2013-08-13T17:59:27-05:00 2012-09-30 861065772 Deloitte Tax LLP 225 W Santa Clara St San Jose CA 95113 990 2011-10-01 562570686 St Luke's Magic Valley Regional Medical Center Ltd STLU 2083813790 801 Pole Line Road Twin Falls ID 83301 Peter DiDio 2083813790 2013-08-13 Sharon Zorbach P00125475 4087044000 2011 2016-02-24 21:20:13Z James Angle 801 Pole Line Road Twin Falls ID 83301 272377517 0 X www.stlukesonline.org/magic valley X 2006 ID Provide health care services 14 7 2460 149 170780 -24963 1246650 1693073 248735920 269930923 65352 276293 505222 156613 250553144 272056902 480619 956613 0 0 99113712 96797604 0 0 0 128364073 160091649 227958404 257845866 22594740 14211036 317937789 303722031 247728091 222297785 70209698 81424246 X Delivery of Health Care Services 0 0 233823102 956613 258405717 Medical & Surgical:St. Luke's Magic Valley is a 186-bed hospital,700,000 square foot health care facility with acute care and acute rehabilitation as well as St. Luke's Canyon View Behavioral Health Services. With more than 1,900 employees and more than 200 physicians with 28 specialties, St. Luke's Magic Valley provides the most comprehensive health care services in south central Idaho, including: general acute care services, Inpatient Rehabilitation services, Behavioral Health Services, cancer services with St. Luke's Mountain States Tumor Institute (MSTI), Cardiopulmonary and Cardiac Catheterization, CARES (Children At Risk Evaluation Services), Community Connection information and referral database, Diabetes and Nutrition Services, Diagnostic Imaging, Radiology and Women's Imaging Services, Emergency Services, Home Health and Hospice Care, Intensive Care and Newborn Intensive Care Units, Laboratory Services, Medical Library (open to the public), Maternal-Child Services (OB, Pediatrics and Women's Services), Pharmacy, Occupational Health, Adult and Pediatric Rehabilitation (Speech, Occupational, Physical Therapy), Comprehensive Surgical Services, Magic Valley SAFE KIDS Coalition, Social Services and Pastoral Care, Volunteer Services and Auxiliary, and St. Luke's Magic Valley Foundation for gift-giving. St. Luke's Magic Valley is fully accreditied by the Joint Commission and is a participant in the Institute for Healthcare Improvement's 5 Million Lives Campaign.At St. Luke's Magic Valley Medical Center, we take great pride in the high quality, skilled, and compassionate care we provide to our patients. This focus on excellence has resulted in honors from national entities, such as Qualis Health and Solucient. These awards recognize that our commitment to safety and performance improvement means enhanced and safer care, and an overall better experience for you, your family, and everyone we serve.During FY'12, St. Luke's Magic Valley Regional Medical Center provided qualified inpatient care for 11,191 admissions covering 38,317 patient days. The hospital also provided care associated with 196,737 outpatient visits. 3319606 7141275 Behavioral Health:St. Luke's Canyon View Behavioral Health Services, a 28-bed inpatient facility, provides treatment for adolescents, adults, and seniors. St. Luke's Canyon View offers intensive inpatient programs that address acute psychiatric issues in addition to medical detoxification from alcohol and drugs. Canyon View utilizes individual, family, and group counseling to address personal, family, emotional, psychiatric, behavioral, and addiction-related problems. Our wide variety of services allows Canyon View to carefully match the needs of each person who comes to us for help with the most appropriate, cost-effective level of care. Outpatient services are scheduled at convenient hours. The common goal of our programs is to help people find positive solutions to resolve the challenges and crises in their lives. The hospital is staffed with a diverse group of dedicated, caring professionals. Psychiatrists and other physicians, psychologists, social workers, nurses, therapists, nutritionists, and alcohol/drug counselors work as a team to provide comprehensive, personalized care to each person who comes to us for help.During FY'12, Canyon View had 677 admissions covering 3,969 patient days. 2745019 4383931 Comprehensive Rehabilitation and Therapy ServicesThe Gwen Neilson Anderson Rehabilitation Center at St. Luke's Magic Valley is a licensed,comprehensive, 14-bed acute inpatient rehabilitation center. Our inpatient unit provides state-of-the-art, evidenced-based rehabilitation care for patients requiring:--Intensive physicial,occupational,and/or speech therapy (at least three hours per day). --Specialized 24-hour rehabilitative nursing in an inpatient setting--Daily oversight by a medical doctor who specializes in physical medicine and rehabilitation(a physiatrist). --Individualized case management provided by a licensed social workerOur rehabilitation services are highly coordinated to optimize clinical outcomes and maximize a patient's independence. All members of the rehabilitation team (physicians, therapists, nurses, case workers.etc.) meet daily to ensure that treatments are tailored to each patient's specific diagnosis and unique needs. Our inpatient programs include:--Spinal cord injury--Stroke--Brain injury--Neuromuscular diseases, such as multiple sclerosis, Guilain-Barre syndrome, and cerebral palsy--Orthopedics--Major multiple trauma--Amputation--Arthritis--Medically complex conditionsAll 14 inpatient rehabilitation rooms at St. Luke's are private, and designed specifically to enhance the safety, comfort, and independence of patients recovering from and adapting to a variety of injuries and illnesses. Room features include ADA design, bed-side environmental controls(lights, nurse call light, window shades, etc.), free wireless, broadband internet access, pull-out couch and reclining chair for visiting family members, and video surveillance capability for patients with confusion due to brain injury, stroke, or other illness.The rehabilitation gymnasium in the Gwen Neilson Anderson Rehabilitation Center contains state-of-the-art equipment and design features. The spacious gym includes private treatment rooms for one-on-one therapy sessions and a large, open space for wheelchair training, advanced mobility training, and group interaction.The rehabilitation gym includes the latest in equipment:--LiteGait gait trainer--Bioness Neuroprostheses: H200,L300,and L300 Plus--Saeboflex Inpatient kit--Dynavision D2--Dynavox Vmax Plus--Empi Vitai Stim--60-inch LCD television with Blu-Ray player and Wii game consoleThe transitional apartment is a fully functional apartment in which patients can practice basic activities of daily living under the supervision of a trained therapist.The activity area offers a place for patients and their visitors to gather and engage in therapeutic recreation.During FY'12, the inpatient rehabilitation unit provided qualified inpatient care for 193 admissions covering 2,447 patient days. 239887727 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 1 1 0 0 1 170 0 1 2460 1 0 0 0 0 0 0 0 0 0 0 X 14 7 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Peter DiDio Vice-President Controller 2083713790 190 E Bannock Boise ID 83712 X Mr Tom Ashenbrener 5.00 X X 0 0 0 Mr Gary Babbel 4.00 X X 0 0 0 Eric Cassidy DO 4.00 X X 0 0 0 Jeff Fox PhD 4.00 X X 0 0 0 Mr Robert Alexander 3.00 X 0 0 0 Ms Cindy Collins 3.00 X 0 0 0 Steve Kaatz 3.00 X 0 0 0 Mr Terry Kramer 3.00 X 0 0 0 Ron McGarrigle MD 3.00 X 0 0 0 Ms Becky Nelson 3.00 X 0 0 0 Russ Newcomb MD 3.00 X 0 0 0 Robert Ward MD 3.00 X 0 0 0 Mr Stephen Westfall 3.00 X 0 0 0 Mr Shawn Barrigar 3.00 X 0 0 0 Mark Wright DDS 3.00 X 12840 0 0 Mr James L Angle 40.00 X X 0 318404 18424 Ms Amy Bearden 40.00 X 164283 0 22254 James H Rao MD 40.00 X 486209 0 18758 Steven FJohnsonMD 40.00 X 448509 0 24685 Timothy A Enders DO 40.00 X 356231 0 23505 Jonathan D Myers MD 40.00 X 333133 0 30204 Randall J Skeem MD 40.00 X 316241 0 17371 2117446 318404 155201 37 0 1 0 Physician Center 630 Addison Ave W Ste 100 Twin Falls ID 83301 Medical Services 6684940 Emergency Physicians of Southern Idaho 2188 Addison Avenue East Twin Falls ID 83301 Emergency Room Physicians 5077213 RMJ Safari PLLC 714 N College Road Ste A Twin Falls ID 83301 Medical Services 3885318 Blue Lakes Gastroenterology 660 Shoshone St East Twin Falls ID 83301 Medical Services 3246441 Magic Valley Women's Health 630 Addison Ave W Ste 210 Twin Falls ID 83301 Medical Services 3194754 121 928079 764994 1693073 Net Patient Revenue 900099 267054592 267054592 2876331 2876331 269930923 309661 309661 160569 174736 -14167 -14167 -14167 112511 145879 -33368 -33368 -33368 MSO Admin & Billing Se 561000 100462 100462 Transcription Services 541900 45540 45540 Information Technology 541519 24117 24117 661 661 170780 272056902 269930923 170780 262126 956613 956613 592403 592403 76285612 67392973 8892639 2557103 2252833 304270 11753321 10334078 1419243 5609165 4919527 689638 40880672 40857144 23528 244212 244212 19251 19251 835797 823716 12081 244822 2000 242822 2190985 85754 2105231 9758549 9758370 179 808484 187475 621009 374724 280222 94502 115688 115688 23026171 22842013 184158 141829 141829 Supplies 36039033 35371198 667835 Provision For Bad Debt 15748442 15748442 Contract Services 9479604 8285510 1194094 Repairs 2336800 1965974 370826 17846586 17566368 280218 257845866 239887727 17958139 0 18989045 9781050 1992708 2046769 37774762 40948117 25158 86656 3018403 3348651 642424 485666 282721960 38180381 252084702 244541579 101560 61101 1570776 786162 1738251 1636280 317937789 303722031 20921590 19141744 2191794 1795135 224614707 201360906 247728091 222297785 X 70142115 81354939 67583 69307 70209698 81424246 317937789 303722031 X 14211036 -2996488 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 185000 9022886 9207886 160023481 10674668 149348813 10549457 2105118 8444339 101500709 25400595 76100114 1440427 1440427 244541579 Due to Related Organizations 165604174 Third Party settlement 17087489 Capital Lease 83221 Pension Liability 18586022 201360906 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 30,2012, the Company had approximately $4,120,000 of UBTI Net Operating Losses from operating losses incurred from 1998 to 2012, which expire in years 2013 to 2027. 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 8909558 8909558 0.03680 34435344 27058180 7377164 0.03050 11231092 8079006 3152086 0.01300 54575994 35137186 19438808 0.08030 1397309 57659 1339650 0.00550 961525 15592 945933 0.00390 2165314 1419383 745931 0.00310 829876 829876 0.00340 5354024 1492634 3861390 0.01590 59930018 36629820 23300198 0.09620 2750 2750 0.00000 7955 7955 0.00000 2072 2072 0.00000 12777 12777 1 7657348 47729850 65546849 -17816999 X 1 1 2 Magic Valley Paramedic Services LLC Paramedic Services 1.00000 3 St Luke's Clinic LLC Physician Services 1.00000 4 Magic Health Partners LLC Admin. Services for non provider-based groups 1.00000 1 1 StLuke's Magic Valley Regional Medical

801 Pole Line Road Twin Falls ID 83301

X X X StLuke's Magic Valley Regional Medical 1 1 1 185.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X X X 1 0 1 X 0 0 12 St Luke's Magic Valley MOB

775 Pole Line Rd W Twin Falls ID 83301

Various Family Medicine & Specialty Physician Clinics St Luke's Canyon View

228 Shoup Avenue W Twin Falls ID 83301

Psychiatric and Addiction St Luke's Clinic-Physician Center

2550 Addison Avenue E Twin Falls ID 83301

Family Medicine,Internal Medicine, & Pediatric Physician Clinics St Luke's Woman's Imaging Center

762 N College Road Twin Falls ID 83301

Women's Imaging Services St Luke's Clinic-Physician Center

746 N College Road Twin Falls ID 83301

Family Medicine & Specialty Physician Clinic St Luke's Clinic-Physician Center

730 N College Road Suite A Twin Falls ID 83301

Family Medicine & ENT Physician Clinics St Luke's Clinic-OrthoPlastic Surg

714 N College Road Suite A Twin Falls ID 83301

Orthopedics and Plastic Surgery-Physician Clinic St Luke's Clinic-Physician Center

550 Polk Suite A Twin Falls ID 83301

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

738 N College Road Suite C Twin Falls ID 83301

Neurology and Physical Med.& Rehab-Physician Clinic Magic Valley Paramedics

121 Aspenwood Twin Falls ID 83301

Ground Paramedic Services Magic Valley Paramedics

285 Martin St Twin Falls ID 83301

Ground Paramedic Services Magic Valley Paramedics

708 Shoshone Twin Falls ID 83301

Ground Paramedic Services 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, then 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 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 Magic Valley Regional Medical Center, Ltd. does not include the activities of any of its other related organizations within its community benefit report. 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. Amount of bad debt expense included in Part IX, line 25, is $15,748,442. Part II: The community building activities for St. Luke's Magic Valley Regional Medical Center, Ltd. include the following:Economic Development:Physician meetings with regional hospitals to discuss development of simulation program.Coalition Building:Activities for Coalition Building include involvement of physicianin:-Chamber of Commerce Leadership-Tobacco-Free Coalition-State Board of Medicine-IMA-President of South Central Idaho Community Health Improvement Advocacy: Support for Serenity Garden project. The Serenity garden Project was established on June 6, 2009 to provide a dignified burial for fetal remains and give the community a place to visit and grieve their loss.Physician meetings with Genesis Group to discuss the Mustard Tree Wellness Clinic operations.Physician meetings with governor and legislators to discuss starting medical school in Idaho. Part III, Line 4: St. Luke's Magic Valley 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.The source of the information is the Medicare Cost Report for fiscal year 2012. The amount is calculated by comparing the total Medicare apportioned costs(allowable costs) to reimbursements received during FY'12. 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. St.Luke's Magic Valley Regional Medical Part V, Section B, Line 9: (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 will be considered only if the patient, driver, and/or owner of the motor vehicle had a motor vehicle liability policy and has properly submitted a claim for payment 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. St.Luke's Magic Valley Regional Medical Part V, Section B, Line 10: Policy for providing discounted care is included in the St. Luke's Health System's overall policy for determining eligibility for Free and discounted care. Please refer to the response provided regarding the criteria used for free care. St.Luke's Magic Valley Regional Medical Part V, Section B, Line 15e: Liens on Vacation Homes Posting of Financial Assistance Policy: Part V: Section B. Line 13 During the summer of FY'11, the organization completed a new hospital, and has since been in the process of transferring its Financial Assistance Policy signage from its old location. This transfer was completed during the early part of FY'13. Community Health Needs Assessment: Schedule H, Part V Section B: The St. Luke's Health System hospital locations are in the process of completing their Community Health Needs Assessments, as required by Internal Revenue Code, Section 501(r). This assessment will be submitted to the IRS by September 30, 2013, which is the deadline for completion. Part VI, Line 2: St. Luke's Magic Valley utilizes internal information and reports from Idaho Vital Statistics,data from the Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System (BRFSS),and South Central Public Health District to determine community health priorities. As we continue to develop community partnerships,identify opportunities to provide needed services close to home,fund uncompensated and under-compensated care,and provide resources for services in the community, we are committed to the long-term health care needs of the Magic Valley. Part VI, Line 3: (A) St. Luke's Magic Valley 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 assitance, 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 Magic Valley Regional Medical Center provides services for eight counties of south central Idaho and Elko County, Nevada. The primary service area consists of Gooding,Jerome,and Twin Falls Counties. The criteria used in selecting this area as the community served was to include the entire population of the counties where greater than 85% of the inpatients reside. The residents of these counties comprise about 90% of the inpatients with approximately 68% of the inpatients living in Twin Falls County, 15% in Jerome County,and 8% in Gooding County. All three counties are part of Idaho Health District 5.Both Idaho and the primary service area are comprised of about a 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 19% of the defined service area. Gooding County is approximately 28% Hispanic, Jerome County 31%, and Twin Falls County is 14% Hispanic.Idaho experienced a 21% increase in population from 2000 to 2010 ranking it as the fourth fastest growing state in the country. The service area followed that trend experiencing a 19% increase in population within that timeframe and is expected to grow by an additional 17% by the year 2020. St. Luke's Magic Valley 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 the fastest growing segment of our community. Over the next ten years, however, the 0 to 19 year old age group is expected to grow by about 25% making it the fastest growing segment. Currently,about 14% of the people in the community are over the age of 65 and by 2020 about the same percentage of our population is expected to be over the age of 65. The official United States poverty rate increased from 12.5% in 2003 to 15.3% in 2010. The poverty rate for the primary service area has increased more than the national average since 2003. In 2003 it was at the national average and by 2010 it was above the national average at over 16%.The poverty rate in the community for children under the age of 18 is 20.9%,which is about the same as the national average.Median income in the United States has risen by 8% since 2005. Growth in income was slower in Idaho but a little faster in our service area during that period. However, median income in the primary service area is well below the national median and lower than the median income for Idaho as well. 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 Magic Valley Regional Medical Center, Ltd(SLMV) maintains an open medical staff. Any physician can apply for practicing privileges as long as they meet the criteria for SLMV. 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 local physicians and boards who further our organization's mission "To improve the health of the people in our region." Working together, we share resources, skills, and knowledge to provide the best possible care, 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(2) St. Luke's Wood River Medical Center,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 Hospital, which consists of a critical access hospital located in McCall, Idaho, as well as various physician clinics.(5) Mountain States Tumor Institute (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 Humphreys Diabetes Center,Inc. (SLHDC) provides education in diabetes self-management and prevention to people with or at-risk for diabetes, their families and health care professionals. Trusted by over 600 Treasure Valley referring physicians, SLHDC provides services to more than 4,000 clients each year. Working with our experienced Certified Diabetes Educators, clients learn how to manage diet, exercise and medication to stay healthy and prevent complications such as heart attacks, strokes, blindness, kidney failure, and amputations. SLHDC programs are recognized by the American Diabetes Assocation. SLHDC also particpates in national research trials for both Type 1 and Type 2 diabetes. A community program of St. Luke's Health System, SLHDC is one of the largest free-standing diabetes centers in the United States.(7) St. Luke's Jerome Hospital,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) Elmore Medical Center(3) North Canyon Medical Center(4) Salmon River Clinic(5) Weiser Memorial Hospital Reports Filed With States Part VI, Line 7 ID 1 College of Southern Idaho 315 Falls Avenue Twin Falls ID 83303 820388193 501(c)(3) 198050 Fundings for support of Health Occupations, Foster Grantparent Program, Dental Voucher Program that are working to improve the health of people in the community Family Health Services Corp 794 Eastland Drive Twin Falls ID 83301 820371093 501(c)(3) 53500 Funds to be used to purchase equipment for 6 new examination rooms at the Kimberly Clinic Hospice Visions 209 Shoup Avenue West Twin Falls ID 83301 820483284 501(c)(3) 27000 Funds will be used to defray the costs for access to end of life indigent and uninsured patients St Luke's Magic Valley Health Foundation 650 Addison Ave W Suite 270 Twin Falls ID 83303 820342863 501(c)(3) 24150 Fund programs for children with special needs South Central District Health 513 North Main Street Hailey ID 83333 820335043 115 23270 Funds to be used to purchase child safety seats for WIC clients Mustard Tree Community Wellness Clinic 676 Shoup Avenue West Suite 2 Twin Falls ID 83301 261249939 501(c)(3) 20000 Fundings to support the Women's health program for the underinsured and uninsured working women of the community Volunteers Against ViolenceInc(Crisis Center) POBox 2444 Twin Falls ID 83303 820372006 501(c)(3) 19000 Provide funding to support victims of domestic violence and sexual assault Shaken Baby Prevention of Idaho 938 River Mist Path Twin Falls ID 83301 450608800 501(c)(3) 15000 Funds will be used to bring more awareness and education on shaken baby syndrome to the people of Idaho Interfaith Volunteer Caregivers of Magic Valley 252 Deere Street Suite A Twin Falls ID 83301 841417706 501(c)(3) 11700 Provides non-medical services to the elderly, disabled, chronically ill Salvation Army 348 4th Ave N Twin Falls ID 83301 132923701 501(c)(3) 10000 Funds will be used to purchase youth specific weight equipment, misc fitness equipment, and instructor costs. Twin Falls County 425 Shoshone Street North Twin Falls ID 83303 826000318 115 10000 Funds provided to improve care for sexual assault victims and collections of forensic evidence, set up a Sexual Assault Nurse Examiner program at CSI. Boys & Girls Club of Nampa 316 Stampede Drive Nampa ID 83687 820504332 501(c)(3) 8500 Funds to be used for the 2012 after-school fitness program to fight childhood obesity City of Rupert Fire Department 624 F Street Rupert ID 83350 826001128 115 7250 Funds to be used to purchase new AEDs Magic Valley Rehabilitation Services Inc 484 Eastland Drive South Twin Falls ID 83301 820306179 501(c)(3) 5000 Funds to be used for the operating costs for the Adult Daycare Program Twin Falls Mental Health Advocates Inc 420 Main Avenue S420 Main Avenue S Twin Falls ID 8 Twin Falls ID 83301 562456562 501(c)(3) 5000 Funds to be used for Group sessions teaching basic living skills, communication and socialization, symptom management, exercise, health & wellness, alcohol and substance abuse, teach vocational skills, provide health meals and food options. St Luke's Magic Valley Health FoundationInc 775 Polie Line Road Twin Falls ID 83301 820342863 501(c)(3) 487528 Funds are used to cover the operational costs of the St. Luke's Magic Valley Health Foundation 16 0 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 0 0 0 0 0 0 0 0 Mr James L Angle 0 265450 0 40617 0 12337 0 3900 0 14524 0 336828 0 0 Ms Amy Bearden 152595 0 0 0 11688 0 7641 0 14613 0 186537 0 0 0 James H Rao MD 198134 0 254632 0 33443 0 4400 0 14358 0 504967 0 0 0 Steven FJohnsonMD 421704 0 0 0 26805 0 10477 0 14208 0 473194 0 0 0 Timothy A Enders DO 238960 0 97217 0 20054 0 6001 0 17504 0 379736 0 0 0 Jonathan D Myers MD 307811 0 0 0 25322 0 11025 0 19179 0 363337 0 0 0 Randall J Skeem MD 147405 0 144482 0 24354 0 11025 0 6346 0 333612 0 0 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 Magic Valley Regional Medical Center,Ltd.(SLMVRMC). 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 SLMVRMC. 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 Jonathan D Myers MD Residency,Housing,and Tuition Assistance X 40000 17483 0 0 1 Timothy A Enders DO Residency,Housing,and Tuition Assistance X 94834 69173 0 0 0 86656 First Federal Savings Common Board Members 2994677 First Federal Savings purchases patient accounts receivable from St. Luke's Magic Valley Regional Medical Center,Ltd. 0 Magic Valley Anesthesiology Association Board Member is a member of Magic Valley Anesthesiolgy Association 5593735 Exclusive contract to provide anesthesia services to the hospital. 0 Emergency Physicians of Southern Idaho Board Member has ownership interest 5125468 Emergency Medicine of Southern Idaho has an Exclusive Service Agreement with St. Luke's Magic Valley Regional Medical Center to provide emergency medical services. 0 Blue Lakes Gastroenterology Board member has ownership interest in Blue Lakes Gastroenterology 3200875 Has a Professional Service Agreement with the organization. 0 Schedule L Part II-Loans To and From Interested Persons Physician Loan Policy: As part of its overall physician recruiting program, St. Luke's will offer various incentives for employment, including:(1) Net Income Guarantee(2) Housing Assistance(3) Relocation Assistance(4) Tail Coverage for Malpractice Claims, and(5) Sign-on BonusThese incentives are structured as a physician loan to the prospective employee, bearing a reasonable rate of interest reflecting market conditions. As the physician fulfills the terms of the employment agreement, the amount advanced is forgiven over the term of the loan. If the physician does not fulfill the terms of the agreement, the physician must repay a liquidated damages amount specified in the loan agreement. Form 990, Part VI, Section A, line 2 Board members Tom Ashenbrener, Steve Westfall, and Becky Nelson are in a business relationship. Form 990, Part VI, Section A, line 6 St. Luke's Health System, Ltd. is the sole member of St. Luke's Magic Valley Regional Medical Center, Ltd. Form 990, Part VI, Section A, line 7a The President and CEO of St. Luke's Magic Valley Regional Medical Center, Ltd.,(Corporation) is cooperatively selected by the Corporation and St. Luke's Health System, Ltd. St. Luke's Health System 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 Magic Valley 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 or personal 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 and 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 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 990 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 board 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. Similar analysis is also completed by St. Luke's leadership for physicians and other health care specialties such as nurses and pharmacists. 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 is available for public inspection,which contains financial information. Allocation of Compensation and Hours: Form 990 Part VII Section A The total hours worked and compensation reported for James Angle represents services rendered to the following organizations within the St. Luke's Health System: St. Luke's Magic Valley Regional Medical Center,Ltd. St. Luke's Jerome,Ltd. St. Luke's Magic Valley Health Foundation,Inc. 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 5: Net unrealized gains on investments: 67,533. Minimum Liability Adj.-Defined Benefit Plan -2,161,746. Donations For Capital Expenditures 839,817. Prior Period Reclassifications -1,742,092. Total to Form 990, Part XI, Line 5: -2,996,488. Magic Valley Paramedics ServicesLLC PO Box 409 Twin Falls ID 83301 205461983 Paramedic Services ID 3138023 0 St Luke's Magic Valley Regional Medical CenterLtd St Luke's ClinicLLC PO Box 409 Twin Falls ID 83301 820527710 Physician Services ID 53370796 8100252 St Luke's Magic Valley Regional Medical CenterLtd Magic Health PartnersLLC PO Box 409 Twin Falls ID 83301 820507483 Admin.Services for Non-Provider Based Physician Groups ID 208034 1228654 St Luke's Magic Valley Regional Medical CenterLtd St Luke's Health SystemLtd 190 E Bannock Boise ID 83712 562570681 Health Care Services ID 501(c)(3) 11-3 St Luke's Health SystemLtd 0 Mountain States Tumor Institute 100 E Idaho Boise ID 83712 820295026 Health Care Services ID 501(c)(3) 3 St Luke's Regional Medical CenterLtd 0 St Luke's Wood River Medical Center Ltd 190 E Bannock Boise ID 83712 841421665 Health Care Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's Health Foundation Ltd 190 E Bannock Boise ID 83712 810600973 Solicit Donations ID 501(c)(3) 7 St Luke's Regional Medical CenterLtd 0 St Luke's Regional Medical CenterLtd 190 E Bannock Boise ID 83712 820161600 Health Care Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's McCall Ltd 190 E Bannock Boise ID 83712 273311774 Health Care Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's Humphreys Diabetes CenterInc 1226 River Street Boise ID 83702 820491110 Diabetes Prev.-Self-Mgmt. ID 501(c)(3) 9 St Luke's Regional Medical CenterLtd 0 St Luke's Jerome Ltd 190 E Bannock Boise ID 83712 820227163 Health Care Services ID 501(c)(3) 3 St Luke's Magic Valley Regional Medical Center Ltd 1 St Luke's Magic Valley Health FoundationInc 775 Pole Line Road Twin Falls ID 83301 820342863 Solicit Donations ID 501(c)(3) 7 St Luke's Magic Valley Regional Medical Center Ltd 1 St Luke's Clinic Coordinated Care Ltd 190 E Bannock Boise ID 83712 455195864 Accountable Care Organization ID 501(c)(3) 9 St Luke's Health System Ltd 0 0 0 1 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 St Luke's Jerome Ltd N 9705333 Payroll St Luke's Magic Valley Health FoundationInc N 369487 Payroll St Luke's Magic Valley Health FoundationInc C 903924 Contribution St. Luke's Humphreys Diabetes Center, Inc.: Schedule R-Part II: Related Tax-Exempt Organizations During FY'12, St. Luke's Humphreys Diabetes Center, Inc.(SLHDC)operated as an independent 501(c)(3)entity. Effective 9/30/2012, the board of directors of SLHDC approved its formal dissolution. As a result of the dissolution, the assets and liabilities were transferred to its sole member, St. Luke's Regional Medical Center, Ltd.