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BJT6 2007-08-27 50064927 HEALTH FACILITIES 0 0 0 B KANSAS DEVELOPMENT FINANCE AUTHORITY 48543BLG1 2008-03-31 27950075 HEALTH FACILITIES 0 0 0 C KANSAS DEVELOPMENT FINANCE AUTHORITY 484538MC9 2011-08-31 61193487 HEALTH FACILITIES 0 0 0 D KANSAS DEVELOPMENT FINANCE AUTHORITY 48453BNS3 2012-08-14 8750000 HEALTH FACILITIES 0 0 0 A 53519801 18107157 689770 1048000 30220000 2009 1 1 1 1 B 27950075 27677500 272575 2008 1 0 1 1 C 61196912 50325531 863086 10008295 2013 1 0 1 1 D 8748889 148649 7320181 1280059 0 0 0 1 A 0 0 0 0 0 0 1 B 0 0 0 0 0 0 1 C 0 0 0 0 0 0 1 D 0 0 0 0 0 0 1 A 1 0 0 0 0 1 B 1 0 0 0 0 1 C 1 0 0 0 0 1 D 1 0 0 0 0 1 A 1 B 1 C 1 D 1 SCHEDULE K SUPPLENTAL INFORMATION THE PROJECT FOR THE 2012 BOND ISSUE WAS NOT COMPLETED AS OF SEPTEMBER 30, 2013 X MEDICAL EQUIPMENT 2 118355 FMV X COMPUTER EQUIPMENT 3 27609 FMV X OTHER EQUIPMENT 4 144145 FMV 0 0 0 FORM 990, PART VI, SECTION B, LINE 11 A DRAFT OF THE RETURN IS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW. ANY CHANGES ARE COMMUNICATED TO THE PAID PREPARER. A COPY OF THE RETURN IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL. WITH THE BOARD'S APPROVAL, THE PAID PREPARER THEN FILES THE RETURN ELECTRONICALLY. FORM 990, PART VI, SECTION B, LINE 12C THE OFFICERS, DIRECTORS AND KEY EMPLOYEES SUBMIT CONFLICT OF INTEREST STATEMENTS TO THE CHAIRMAN OF THE AUDIT COMMITTEE OF STORMONT-VAIL HEALTHCARE EACH YEAR. THE CHAIRMAN REVIEWS THE RESPONSES AND REPORTS TO THE AUDIT COMMITTEE FOR THEIR REVIEW, ANY APPROPRIATE ACTION IF REQUIRED AND APPROVAL. THE CHAIRMAN ALSO THEN REPORTS THE RESULTS TO THE FULL BOARD OF DIRECTORS. FORM 990, PART VI, SECTION B, LINE 15 THE PERFORMANCE COMMITTEE OF THE STORMONT-VAIL HEALTHCARE BOARD OF DIRECTORS ENGAGED INTEGRATED HEALTHCARE STRATEGIES, AN EXECUTIVE COMPENSATION CONSULTING FIRM, TO PROVIDE RECOMMENDATIONS REGARDING ALL ASPECTS OF COMPENSATION OF THE ORGANIZATION'S SENIOR LEADERSHIP GROUP, INCLUDING THE PRESIDENT & CEO. THAT ENGAGEMENT INCLUDED THE FOLLOWING COMPONENTS: -REVIEW OF BACKGROUND DATA, INCLUDING INFORMATION ON CURRENT PROGRAM; -COMPILATION OF DATA ON COMPENSATION AND BENEFIT PRACTICES OF COMPARABLE ORGANIZATIONS; -COMPARISON OF BASE SALARIES AT SVHC TO BASE SALARY LEVELS IN THE MARKET; -COMPARISON OF ANNUAL AND LONG-TERM INCENTIVES AT SVHC TO INCENTIVE LEVELS IN THE MARKET; -ANALYSIS OF BENEFITS ON BOTH A QUANTITATIVE AND QUALITATIVE BASIS; -COMPARISON OF SVHC TOTAL COMPENSATION (BASE, INCENTIVE, BENEFITS) TO PEER GROUP TOTAL COMPENSATION; -PREPARATION OF REPORT TO FACILITATE SVHC BOARD DISCUSSION OF THE TOTAL COMPENSATION; AND -RECOMMENDATIONS REGARDING ESTABLISHMENT OF SALARY RANGES FOR SENIOR LEADERSHIP POSITIONS. THE DELIBERATIONS AND DECISIONS OF THE PERFORMANCE COMMITTEE AND THE BOARD OF DIRECTORS ARE DOCUMENTED IN MEETING MINUTES MAINTAINED BY SVHC. FORM 990, PART VI, SECTION C, LINE 19 STORMONT-VAIL HEALTHCARE, INC. MAKES THEIR FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION AS PART OF THE 990 INFORMATION RETURN. ANY CHANGES TO THE GOVERNING DOCUMENTS ARE INCLUDED WITH THE 990 RETURN. AT THIS TIME, THE HEALTH CENTER DOES NOT MAKE THEIR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: EQUITY IN NET INCOME OF CONSOLIDATED AFFILIATES 290,181. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS 39,923,803. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES -283,177. BOOK AMORTIZATION GREATER THAN TAX -151,706. PART XII, LINE 2C NO CHANGE FROM PRIOR YEAR. STORMONT-VAIL FOUNDATION 1500 SW 10TH AVE TOPEKA KS 66604 480980926 GENERATE VOLUNTARY GIFTS TO SUPPORT STORMONT-VAIL HEALTHCARE KS 501(C)(3) LINE 7 STORMONT-VAIL HEALTHCARE 0 STORMONT-VAIL HEALTHCARE AUXILARY 1500 SW 10TH AVE TOPEKA KS 66604 486140517 PROVIDE GIFT SHOP, RESTAURANT AND PROJECTS FOR THE CONVENIENCE OF PATIENTS KS 501(C)(3) LINE 11A, I N/A 0 STORMONT-VAIL SERVICES INC 1500 SW 10TH AVE TOPEKA KS 66604 481021165 MEDICAL SERVICES KS 501(C)(3) LINE 7 N/A 0 URISH MEDICAL PLAZA LLC 1500 SW 10TH TOPEKA KS 66604 480782848 REAL ESTATE KS STORMONT-VAIL INC RELATED 86017 844160 0 1 0.71670 STORMONT-VAIL INC 901 GARFIELD TOPEKA KS 66606 480782848 RETAIL PHARMACY KS STORMONT-VAIL HEALTHCARE INC C 1689981 16176613 1.00000 0 DECHAIRO HOSPITAL INC 1500 SW 10TH ST TOPEKA KS 66604 480788844 REAL ESTATE KS STORMONT-VAIL INC C 343458 1.00000 0 CENTURY HEALTH SOLUTIONS INC 2951 SW WOODSIDE DR TOPEKA KS 66614 481206397 INSURANCE MANAGEMENT OPERATIONS KS STORMONT-VAIL INC C -204903 227191 1.00000 0 UAT INC 1500 SW 10TH ST TOPEKA KS 66604 480907989 MEDICAL BILLINGS PRACTICE KS STORMONT-VAIL HEALTHCARE INC C 87242 1.00000 0 KOSM INC 1500 SW 10TH ST TOPEKA KS 66604 480807000 MEDICAL BILLINGS PRACTICE KS STORMONT-VAIL HEALTHCARE INC C 50151 181429 1.00000 0 0 1 1 0 0 0 0 1 0 0 0 0 0 1 1 0 1 0 1 STORMONT-VAIL FOUNDATION B 420000 STORMONT-VAIL FOUNDATION S 181627 STORMONT-VAIL HEALTHCARE AUXILIARY C 208543 STORMONT-VAIL HEALTHCARE AUXILIARY Q 246707 STORMONT-VAIL INC O 1396479 STORMONT-VAIL FOUNDATION O 355791