HOLY ROSARY HEALTHCARE: Form 990, tax year 2012

View the entire original 990 at ProPublica ↗

Organization
HOLY ROSARY HEALTHCARE (EIN 81-0231792)
Tax period
2012-01-01 to 2012-12-31
Filed
2013-11-14
IRS object ID
201333189349305818
Schema version
2012v2.1
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Timestamp2013-11-14T15:49:36-06:00Timestamp
Tax Period End Date2012-12-31TaxPeriodEndDate

Preparer Firm PreparerFirm

Preparer Firm Business Name PreparerFirmBusinessName

FieldValueIRS element (for citing)
Business Name Line1ERNST & YOUNG US LLPBusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

FieldValueIRS element (for citing)
Address Line1178 S RIO GRANDE STREET SUITE 400AddressLine1
CitySALT LAKE CITYCity
StateUTState
ZIP Code84101ZIPCode
FieldValueIRS element (for citing)
Return Type990ReturnType
Tax Period Begin Date2012-01-01TaxPeriodBeginDate

Filer Filer

FieldValueIRS element (for citing)
EIN810231792EIN

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOLY ROSARY HEALTHCAREBusinessNameLine1
FieldValueIRS element (for citing)
In Care Of Name% SHARON OWENS VP OF FINANCEInCareOfName
Name ControlHOLYNameControl
Phone4062373318Phone

US Address USAddress

FieldValueIRS element (for citing)
Address Line12600 WILSON STREETAddressLine1
Address Line2SuiteAddressLine2
CityMILES CITYCity
StateMTState
ZIP Code59301ZIPCode

Officer Officer

FieldValueIRS element (for citing)
NameCalvin CareyName
TitleVP/CFOTitle
Date Signed2013-11-14DateSigned

Preparer Preparer

FieldValueIRS element (for citing)
Phone8013503300Phone
FieldValueIRS element (for citing)
Tax Year2012TaxYear
Build TS2016-02-25 16:41:14ZBuildTS

Form 990 IRS990

FieldValueIRS element (for citing)
Name Of Principal Officer PersonCALVIN CAREYNameOfPrincipalOfficerPerson

Address Principal Officer US AddressPrincipalOfficerUS

FieldValueIRS element (for citing)
Address Line12600 WILSON STREETAddressLine1
CityMILES CITYCity
StateMTState
ZIP Code59301ZIPCode
FieldValueIRS element (for citing)
Gross Receipts43390560GrossReceipts
Group Return For AffiliatesfalseGroupReturnForAffiliates
Group Exemption Number0928GroupExemptionNumber
Organization501c3XOrganization501c3
Web SiteWWW.HRH-MT.ORGWebSite
Type Of Organization CorporationXTypeOfOrganizationCorporation
Year Formation1997YearFormation
State Legal DomicileMTStateLegalDomicile
Activity Or Mission DescriptionWE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE.ActivityOrMissionDescription
Nbr Voting Members Governing Body13NbrVotingMembersGoverningBody
Nbr Independent Voting Members11NbrIndependentVotingMembers
Total Nbr Employees427TotalNbrEmployees
Total Nbr Volunteers69TotalNbrVolunteers
Total Gross UBI115326TotalGrossUBI
Net Unrelated Business Txbl Income-15951NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year180948ContributionsGrantsPriorYear
Contributions Grants Current Year35258ContributionsGrantsCurrentYear
Program Service Revenue Prior Year39089244ProgramServiceRevenuePriorYear
Program Service Revenue CY42952231ProgramServiceRevenueCY
Investment Income Prior Year-17832InvestmentIncomePriorYear
Investment Income Current Year4377InvestmentIncomeCurrentYear
Other Revenue Prior Year459813OtherRevenuePriorYear
Other Revenue Current Year398694OtherRevenueCurrentYear
Total Revenue Prior Year39712173TotalRevenuePriorYear
Total Revenue Current Year43390560TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year46193GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY32740GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year0BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY0BenefitsPaidToMembersCY
Salaries Etc Prior Year20522665SalariesEtcPriorYear
Salaries Etc Current Year20977711SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year0TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY0TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year0TotalFundrsngExpCurrentYear
Other Expense Prior Year19642049OtherExpensePriorYear
Other Expenses Current Year19704959OtherExpensesCurrentYear
Total Expenses Prior Year40210907TotalExpensesPriorYear
Total Expenses Current Year40715410TotalExpensesCurrentYear
Revenues Less Expenses Prior Year-498734RevenuesLessExpensesPriorYear
Revenues Less Expenses CY2675150RevenuesLessExpensesCY
Total Assets BOY21832173TotalAssetsBOY
Total Assets EOY22726122TotalAssetsEOY
Total Liabilities BOY3406568TotalLiabilitiesBOY
Total Liabilities EOY1621772TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY18425605NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY21104350NetAssetsOrFundBalancesEOY
Info In Schedule O Part IIIXInfoInScheduleOPartIII
Mission DescriptionWe reveal and foster God's healing love by improving the health of the people and communities we serve, especially those who are poor and vulnerable.MissionDescription
Significant New Program ServicesfalseSignificantNewProgramServices
Significant ChangefalseSignificantChange
Expense28801533Expense
Grants0Grants
Revenue36162861Revenue
DescriptionHOLY ROSARY HEALTHCARE PROVIDES INPATIENT AND OUTPATIENT HOSPITAL SERVICES TO THE POPULATIONS OF EASTERN MONTANA. THESE SERVICES INCLUDE SURGICAL, ONCOLOGY, AND MATERNITY SERVICES, AS WELL AS 24- HOUR EMERGENCY ROOM AND DIAGNOSTIC AND THERAPEUTIC SERVICES.Description

Activity2 Activity2

FieldValueIRS element (for citing)
Expense3117174Expense
Grants0Grants
Revenue3787365Revenue
DescriptionHOLY ROSARY HEALTHCARE'S EXTENDED CARE UNIT PROVIDES SHORT-TERM TRANSITIONAL CARE AFTER ILLNESS, INJURY, OR SURGERY, AS WELL AS, LONG-TERM CARE FOR THOSE UNABLE TO LIVE INDEPENDENTLY.Description

Activity3 Activity3

FieldValueIRS element (for citing)
Expense3507296Expense
Grants0Grants
Revenue3443929Revenue
DescriptionHOLY ROSARY HEALTHCARE CLINIC PROVIDES PRIMARY CARE SERVICES. THE CLINIC ALSO MAKES AVAILABLE VARIOUS SPECIALTY SERVICES OFFERED BY VISITING PROVIDERS.Description
FieldValueIRS element (for citing)
Total Of Other Program Service Exp32740TotalOfOtherProgramServiceExp
Total Of Other Program Service Grnt32740TotalOfOtherProgramServiceGrnt
Total Of Other Program Service Rev0TotalOfOtherProgramServiceRev
Total Program Service Expense35458743TotalProgramServiceExpense
Described In501 C3trueDescribedIn501C3
Schedule B RequiredtrueScheduleBRequired
Political ActivitiesfalsePoliticalActivities
Lobbying ActivitiestrueLobbyingActivities
Subject To Proxy TaxfalseSubjectToProxyTax
Donor Advised FundsfalseDonorAdvisedFunds
Conservation EasementsfalseConservationEasements
Collections Of ArtfalseCollectionsOfArt
Credit CounselingfalseCreditCounseling
Term Or Permanent EndowmentstrueTermOrPermanentEndowments
Report Land Bldg EquiptrueReportLandBldgEquip
Report Invest Oth SecuritiesfalseReportInvestOthSecurities
Report Prog Rel InvestfalseReportProgRelInvest
Report Other AssetstrueReportOtherAssets
Report Other LiabilitiesfalseReportOtherLiabilities
Report Fin48 FootnotefalseReportFin48Footnote
Independent Audit Financial StmtfalseIndependentAuditFinancialStmt
Consolidated Audit Financial StmttrueConsolidatedAuditFinancialStmt
SchoolfalseSchool
Foreign OfficefalseForeignOffice
Foreign ActivitiesfalseForeignActivities
More Than5000 K To OrganizationsfalseMoreThan5000KToOrganizations
More Than5000 K To IndividualsfalseMoreThan5000KToIndividuals
Professional FundraisingfalseProfessionalFundraising
Fundraising ActivitiesfalseFundraisingActivities
GamingfalseGaming
HospitaltrueHospital
Financial Stmt AttachedtrueFinancialStmtAttached
Grants To OrganizationstrueGrantsToOrganizations
Grants To IndividualsfalseGrantsToIndividuals
Schedule J RequiredtrueScheduleJRequired
Tax Exempt BondsfalseTaxExemptBonds
Excess Benefit TransactionfalseExcessBenefitTransaction
Prior Excess Benefit TransactionfalsePriorExcessBenefitTransaction
Loan To Officer Or DQPfalseLoanToOfficerOrDQP
Grant To Related PersonfalseGrantToRelatedPerson
Bsnss Rltnshp With OrganizationfalseBsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family MemberfalseBsnssRltnshpThruFamilyMember
Officer Entity With Bsnss RltnshpfalseOfficerEntityWithBsnssRltnshp
Deductible Non Cash ContributionsfalseDeductibleNonCashContributions
Deductible Contributions Of ArtfalseDeductibleContributionsOfArt
TerminatedfalseTerminated
Partial LiquidationfalsePartialLiquidation
Disregarded EntityfalseDisregardedEntity
Related EntitytrueRelatedEntity
Related Org Controlled EntitytrueRelatedOrgControlledEntity
Transaction Related EntitytrueTransactionRelatedEntity
Transfers To Exempt Non Chrtbl OrgfalseTransfersToExemptNonChrtblOrg
Activities Conducted PartnershipfalseActivitiesConductedPartnership
Schedule O RequiredtrueScheduleORequired
Number Forms Transmitted With109683NumberFormsTransmittedWith1096
Number W2 G Included0NumberW2GIncluded
Compliance With Backup WitholdingtrueComplianceWithBackupWitholding
Number Of Employees427NumberOfEmployees
Employment Tax Returns FiledtrueEmploymentTaxReturnsFiled
Unrelated Business IncometrueUnrelatedBusinessIncome
Form990-T FiledtrueForm990-TFiled
Foreign Financial AccountfalseForeignFinancialAccount
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTrans
Taxable Party NotificationfalseTaxablePartyNotification
Non Deductible ContributionsfalseNonDeductibleContributions
Quid Pro Quo ContributionsfalseQuidProQuoContributions
Form8282 Property Disposed OffalseForm8282PropertyDisposedOf
Funds To Pay PremiumsfalseFundsToPayPremiums
Premiums PaidfalsePremiumsPaid
Indoor Tanning ServicesfalseIndoorTanningServices
Info In Schedule O Part VIXInfoInScheduleOPartVI
Nbr Voting Governing Body Members13NbrVotingGoverningBodyMembers
Number Independent Voting Members11NumberIndependentVotingMembers
Family Or Business RelationshipfalseFamilyOrBusinessRelationship
Delegation Of Management DutiestrueDelegationOfManagementDuties
Changes To Organizing DocsfalseChangesToOrganizingDocs
Material Diversion Or MisusefalseMaterialDiversionOrMisuse
Members Or StockholderstrueMembersOrStockholders
Election Of Board MemberstrueElectionOfBoardMembers
Decisions Subject To ApprovaltrueDecisionsSubjectToApproval
Minutes Of Governing BodytrueMinutesOfGoverningBody
Minutes Of CommitteestrueMinutesOfCommittees
Officer Mailing AddressfalseOfficerMailingAddress
Local ChaptersfalseLocalChapters
Form990 Provided To Governing BodytrueForm990ProvidedToGoverningBody
Conflict Of Interest PolicytrueConflictOfInterestPolicy
Annual Disclosure Covered PersonstrueAnnualDisclosureCoveredPersons
Regular Monitoring EnforcementtrueRegularMonitoringEnforcement
Whistleblower PolicytrueWhistleblowerPolicy
Document Retention PolicytrueDocumentRetentionPolicy
Compensation Process CEOfalseCompensationProcessCEO
Compensation Process OtherfalseCompensationProcessOther
Investment In Joint VenturefalseInvestmentInJointVenture
Upon RequestXUponRequest

The Books Are In Care Of TheBooksAreInCareOf

FieldValueIRS element (for citing)
Name PersonSHARON OWENS VP OF FINANCENamePerson
Telephone Number3038135280TelephoneNumber

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12480 W 26TH AVE SUITE 200AddressLine1
CityDENVERCity
StateCOState
ZIP Code80211ZIPCode

Form990 Part VII Section A Form990PartVIISectionA (19 entries)

TitleTitleAverage Hours Per WeekAverageHoursPerWeekAverage Hours Per Week RelatedAverageHoursPerWeekRelatedIndividual Trustee Or DirectorIndividualTrusteeOrDirectorOfficerOfficerReportable Comp From OrganizationReportableCompFromOrganizationOther CompensationOtherCompensationReportable Comp From Related OrgsReportableCompFromRelatedOrgsHighest Compensated EmployeeHighestCompensatedEmployee
SISTER JUDITH JACKSON
BOARD MEMBER1.00.0X
TRACI SCHELL
BOARD MEMBER1.00.0X
PAUL LEWIS
CEO EX-OFFICIO36.01.0XX20289940725
BILL OFTEDAL
BOARD MEMBER1.00.0XX
RACHEL ARMSTRONG
BOARD MEMBER1.00.0XX
SISTER KATHERINE FRANCHETT
BOARD MEMBER1.00.0X
STEFANI HICSWA MD
BOARD MEMBER1.00.0X
JASON BARKER
EX-OFFICIO CEO SVB36.01.0XX588371672450
RONALD HATHAWAY
BOARD MEMBER1.00.0X
TAMMIE MCFARLAND
BOARD MEMBER1.00.0X
ROGER MUGGLI
BOARD MEMBER1.00.0X
POLLY PETERSEN
BOARD MEMBER1.00.0X
DONOVAN MCCOMB
BOARD MEMBER1.00.0X
CALVIN CAREY
CFO36.01.0X168656153670
JAMES MACMILLIAN
PHYSICIAN40.00.025569110010X
JEFF WILLIAMS
PHYSICIAN40.00.0294481244350X
DORTHY BRADBURY
PHYSICIAN40.00.0311722115050X
CHRISTOPHER LIEB
PHYCICIAN40.00.0264077341970X
TRAVIS WALKER
PHYSICIAN40.00.0218982123730X
FieldValueIRS element (for citing)
Total Reportable Comp From Org2304879TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs0TotalReportableCompFrmRltdOrgs
Total Other Compensation206848TotalOtherCompensation
Number Individuals GT100 K8NumberIndividualsGT100K
Formers ListedfalseFormersListed
Total Comp GT150 KtrueTotalCompGT150K
Compensation From Other SourcesfalseCompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1CityAddressOfContractor/AddressUS/CityStateAddressOfContractor/AddressUS/StateZIP CodeAddressOfContractor/AddressUS/ZIPCodeDescription Of ServicesDescriptionOfServicesCompensationCompensation
MEDEFIS INC
10826 OLD MILL ROAD SUITE 101OMAHANE68154TEMPORARY STAFFING811635
ROCKY MOUNTAIN HEALTH NETWORK
315 NORTH 25TH STREETBILLINGSMT59101PATIENT BILLING SERV152940
Synaptic Healthcare LLC
1006 S COTTAGEMILES CITYMT59301TEMPORARY STAFFING1154273
CHG Companies Inc
PO BOX 972651DALLASTX753972651TEMPORARY STAFFING177405
Yellowstone Pathology Inst Inc
2900 12TH AVE N STE 295WBILLINGSMT59101LAB SERVICES139000
FieldValueIRS element (for citing)
Number Of Contractors GT100 K6NumberOfContractorsGT100K
Related Organizations35258RelatedOrganizations
Total Contributions35258TotalContributions

Program Service Revenue ProgramServiceRevenue (2 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NET PATIENT SERVICE9000994283899142838991
PROGRAM SERVICE RENTAL INCOME532000113240113240
FieldValueIRS element (for citing)
Total Program Service Revenue42952231TotalProgramServiceRevenue

Investment Income InvestmentIncome

FieldValueIRS element (for citing)
Total Revenue Column4377TotalRevenueColumn
Exclusion$7,972ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Rental Income Or Loss RentalIncomeOrLoss

FieldValueIRS element (for citing)
Real0Real
Personal0Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Gain Or Loss Investments NetGainOrLossInvestments

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

FieldValueIRS element (for citing)
Total Revenue Column0TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescriptionBusiness CodeBusinessCodeTotal Revenue ColumnTotalRevenueColumnRelated Or Exempt Function IncomeRelatedOrExemptFunctionIncomeUnrelated Business RevenueUnrelatedBusinessRevenue
NON-PATIENT FOOD SERVICES7223203420213399352086
DEPARTMENT OTHER OPERATING REVENUE9000995045750457
MANAGEMENT FEES90009960006000

Miscellaneous Revenue MiscellaneousRevenue

FieldValueIRS element (for citing)
Total Revenue Column216TotalRevenueColumn
Related Or Exempt Function Income216RelatedOrExemptFunctionIncome
FieldValueIRS element (for citing)
Total Other Revenue398694TotalOtherRevenue

Total Revenue TotalRevenue

FieldValueIRS element (for citing)
Total Revenue Column43390560TotalRevenueColumn
Related Or Exempt Function Income43235599RelatedOrExemptFunctionIncome
Unrelated Business Revenue115326UnrelatedBusinessRevenue
Exclusion$7,972ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

FieldValueIRS element (for citing)
Total32740Total
Program Services32740ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

FieldValueIRS element (for citing)
Total0Total

Foreign Grants ForeignGrants

FieldValueIRS element (for citing)
Total0Total

Benefits To Members BenefitsToMembers

FieldValueIRS element (for citing)
Total0Total

Comp Current Officers Directors CompCurrentOfficersDirectors

FieldValueIRS element (for citing)
Total1083263Total
Management And General1083263ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

FieldValueIRS element (for citing)
Total0Total

Other Salaries And Wages OtherSalariesAndWages

FieldValueIRS element (for citing)
Total15971547Total
Program Services15635789ProgramServices
Management And General335758ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

FieldValueIRS element (for citing)
Total642500Total
Program Services642500ProgramServices

Other Employee Benefits OtherEmployeeBenefits

FieldValueIRS element (for citing)
Total2180232Total
Program Services2180232ProgramServices

Payroll Taxes PayrollTaxes

FieldValueIRS element (for citing)
Total1100169Total
Program Services986852ProgramServices
Management And General113317ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

FieldValueIRS element (for citing)
Total4361023Total
Program Services2529394ProgramServices
Management And General1831629ManagementAndGeneral

Fees For Services Legal FeesForServicesLegal

FieldValueIRS element (for citing)
Total290284Total
Management And General290284ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

FieldValueIRS element (for citing)
Total0Total

Fees For Services Lobbying FeesForServicesLobbying

FieldValueIRS element (for citing)
Total438Total
Management And General438ManagementAndGeneral

Fees For Services Prof Fundraising FeesForServicesProfFundraising

FieldValueIRS element (for citing)
Total0Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

FieldValueIRS element (for citing)
Total0Total

Fees For Services Other FeesForServicesOther

FieldValueIRS element (for citing)
Total3408801Total
Program Services2829305ProgramServices
Management And General579496ManagementAndGeneral

Advertising Advertising

FieldValueIRS element (for citing)
Total88928Total
Management And General88928ManagementAndGeneral

Office Expenses OfficeExpenses

FieldValueIRS element (for citing)
Total1155454Total
Program Services935918ProgramServices
Management And General219536ManagementAndGeneral

Information Technology InformationTechnology

FieldValueIRS element (for citing)
Total0Total

Royalties Royalties

FieldValueIRS element (for citing)
Total0Total

Occupancy Occupancy

FieldValueIRS element (for citing)
Total638978Total
Program Services587860ProgramServices
Management And General51118ManagementAndGeneral

Travel Travel

FieldValueIRS element (for citing)
Total185024Total
Program Services85111ProgramServices
Management And General99913ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

FieldValueIRS element (for citing)
Total0Total

Conferences Meetings ConferencesMeetings

FieldValueIRS element (for citing)
Total0Total

Interest Interest

FieldValueIRS element (for citing)
Total0Total

Payments To Affiliates PaymentsToAffiliates

FieldValueIRS element (for citing)
Total0Total

Depreciation Depletion DepreciationDepletion

FieldValueIRS element (for citing)
Total1910361Total
Program Services1910361ProgramServices

Insurance Insurance

FieldValueIRS element (for citing)
Total361990Total
Program Services361990ProgramServices

Other Expenses OtherExpenses (4 entries)

DescriptionDescriptionTotalTotalProgram ServicesProgramServicesManagement And GeneralManagementAndGeneral
BAD DEBTS27761442776144
MEDICAID PROVIDER TAXES385633385633
RECRUITING EXPENSES16692746740120187
MEDICAL EXPENSES38986053898605

All Other Expenses AllOtherExpenses

FieldValueIRS element (for citing)
Total76369Total
Program Services19202ProgramServices
Management And General57167ManagementAndGeneral

Total Functional Expenses TotalFunctionalExpenses

FieldValueIRS element (for citing)
Total40715410Total
Program Services35458743ProgramServices
Management And General5256667ManagementAndGeneral
Fundraising0Fundraising

Cash Non Interest Bearing CashNonInterestBearing

FieldValueIRS element (for citing)
BOY-754125BOY
EOY1615576EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

FieldValueIRS element (for citing)
BOY219612BOY
EOY111242EOY

Pledges And Grants Receivable PledgesAndGrantsReceivable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Accounts Receivable AccountsReceivable

FieldValueIRS element (for citing)
BOY4565306BOY
EOY5767375EOY

Receivables From Officers Etc ReceivablesFromOfficersEtc

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Receivables From Disqual Persons ReceivablesFromDisqualPersons

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

FieldValueIRS element (for citing)
BOY22783BOY
EOY9051EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

FieldValueIRS element (for citing)
BOY902468BOY
EOY885693EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

FieldValueIRS element (for citing)
BOY436985BOY
EOY602795EOY
FieldValueIRS element (for citing)
Land Buildings Equipment Basis40796378LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec28656289LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

FieldValueIRS element (for citing)
BOY13442182BOY
EOY12140089EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY178820EOY

Investments Other Securities InvestmentsOtherSecurities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Investments Program Related InvestmentsProgramRelated

FieldValueIRS element (for citing)
BOY662381BOY
EOY0EOY

Intangible Assets IntangibleAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Assets Total OtherAssetsTotal

FieldValueIRS element (for citing)
BOY2334581BOY
EOY1415481EOY

Total Assets TotalAssets

FieldValueIRS element (for citing)
BOY21832173BOY
EOY22726122EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

FieldValueIRS element (for citing)
BOY3406568BOY
EOY1621772EOY

Grants Payable GrantsPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Deferred Revenue DeferredRevenue

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Tax Exempt Bond Liabilities TaxExemptBondLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Escrow Account Liability EscrowAccountLiability

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Loans From Officers Directors LoansFromOfficersDirectors

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Unsecured Notes Loans Payable UnsecuredNotesLoansPayable

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Other Liabilities OtherLiabilities

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Liabilities TotalLiabilities

FieldValueIRS element (for citing)
BOY3406568BOY
EOY1621772EOY
FieldValueIRS element (for citing)
Follow SFAS117XFollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

FieldValueIRS element (for citing)
BOY18425605BOY
EOY21104350EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

FieldValueIRS element (for citing)
BOY0BOY
EOY0EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY18425605BOY
EOY21104350EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

FieldValueIRS element (for citing)
BOY21832173BOY
EOY22726122EOY
FieldValueIRS element (for citing)
Reconcilation Revenue Expenses2675150ReconcilationRevenueExpenses
Reconciliation Unrealized Invest3595ReconciliationUnrealizedInvest
Method Of Accounting AccrualXMethodOfAccountingAccrual
Accountant Compile Or ReviewfalseAccountantCompileOrReview
FS AuditedtrueFSAudited

FS Audited Basis FSAuditedBasis

FieldValueIRS element (for citing)
Financial Statement ConsolidatedXFinancialStatementConsolidated
FieldValueIRS element (for citing)
Audit CommitteetrueAuditCommittee
Federal Grant Audit RequiredfalseFederalGrantAuditRequired

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
Hospital170b1 AiiiXHospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

FieldValueIRS element (for citing)
Contributor NumberRESTRICTEDContributorNumber

Contributor Name Business ContributorNameBusiness

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor Address US ContributorAddressUS

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Aggregate ContributionsRESTRICTEDAggregateContributions

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
Total Grassroots LobbyingTotalGrassrootsLobbying
Total Direct LobbyingTotalDirectLobbying
Total Lobbying ExpendituresTotalLobbyingExpenditures
Other Exempt Purpose ExpendituresOtherExemptPurposeExpenditures
Total Exempt Purpose ExpendituresTotalExemptPurposeExpenditures
Lobbying NontaxableLobbyingNontaxableAmount
Grassroots NontaxableGrassrootsNontaxableAmount
Tot Lobbying Grassroot Minus Non TxTotLobbyingGrassrootMinusNonTx
Tot Lobby Expend Mns Lobbying NontxTotLobbyExpendMnsLobbyingNontx
VolunteersfalseVolunteers
Paid Staff Or ManagementfalsePaidStaffOrManagement
Media AdvertisementsfalseMediaAdvertisements
Mailings MembersfalseMailingsMembers
Publications Or BroadcastfalsePublicationsOrBroadcast
Grants Other OrganizationsfalseGrantsOtherOrganizations
Direct Contact LegislatorstrueDirectContactLegislators
Direct Contact Legislators$438DirectContactLegislatorsAmount
Rallies DemonstrationsfalseRalliesDemonstrations
Other ActivitiesfalseOtherActivities
Total Lobbying Expenditures IIB438TotalLobbyingExpendituresIIB
Not Described In501c3falseNotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

FieldValueIRS element (for citing)
IdentifierSchedule C, Part II-BIdentifier
Return ReferenceLobbying Activity ExplanationReturnReference
ExplanationHoly Rosary Healthcare pays dues to the Montana Hospital Association, of which $438 is charged for lobbying.Explanation

Schedule D IRS990ScheduleD

FieldValueIRS element (for citing)
Art Public Exhibition AmtsArtPublicExhibitionAmts
Held Works Of Art AmtsHeldWorksOfArtAmts

Current Year CurrentYear

FieldValueIRS element (for citing)
Beginning Of Year Balance157436BeginningOfYearBalance
Contributions2655Contributions
Investment Earnings Or Losses13771InvestmentEarningsOrLosses
Grants Or Scholarships2500GrantsOrScholarships
Administrative Expenses529AdministrativeExpenses
End Of Year Balance170833EndOfYearBalance

Current Year Minus1 Year CurrentYearMinus1Year

FieldValueIRS element (for citing)
Beginning Of Year Balance152032BeginningOfYearBalance
Investment Earnings Or Losses8504InvestmentEarningsOrLosses
Grants Or Scholarships2500GrantsOrScholarships
Administrative Expenses600AdministrativeExpenses
End Of Year Balance157436EndOfYearBalance

Current Year Minus2 Years CurrentYearMinus2Years

FieldValueIRS element (for citing)
Beginning Of Year Balance170256BeginningOfYearBalance
Investment Earnings Or Losses-15721InvestmentEarningsOrLosses
Grants Or Scholarships2500GrantsOrScholarships
Administrative Expenses3AdministrativeExpenses
End Of Year Balance152032EndOfYearBalance

Current Year Minus3 Years CurrentYearMinus3Years

FieldValueIRS element (for citing)
Beginning Of Year Balance126507BeginningOfYearBalance
Investment Earnings Or Losses46785InvestmentEarningsOrLosses
Grants Or Scholarships3000GrantsOrScholarships
Administrative Expenses36AdministrativeExpenses
End Of Year Balance170256EndOfYearBalance

Current Year Minus4 Years CurrentYearMinus4Years

FieldValueIRS element (for citing)
Beginning Of Year Balance152571BeginningOfYearBalance
Investment Earnings Or Losses-23564InvestmentEarningsOrLosses
Grants Or Scholarships2500GrantsOrScholarships
End Of Year Balance126507EndOfYearBalance
FieldValueIRS element (for citing)
Permanent Endowment EOY Balance1.00000PermanentEndowmentEOYBalance
Endowments Held By Unrelated OrgsfalseEndowmentsHeldByUnrelatedOrgs
Endowments Held By Related OrgstrueEndowmentsHeldByRelatedOrgs
Are Related Orgs Listed Schedule RtrueAreRelatedOrgsListedScheduleR

Land Land

FieldValueIRS element (for citing)
Other Cost Or Other Basis135511OtherCostOrOtherBasis
Book Value135511BookValue

Buildings Buildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis13634903OtherCostOrOtherBasis
Depreciation7003867Depreciation
Book Value6631036BookValue

Leasehold Improvements LeaseholdImprovements

FieldValueIRS element (for citing)
Other Cost Or Other Basis9473977OtherCostOrOtherBasis
Depreciation7016786Depreciation
Book Value2457191BookValue

Equipment Equipment

FieldValueIRS element (for citing)
Other Cost Or Other Basis15749499OtherCostOrOtherBasis
Depreciation13250317Depreciation
Book Value2499182BookValue

Other Land Buildings OtherLandBuildings

FieldValueIRS element (for citing)
Other Cost Or Other Basis1802488OtherCostOrOtherBasis
Depreciation1385319Depreciation
Book Value417169BookValue
FieldValueIRS element (for citing)
Total Of Book Value Land Buildings12140089TotalOfBookValueLandBuildings

Other Assets OtherAssets

FieldValueIRS element (for citing)
DescriptionOTHER RECEIVABLESDescription
Book Value1415481BookValue
FieldValueIRS element (for citing)
Total Book Value Other Assets1415481TotalBookValueOtherAssets
Footnote In Part XIIIXFootnoteInPartXIII

Form990 Schedule D Part XIII Form990ScheduleDPartXIII

FieldValueIRS element (for citing)
IdentifierSCH. D, PART V, LINE 4Identifier
Return ReferenceENDOWMENT FUNDSReturnReference
ExplanationTHE INTENDED USE FOR THE KENNETH HOM TRUST ENDOWMENT FUND IS TO PROVIDE NURSING SCHOLARSHIPS. EACH YEAR A SCHOLARSHIP IS AWARDED TO AN INDIVIDUAL WITH EASTERN MONTANA TIES WHO IS PURSUING HIS OR HER NURSING EDUCATION. IN 2012, ONE SCHOLARSHIP WAS AWARDED. Endowment funds are held by the Holy Rosary Healthcare Foundation.Explanation

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Charity Care PolicytrueCharityCarePolicy
Written PolicytrueWrittenPolicy
FPG Reference Free CaretrueFPGReferenceFreeCare
Pcent200XPcent200
FPG Reference Discounted CaretrueFPGReferenceDiscountedCare
Pcent400XPcent400
Free Disc Care Medically IndigenttrueFreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity CaretrueAmountsBudgetedForCharityCare
Expenses Exceeded BudgetfalseExpensesExceededBudget
Annual Community Benefit ReporttrueAnnualCommunityBenefitReport
Report Publically AvailabletrueReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

FieldValueIRS element (for citing)
Total Community Benefit Expense1022838TotalCommunityBenefitExpense
Net Community Benefit Expense1022838NetCommunityBenefitExpense
Percent Of Total Expense0.02700PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

FieldValueIRS element (for citing)
Total Community Benefit Expense950362TotalCommunityBenefitExpense
Net Community Benefit Expense950362NetCommunityBenefitExpense
Percent Of Total Expense0.02500PercentOfTotalExpense

Total Charity Care TotalCharityCare

FieldValueIRS element (for citing)
Total Community Benefit Expense1973200TotalCommunityBenefitExpense
Net Community Benefit Expense1973200NetCommunityBenefitExpense
Percent Of Total Expense0.05200PercentOfTotalExpense

Community Health Services CommunityHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs19NumberOfActivitiesOrPrograms
Persons Served2548PersonsServed
Total Community Benefit Expense192184TotalCommunityBenefitExpense
Direct Offsetting Revenue28791DirectOffsettingRevenue
Net Community Benefit Expense163393NetCommunityBenefitExpense
Percent Of Total Expense0.00430PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

FieldValueIRS element (for citing)
Number Of Activities Or Programs11NumberOfActivitiesOrPrograms
Persons Served288PersonsServed
Total Community Benefit Expense189163TotalCommunityBenefitExpense
Net Community Benefit Expense189163NetCommunityBenefitExpense
Percent Of Total Expense0.00500PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Total Community Benefit Expense1876188TotalCommunityBenefitExpense
Net Community Benefit Expense1876188NetCommunityBenefitExpense
Percent Of Total Expense0.04950PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served1408PersonsServed
Total Community Benefit Expense19431TotalCommunityBenefitExpense
Net Community Benefit Expense19431NetCommunityBenefitExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs41NumberOfActivitiesOrPrograms
Persons Served4244PersonsServed
Total Community Benefit Expense2276966TotalCommunityBenefitExpense
Direct Offsetting Revenue28791DirectOffsettingRevenue
Net Community Benefit Expense2248175NetCommunityBenefitExpense
Percent Of Total Expense0.05930PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

FieldValueIRS element (for citing)
Number Of Activities Or Programs41NumberOfActivitiesOrPrograms
Persons Served4244PersonsServed
Total Community Benefit Expense4250166TotalCommunityBenefitExpense
Direct Offsetting Revenue28791DirectOffsettingRevenue
Net Community Benefit Expense4221375NetCommunityBenefitExpense
Percent Of Total Expense0.11130PercentOfTotalExpense

Community Support CommunitySupport

FieldValueIRS element (for citing)
Number Of Activities Or Programs3NumberOfActivitiesOrPrograms
Persons Served151PersonsServed
Total Community Building Expense3213TotalCommunityBuildingExpense
Net Community Building Expense3213NetCommunityBuildingExpense

Coalition Building CoalitionBuilding

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served3PersonsServed
Total Community Building Expense183TotalCommunityBuildingExpense
Net Community Building Expense183NetCommunityBuildingExpense

Health Improvement Advocacy HealthImprovementAdvocacy

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served2PersonsServed
Total Community Building Expense245TotalCommunityBuildingExpense
Net Community Building Expense245NetCommunityBuildingExpense

Workforce Development WorkforceDevelopment

FieldValueIRS element (for citing)
Number Of Activities Or Programs1NumberOfActivitiesOrPrograms
Persons Served1PersonsServed
Total Community Building Expense194407TotalCommunityBuildingExpense
Net Community Building Expense194407NetCommunityBuildingExpense
Percent Of Total Expense0.00050PercentOfTotalExpense

Other Other

FieldValueIRS element (for citing)
Number Of Activities Or Programs2NumberOfActivitiesOrPrograms
Persons Served220PersonsServed
Total Community Building Expense4666TotalCommunityBuildingExpense
Net Community Building Expense4666NetCommunityBuildingExpense
Percent Of Total Expense0.00010PercentOfTotalExpense

Total Total

FieldValueIRS element (for citing)
Number Of Activities Or Programs8NumberOfActivitiesOrPrograms
Persons Served377PersonsServed
Total Community Building Expense202714TotalCommunityBuildingExpense
Net Community Building Expense202714NetCommunityBuildingExpense
Percent Of Total Expense0.00060PercentOfTotalExpense
FieldValueIRS element (for citing)
Bad Debt Expense ReportedfalseBadDebtExpenseReported
Bad Debt Expense$1,517,440BadDebtExpenseAmount
Amount Reimbursed By Medicare9216284AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare16083681CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall-6867397MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

FieldValueIRS element (for citing)
Cost To Charge RatioXCostToChargeRatio
FieldValueIRS element (for citing)
Written Debt Collection PolicytrueWrittenDebtCollectionPolicy
Provision For Charity CaretrueProvisionForCharityCare
Number Of Hospital Facilities1NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA

FieldValueIRS element (for citing)
Facility Number1FacilityNumber

Name Name

FieldValueIRS element (for citing)
Business Name Line1HOLY ROSARY HEALTHCAREBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line12600 WILSON STREETAddressLine1
CityMILES CITYCity
StateMTState
ZIP Code59301ZIPCode
FieldValueIRS element (for citing)
Licensed HospitalXLicensedHospital
General Medical And SurgicalXGeneralMedicalAndSurgical
Er24 HoursXEr24Hours

Form990 Schedule H Part V Section B Form990ScheduleHPartVSectionB

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1HOLY ROSARY HEALTHCAREBusinessNameLine1
FieldValueIRS element (for citing)
Hospital Facility Number1HospitalFacilityNumber
Eligibility Criteria ExplainedtrueEligibilityCriteriaExplained
Uses FPG FreetrueUsesFPGFree
FPG Free Percent200.FPGFreePercent
Uses FPG DiscountedtrueUsesFPGDiscounted
FPG Discount Percent400.FPGDiscountPercent
Explains BasistrueExplainsBasis
Income LevelXIncomeLevel
Asset LevelXAssetLevel
Medical IndigencyXMedicalIndigency
Insurance StatusXInsuranceStatus
Uninsured DiscountXUninsuredDiscount
Medicaid MedicareXMedicaidMedicare
Explains Application MethodtrueExplainsApplicationMethod
Includes Publicity MeasurestrueIncludesPublicityMeasures
Posted On WebsiteXPostedOnWebsite
Attached To InvoicesXAttachedToInvoices
Posted In Emergency RoomXPostedInEmergencyRoom
Posted In Admission OfficeXPostedInAdmissionOffice
Provided On AdmissionXProvidedOnAdmission
Available On RequestXAvailableOnRequest
Actions On NonpaymenttrueActionsOnNonpayment
Collection ActivitiesfalseCollectionActivities
Notify Upon AdmissionXNotifyUponAdmission
Notify Before DischargeXNotifyBeforeDischarge
Notified All PatientsXNotifiedAllPatients
Documented DeterminationXDocumentedDetermination
Nondiscrim Emergency Care PolicytrueNondiscrimEmergencyCarePolicy
Lowest Negotiated RatesXLowestNegotiatedRates
Amounts Generally BilledfalseAmountsGenerallyBilled
Gross ChargesfalseGrossCharges

Form990 Schedule H Part V Section C Form990ScheduleHPartVSectionC

FieldValueIRS element (for citing)
Number Of Other Facilities1NumberOfOtherFacilities

Other Facilities OtherFacilities

Name Name

FieldValueIRS element (for citing)
Business Name Line1POWDER RIVER MEDICAL CLINICBusinessNameLine1

Address Address

FieldValueIRS element (for citing)
Address Line1507 NORTH LINCOLN AVENUEAddressLine1
CityBROADUSCity
StateMTState
ZIP Code59317ZIPCode
FieldValueIRS element (for citing)
Facility TypeAMBULATORY CARE CLINICFacilityType

Form990 Schedule H Part VI Form990ScheduleHPartVI

FieldValueIRS element (for citing)
IdentifierSCHEDULE H, PART VIIdentifier
Return ReferenceSUPPLEMENTAL INFORMATIONReturnReference
ExplanationPART I, LINE 3C ELIGIBILITY IS BASED ON FEDERAL POVERTY GUIDELINES. PART I, LINE 6A THE ANNUAL COMMUNITY BENEFIT REPORT IS INCLUDED IN THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM REPORT TO THE COMMUNITY. WE SUBMIT COMMUNITY BENEFIT ACTIVITIES AS NEWS TO LOCAL MEDIA AND REPORT THEM ON OUR WEBSITE AS THEY OCCUR. A SEPARATE PUBLICATION SPECIFICALLY DEDICATED TO COMMUNITY BENEFIT WAS NOT RELEASED IN 2011. PART I, LINE 7G PHYSICIAN CLINICS ACCOUNT FOR $31,649 OF TOTAL SUBSIDIZED SERVICE EXPENSE; THIS IS A CLINIC IN A REMOTE RURAL AREA WITH NO OTHER ACCESS TO HEALTHCARE WITHIN AN 80 MILE RADIUS. PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE DELETED FROM THE DENOMINATOR BEFORE CALCULATING PERCENTAGES IN COLUMN (F) IS $2,776,144. PART I, LINE 7 COST TO CHARGE RATIO IS USED FOR ALL REMAINING CATEGORIES OF COMMUNITY BENEFIT. THE COST TO CHARGE RATIO USED WAS DERIVED FROM WORKSHEET 2. PART II Community Building Activities, those that enhance existing efforts or support gaps of community need, include programs that support those in the community who are living at or below poverty. Holy Rosary Healthcare ("Holy Rosary") leadership and its employees performed civic activities in which the health of the community was advocated as a priority by the hospital. In 2012, Holy Rosary performed the following activities: -Participating in "Meals on Wheels" program delivering noon meals to those in our community. -Healthcare talks to community members and or members of local communities by Clinic physicians, hospice team and physical therapy team. -Taxi vouchers for seniors to get to their physician and lab appointments. -Medicaid Waiver team provides education to patients and prepares them for admission to state program. -Financial assistance is provided by hospital staff to assist those needing help registering for public programs, such as Medicaid. -Pastoral care outreach on behalf of Holy Rosary is provided to local community emergency medical responders.-Mission Department provides funding for hotels, gas, food, and prescriptions to assist patients in their release from the hospital. -Membership in civic groups such as Kiwanis and Rotary where we represent the health of our community and our hospital. We provide lectures, trainings and will organize events that relate to needs of the community. In 2012, we provided manpower to improve a local park specifically to building a restroom facility PART III, LINE 4 DISCOUNTS AND PAYMENTS APPLIED TO ACCOUNTS REDUCE BAD DEBT EXPENSE. NO METHOD IS USED TO DETERMINE THE AMOUNT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE, HOWEVER, THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY ALLOWS FINANCIAL ASSISTANCE AWARDS TO BE MADE PRESUMPTIVELY TO INDIVIDUALS WHO HAVE NOT ADEQUATELY COMPLETED THE APPLICATION PROCESS IF THE INDIVIDUAL IS HOMELESS OR IF THE INDIVIDUAL IS NON-RESPONSIVE AND HAS A CREDIT SCORE LESS THAN 600. BAD DEBT EXPENSES INCLUDE ACTUAL WRITE OFFS AND ANY ASSOCIATED ACCRUAL BASED ON ACCOUNTS RECEIVABLE. THE COSTING METHODOLOGY USED TO CALCULATE THE COST OF BAD DEBT INCLUDED ON PART III LINE 2 WAS THE COST TO CHARGE RATIO DERIVED USING THE METHODOLOGY FROM WORKSHEET 2. PART III, LINE 8 THE ORGANIZATION DOES NOT BELIEVE THAT MEDICARE SHORTFALLS SHOULD BE INCLUDED AS COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT'S SCHEDULE D PART V, PART VI AND SCHEDULE D-1. PART III, 9B AN INTEGRAL COMPONENT OF OUR MISSION IS TO BE GOOD FINANCIAL STEWARDS. THIS REQUIRES US TO DETERMINE WHICH PATIENTS ARE IN NEED OF CHARITY CARE AND WHICH ARE ABLE TO CONTRIBUTE SOME PAYMENT FOR CARE RECEIVED. WE MAINTAIN A BALANCE THAT ENABLES US TO CONTINUE TO PROVIDE CHARITY CARE TO THOSE WHO NEED IT MOST, AND TO ENSURE THAT WE MANAGE OUR RESOURCES SO THAT WE CAN CONTINUE TO BE HERE WHEN PEOPLE NEED US MOST. HOLY ROSARY HEALTHCARE NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION, DISCHARGE AND IN COMMUNICATION REGARDING PATIENT BILLS. PATIENTS ARE CONTACTED MULTIPLE TIMES ABOUT UNPAID BALANCES PRIOR TO INITIATING ANY COLLECTION ACTION. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION PROCESS, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED. PART VI, Supplemental Information, Question 2: NEEDS ASSESSMENT - AS PART OF OUR ORGANIZATIONAL MISSION TO RESPOND TO THE HEALTH NEEDS OF THE PEOPLE AND COMMUNITIES SERVED, WE TAKE STEPS TO DETERMINE WHERE THERE IS THE MOST NEED IN ORDER TO PROVIDE THE GREATEST GOOD. HOLY ROSARY HAS REGULARLY PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN 2011. THIS ASSESSMENT STUDIED MILES CITY, MONTANA, AND THE NINE-COUNTY SURROUNDING AREA SERVED BY HOLY ROSARY. THE ASSESSMENT, COMPLETED BY A THIRD-PARTY FIRM SPECIALIZING IN RURAL COMMUNITY RESEARCH, INCLUDED COLLABORATIVE PARTNERSHIPS WITH LOCAL GOVERNMENT AND SOCIAL AGENCIES AND THE CUSTER COUNTY PUBLIC HEALTH NURSING OFFICE; COMBINING EFFORTS WITH OTHER LOCAL HOSPITALS AND HEALTH CARE ORGANIZATIONS; AND CONDUCTING SURVEYS, FOCUS GROUPS, AND ASSESSMENTS WITH THE ASSISTANCE OF THE Montana OFFICE OF RURAL HEALTH and the National Rural Health Resource Center. COMMUNITY EDUCATION WAS COMPLETED UTILIZING THE MEDIA, INTERNET, AND MAILINGS TO BUILD AWARENESS AND ENCOURAGE PARTICIPATION IN THIS PROJECT. RESULTS WERE RECEIVED IN EARLY 2012, INFORMATION WAS SHARED WITH KEY STAKEHOLDER GROUPS IN THE COMMUNITY AND REGION, RESPECTIVE PRIORITIES WERE IDENTIFIED AND ACTION PLANS WERE PURSUED. To obtain input from the community, Holy Rosary provided the National Rural Health Resource Health Center with a list of inpatient and outpatient admissions. Zip codes with the greatest number of admissions were selected to be included in the survey. A random list of 575 residents was selected from Prime Net Data Source. Residence was stratified in the initial sample selection so that each area would be represented in proportion to the overall service population and the proportion of past admissions. In addition another 300 surveys were hand-distributed in the community to boost the response rate. Thus a total of 875 surveys were distributed amongst the Holy Rosary service area. Two focus groups were held to identify the motives of local residents when selecting health care providers and discover reasons why people may leave the service area to seek health care services. It was intended that this information would help determine gaps in service, increase awareness of local programs and services, and improve satisfaction with local services providers and facilities, which relates to understanding the health needs of the community. The Community Benefit Committee ("CBC") of the Holy Rosary Board of Directors was charged with addressing the top needs discovered in the CHNA. The top community needs and priorities were: Alcohol abuse, overweight/obesity, cancer, drug abuse (including prescription) and lack of exercise. A grant program available to community organizations was established to specifically address the top needs. The CBC held quarterly meetings to review and approve or deny the grant applications received from the southeastern Montana communities within the Holy Rosary primary and secondary service areas. Notification was placed in the local newspaper announcing grant funds were available. A total of seven grants totaling $5,000 were awarded to Eastern Montana Veterans Stand Down, Custer County Family Treatment Court, Sacred Heart School, Ashland Community Health Center, Miles City Fire Rescue, Global Health Equity Foundation and First United Methodist Church. Holy Rosary provided funding for community programs to deal with four of the top concerns/needs: Alcohol/drug abuse, obesity, cancer and mental health issues. These needs were addressed by Holy Rosary's support of a student lunch program for high school students that provide a healthy-approach balanced noon meal; a food, clothing and supplies donation program for the Eastern Montana Veterans Stand Down project; "Let's Talk Miles City" suicide prevention program; and a reward incentive program for the Custer County Family Treatment Court program. Holy Rosary provided office space for an oncologist and an infusion center at the hospital which is available to any community patient, regardless of insurance or hospital affiliation. As a small rural community, not all needs can be addressed by Holy Rosary. Of those, cancer was not specifically addressed due to the lack of resources in people and funding. A local non-profit group not related to our hospital or health system will address personal needs (fuel, food, and hotel) of individuals and their families in Eastern Montana who are undergoing cancer treatment. Holy Rosary is part of the Diabetes Prevention Program grant as funded by the Centers forExplanation

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Records MaintainedtrueRecordsMaintained

Recipient Table RecipientTable

Recipient Name Business RecipientNameBusiness

FieldValueIRS element (for citing)
Business Name Line1HOLY ROSARY FOUNDATIONBusinessNameLine1

Address US AddressUS

FieldValueIRS element (for citing)
Address Line12600 WILSONAddressLine1
CityMILES CITYCity
StateMTState
ZIP Code59301ZIPCode
FieldValueIRS element (for citing)
EIN Of Recipient202270238EINOfRecipient
IRC Section501(C)(3)IRCSection
Amount Of Cash Grant31239AmountOfCashGrant
Purpose Of GrantASSIST IN CHARITY EXEMPT PURPOSESPurposeOfGrant
FieldValueIRS element (for citing)
Total Nbr Of501 C3 And Govt Grants1TotalNbrOf501C3AndGovtGrants

Form990 Schedule I Part IV Form990ScheduleIPartIV

FieldValueIRS element (for citing)
IdentifierDescription of Organization's Procedures for Monitoring the Use of GrantsIdentifier
Return ReferenceForm 990, Schedule I, Part I, Line 2ReturnReference
ExplanationGRANTS ARE MONITORED THROUGH THE HOLY ROSARY HEALTHCARE FOUNDATION. THE FOUNDATION FOLLOWS A TWO-STEP PROCESS IN PREPARING THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (SEFA). THE GRANT PROJECT DIRECTOR IS RESPONSIBLE TO SUBMIT THE INVOICES FOR EACH MONTH'S ACTIVITY TO THE FOUNDATION DIRECTOR. THESE ARE THEN REVIEWED FOR COMPLIANCE WITH FEDERAL STANDARDS AND GUIDELINES AND ARE SUBMITTED TO THE FEDERAL GOVERNMENT FOR REIMBURSEMENT OR APPLIED TO GRANT IF AWARDED UPFRONT. THE AMOUNTS ARE THEN DRAWN DOWN BY THE FOUNDATION ADMINISTRATOR AND THE MONEY IS WIRED TO THE FOUNDATION'S BANK ACCOUNT OR REIMBURSED TO THE HOSPITAL IF THE EXPENDITURES WERE PAID BY THE HOSPITAL AND THE FUNDS MADE AVAILABLE TO THE FOUNDATION IN ADVANCE. THIS INFORMATION IS COMPILED QUARTERLY BY THE DIRECTOR OF FINANCE AND IS TRACKED BY GRANT NAME AND CEDA NUMBER. THE FOUNDATION DIRECTOR ALSO PROVIDES THE FINANCE DIRECTOR WITH THE AWARD LETTER AND ANY COMMUNICATIONS RELATED TO THE GRANT AS WELL AS SUPPORTING INVOICES AND EXPENDITURES. AT THE END OF THE YEAR, QUARTERLY WORKSHEETS ARE USED TO PREPARE THE SEFA. THE SEFA IS PREPARED BY THE DIRECTOR OF FINANCE, REVIEWED BY THE GRANTS ADMINISTRATOR AND FORWARDED TO THE SYSTEM OFFICE AND ERNST AND YOUNG CPA FIRM.Explanation

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePayment
Supplemental Nonqual Retire PlantrueSupplementalNonqualRetirePlan
Equity Based Comp ArrangementfalseEquityBasedCompArrangement
Comp Based On Revenue Of Filing OrgfalseCompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related OrgsfalseCompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing OrgfalseCompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate OrgsfalseCompBasedNetEarningsRelateOrgs
Any Non Fixed PaymentstrueAnyNonFixedPayments
Initial Contract ExceptionfalseInitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (8 entries)

TitleTitleBase Compensation Filing OrgBaseCompensationFilingOrgBonus Filing OrgBonusFilingOrgOther Compensation Filing OrgOtherCompensationFilingOrgDeferred Comp Filing OrgDeferredCompFilingOrgNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgTotal Compensation Filing OrgTotalCompensationFilingOrgComp Based On Related OrgsCompBasedOnRelatedOrgsBonus Related OrgsBonusRelatedOrgsOther Compensation Related OrgsOtherCompensationRelatedOrgsDeferred Comp Related OrgsDeferredCompRelatedOrgsNontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgsTotal Compensation Related OrgsTotalCompensationRelatedOrgsComp Report Prior990 Filing OrgCompReportPrior990FilingOrgComp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
PAUL LEWIS
CEO EX-OFFICIO17029120700119082431716408243624
JASON BARKER
EX-OFFICIO CEO SVB42853014700012841543841286165561600000000
JAMES MACMILLIAN
PHYSICIAN11030101453900100125669200000000
JEFF WILLIAMS
PHYSICIAN2932240125717946648931891600000000
DORTHY BRADBURY
PHYSICIAN2394356888034074984652132322700000000
CHRISTOPHER LIEB
PHYCICIAN199828628851364181951600229827400000000
CALVIN CAREY
CFO1360470326097000836718402300000000
TRAVIS WALKER
PHYSICIAN21818807946545582823135500000000

Form990 Schedule J Part III Form990ScheduleJPartIII (4 entries)

IdentifierIdentifierExplanationExplanationReturn ReferenceReturnReference
FORM 990, SCHEDULE J, PART I, LINE 3SEE FORM 990, SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, LINES 15A & B REGARDING THE PROCESS USED BY SCLHS TO DETERMINE EXECUTIVE COMPENSATION WHICH IS RELIED UPON BY THIS ORGANIZATION.
FORM 990, SCHEDULE J, PART I, LINE 4BOTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR IRS IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. ON THE ADVICE OF COUNSEL, SCLHS HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. FOR 2012, THIS WAS ZERO.PAYMENTS FROM NONQUALIFIED RETIREMENT PLAN
FORM 990, SCHEDULE J, PART I, LINE 7 (NON-FIXED PAYMENTS)SCLHS HAS MANAGEMENT INCENTIVE PLANS WHICH ARE BASED ON A COMBINATION OF MEASURES. MANAGEMENT AND SENIOR LEADERSHIP ARE ELIGIBLE FOR THE INCENTIVE COMPENSATION. PERFORMANCE CATEGORIES ARE MADE UP OF A COMBINATION OF CLINICAL QUALITY MEASURES AND OPERATING INCOME. THE OPERATING INCOME CATEGORY IS GENERALLY RELATED TO THE NET EARNINGS OF THE CARE SITE IN WHICH THE INDIVIDUAL WORKS, OR IN THE CASE OF SCLHS SENIOR MANAGEMENT, THE NET EARNINGS OF SCLHS.
FORM 990 SCHEDULE J, PART II AND FORM 990 PART VIITHE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES INCLUDING HOLY ROSARY HEALTHCARE (HOLY ROSARY) IN MILES CITY, MONTANA. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. JASON L. BARKER IS PRESIDENT AND CHIEF EXECUTIVE OFFICER FOR ST. VINCENT HEALTHCARE. HE FORMERLY SERVED AS A MEMBER OF HOLY ROSARY HEALTHCARE'S BOARD. HE ALSO SERVE AS A MEMBER OF HOLY ROSARY HEALTHCARE'S BOARD. THE COMPENSATION REFLECTED IS THAT OF MR. BARKER'S POSITION AS A ST. VINCENT HEALTHCARE EXECUTIVE AND IS NOT RELATED TO HOLY ROSARY HEALTHCARE. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation

FieldValueIRS element (for citing)
IdentifierDISCLOSURESIdentifier
ExplanationFORM 990, PART III, LINE 4D PROGRAM SERVICE ACCOMPLISHMENTS HOLY ROSARY HEALTHCARE (HOSPITAL) PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO INDIVIDUALS COVERED BY GOVERNMENTAL PROGRAMS, OTHER BENEFITS, AND ACCOMPLISHMENTS INCLUDE: -ASSISTING EDUCATORS BY WORKING WITH HEALTHCARE INTERNS -PRESENT SPEAKING ENGAGEMENTS TO THE COMMUNITY COVERING HEALTHCARE ISSUES SUCH AS TELEMEDICINE, ARTHRITIS, HOSPICE PROGRAM, SLEEP DISORDERS, ETHICS, JOINT SEMINARS, EAR, NOSE, AND THROAT ISSUES, PSYCHOLOGY, AND DIABETES -PARTICIPATED IN HEALTH FAIRS TO PROMOTE HEALTH EDUCATION AND FOSTER PREVENTION TECHNIQUES -PROVIDE HOSPICE PROGRAM TO COMMUNITY -PROVIDE DENTAL CARE FOR CHILDREN THROUGH SMILE SAVERS -PROVIDE HEALTH RELATED ARTICLES TO LOCAL PRESS TO EDUCATE PUBLIC ON VARIOUS TOPICS -PROVIDE WELLNESS SCREENS TO SCHOOL DISTRICT AT DISCOUNTED RATE -PROVIDE FREE TOURS TO AREA SCHOOL CHILDREN AND OTHER COMMUNITY GROUPS TO TEACH THEM ABOUT THE HOSPITAL -PROVIDE MEDICAL EXPLORERS PROGRAM TO PROMOTE CAREERS IN HEALTHCARE -SPONSOR AFFORDABLE ACCESS ADVANTAGE FOR OUR EMPLOYEES -SPONSOR BLOOD DRIVES, CHARITY WALKS, 55 ALIVE, SCHOOL NURSE PROGRAM, AND OTHER GROUPS EXPENSES - $32,740 GRANTS - $32,740 REVENUE - $0 FORM 990 PART VI, SEC A, LINE 3 MANAGEMENT COMPANIES MANAGEMENT DUTIES DELEGATED BY HOLY ROSARY HEALTHCARE TO MANAGEMENT COMPANIES WERE IN THE FOLLOWING AREAS: (1) ARAMARK CORPORATION: FOOD SERVICES (2) BROADLANE: SUPPLY CHAIN MANAGEMENT FORM 990 PART VI, SEC A, LINES 6, 7A & 7B CLASS OF MEMBER, NATURE OF RIGHTS, ELECTION OF BOARD MEMBERS, DECISIONS SUBJECT TO APPROVAL THE SOLE MEMBER AND CONTROLLING MEMBER OF THE HOLY ROSARY HEALTHCARE (HRH) CORPORATION IS THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC (SCLHS), A KANSAS NON-FOR-PROFIT CORPORATION. SOME OF THE EXCLUSIVE POWERS OF SCLHS INCLUDE: - TO APPOINT, AFTER CONSULTATION WITH THE HRH CORPORATE BOARD, THE BOARD OF DIRECTORS OF HRH AND APPOINT MEMBERS OF SCLHS TO THE HRH BOARD OF DIRECTORS; - TO REMOVE, WITH OR WITHOUT CAUSE, AFTER CONSULTATION WITH THE HRH CORPORATE BOARD, ANY MEMBER OF THE HRH BOARD OF DIRECTORS; - TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE CHIEF EXECUTIVE OFFICER AND THE CHIEF ADMINISTRATIVE OFFICER OF HRH; - TO IMPLEMENT CORPORATE GOALS, POLICIES, AND PROCEDURES OF HRH; - TO APPROVE FOR HRH THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS, OR THE LEASE, SALE, TRANSFER, ASSUMPTION, OR ENCUMBERING OF HRH ASSETS; - TO APPROVE THE MERGER, DISSOLUTION, OR CORPORATE RESTRUCTURING OF HRH; AND - TO APPROVE HRH ANNUAL STRATEGIC PLANS AND OPERATING AND CAPITAL BUDGETS. THE HRH BOARD OF DIRECTORS HAVE THE POWERS TO EXERCISE GENERAL MANAGEMENT AND CONTROL OF THE BUSINESS AFFAIRS OF HRH WITH DUE REGARD FOR THE POWERS RESERVED BY SCLHS. THE POWERS OF THE HRH BOARD OF DIRECTORS INCLUDE NOMINATION OF BOARD MEMBERS FOR APPOINTMENT BY SCLHS. FORM 990 PART VI, SEC B, LINE 11B PROCESS THE ORGANIZATION USES TO REVIEW FORM 990 THE 990 FOR HOLY ROSARY HEALTHCARE WILL BE REVIEWED AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM AND THE HOLY ROSARY HEALTHCARE BOARD MEETINGS BEFORE THE RETURN IS FILED WITH THE IRS. THE 990 TAX RETURN IS REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. FORM 990, PART VI, SEC B, LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST ALL HOLY ROSARY HEALTHCARE EXECUTIVES, DIRECTORS, AND MANAGERS, BOARD MEMBERS AND BOARD COMMITTEE MEMBERS, MEDICAL EXECUTIVE COMMITTEE (MEC) MEMBERS AND OTHER PHYSICIANS IN DECISION MAKING ROLES OR SERVING ON HRH COMMITTEES, COMPLETE A NEW CONFLICT OF INTEREST (COI) DISCLOSURE FORM ANNUALLY. A COPY OF THE POLICY IS DISTRIBUTED ALONG WITH THE COI FORMS. IN THE EVENT OF A CHANGE OF CIRCUMSTANCE, EACH INDIVIDUAL WHO HAS ALREADY SIGNED A COI IS EXPECTED TO NOTIFY THE ORGANIZATION OF THE CHANGE AND UPDATE THE CONFLICT OF INTEREST INFORMATION. THE STATEMENTS ARE REVIEWED AND COI ISSUES ARE ADDRESSED BY THE ORGANIZATION RESPONSIBILITY OFFICER (ORO) AND LEADERSHIP AT THE APPROPRIATE LEVEL: - BOARD BY BOARD CHAIR - PHYSICIANS BY THE MEC PRESIDENT - HRH DIRECTORS AND MANAGERS BY THE HRH ADMINISTRATION - HRH EXECUTIVES BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM THE SIGNED COI FORMS ARE MAINTAINED IN HRH ADMISTRATION. THE CONFLICT OF INTEREST DISCLOSURE STATEMENTS FOR HRH EXECUTIVES ARE MAINTAINED AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AT THE BEGINNING OF BOARD AND BOARD COMMITTEE MEETINGS, THE QUESTION OF COI IS ASKED OF THOSE IN ATTENDANCE. WHEN AN ACTUAL CONFLICT IS IDENTIFIED, THE INDIVIDUAL ASKS TO BE EXCUSED FROM PARTICIPATING IN THE DISCUSSIONS AND DECISION-MAKING. FORM 990, PART VI, LINES 15A & B SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACTS -COMPENSATION SURVEYS AND STUDIES -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.) IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY AT THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. FORM 990 PART VI, SEC C, LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE AT HOSPITAL ADMINISTRATION UPON REQUEST. THE SISTERS OF CHARITY CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE ON THE SISTERS OF CHARITY WEBSITE WWW.SCLHEALTHSYSTEM.ORG.Explanation

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (28 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivitiesPrimaryActivitiesLegal Domicile StateLegalDomicileStateExempt Code SectionExemptCodeSectionPublic Charity StatusPublicCharityStatusBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Controlled OrgControlledOrg
SISTERS OF CHARITY LEAVENWORTH HLTH SYST
2420 WEST 26TH AVE STE 100-DDENVERCO80211237379161SUPPORT MMBRSKS501(C)(3)11B-TYPE IINAfalse
CARITAS CLINICS INC
818 NORTH 7TH STREETLEAVENWORTHKS66048481009910CLINIC SVCSKS501(C)(3)3SCLHStrue
MARIAN CLINIC INC
1001 SW GARFIELDTOPEKAKS66604481046905CLINIC SVCSKS501(C)(3)3SCLHStrue
MARILLAC CLINIC INC
2333 N 6TH STREETGRAND JUNCTIONCO81501841085822CLINIC SVCSCO501(C)(3)3SCLHStrue
PROVIDENCE MEDICAL CENTER
8929 PARALLEL PARKWAYKANSAS CITYKS66112480784446HEALTHCAREKS501(C)(3)3SCLHStrue
ST JOHN HOSPITAL INC
3500 SOUTH FOURTH STREETLEAVENWORTHKS66048480543768HEALTHCAREKS501(C)(3)3PMCtrue
BETHANY COMMUNITY PLAZA INC
15 NORTH 12TH STREETKANSAS CITYKS66102481207407HEALTHCAREKS501(C)(3)3PMCtrue
PROVIDENCEST JOHN FOUNDATION INC
8929 PARALLEL PARKWAYKANSAS CITYKS66112480925688SUPPORT 501C3KS501(C)(3)7PMCtrue
ST FRANCIS HEALTH CENTER INC
1700 SW 7TH STREETTOPEKAKS66606480547719HEALTHCAREKS501(C)(3)3SCLHStrue
ST FRANCIS HEALTH CENTER FOUNDATION
1700 SW 7TH STREETTOPEKAKS66606481092520SUPPORT 501C3KS501(C)(3)11A-TYPE ISFHCtrue
ST MARYS HOSPITAL & MEDICAL CENTER INC
2635 N 7TH STREETGRAND JUNCTIONCO81502840425720HEALTHCARECO501(C)(3)3SCLHStrue
ST MARYS HOSPITAL FOUNDATION
2635 N 7TH STREETGRAND JUNCTIONCO81502237001007SUPPORT 501C3CO501(C)(3)11A-TYPE ISMHMCtrue
SAINT JOSEPH HOSPITAL FOUNDATION
1835 FRANKLIN STREETDENVERCO80218840735096SUPPORT 501C3CO501(C)(3)11A-TYPE ISJHtrue
HOLY ROSARY HEALTHCARE FOUNDATION INC
2600 WILSONMILES CITYMT59301202270238SUPPORT 501C3MT501(C)(3)11A-TYPE IHRHCtrue
ST VINCENT HEALTHCARE
1233 NORTH 30THBILLINGSMT59101810232124HEALTHCAREMT501(C)(3)3SCLHStrue
ST VINCENT HEALTHCARE FOUNDATION
PO BOX 35200BILLINGSMT59107810468034SUPPORT 501C3MT501(C)(3)7SVHCtrue
NORTHWEST RESEARCH & EDUCATION INSTITUTE
315 NORTH 25TH STREETBILLINGSMT59101201343024COMM HLTH RESMT501(C)(3)9SVHCtrue
ST JAMES HEALTHCARE
400 SOUTH CLARK STREETBUTTEMT59701810231785HEALTHCAREMT501(C)(3)3SCLHStrue
ST JAMES HEALTHCARE FOUNDATION
400 SOUTH CLARK STREETBUTTEMT59701651202190SUPPORT 501C3MT501(C)(3)11A-TYPE ISJHCtrue
SAINT JOHN'S HEALTH CENTER
2121 SANTA MONICA BLVDSANTA MONICACA90404951684082HEALTHCARECA501(C)(3)3SCLHStrue
JOHN WAYNE CANCER INSTITUTE
2000 SANTA MONICA BLVDSANTA MONICACA90404954291515CANCER R&DCA501(C)(3)4SJHHCtrue
SAINT JOHNS HOSPITAL & HLTH CENTER FNDTN
2121 SANTA MONICA BLVDSANTA MONICACA90404956100079SUPPORT 501C3CA501(C)(3)11A-TYPE ISJHHCtrue
EXEMPLA INC FKA LUTHERAN HOSPITAL
2420 W 26TH AVE SUITE 100DDENVERCO80211841103606HEALTHCARECO501(C)(3)3SCLHStrue
EXEMPLA LUTHERAN MEDICAL CENTER FNDTN
2480 W 26TH AVESUITE 360BDENVERCO80211208846152SUPPORT 501C3CO501(C)(3)7EXEMPLA INCtrue
EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN
200 EXEMPLA CIRCLELAFAYETTECO80026841649162SUPPORT 501C3CO501(C)(3)7EXEMPLA INCtrue
LUTH MED CNTR PRO&GEN LIAB SELF-INS TRST
2480 W 26TH AVESUITE 360BDENVERCO80211742571584INSURANCECO501(C)(3)11A-TYPE IEXEMPLA INCtrue
SAINT JOSEPH HOSPITAL
1835 FRANKLIN STREETDENVERCO80218840417134HEALTHCARECO501(C)(3)3SCLHStrue
MOUNT ST VINCENT HOME INC
4159 LOWELL BOULEVARDDENVERCO80211840405260RESIDENT CARECO501(C)(3)11A-TYPE1SCLHStrue

Form990 Schedule R Part III Form990ScheduleRPartIII (7 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateBusiness Name Line1DirectControllingEntityName/BusinessNameLine1Predominant Income TypePredominantIncomeType
PAVILION IMAGING LLC
750 WELLINGTONGRAND JUNCTIONCO81501030516198RADIOLOGYCONAN/A
GRAND VALLEY SURGICAL CENTER LLC
710 WELLINGTONGRAND JUNCTIONCO81501841505075OP SURGERYCONAN/A
SAN JUAN CANCER CENTER LLC
600 SOUTH 5TH STREETMONTROSECO81401202856331OP CANCERCONAN/A
BILLINGS MRI CENTER LLC
1041 NORTH 29TH STREETBILLINGSMT59101810450943MRI-PET SCANMTNAN/A
LUTHERAN CAMPUS ASC LLC
3455 LUTHRN PKW SUITE 150WHEATRIDGECO800336028020749532OP SURGERYCONAN/A
COLORADO SURGICAL VENTURES LLC
30 S WACKER DR SUITE 2302CHICAGOIL60605208038915OP SURGERYCONAN/A
COLORADO SURGICAL HOSPITAL LLC
30 S WACKER DR SUITE 2302CHICAGOIL60605208038977OP SURGERYCONAN/A

Form990 Schedule R Part IV Form990ScheduleRPartIV (2 entries)

Address Line1AddressUS/AddressLine1CityAddressUS/CityStateAddressUS/StateZIP CodeAddressUS/ZIPCodeEINEINPrimary ActivityPrimaryActivityLegal Domicile StateLegalDomicileStateType Of EntityTypeOfEntityAddress Line1AddressForeign/AddressLine1CityAddressForeign/CityProvince Or StateAddressForeign/ProvinceOrStateCountryAddressForeign/CountryPostal CodeAddressForeign/PostalCodeLegal Domicile Foreign CountryLegalDomicileForeignCountry
CARITAS INC AND SUBSIDIARIES
2420 W 26th Ave Suite 100DDenverCO80211480941069OTHER MEDICALKSC CORP
LEAVEN INSURANCE COMPANY LTD
980370522INSURANCE23 LIME TREE BAY AVE PO BOX 1051GEORGETOWNGRAND CAYMANCJKY1-1102CJ
FieldValueIRS element (for citing)
Receipt Of Int Ann Rents RoyaltiesfalseReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other OrgtrueGiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other OrgtrueGiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other OrgfalseLoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other OrgfalseSaleOfAssetsToOtherOrg
Purchase Of Assets From Other OrgfalsePurchaseOfAssetsFromOtherOrg
Exchange Of AssetsfalseExchangeOfAssets
Rental Of Facilities To Other OrgsfalseRentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other OrgsfalseRentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other OrgsfalsePerformOfServicesForOtherOrgs
Perform Of Services By Other OrgsfalsePerformOfServicesByOtherOrgs
Sharing Of FacilitiesfalseSharingOfFacilities
Sharing Of Paid EmployeesfalseSharingOfPaidEmployees
Reimbursement Paid To Other OrgtrueReimbursementPaidToOtherOrg
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrg
Other Transfer To Other OrgfalseOtherTransferToOtherOrg
Other Transfer From Other OrgfalseOtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable

Name Of Other Organization NameOfOtherOrganization

FieldValueIRS element (for citing)
Business Name Line1HOLY ROSARY HEALTHCARE FOUNDATIONBusinessNameLine1
FieldValueIRS element (for citing)
Transaction TypeCTransactionType
Amount Involved35258AmountInvolved
Method Of Amt DeterminationFMVMethodOfAmtDetermination

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