2014-08-13T21:47:25-05:00 2013-09-30 861065772 Deloitte Tax LLP 225 W Santa Clara St San Jose CA 95113 990 2012-10-01 820161600 St Luke's Regional Medical Center STLU 2083813790 190 E Bannock Boise ID 83712 Peter DiDio 2083813790 2014-08-13 1 Sharon Zorbach P00125475 4087044000 2012 2015-11-30 17:44:51Z Kathy Moore 190 E Bannock Boise ID 83712 1738496498 0 X www.stlukesonline.org X 1906 ID Provide healthcare services to the community. 20 10 9565 547 2313605 -506420 9368523 12714007 942985344 1032454327 5147030 3342779 405821 524690 957906718 1049035803 4272703 4611555 0 0 443779008 501872392 0 0 0 451369246 548146374 899420957 1054630321 58485761 -5594518 1230525119 1302029685 804700186 820592972 425824933 481436713 X Improve the health of people in the communities we serve by aligningphysicians and other providers to deliver integrated,patient-centered,quality care. 0 0 816195816 3731925 780841029 Medical & Surgical:St. Luke's Regional Medical Center is comprised of three hospitalcampuses(Boise,Meridian and Mountain Home),one urgent carecenter(Eagle),one free-standing emergency department( Nampa),andphysician clinics throughout the Treasure Valley. The hospitalsprovide 24-hour emergency care,diagnostic procedures,a varietyof inpatient and outpatient care,and maternity and pediatric care.Known for its clinical excellence,St. Luke's has been recognizedfor quality and patient safety,and is proud to be designated a MagnetHospital,the gold standard for nursing care. In addition,St. Luke'shas the only children's hospital in the state of Idaho.During FY'13,St. Luke's Hospital locations in the Treasure Valleyprovided inpatient care for 33,886 admissions,covering 119,501patient days. Also,the hospitals provided patient care associated with 507,754 outpatient visits. In addition to hospital patient care,thevarious physician clinics located in the Treasure Valley providedpatient care asociated with 907,848 visits. 48726582 239323 50058261 St. Luke's Childrens Hospital/Specialty CenterSt. Luke's Boise Medical Center is home to Idaho's only children's hospital. The Children's Hospital cares for more than 50,000 children every year,with more than 140 pediatricians and pediatric specialists working with referring physicians from around the region. Features of the Children's Hospital include Idaho's largest and most experienced Level III Newborn Intensive Care Unit,Pediatric Intensive Care Unit,and full service Pediatrics Unit. We also provide care in the state's only Pediatric Cancer Unit,Pediatric Emergency Department,and Pediatric Surgery Suites. At our Children's Hospital School,we help our young patients keep pace with their classmates. At CARES(Children at Risk Evaluation Services),medical evaluation,treatment,and documentation in cases of alleged abuse are provided.Within the Children's Hospital,experienced the following patient volumes during FY'13:Pediatrics: Admissions 2,320 Patient Days 7,372 Pediatric Intensive Care Unit: Admissions 153 Patient Days 1,753 63150003 640307 133681342 Heart & Vascular:St. Luke's provides more heart procedures than any other hospital in Idaho, providing cardiac care for heart patients throughout Idaho,and into parts of Oregon,Nevada,and Utah. St. Luke's supports the region through partnerships with physicians,hospitals,and regional clinics where patients are cared for in their own communities. Classes and screenings are offered to promote heart and vascular health and support those living with cardiovascular disease. In addition,St. Luke's has provided hundreds of automated external defibrillators(AEDs)to local schools,civic organizations and businesses,and has worked with area hospitals to achieve standardized clinical protocols for heart attack patients.Integral to the Heart & Vascular line is St. Luke's CardiologyAssociates(SLICA),a 16-physician cardiology practice servicing Boiseand the surrounding communities within Idaho. SLICA specializes inthe treatment of diseases and disorders that affect the heart and its associated blood vessels. In-office diagnostic services includetreadmill stress testing,echocardiography,heart rhythm monitoring,heartcatheterization and nuclear cardiology. Also included in the practice are special clinics designed to manage irregular heart beats(arrhythmias)pacemakers and defibrillators,blood thinning medications,congestive heart failure,and lipids.During FY'13 the St. Luke's Cardiology Clinics had 57,867 visits. 40764099 59312383 Emergency and Transport 1992433 1676308 Management Services 6914619 2726409 Joint VenturesRestated FY'12 amounts for Joint Ventures: Expenses: $ 7,227,331 Revenue: $ 2,614,669FY'13 Amounts: 341130 2759548 All OtherRestated FY'12 amounts for All Other: Expenses: $ 226,676 Revenue: $ 2,924,210FY'13 Amounts: 50012281 66474648 978084682 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 1 1 1 0 0 0 1 1 1 1 0 0 1 912 0 1 9565 1 0 0 0 0 0 0 0 0 0 0 X 20 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X Peter DiDio Vice-PresidentController 2083813790 190 E Bannock Boise ID 83712 X Mr Michael M Mooney 2.50 2.50 X X 0 0 0 Mr Patrick McMurray 2.00 2.00 X X 0 0 0 Mr Charles H Wilson 2.00 2.00 X X 0 0 0 Mr A J Balukoff 2.00 2.00 X X 0 0 0 Mr Jim Everett 2.00 2.00 X X 0 0 0 Mr George Iliff 2.00 2.00 X X 0 0 0 Mr Bill Ringert 2.00 2.00 X 0 0 0 Ms Carolyn Terteling- 2.00 2.00 X 0 0 0 Bishop Brian Thom 2.00 2.00 X 0 0 0 Ms Joy Kealey 2.00 2.00 X 0 0 0 Mr LaMont Keen 2.00 2.00 X 0 0 0 Ms Gay Simplot 2.00 2.00 X 0 0 0 Catherine ReynoldsMD 40.00 2.00 X 0 0 0 Thomas R HuntingtonMD 2.00 2.00 X 9450 0 0 Alan SwajkoskiMD 40.00 2.00 X 356564 0 38511 Leslie NonaMD 40.00 2.00 X 241376 0 33668 Mr John Jackson 2.00 2.00 X 0 0 0 Mr Ron JutzyMD 40.00 2.00 X 475361 0 23012 Mr Ron Sali 2.00 2.00 X 0 0 0 Mr Darin DeAngeli 2.00 4.00 X 0 0 0 Mr Chris Roth 40.00 4.00 X X 483255 0 34070 Jeffrey S Taylor 2.00 44.00 X 743235 0 141439 Ronald M KristensenMD 40.00 0.00 X 1181833 0 51270 Donald A StritzkeMD 40.00 0.00 X 977805 0 42449 Jon B GetzMD 40.00 0.00 X 1185482 0 41460 Steven S HuerdMD 40.00 0.00 X 950543 0 61100 David A HinchmanMD 40.00 0.00 X 922956 0 52835 Mr Gary L Fletcher 0.00 42.00 X 901567 0 180087 8429427 0 699901 456 1 1 0 Emergency Medicine Of Idaho 13960 W WainwrightSuite A Boise ID 83713 Emergency Medicine Services 19130714 Woman's ClinicLLP 100 E IdahoSte 400 Boise ID 83702 Medical Services 4762326 Quest DiagnosticsInc 3924 Collection Center Chicago IL 60693 Medical Laboratory Services 2632520 Boise Radiology GroupPLLC PO Box 9696 Boise ID 83707 Imaging Services 2565140 Alliance Recruiting Resources PO Box 4356 Dept 611 Houston TX 772104356 HR Recruiting Services 1552150 107 1404793 10259585 1049629 960000 12714007 Net Patient Revenue 900099 1010063994 1010063994 Outpatient Retail Rx 446110 4233455 2834408 1399047 VHA Coop Cash Distrib. 900099 3086033 3086033 Joint Venture Income 900099 2247445 2247445 12823400 12823400 1032454327 6204369 6204369 1911997 2386785 -474788 -474788 -474788 684120843 91477 686828410 245500 -2707567 -154023 -2861590 -2861590 LAUNDRY 812300 914558 914558 EMPLOYEE PARKING REV 900099 84920 84920 999478 1049035803 1031055280 2313605 2952911 4611555 4611555 3587907 3587907 405055930 364789475 40266455 23177477 20859729 2317748 44278487 39850638 4427849 25772591 23195332 2577259 54054977 52136043 1918934 2322236 2322236 13220 540 12680 124790 124790 590764 590764 6214640 4516134 1698506 1952772 386546 1566226 8049296 6798175 1251121 43985553 43985553 13928766 11886202 2042564 2747396 2199795 547601 22571006 22571006 70347769 70347769 300391 284518 15873 Supplies 160184639 157777673 2406966 Provision for Bad Debt 50994961 50994961 Contract Services 27620655 22595258 5025397 Repairs 15506803 14524453 982350 66635740 63057773 3577967 1054630321 978084682 76545639 0 76601 4653626 26528360 23119009 70141117 169935886 325000 325000 18331769 20190579 5592040 4302249 959255082 434855187 428933695 524399895 354902978 306894814 8053660 8095754 9864972 9258159 51078547 56285355 256696380 174569359 1230525119 1302029685 75075596 92009886 3119729 2136643 592645288 613802555 1685602 1683475 132173971 110960413 804700186 820592972 X 424991953 480507236 832980 929477 425824933 481436713 1230525119 1302029685 X -5594518 -1953302 63159600 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED X 124790 124790 124790 124790 1054505531 1054505531 1054630321 1054630321 1000000 1000000 250000 250000 0 0 0 0 1000000 1000000 1000000 1000000 4000000 6000000 120363 122297 124298 124790 491748 250000 250000 250000 250000 1000000 1500000 752623 262073 75872 9347 929477 752623 752623 1.00000 1 0 39777050 27862435 67639485 883941 483608184 199703053 284789072 12644208 1315906 11328302 360275776 233836228 126439548 34203488 34203488 524399895 Def. Bond Finance Costs 7966691 Physician Loans 423611 Executive Flex Plan 33945 Due From Related Organizations 164881884 Idaho Community Trust Endowment-Humphrey Diabetes 929477 Intangible Assets 333751 174569359 Third Party Settlement 70791545 Benefit Plan Liabilities 34253409 Accrued Interest Payable-Bonds 5915459 110960413 X Description of Intended Use of Endowment Funds: Part V, Line 4: Part V, line 4: The Humphreys Diabetes Center Endowment Fund was established in 2000 from donations by several Idahoans for the purpose of supporting its diabetes based mission in the State of Idaho. This fund is to be used only for ongoing operating needs in service to the diabetic community and to provide assistance for Sweet Kids Camp and other priorities determined by the Board of Directors. The fund is in the possession of and administered by The Idaho Community Foundation. Form 990 Schedule D,Part X,Line 2: Footnote Disclosure-Uncertain Tax Positions Under FIN #48 (Source: Consolidated Financial Statements-St. Luke's Health System) "The Health System is subject to federal excise tax on its unrelated business taxable income(UBTI). For the period ended September 30,2013,the Company had approximately $3,947,000 of UBTI Net Operating Losses from operating losses incurred from 1999 to 2013 which expire in years 2014 to 2028. The Health System does not believe it is more likely than not they will utilize these losses prior to their expiration and as such has provided a full valuation allowance against these losses." 1 1 X 1 X 185.000000000000 1 X 1 1 1 0 1 1 15247564 15247564 0.01520 127989664 100276466 27713198 0.02760 9560471 5617779 3942692 0.00390 152797699 105894245 46903454 0.04670 2885464 547941 2337523 0.00230 10186294 10186294 0.01010 7112397 3931045 3181352 0.00320 5599948 1506258 4093690 0.00410 1531600 1531600 0.00150 27315703 5985244 21330459 0.02120 180113402 111879489 68233913 0.06790 242 242 0.00000 360780 2273 358507 0.00040 361022 2273 358749 0.00040 1 26035333 138056772 205645850 -67589078 X 1 1 1 Ortho Neuro ManagementLLC MSO-Provides consulting services for Ortho Neuro service lines 0.58180 0.41820 2 1 St Luke's Regional Medical Center

190 E Bannock Boise ID 83712

www.stlukesonline.org X X X X A 2 St Luke's Elmore

895 N 6th E Street Mountain Home ID 83647

www.stlukesonline.org X X X X A Facility Reporting Group - A 1 X X X X X X X X X 12 1 0 1 X X X X X X X X X X 0 0 1 1 185.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X X X X 1 0 1 X 0 0 50 Children's Specialty Center

100 E Idaho St Boise ID 83712

Specialty Peds Physician Clinics St Luke's Clinic-Intermountain Ortho

600 W Robbins Rd Suite 100 Boise ID 83702

Orthopedics/Rheumatology Physician Clinics St Luke's Clinic-Intermountain Ortho

1109 W Myrtle St Boise ID 83702

Orthopedics-Physician Clinic Saltzer Rehabilitation South

290 W Georga Ave Nampa ID 83686

Physical Therapy Clinic Saltzer Hearing and Balance

210 W Georga Ave Suite 100 Nampa ID 83686

Hearing and Balance Clinic Portico East MOB

3277 E Louise Dr Meridian ID 83642

Speciality Physician Clinics Caldwell Medical Arts Bldg

1818 S 10th AveSuite 220 Suite 120 Caldwell ID 83605

Speciality Physician Clinics Idaho Sleep Health-Saltzer

7272 Potomac Dr Boise ID 83704

Sleep Disorders Clinic Saltzer-Idaho Pain Management

8950 W Emerald StSuite 168 Boise ID 83704

Pain Management-Physician Clinic Saltzer Imaging

4403 E Flamingo Ave Nampa ID 83687

Outpatient Imaging Services St Luke's Eagle Urgent Care

3101 E State St Eagle ID 83616

Urgent Care and Specialty Physician Clinics St Luke's Imaging Center

703 S Americana Blvd Boise ID 83702

Imaging Services and Specialty Physician Clinics Meadowlake Village MOB

3525 E Louise Dr Meridian ID 83642

Specialty Physician Clinics St Luke's Nampa

9850 W St Lukes Drive Nampa ID 83687

Free Standing ED,Physician Clinics,Physical Therapy Clinic St Luke's Clinics-Park Center

701 E Parkcenter Blvd Boise ID 83706

Specialty Physician Clinics Anderson Plaza Medical Office Plaza

222 N 2nd St Boise ID 83702

Specialty Physician Clinics Idaho Professional Building

125 E Idaho St Boise ID 83712

Specialty Physician Clinics St Luke's-Caldwell Urology

1620 S Kimball Ave Caldwell ID 83605

Physician Clinic-Urology St Luke's Clinic-Fruitland

1210 NW 16th St Fruitland ID 83619

Physician Clinic-Surgery St Luke's Clinic-EOMA

3950 17th StSuite A Baker City OR 97814

Family Medicine-Physician Clinic St Luke's Clinic-Capital City Family

1520 W State StSuite 100 Boise ID 83702

Family Medicine-Physician Clinic St Luke's Family Health

3090 Gentry WaySuite 200 Meridian ID 83642

Family Medicine-Physician Clinic St Luke's Clinic-Idaho Family Phys

130 E Boise Ave Boise ID 83706

Family Medicine-Physician Clinic St Luke's Family Health

12080 W McMillan Rd Boise ID 83713

Family Medicine-Physician Clinic St Luke's Mountain States Urology

510 N 2nd StSuite 103 Boise ID 83702

Physician Clinic-Urology St Luke's Idaho Cardiology Assoc

315 E Elm Suite 350 Boise ID 83608

Cardiology-Physician Clinic St Luke's Medical Office Plaza

333 N 1st Street Boise ID 83702

Surgery Center/Specialty Physician Clinics St Luke's Clinic-MtView Family Med

3301 N Sawgrass Way Boise ID 83704

Family Medicine-Physician Clinic St Lukes's Treasure Valley Pediatrics

1620 S Celebration Ave Meridian ID 83642

Pediatric Physician Clinic St Luke's Internal Medicine

4840 N Cloverdale Rd Boise ID 83713

Internal Medicine-Physician Clinic St Luke's Clinic-Idaho Endocrinology

403 S 11th St Suite 100 Boise ID 83702

Endocrinology-Physician Clinic St Luke's Family Health

2083 Hospitality Lane Boise ID 83716

Family Medicine-Physician Clinic St Luke's Clinic-Warm Springs

100 E Warm Springs Ave Suite B Boise ID 83712

Physician Clinic-Surgery St Luke's Clinic-Boise Heart

287 W Jefferson St Boise ID 83702

Cardiology-Physician Clinic St Luke's Clinic-Family Medicine

3165 Greenhurst Rd Nampa ID 83686

Family Medicine Physician Clinic St Luke's Family Health

3140 W Milano DrSuite 150 Meridian ID 83646

Family Medicine-Physician Clinic St Luke's Clinic-Family Medicine

824 S Diamond St Nampa ID 83686

Family Medicine-Physician Clinic St Lukes Clinic-Stark Medical

932 W Idaho Suite 100 Ontario OR 97914

Family Medicine-Physician Clinic St Lukes's Treasure Valley Pediatrics

450 W State St Eagle ID 83616

Pediatric Physician Clinic St Luke's Clinic-OBGYN

300 Main StSuite 100 Boise ID 83702

Obstetrics and Gynecology-Physician Clinic St Luke's Clinic-Family Medicine

1107 NW 11th St Fruitland ID 83619

Family Medicine-Physician Clinic St Luke's Clinic-Syringa Family Med

2347 E Gala StSuite 150 Meridian ID 83642

Specialty Physician Clinics Jefferson Medical Office Plaza

300 E Jefferson St Boise ID 83712

Cardiology & Internal Medicine Physician Clinics St Luke's Meridian MOB

520 S Eagle Road Meridian ID 83642

Specialty Physician Clinics St Luke's Idaho Pulmonary Associates

2347 E Gala St Meridian ID 83642

Pulmonary Physician Clinic St Luke's Boise Orthopedic Surgery

1425 W River Street Boise ID 83702

Orthopedic Surgery Center St Luke's Idaho Cardiology-Saltzer

215 E Hawaii Nampa ID 83687

Specialty Physician Clinics St Luke's Ref Lab & Central Laundry

3000 S Denver Way Boise ID 83705

Reference Lab and Central Laundry Facility St Luke's Clinic-Pain Management

2275 S Eagle Rd Suite 160 Meridian ID 83642

Physician Clinic-Pain Management St Lukes Clinic-Trinity Mountain

465 McKenna Drive Mountain Home ID 86347

Family Medicine & OB/GYN clinic Part I, Line 3c: (A) St. Luke's does provide charity care services to patients who meet one or both of the following guidelines based on income and expenses: 1. Income. Patients whose family income is equal to or less than 400% of the then current Federal Poverty Guideline are eligible for possible fee elimination or reduction on a sliding scale. 2. Expenses. Patients may be eligible for charity care if his or her allowable medical expenses have so depleted the family's income and resources that he or she is unable to pay for eligible services. The following two qualifications must apply: a. Expenses-The patients allowable medical expenses must be greater than 30% of the family income. Allowable medical expenses are the total of the family medical bills that, if paid,would qualify as deductible medical expenses for Federal income tax purposes without regard to whether the expenses exceed the IRS-required threshold for taking the deduction. Paid and unpaid bills may be included. b. Resources-The patient's excess medical expenses must be greater than available assets. Excess medical expenses are the amount by which allowable medical expenses exceed 30% of the family income. Available assets do not include the primary residence,the first motor vehicle,and a resource exclusion of the first $4,000 of other assets for an individual,or $6,000 for a family of two,and $1,500 for each additional family member. (B) Service Exclusions: 1. Services that are not medically necessary (e.g. cosmetic surgery) are not eligible for charity care. 2. Eligibility for charity care for a patient whose need for services arose from injuries sustained in a motor vehicle accident where the patient,driver,and/or owner of the motor vehicle had a motor vehicle liability policy,and only if a claim for payment has been properly submitted to the motor vehicle liability insurer,where applicable.(C) Eligibility Approval Process: 1. St. Luke's screens patients for other sources of coverage and eligibility in government programs. St. Luke's documents the results of each screening. If St. Luke's determines that a patient is potentially eligible for Medicaid or another government program,St. Luke's shall encourage the patient to apply for such a program and shall assist the patient in applying for benefits under such a program. 2. The patient must complete a Financial Assistance Application and provide required supporting documentation in order to be eligible. 3. St. Luke's verifies reported family income and compares to the latest Poverty Guidelines published by the U.S. Department of Health and Human Services. 4. St. Luke's verifies reported assets. 5. St. Luke's provides a written notice of determination of eligibility to the patient or the responsible party within 10 business days of receiving a completed application and the required supporting documentation. 6. St. Luke's reserves the right to run a credit report on all patients applying for charity care services. (D) Eligibility Period. The determination that an individual is approved for charity care will be effective for six months from the date the application is submitted,unless during that time the patient's family income or insurance status changes to such an extent that the patient becomes ineligible. Part I, Line 6a: St. Luke's Regional Medical Center,Ltd.(SLRMC) includes the activity of Mountain States Tumor Institute(MSTI) within its community benefit report since SLRMC is the sole member of MSTI. Part I, Line 7: The cost to charge ratio was used for the calculation of charity care at cost,unreimbursed Medicaid and other means-tested programs. Part I, L7 Col(f): Bad Debt is defined as expenses resulting from services provided to a patient and/or guarantor who,having the requisite financial resources to pay for health care services,has demonstrated an unwillingness to do so. The amount of bad debt expense included in Form 990,Part IX,line 25 is $50,994,961. Part II: The community building activities for St. Luke's Regional Medical Center, Ltd.("SLRMC") include the following:Economic Development:Participation of SLRMC CEO in Chamber of Commerce Meeting.Coalition Building:Air St. Luke's program director attended monthly/quarterly EMS Council meetings throughout the region to build relationships and discuss emergency management procedures.SLRMC research leadership and staff particpated in an annual researchsymposium. The research symposium brought together leading physicians, scientists,and business executives for a day of information sharing, collaboration,and innovation. Participants learned the role investment in research and development plays in long-term viability and business performance,and to consider how clinical research efforts at St. Luke's and research and development at leading regional businesses might collaborate with shared benefit to our community and those we serve. Participants learned about different types of translational research, providing an overview of biomedical research being conducted at academic centers in our region. Attendees considered how regular interchange of information between St. Luke's research investigators and academicians might best occur to increase collaboration in research. Part III, Line 4: St. Luke's Regional Medical Center,Ltd. grants credit without collateral to its patients,most of whom are local residents and many of whom are insured under third-party agreements. The allowance for estimated uncollectible amounts is determined by analyzing both historical information(write-offs by payor classification),as well as current economic conditions. Part III, Line 8: 100% of the shortfall in Medicare reimbursement is considered a community benefit. St. Luke's Regional Medical Center,Ltd. provides medicalcare to all patients eligble for Medicare regardless of the shortfall and thereby relieves the Federal Government of the burden for paying the full cost of Medicare.The source of the information is the Medicare Cost Report for fiscal year 2013. The amount is calculated by comparing the total Medicare apportioned costs(allowable costs) to reimbursements received during FY'13. It should be noted that the unreimbursed costs reported within this schedule are significantly less than the amount reported in the annual Community Benefit Report to Ada County("County"). In the report to the County,unreimbursed costs include program costs allocated to the Medicare Advantage program,along with costs that offset the provider-based physician clinic operations;i.e. professional component billing for physician time and effort. The Medicare Cost Report does not include these components. In addition,the report to the County includes all allocated costs to the Medicare Programs,whereas the Medicare Cost Report reports allowable costsonly. Part III, Line 9b: All subsidiaries within the St. Luke's Health System have policies in place to provide financial assistance to those who meet established criteria and need assistance in paying for the amounts billed for their provided health care services. In addition,the collection policies and practices in place within the St. Luke's Health System provide guidance to patients on how to apply for this assistance. Collection of amounts due may be pursued in cases where the patient is unable to qualify for charity care or financial assistance and the patient has the financial resources to pay for the billed amounts. Part VI, Line 2: A Community Health Needs Assessment(CHNA)was conducted forfiscal year ending 9/30/2013. Information related to the2013 CHNA is shown in the responses to questions 3 and 7 of"Part V,Section B,Facility Policies and Practices".A complete copy of the CHNA assessments for all of the hospitalsoperating within the St. Luke's Health System can be found atthe following website: http://www.stlukesonline.org/about_us/chna.php Part VI, Line 3: (A) St. Luke's Regional Medical Center provides notice of the availability of financial assistance via: 1. Signage 2. Patient brochure 3. Billing Statement 4. Written collection action letter 5. Online at www.stlukesonline.org/billing(B) All notices are translated into the following language:Spanish(C) St. Luke's provides individual notice of the availability of financial assistance to a patient expected to incur charges that may not be paid in full by third party coverage,along with an estimate of the patient's liability.(D) For cases in which St. Luke's independently determines patient eligibility for financial assistance,St. Luke's provides written notice of determination that the patient is or is not eligible within 10 business days of receiving a completed application and the required supporting documentation. Part VI, Line 4: St. Luke's Regional Medical Center(SLRMC)serves Idaho's Ada and Canyon Counties,with its secondary service area covering southwest and south central Idaho and Eastern Oregon. Certain tertiary areas routinely provide care to residents from throughout Idaho and into its surrounding states.SLRMC's primary service area includes Ada and Canyon counties and are used to define the community served. The criteria used in selecting this area was to include the entire population of the counties where greater than 70% of the inpatients reside. The residents of these counties comprise about 83% of the inpatients with approximately 64% of the inpatients living in Ada County and 19% in Canyon County. Ada and Canyon counties are part of Idaho Health Districts 3 and 4.Both Idaho and the service territory are comprised of about 95% white population while the nation as a whole is 72% white. The Hispanic population in Idaho represents 11% of the overall population and about 12% of the defined service area. Canyon County is approximately 24% Hispanic,and Ada County is 7% Hispanic.Idaho experienced a 21% increase in population from 2000 to 2010 ranking it as the fourth fastest growing state in the country. Ada and Canyon Counties followed that trend,experiencing an even more rapid 34% increase in population within the timeframe. The service area is expected to grow by over 20% again by the year 2020. St. Luke's Regional Medical Center is constantly working to manage the volume and scope of its services in order to meet the needs of an increasing population.Over the past ten years the 45 to 64 year old age group was thefastest growing segment of the community. Over the next ten years, however,the 65 years or older age group is expected to grow by over 50%, making it the fastest growing segment. Currently,about 11% of the people in the community are over the age of 65 and by 2020 about 13% of the population in the community is expected to be over the age of 65.The official United States poverty rate increased from 13.3% in 2005 to 15.3% in 2010. The service area poverty rate has increased more than the national average since 2005. In 2005 it was below the national average at 11% and by 2010 it was above the national average at 16%. The poverty rate in the community for children under the age of 18 is 19%,which is below the national average. However,Canyon County's poverty rate is above the national average for both adults and children.Median Income in the United States has risen by 8% since 2005. However, growth in income was slower in Idaho and in the service area during that period. Median income in Canyon County is well below the national median and slightly lower than Idaho's median income. Despite decreasing over the past five years,median income in Ada County is still slightly higher than the national median income. Part VI, Line 5: The people who serve on the various boards for subsidiaries within the St. Lukes Health System are local citizens who have a vested interest in the health of their communities. These committed leaders volunteer on our boards because they are dedicated to ensuring that the people of southern Idaho and the surrounding area have access to the most advanced,most comprehensive health care possible. St. Luke's believes that locally owned and governed hospitals can take the best measure of community health care needs. We are grateful to our board leadership for giving generously of their time and talents and bringing to the table their unique perspectives and intimate knowledge of their communities. St. Luke's would not be the organization it is today without our volunteer board members. The vision of dedicated community leaders has guided St. Luke's for many decades,and will continue to guide us well into the future.As a not-for-profit organization,100% of St. Luke's revenue after expenses is reinvested in the organization to serve the community in the form of staff,buildings,or new technology.Also,St. Luke's Regional Medical Center,Ltd.(SLRMC)maintains an open medical staff. Any physician can apply for practicing privileges as long as they meet the criteria of SLRMC. Part VI, Line 6: As the only Idaho-based not-for-profit health system,St. Luke's Health System is part of the communities we serve,with localphysicians and boards who further our organization's mission "Toimprove the health of the people in our region." Working together,we share resources,skills,and knowledge to provide the best possiblecare,no matter which of our hospitals provide that care. Each St. Luke's Health System hospital is nationally recognized for excellence in patient care,with prestigious awards and designations reflecting the exceptional care that is synonymous with the St. Luke's name. St. Luke's Health System provides facilities and services across the region,covering a 150-mile radius that encompasses southern and central Idaho,northern Nevada,and eastern Oregon-bringing care close to home and family. The following entities are part of the St. Luke's Health System:(1) St. Luke's Regional Medical Center,Ltd. with the following locations: --St. Luke's Boise Hospital --St. Luke's Meridian Hospital --St. Luke's Childrens Hospital --St. Luke's Boise/Meridian Physician Clinics --St. Luke's Nampa Emergency Department --St. Luke's Eagle Urgent Care --St. Luke's Elmore Hospital (2) St. Luke's Wood River Medical Center,Ltd. which consists of a critical access hospital located in Ketchum,Idaho as well as various physician clinics.(3) St. Luke's Magic Valley Regional Medical Center,Ltd. which consists of the following: --St. Luke's Magic Valley Hospital-Twin Falls, Idaho --Various St. Luke's Physician Clinics in Twin Falls. --Canyon View-(Behavioral Health)(4) St. Luke's McCall,Ltd. which consists of a critical access hospital located in McCall,Idaho as well as various physician clinics.(5) Mountain States Tumor Institute,Inc.(MSTI)is the region's largest provider of cancer services and a nationally recognized leader in cancer research. MSTI provides advanced care to thousands of cancer patients each year at clinics in Boise,Fruitland,Meridian,Nampa, and Twin Falls,Idaho. MSTI is home to Idaho's only cancer treatment center for children,only federally sponsored center for hemophilia,and only blood and marrow transplant program. MSTI's services and therapies include breast care services,blood and marrow transplant,chemotherapy,genetic counseling,hematology, hemophilia treatment,hospice,integrative medicine,marrow donor center,mobile mammography,mole mapping,nutritional counseling, PET/CT scanning,patient/family support,pediatric oncology, radiation therapy,rehabilitation,research and clinical trials, Schwartz Center Rounds for Caregivers,spiritual care,support groups/classes,tumor boards,and Wound Ostomy,and Continence Nursing. MSTI is expanding as rapidly as today's cancer treatment. Patients can now visit a MSTI clinic or Breast Cancer detection center at 12 different locations in southwest Idaho and Eastern Oregon. Locations include Boise,Meridian,Nampa,Twin Falls,and Fruitland.(6) St. Luke's Jerome,Ltd. which consists of a critical access hospital located in Jerome,Idaho as well as one physician clinic. St. Luke's physician clinics and services are provided in partnership with area physicians and other health care professionals. These include:Cardiovascular;Child Abuse and Neglect Evaluation;Endocrinology;Ear, Nose,and Throat;Family Medicine;Gastroenterology;General Surgery;Hypertensive Disease;Internal Medicine;Maternal/Fetal Medicine;Medical Imaging;Metabolic and Bariatric Surgery;Nephrology;Neurology;Neurosurgery;Obstetrics/Gynecology;Occupational Medicine;Orthopedics;Outpatient Rehabilitation;Plastic Surgery;Psychiatry and Addiction;Pulmonary Medicine;Sleep Disorders;and Urology. In addition,St. Luke's partners with other regional facilities through management service contracts. These partners include:(1) Challis Area Health Center(2) North Canyon Medical Center(3) Salmon River Clinic(4) Weiser Memorial Hospital Reports Filed With States Part VI, Line 7 ID Part V, Line 8 Facility Reporting Group A See below Facility 1 -- St. Luke's Regional Medical Center Part V, Section B, line 3: A series of interviews with and surveys(questionnaires)of community representatives and leaders representing the broad interests of our community were conducted in order to assist us in defining,prioritizing,and understanding our most important community needs. Most of theleaders that participated in our process are individuals who have devoted decades to helping others lead healthier and more independent lives. All of the leaders we interviewed have significant knowledge of our community. To ensure they came from distinct and varied backgrounds,we included multiple representatives from each of these categories:Category I: Persons with special knowledge of or expertise in public healthCategory II: Federal,Regional,State,or Local health or other departments or agencies(with current data or other information relevant to the health needs of the community served by the hospital)Category III: Leaders,representatives,or members of medically underserved,low income,and minority populations,and populations with chronic disease needsEach potential need was scored by the community representative on a scale of 1 to 10. Higher scores represent potential needs the community representatives believed were were important to address with additional resources. Lower scores usually meant our leaders thought our community was healthy in that area already or had relatively good programs addressing the potential need. These scores were incorporated directly into our health need prioritization process. In addition,we invited the leaders to suggest programs,legislation,or other measures they believed to be effective in addressing the needs.The following community leaders/representatives were contacted:(1) Idaho Arc(2) Boise Rescue Mission(3) Boise VA Medical Center(4) Community Council of Idaho(5) Family Medicine Residency of Idaho(6) Genesis World Mission(7) Southwest District Health, District 3(8) Idaho Department of Health and Welfare(9) Idaho Department of Labor: Provided unemployment information(10) Idaho Council of Governments(11) Idaho Office for Refugees(12) Terry Reilly Health Services(13) Treasure Valley Family YMCA(14) United Way(15) Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services,Region X. Facility 1 -- St. Luke's Regional Medical Center Part V, Section B, line 7: We organized our significant health needs into five groups:Program Group 1:Weight Management,Nutrition,and Fitness -Adult and teen weight management -Adult and teen nutrition -Adult and teen exercise Program Group 2:Diabetes -Wellness and prevention for diabetes -Chronic condition for diabetes -Diabetes screening Program Group 3:Mental Health -Mental illness wellness and management -Suicide prevention -Availability of mental health service providers Program Group 4:Barriers to Access -Affordable care -Affordable health insurance -Affordable dental care -Children and family services(low income) -More providers accept public health insurance -Primary Care Providers(availability) -Integrated,coordinated care -Transportation to and from appointmentsProgram Group 5:Additional Health Screening and Education Programs Ranked above the median. -Excessive drinking and illicit drug use prevention and wellness programs -Skin cancer wellness and prevention -High cholesterol screening and wellness -Asthma chronic care and wellness Next we examined whether it would be effective and efficient for St. Luke's Regional Medical Center("SLRMC")to address each significant health need directly. To make this determination,we reviewed the resources we had available and determined whether the health need was in alignment with our mission and strengths. Where a high priority need was not in alignment with our mission and strengths,SLRMC tried to identify a community group or organization better able to serve the need. Significant community health needs not addressed by SLRMC are as follows:(1) Substance abuse services and programs Drug and alcohol use were not ranked as a top 20th percentile need in our CHNA. In addition, substance abuse treatment is a low strength of SLRMC. Therefore,due to limited resources,St. Luke's will partner with Drug Free Idaho and rely on other organizations in our community to continue to address this need. How we partner with Drug Free Idaho is described in our Implementation Plan.(2) Affordable Dental Care SLRMC will not directly provide an affordable dental care program because dental care is not aligned with our mission or strengths. However,this need is ranked above the median and SLRMC will allocate funds to donate to organizations in our community that have quality programs to address dental health needs already. A program description has been completed in our Implementation Plan describing the availability of funds for organizations providing care for low income individuals with dental care needs. (3) Children and family services SLRMC will not develop its own children and family support services program because this need has a low alignment with our mission and strengths. However,we will provide financial support to organizations in our community serving this need because the need is ranked above the median. The program for financial services is described in our implementation plan. Facility 1 -- St. Luke's Regional Medical Center Part V, Section B, line 14g: A Financial Care application is provided to the patient which contains Patient Financial Advocate contact information. Facility 2 -- St. Luke's Elmore Part V, Section B, line 3: A series of interviews with and surveys(questionnaires)of community representatives and leaders representing the broad interests of our community were conducted in order to assist us in defining,prioritizing,and understanding our most important community needs. Many leaders that participated in our process are individuals who have devoted decades to helping others lead healthier and more independent lives. All of the leaders we interviewed have significant knowledge of our community. To ensure they came from distinct and varied backgrounds,we included multiple representatives from each of these categories:Category I: Persons with special knowledge of or expertise in public healthCategory II: Federal,Regional,State, or Local health or other departments or agencies(with current data or other information relevant to the health needs of the community served by the hospital)Category III: Leaders,representatives,or members of medically underserved,low income,and minority populations,and populations with chronic disease needsEach potential need was scored by the community representative on a scale of 1 to 10. Higher scores represent potential needs the community representatives believed were were important to address with additional resources. Lower scores usually meant our leaders thought our community was healthy in that area already or had relatively good programs addressing the potential need. These scores were incorporated directly into our health need prioritization process. In addition,we invited the leaders to suggest programs,legislation,or other measures they believed to be effective in addressing the needs. The following community leaders/representatives were contacted:(1) Idaho Department of Health and Welfare(2) VA Medical Center-Boise, Idaho(3) Idaho Department of Labor-(umeployment information)(4) Idaho Central District Health, District 4(5) Substance Abuse and Mental Health Services Administration U.S. Department of Health and Human Services,Region X(6) Family Medicine Residency of Idaho (7) Elmore County Drug and DUI Court(8) Family Care Clinic(9) Elmore County(10) Idaho Partnership for Hispanic Health(11) The Tooth Dome(12) Mountain Home AFB Family Support Center(13) Expanded Food and Nutrition Education Program(14) MHAFB Family Advocacy(15) Senior Health Insurance Benefits Advisors (SHIBA) Facility 2 -- St. Luke's Elmore Part V, Section B, line 7: We organized our significant health needs into five groups:Program Group 1:Weight Management,Nutrition,and Fitness -Adult and teen weight management -Adult and teen nutrition -Adult and teen exercise Program Group 2:Diabetes -Wellness and prevention for diabetes -Chronic condition for diabetes Program Group 3:Mental Health -Mental illness wellness and management -Suicide prevention -Availability of mental health service providers Program Group 4:Barriers to Access -Affordable care -Affordable health insurance -Integrated Coordinated Care -Children and family services (low income) -More providers accept public health insurance Program Group 5:Additional Health Screening and Education Programs Ranked above the Median -Alcohol and illicit drug use programs -Education support and assistance programs -High cholesterol prevention -Respiratory disease prevention and wellness -Safe-sex education and programs Next we examined whether it would be effective and efficient for St. Luke's Elmore(SLE)to address each significant health need directly. To make this determination,we reviewed the resources we had available and determined whether the health need was in alignment with our mission and strengths. Where a high priority need was not in alignment with our mission and strengths,St. Lukes tried to identify a community group or organization better able to serve the need. Significant community health needs not addressed by SLE areas follows:(1) Mental illness,mental health service providers,and suicide: As a critical access hospital,mental health services are not a strength of SLE. SLE doesn't have the expert resources needed to address this need in an effective and meaningful manner. Due to resource constraints SLE will be unable to provide any programs at this time. SLE will continue to rely on community and Boise area programs and resources to help address this need.(2) Alcohol and illicit drug use prevention and wellness programs: Substance abuse is not a top 20th percentile need and is a low strength of SLE. Therefore,due to limited resources,SLE will partner with community resources and primarily rely on other programs in the community to continue to address this need. The program SLE supports is described in the Implementation Plan.(3) Adult and teen physical activity: Adult physical activity programs are not aligned with our mission or strengths and there are programs available in the community. Therefore,due to resource constraints,SLE will mostly depend on the community to address this need. The programs SLE directly supports are described in the Implementation Plan.(4) Safe-sex education: SLE will not directly provide a safe-sex education program because this need has a low mission,low strength alignment for St. Luke's. SLE will rely on Central District Health and other community resources to help address this need.(5) Respiratory Disease SLE will rely on St. Luke's Regional Medical Center to provide the necessary respiratory services for our community for three primary reasons:(1)resource constraints inherent with being a Critical Access hospital,(2)the need is not a top 20th percentile and (3)this need is a low strength for SLE. As a Critical Access Hospital,SLE has chosen to focus its limited resources on higher priority needs.(6) Children and family services Although this need is ranked in the CHNA's top percentile,SLE will not develop its own children and family support program,mainly due to resource constraints. In addition,this need has a low alignment with its mission and strengths. SLE will support the programs and services available through other organizations that have this as their primary mission.(7) Education support and assistance programs Although this need is ranked above the median,SLE will not develop its own education and support assistance programs because this need has a low alignment with our mission and strengths. However,SLE will provide support for training and education as described in the Implementaton plan. 1 Family Medicine Residency of Idaho 777 North Raymond Street Boise ID 83712 205934739 501(c)(3) 1521283 Provide financial support to the Family Residency Program in Idaho. St Luke's Health FoundationLtd 190 East Bannock Street Boise ID 83712 810600973 501(c)(3) 1345006 Cover operational needs of the St. Luke's Health Foundation. Hands of Hope NorthwestInc 1201 Powerline Rd Nampa ID 83686 841398889 501(c)(3) 612663 FMV Medical equipment and Medical supplies Provide durable medical equipment and medical supplies to people in need in the Treasure Valley. Oregon Health Science University 3181 SW Sam Jackson Park Road Portland ID 97239 262998718 501(c)(3) 175000 Provide financial support for development of the nurse practitioner program. City of Boise Planning PO Box 500 Boise ID 83701 826000165 115 150660 Donations represent rent paid on behalf of the Allumbaugh House(operated by Terry Reilly). Boise State University 1910 University Drive Boise ID 83725 826010706 501(c)(3) 138254 Provide financial support for general programs and scholarships. Idaho State University FoundationInc 921 South 8th Avenue Stop 8050 Pocatello ID 83209 826013543 501(c)(3) 100000 Support the Treasure Valley Anatomy and Physiology Laboratory at ISU-Meridian Health Science Center. University of Washington PO Box 94224 Seattle WA 98124 916001537 501(c)(3) 98047 Support the education and retention of internal medicine and psychiatry residents for the state of Idaho. Boise Metro Chamber of Commerce PO Box 2368 Boise ID 83701 820100595 501[c](6) 43050 Provide general support of programs and services. Treasure Valley Family YMCA 1050 West State Street Boise ID 83702 820200908 501(c)(3) 35500 Support the 2013 Strong Kids Campaign,Cancer Survivor Programs,Boise PHIT, YEAH! Program and YMCA Diabetes Prevention Program. Ada Canyon Medical Education Consortium 305 West Jefferson Boise ID 83702 841417388 501(c)(3) 30000 Provide financial support for medical education for physicians,PA's and nurses for Ada County,City of Nampa and City of Wood River. Harmon Killebrew-Danny Thompson Memorial Cancer Foundation Inc PO Box 232 Sun Valley ID 83353 820341683 501(c)(3) 30000 Provide funding for leukemia and cancer research. Star Elementary School PTOInc 700 North Star Road Star ID 83669 364619322 501(c)(3) 26020 Funds will be used to build a running track. Family Advocacy Center & Education Services (FACES) 417 South 6th Street Boise ID 83702 204883532 501(c)(3) 15000 Support the Court Appointed Special Advocate(CASA)& Families First programs. Women's and Children's Alliance 720 West Washington Street Boise ID 83702 820204464 501(c)(3) 10000 Support "Healing Begins with Hope" breakfast event and Tribute to Women and Industry(TWIN)lunch event. Nampa Harvest Festival Association Dba Snake River Stampede PO Box 231 Nampa ID 83653 820148165 501(c)(3) 12500 Support awareness campaign and no-cost screen mammograms to women in Treasure Valley. Boys & Girls Club of Ada County 610 East 42nd Street Boise ID 83714 820481687 501(c)(3) 9000 Support Wild West Auction Event. Genesis World MissionInc 215 West 35th Street Garden City ID 83714 820505074 501(c)(3) 8000 Provide funding support for the operational costs of the Garden City Community Clinic. Idaho Stampede Community FoundationInc PO Box 6525 Boise ID 83707 470881811 501(c)(3) 7500 Provide financial support for the various programs of the Idaho Stampede Foundation. Idaho Community FoundationInc PO Box 8143 Boise ID 83707 820425063 501(c)(3) 5000 Provide general support donation. Idaho Alliance of Leaders In NursingInc 615 North 7th Street Boise ID 83701 830408538 501(c)(3) 5000 Support the Idaho Nursing Action Coalition(INAC)for the Robert Wood Johnson Foundation(RWJF)State Implementation Project(SIP)Grant. Idaho Foodbank WarehouseInc 3562 South T K Avenue Boise ID 83705 820425400 501(c)(3) 5000 Provide support for The Idaho Foodbank programs. Children's Home Society 740 Warm Springs Avenue Boise ID 83712 820201128 501(c)(3) 5000 Provide subsidies to low-income children and family members for mental and behavioral health services and to support annual "Culinary World Tour" gala. Meridian Police Activities League 250 North Baltic PlSuite A Meridian ID 83642 820484108 501(c)(3) 5000 Provide support to Athletic Training programs. Boys & Girls Club of NampaInc 316 Stampede Drive Nampa ID 83687 820504332 501(c)(3) 5000 Provide support for a Community Day Event. 24 1 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization endeavors to monitor its grants to ensure that such grants are used for proper purposes and not otherwise diverted from their intended use. This is accomplished by requesting recipient organizations to affirm that funds must be used solely in accordance with the grant request and budget on which the grant was based and that funds not expended for the stated purpose are to be returned to the organization. Reports are requested from time to time as deemed appropriate. 0 1 0 0 0 0 0 0 0 Alan SwajkoskiMD 296873 0 29669 0 30022 0 28394 0 10117 0 395075 0 0 0 Leslie NonaMD 204122 0 12814 0 24440 0 27268 0 6400 0 275044 0 0 0 Mr Ron JutzyMD 471797 0 0 0 3564 0 11697 0 11315 0 498373 0 0 0 Mr Chris Roth 434568 0 0 0 48687 0 20596 0 13474 0 517325 0 29460 0 Jeffrey S Taylor 450826 0 0 0 292409 0 130421 0 11018 0 884674 0 49659 0 Ronald M KristensenMD 1136324 0 10699 0 34810 0 46000 0 5270 0 1233103 0 0 0 Donald A StritzkeMD 954563 0 0 0 23242 0 28394 0 14055 0 1020254 0 0 0 Jon B GetzMD 1111581 0 33360 0 40541 0 28394 0 13066 0 1226942 0 0 0 Steven S HuerdMD 890827 0 25176 0 34540 0 60596 0 504 0 1011643 0 0 0 David A HinchmanMD 591938 0 277793 0 53225 0 36578 0 16257 0 975791 0 18415 0 Mr Gary L Fletcher 641987 0 0 0 259580 0 169029 0 11058 0 1081654 0 115884 0 Part I, Line 3 Part I, Line 3: Compensation for the organization's CEO is determined by St. Luke's Health System,Ltd.(System),sole member of St. Luke's Regional Medical Center,Ltd.(SLRMC). The System board approves the compensation amount per the recommendation of its compensation committee,and the decision is then reviewed and ratified by the board of directors for SLRMC. In determining compensation for the CEO,the System board utilizes the following criteria: Compensation Committee Independent compensation consultant Compensation survey or study Approval by the board or compensation committee Part I, Line 4b Part I, Line 4b: During CY'12,the following individuals participated in a supplemental non-qualified executive retirement plan: SERP SERP-Gross Up Total Gary L. Fletcher $ 61,142 $ 43,553 $104,695 Jeffrey S. Taylor $121,554 $ 86,586 $208,140 Supplemental Information Part III Part II-Column (f) Explanation of Prior Compensation: Reportable compensation is based on the total amount paid during calendar year 2012,including current year payments of amounts reported in prior years as contributions to employee benefit plans and deferred compensation, together with investment earnings from those prior year contributions. As a result,certain amounts have been reported twice,both in prior years when earned or accrued,and again in the current year paid. A Idaho Health Facilities Authority 826051863 451295TW9 2008-12-04 126435101 Capital Projects for Health Care Facilities 0 0 0 B Idaho Health Facilities Authority 826051863 451295VK2 2010-09-09 210427891 Current Refunding of Bonds Issued 7/20/2000 and 5/26/2005 0 0 0 C Idaho Health Facilities Authority 826051863 451295VN6 2012-07-11 75896250 Capital Projects for Health Care Facilities 0 0 0 D Idaho Health Facilities Authority 826051863 NONEAVAIL 2012-07-31 75000000 Capital Projects for Health Care Facilities 0 0 0 A 4840000 126443653 15731849 1410199 112389945 2009 0 0 1 1 B 17050000 210427891 3676931 210427891 1 0 1 1 C 76039044 946613 39243249 35849182 0 0 0 1 D 4445000 75000000 75000000 2013 0 0 0 1 A 0 0 1 0 1 0 0.00000 0.00000 0.00000 0 0 0 B 0 0 1 0 1 0 0.00000 0.00000 0.00000 0 0 0 C 0 0 0 0 0.00000 0.00000 0.00000 0 0 0 D 0 0 1 0 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 0 0 0 0 0 B 0 1 0 0 0 0 0 0 0 C 0 1 0 0 0 0 0 0 0 D 0 1 0 0 1 0 0 0 0 A 0 B 0 C 0 D 0 Schedule K Supplental Information Differences between the issue price(Part I)and total proceeds(Part II, line 3)are due to investment earnings. A Idaho Health Facilities Authority 826051863 451295VP1 2012-10-24 150000000 Current Refunding of Bonds issued 3/4/2009 0 0 0 A 150000000 150000000 1 0 1 1 A 0 0 1 0 1 0 0.00000 0.00000 0.00000 0 0 0 A 0 1 0 0 1 0 0 0 0 A 0 S-Sixteen Limited Partnership Two Board Members have a family and/or business relationship with S-16 4684720 St. Lukes Regional Medical Center leases property from three real estate LLCs,of which S-Sixteen is a member. 0 Syringa Family MedicinePA Board Member is a member of Syringa Family Medicine,P.A. 144844 Catherine Reynolds,M.D.,is a member of Syringa Family Medicine,PA. Compensation for Dr. Reynolds was paid to Syringa Family Medicine under a Professional Service Agreement. 0 Idaho Power Board Member is the CEO of Idaho Power. 3973364 St. Luke's Regional Medical Center purchases power from Idaho Power. 0 Blue Cross of Idaho Board member's spouse is on the Board of Directors for Blue Cross of Idaho 294000000 Blue Cross of Idaho is a major third party payer of St. Luke's Regional Medical Center,Ltd. 0 Colliers Paragon dba Colliers International Board Member is owner of Colliers Paragon. 770142 Colliers Paragon dba Colliers International provides property management services for St. Luke's Regional Medical Center,Ltd. 0 X 1 960000 FMV less Purchase Price 0 0 0 Line 1F: Name and address of principal officer Form 990 Part I On April 1,2014,Chris Roth was appointed Chief Operating Officer of St. Luke's Health System,Ltd. As a result of this change, Kathy Moore was appointed Chief Executive Officer for St. Luke's Regional Medical Center,Ltd.,Mountain States Tumor Institute,Inc., and St. Luke's Health Foundation,Ltd. In addition,effective April 1,2014,the Board of Directors for St. Luke's Regional Medical Center, Ltd.,became the fiduciary board for St. Luke's McCall,Ltd. With this change,Kathy Moore also became Chief Executive Officer over St. Luke's McCall,Ltd. It should be noted,however,that with this change in governance St. Luke's Health System,Ltd. is still the sole member of St. Luke's McCall,Ltd. Program Expense: Form 990 Part III-Statement of Program Accomplishments Please note that the program expense amounts reported in Statement III-Statement of Program Accomplishments,do not include an allocation of certain administrative and functional support costs. These costs are classified as Management and General within Part IX-Statement of Functional Expenses. Form 990, Part VI, Section A, line 6 St. Luke's Health System,Ltd. is the sole member of St. Luke's Regional Medical Center,Ltd. Form 990, Part VI, Section A, line 7a St. Luke's Health System,Ltd.(Member)and St. Luke's Regional Medical Center,Ltd.(Corporation)cooperatively select and employ the CEO of the Corporation. St. Luke's Health System, Ltd.,is the sole member of the Corporation. Form 990, Part VI, Section A, line 7b St. Luke's Health System,Ltd.(Member)maintains approval and implementation authority over St. Luke's Regional Medical Center,Ltd.(Corporation). Actions requiring approval authority may be initiated by either the Corporation or its Member,but must be approved by both the Corporation (by action of its Board of Directors) and the Member. Actions requiring approval authority of the Member include: (a) Amendment to the Articles of Incorporation; (b) Amendment to the Bylaws of the Corporation; (c) Appointment of members of the Corporation's Board of Directors,other than ex officio directors; (d) Removal of an individual from the Corporation's Board of Directors if and when removal is requested by the Corporation's Board of Directors, which request may only be made if the Director is failing to meet the reasonable expectations for service on the Corporation's Board of Directors that are established by the Member and are uniform for the Corporation and for all of the other hospitals for which the Member then serves as the sole corporate member. (e) Approval of operating and capital budgets of the Corporation,and deviations to an approved budget over the amounts established from time to time by the Member;and (f) Approval of the strategic/tactical plans and goals and objectives of the Corporation. Implementation Authority means those actions which the Member may take without the approval or recommendation of the Corporation. This authority will not be utilized until there has been appropriate communication between the Member and the Corporation's Board of Directors and its Chief Executive Officer. Actions requiring implementation authority include: (a) Changes to the Statements of mission,philosophy,and values of the Corporation; (b) Removal of an individual from the Corporation's Board of Directors if and when the Member determines in good faith that the Director is failing to meet the Approved Board of Member Expectations. This authority to remove Directors shall not be used merely because there is a difference in business judgment between the Director and the Corporation or the Member,and shall never be used to remove one or more Directors from the Corporation's Board of Directors in order to change a decision made by the Corporation's Board of Directors; (c) Employment and termination of the Chief Executive Officer of the Corporation; (d) Appointment of the auditor for the Corporation and the coordination of the Corporation's annual audit; (e) Sales,lease,exchange,mortgage,pledge,creation of a security interest in or other disposition of real property of the Corporation if such property has a fair market value in excess of a limit set from time to time by the Member that is not otherwise contained in an Approved Budget; (f) Sale,merger,consolidation,change of membership,sale of all or substantially all of the assets of the corporation,or closure of any facility operated by the Corporation; (g) The dissolution of the Corporation; (h) Incurrence of debt by or for the Corporation in accordance with requirements established from time to time by the Member and that is not otherwise contained in an Approved Budget;and (i) Authority to establish policies to promote and develop an integrated, cohesive health care delivery system across all corporations for which the Member serves as the corporate member. Form 990, Part VI, Section B, line 11 The Form 990(Form)is reviewed by an independent public accounting firm based on audited financial statements and with the assistance of the organization's finance and accounting staff. The final draft of the Form is made available to the Finance Committee of the Board of Directors. The Board receives the final version of the Form prior to filing. Form 990, Part VI, Section B, line 12c The organization annually reviews the conflict of interest policy with each board member and also with new board members. Persons covered under the policy include officers,directors,senior executives,non-director members of Board committees and others as identified by a senior executive. At all levels the board is responsible for assessing,reviewing,and resolving any conflicts of interest that have been disclosed by a covered person,or a conflict of interest disclosed by a covered person with respect to a covered person other than himself/herself. Where a conflict exists,the affected parties must excuse themselves from participating in the situation. Form 990, Part VI, Section B, line 15 Executive compensation is set by St. Luke's boards of directors and is reviewed annually. Compensation levels are based on an independent analysis of comparable pay packages offered at similar institutions across the country, with the goal of placing executives in the 50th percentile of those surveyed. These surveys are usually done every two years,with the most recent compensation survey completed during calendar year 2012. St. Luke's Health System is committed to providing the highest quality medical care to all people regardless of their ability to pay. To keep that commitment,St. Luke's puts a great deal of time and effort into recruiting and retaining the top physicians in a variety of medical fields. Our relationships with physicians range from having privileges at the hospital to full employment. For those physicians who choose to be employed,St. Luke's must offer competitive pay and benefits. Physician compensation is based on a range of criteria and can be influenced by a number of variables including: -Community need for medical specialty -Experience -Productivity -Geography -National surveys adjusted for local conditions -Willingness to serve regardless of patients' ability to pay -Duration of relationship and contractual terms -Performance on quality metrics To ensure physician compensation and benefits remain within industry standards and legal requirements for not-for-profit institutions, St. Luke's has a Physician Arrangements policy that specifies circumstances requiring a third-party valuation and also periodically uses third-party consulting firms to review St. Luke's physician compensation arrangements. Given the growing national shortage of physicians,recruiting and retaining physicians is more critical than ever to guarantee that people seeking care at St. Luke's will continue to have access to the physicians and specialists they need regardless of their insurance status or insurance provider. Form 990, Part VI, Section C, line 19 Form 990, Part VI, Section C, Line 19: The organization's governing documents,conflict of interest policy,and financial statements are not available to the public. Form 990,which contains financial information,is available for public inspection. Allocation of Compensation and Hours: Form 990 Part VII Section A The total hours worked and compensation reported for Chris Roth,Jeff Taylor,and Gary Fletcher,represent services rendered to the following organizations within the St. Luke's Health System: Chris Roth: St. Luke's Regional Medical Center,Ltd. Mountain States Tumor Institute,Inc. St. Luke's Health Foundation,Ltd. Jeff Taylor: St. Luke's Health System,Ltd. St. Luke's Regional Medical Center,Ltd. Mountain States Tumor Institute,Inc. St. Luke's Clinic Coordinated Care,Ltd. Gary Fletcher: St. Luke's Health System,Ltd. St. Luke's Clinic Coordinated Care,Ltd. In addition,Catherine Reynolds,M.D. is a member of Syringa Family Medicine,P.A.,(Syringa)a physician practice that has a professional service agreement with St. Luke's Regional Medical Center,Ltd.(SLRMC). Dr. Reynolds works at least 40 hours per week on behalf of this practice for SLRMC. During CY'12,SLRMC paid Syringa $150,000 for services rendered to St. Luke's patients. Also,it should be noted that the hours reported for the directors (employed by St. Luke's)officers,key employees,and highest-paid employees are based on a minimum 40 hour work week. However,due to the demands of their roles within the St. Luke's Health System,the hours worked by these individuals often exceed the minimum required 40 hours. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 9: Minimum Liability Adj.-Defined Benefit Plan 39,899,181. Excess assets acquired over liabilities due to acquisition 20,645,923. Donations for Capital Expenditures 2,614,496. Definitive Agreement-Change in Ownership-Elmore Medical Center St. Luke's Elmore Effective April 1,2013,St. Luke's Regional Medical Center, Ltd.(SLRMC) took over the ownership and control of the operations of Elmore Medical Center(EMC),a Critical Access Hospital(CAH)located in Mountain Home,Idaho. Prior to April 1,EMC was owned and operated by the Elmore County Hospital District. The medical center was renamed St. Luke's Elmore(SLE) and continues to operate as a separately licensed CAH. The SLRMC board of directors has fiduciary responsibility over the operations of SLE. St Luke's Clinic-Treasure ValleyLLC 190 E Bannock Boise ID 83712 452716222 Physician Clinic Services ID 131463903 0 St Luke's Regional Medical CenterLtd St Luke's Health SystemLtd 190 E Bannock Boise ID 83712 562570681 Healthcare Services ID 501(c)(3) 11-3 N/A 0 Mountain States Tumor InstituteInc 100 E Idaho Boise ID 83712 820295026 Healthcare Services ID 501(c)(3) 3 St Luke's Regional Medical CenterLTd 1 St Luke's Wood River Medical CenterLtd 190 E Bannock Boise ID 83712 841421665 Healthcare Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's Health FoundationLtd 190 E Bannock Boise ID 83712 810600973 Fundraising ID 501(c)(3) 7 St Luke's Regional Medical CenterLTd 1 St Luke's Magic Valley Regional Medical CenterLtd 801 Pole Line Road Twin Falls ID 83301 562570686 Healthcare Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's McCallLtd 190 E Bannock Boise ID 83712 273311774 Healthcare Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's JeromeLtd 190 E Bannock Boise ID 83712 820227163 Healthcare Services ID 501(c)(3) 3 St Luke's Magic Valley Regional Medical CenterLtd 0 St Luke's Magic Valley Health FoundationInc 775 Pole Line Road Twin Falls ID 83301 820342863 Fundraising ID 501(c)(3) 7 St Luke's Magic Valley Regional Medical CenterLtd 0 St Luke's Clinic Coordinated CareLtd 190 E Bannock Boise ID 83712 455195864 Accountable Care Organization ID 501(c)(3) 9 St Luke's Health SystemLtd 0 St Luke's Regional Medical Center Auxiliary 190 E Bannock Boise ID 83702 820255667 Supporting Organization ID 501(c)(3) 11-1 N/A 0 SL Phys Realty-LouiseLLC 190 E Bannock Boise ID 83712 263731325 Real Estate Lease ID N/A Related 776947 1352860 1 1 0.87000 1500 ShorelineLLC 190 E Bannock Boise ID 83712 270681501 Real Estate Lease ID N/A Related 303726 1010462 1 1 0.55000 3399 East Louise MOBLLC 190 E Bannock Boise ID 83712 270848198 Real Estate Lease ID N/A Related 502117 1408082 1 1 0.67000 Ortho-Neuro ManagementLLC 190 E Bannock Boise ID 83712 264483076 Mgmt. Consulting ID N/A Related 878451 2565099 1 1 0.58000 Idaho GynOncology ServicesLLC 1055 N Curtis Rd Boise ID 83706 202975807 Health Care ID N/A Related -6045 44620 0 1 0.50000 Idaho Cytogenetics LaboratoryLLC 190 E Bannock Boise ID 83712 331012210 Health Care ID N/A Related 73719 61514 0 1 0.50000 St Luke's-Elk's Rehabilitation ServiceLLC 204 Fort Place PO BOX 1100 Boise ID 83701 820503100 Health Care ID N/A Related -976538 1983067 0 1 0.50000 Wound Care and Hyperbaric Treatment CenterLLP 600 N Robbins Road Boise ID 83702 900288299 Health Care ID N/A Related -366239 4573560 0 1 0.90000 Southwest Idaho Health Community NetworkLLC PO Box 607 Boise ID 837010607 820506533 Group Purchasing-Drugs ID N/A Related 69734 76930 0 1 0.63340 Medical Building Investment GroupLLC PO Box 1271 Ketchum ID 83340 263667995 Real Estate Lease ID N/A Related -125618 -142518 0 1 0.64880 0 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 St Luke's Health FoundationLtd B 1345046 Operating Loss Subsidy St Luke's Health FoundationLtd C 1399617 Donations specified for SLRMC Ortho Neuro Management ServicesLLC P 2339610 Per Mgmt. Agreement SL Phys Realty-LouiseLLC K 1858342 Per Master Lease Agreement 1500 ShorelineLLC K 1149045 Per Master Lease Agreement 3399 East LouiseMOB-LLC K 1677334 Per Master Lease Agreement Mountain States Tumor InstituteInc O 50804738 Salaries & Wages Paid by SLRMC St Luke's Health FoundationLtd O 667433 Salaries & Wages Paid by SLRMC St. Luke's Jerome,Ltd. Schedule R-Part II: Related Tax-Exempt Organizations During FY'13,St. Luke's Jerome,Ltd.(SLJ)operated as an independent 501(c)(3)entity. Effective 9/30/2013,the board of directors of SLJ approved its formal dissolution. As a result of the dissolution,the assets and liabilities were transferred to its sole member,St. Luke's Magic Valley Regional Medical Center,Ltd.