2013-11-15T18:59:14-06:00 2012-12-31 ERNST & YOUNG US LLP 190 CARONDELET PLAZA SUITE 1300 CLAYTON MO 63105 990 2012-01-01 237379161 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC % SHARON OWENS SCL HEALTH SYS SIST 3038135190 2420 WEST 26TH AVE Suite 100-D DENVER CO 80211 Lydia W Jumonville 2013-11-15 3142901000 2012 2016-03-07 17:11:31Z LYDIA W JUMONVILLE 2420 WEST 26TH AVE STE 100-D DENVER CO 80211 339795330 false 0928 X www.sclhealthsystem.org X 1972 KS We 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. 15 14 904 45308 -179363 1082 594403 103634794 287741687 17743348 43116028 5082147 7777619 126461371 339229737 278650 1016819 0 0 54088418 150330840 0 0 0 116581852 209724197 170948920 361071856 -44487549 -21842119 1431133067 1347260339 1535000716 1735511665 -103867649 -388251326 X We 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. false false 124953255 127871631 FINANCE, AUDIT AND DEBT SERVICES - ADMINISTERS FINANCING PROGRAM AND REVIEWS THE CAPITAL FORMATION PROGRAM (FOR ELEVEN HOSPITALS AND FOUR CLINICS). IT ALSO OVERSEES THE AUDITS OF ITS RELATED AFFILIATES TO PROVIDE ASSURANCE REGARDING THE EFFECTIVENESS AND EFFICIENCY OF OPERATIONS AND THE RELIABILITY OF FINANCIAL REPORTING. 20273217 17642598 HUMAN RESOURCES - ADMINISTERS PROGRAMS AND OTHER SERVICES TO THE ELEVEN HOSPITALS, FOUR CLINICS AND VARIOUS FOR-PROFIT ENTITIES WHICH ARE AFFILIATES OF SCLHS. PROGRAMS ADMINISTERED INCLUDE EMPLOYEE WELFARE BENEFIT PLANS, RETIREMENT PLANS, AND CERTAIN EXECUTIVE RECRUITING FUNCTIONS. 142738210 124216742 INFORMATION SYSTEMS - COORDINATES THE CENTRALIZATION OF MANY OF THE INFORMATION SYSTEMS OF THE HEALTH SYSTEM. CURRENTLY, AN ENTERPRISE RESOURCE PLANNING (ERP) SYSTEM AND A RADIOLOGY INFORMATION SYSTEM (RIS) ARE INSTALLED AND BEING OPERATED. In 2012, a clinical and patient administrative system was installed at seven hospitals and was in use at ten of the eleven hospitals across the system by year end. 21111383 18370006 ADMIN, QUALITY, RISK MANAGEMENT, COMMUNICATIONS 1016819 1016819 GRANTS RELATED TO SCLHS MISSION 22128202 1016819 18370006 310092884 true false false true false false false false false true true false true false true false false true false false true true false false false false false true true true true false false false false false false false false false false false false false false false true true true false false true 251 0 true 904 true true true true CJ CA UK false false false false false false false false false X 15 14 false false false false true true true true true false true true true true true true true true true true false X SHARON OWENS SCL HEALTH SYS 3038135190 2420 W 26TH AVE STE 100-D DENVER CO 80211 SISTER LYNN CASEY SCL 3.0 X SISTER MAUREEN HALL SCL 3.0 X X TERRY HEATH 3.0 X GORDON HOWIE 3.0 X X SISTER EILEEN HURLEY SCL 3.0 X DONNA J KING 3.0 X KNUTE KNUDSON 3.0 X MATTHEW LAMBERT III MD 3.0 X X MAUREEN MAHONEY 3.0 X MARLON PRIEST MD 3.0 X KENT RUSSELL 3.0 X VINOD SAHNEY PhD 3.0 X RONALD SPERLING 3.0 X MICHAEL A SLUBOWSKI 40.0 X X 1513703 36584 KATHRYN PAUL 3.0 X LYDIA W JUMONVILLE 40.0 X 665251 89581 EDWARD L BARKER 40.0 X 942869 1127513 MARK A WILKINSON 40.0 X 369723 48866 PAMELA G LOGAN 40.0 X 123677 11161 LYNN SMITH 40.0 X 83463 10050 ROBERT W LADENBURGER 40.0 X 1376046 106636 WILLIAM M ANDERSON 40.0 X 552258 34950 BRENDA S CHILMAN 40.0 X 263082 42117 TODD A CONKLIN SR 40.0 X 626681 76029 JILL W KENNELLY 40.0 X 505112 664888 RICHARD T LOPES 40.0 X 917605 55755 DAVID PECORARO 40.0 X 483533 109167 DEBORAH WELLE-POWELL 40.0 X 318276 46736 STEVE CHYUNG 40.0 X 396079 51728 LOURDES J LAZATIN 40.0 X 839840 1288523 BAIN J FARRIS 40.0 X 618414 211829 IRMA NAPOLI 40.0 X 621299 726378 JASON BARKER 40.0 X 588371 67245 TAJQUAH J HUDSON 40.0 X 496078 0 25373 MARY JO GREGORY 0.0 X 911058 10765 ROBERT A BOYSEN 0.0 X 382488 12511 JAMES T PAQUETTE 40.0 X 1124995 14498 14719901 0 4868883 175 true true false MEDASSETS INC PO BOX 405652 ATLANTA GA 30384 SUPPLY CHAIN CONTRAC 9420725 HURON CONSULTING SERVICES 3005 MOMENTUM PLACE CHICAGO IL 60689 Consulting 9989906 Catholic Healthcare Audit Network 231 SOUTH BEMISTON ST LOUIS MO 63105 INT AUDIT SERVICES 2866212 ERNST AND YOUNG LLP PO BOX 660401 DALLAS TX 75260 AUDIT & TAX SERVICES 2409351 NEI GLOBAL RELOCATION COMPANY PO BOX 241886 OMAHA NE 68124 RELOCATION 1892939 43 594403 594403 AFFILIATE MANAGEMENT FEES 541900 269000879 268970879 30000 INTEREST INCOME FROM NOTES RECEIVABLE 900099 18740808 18740808 287741687 20060169 15308 20044861 0 0 0 0 0 23621452 565593 23621452 -565593 23055859 23055859 0 0 0 VENDOR ADMINISTRATION REBATE 900099 7416329 7416329 DEBT GUARANTEE FEES 900099 176341 176341 MISCELLANEOUS REVENUE 900099 184949 184949 7777619 339229737 288072977 45308 50517049 822237 822237 140700 140700 53882 53882 0 11814721 11814721 0 112890298 94071170 18819128 8183539 5486494 2697045 10127965 5627036 4500929 7314317 6210520 1103797 0 4762008 4762008 4304263 4304263 90568 90568 0 4530368 4530368 35238074 33786265 1451809 0 17670837 15020211 2650626 36561774 31077508 5484266 0 4241552 3605319 636233 2577787 2577787 0 751673 751673 58053539 58053539 0 37063027 37063027 256664 218164 38500 OTHER 134742 134742 SYSTEM DUES 3487321 3487321 361071856 310092884 50978972 0 128 0 0 18165168 0 0 38389891 51294336 0 0 0 0 60000 60000 0 0 5034475 7120044 230987885 120537738 91722762 110450147 539045966 582828653 260632603 55485431 475073655 469602160 0 0 21173587 52254400 1431133067 1347260339 123251945 104356018 0 0 0 0 1361576377 1324260577 0 0 0 0 0 0 0 230000000 50172394 76895070 1535000716 1735511665 X -128252848 -415989235 22385199 25737909 2000000 2000000 -103867649 -388251326 1431133067 1347260339 X -21842119 35916625 -298458183 X X false true X true false X X X false false false PROVIDENCE MEDICAL CENTER INC 480784446 03 true true true 0 ST FRANCIS HEALTH CENTER INC 480547719 03 true true true 0 ST JAMES HEALTHCARE 810231785 03 true true true 0 SAINT JOHN HOSPITAL INC 480543768 03 true true true 0 SAINT JOHN'S HEALTH CENTER 951684082 03 true true true 0 SAINT JOSEPH HOSPITAL INC 840417134 03 true true true 0 EXEMPLA INC 841103606 03 true true true 0 ST MARY'S HOSPITAL AND MEDICAL CENTER INC 840425720 03 true true true 0 ST VINCENT HEALTHCARE 810232124 03 true true true 0 HOLY ROSARY HEALTHCARE 810231792 03 true true true 0 BETHANY COMMUNITY PLAZA INC 481207407 03 true true true 0 CARITAS CLINICS INC 481009910 03 true true true 0 MARIAN CLINIC INC 481046905 03 true true true 0 MARILLAC CLINIC INC 841085822 03 true true true 0 MOUNT ST VINCENT HOME INC 840405260 09 true true true 0 15 true true false true 16044 false false true 24066 false true 120329 160439 false Sch C Part II-B EXPENSES LISTED IN PART II-B INCLUDE RESOURCES DEDICATED TO TRACKING LEGISLATION THAT MAY ADVERSELY IMPACT THE FILING ORGANIZATION. INDIRECT ALLOCATION OF EXPENSES INCLUDE RELEVANT PORTIONS OF LOBBYING ACTIVITIES THAT ARE SEPARATELY STATED IN DUES PAID TO VARIOUS HOSPITAL AND OTHER MEDICAL ASSOCIATIONS. 3524552 140511 144000 3521063 3639978 17492 132918 3524552 3502137 60804 277272 200235 3639978 3435586 261551 195000 3502137 4177114 -620022 121506 3435586 0.56740 0.43260 false false 37026811 37026811 438785 99752 339033 3396797 306194 3090603 190125492 120131792 69993700 110450147 PROVIDENCE MEDICAL CENTER 3672442 F ST. JOHN HOSPITAL, INC. 1370188 F ST. JAMES HEALTHCARE 15398555 F ST. MARY'S HOSPITAL & MEDICAL 36188267 F SAINT JOHN'S HEALTH CENTER 97972708 F EXEMPLA SYSTEM SERVICES 315000000 F 469602160 0 DEFERRED COMP 457 PLAN LIAB 11400720 INTEREST RATE SWAP LIABILITY 28729888 FROZEN DB PLAN 37680476 FAS 157 CREDIT RISK -916014 76895070 FORM 990, SCHEDULE D, PART V, LINE 4 (ENDOWMENT FUNDS): SCLHS HAS A PERMANENT ENDOWMENT IN THE AMOUNT OF $2,000,000. THE EARNINGS FROM THE PERMANENT ENDOWMENT ARE A TERM ENDOWMENT TO BE USED FOR EDUCATION PURPOSES AS DETERMINED BY SCLHS MANAGEMENT. true Central America and the Caribbean Program Services CAPTIVE INSURANCE PREM 13857690 Central America and the Caribbean Investments 68194445 Europe (Including Iceland and Greenland) Investments 3708118 85760253 85760253 Sub-Saharan Africa CONSTRUCT BUILDING 53882 ACH 1 true false true true true false SCHEDULE F, PART I, LINE 2 SCLHS' MISSION DEPARTMENT REQUIRES WRITTEN STATEMENTS THREE TIMES A YEAR REGARDING THE PROGRESS AND STATUS OF THE GRANT. SCHEDULE F, PART I, LINE 3 SCLHS' expenditures (premiums paid) for its captive insurance premiums was $13,857,690 net of premium discounts. true ST MARYS HOSPITAL FOUNDATION 2635 N 7TH STREET GRAND JUNCTION CO 81502 651202190 501(c)(3) 50000 FUNDRAISER SPONSOR UNIVERSITY OF ST MARY 4100 SOUTH 4TH STREET LEAVENWORTH KS 66048 480547846 501(C)(3) 462992 FUNDRAISER SPONSOR AND SUPPORT MOUNT ST VINCENT HOME 4159 LOWELL BLVD DENVER CO 80211 840405260 501(c)(3) 101806 FUNDRAISER SPONSOR AMERICAN HEART ASSOCIATION 7272 GREENVILLE AVENUE DALLAS TX 75231 135613797 501(c)(3) 75000 EVENT SPONSOR METRO DENVER ECONOMIC DEVELOPMENT CORP 1445 MARKET STREET DENVER CO 80202 840186760 501(c)(6) 25000 GENERAL SUPPORT DENVER MUSEUM OF NATURE & SCIENCE 2001 COLORADO BLVD DENVER CO 80205 840518447 501(c)(3) 25000 SUPPORT ELEMENTARY EDUCATION IVINSON MEMORIAL HOSPITAL FOUNDATION 255 N 30TH STREET LARAMIE WY 82070 830259429 501(c)(3) 6000 EVENT SPONSOR CARITAS CLINICS INC 9801 Renner Boulevard Suite 100 Lenexa KS 66219 481009910 501(C)(3) 20565 General Support MARIAN CLINIC 1001 SW GARFIELD TOPEKA KS 66604 481046905 501(C)(3) 30739 General Support 8 1 SECONDARY EDUCATION SCHOLARSHIPS 36 66100 CRISTO REY KANSAS CITY SCHOOL 2 12500 UNIVERSITY OF ST. MARY 4 62100 Form 990, SCHEDULE I, PART I, LINE 2 (MONITORING OF GRANTS) SCLHS' MISSION DEPARTMENT REQUIRES WRITTEN STATEMENTS THREE TIMES A YEAR REGARDING THE PROGRESS AND STATUS OF THE GRANT. X X true true X X X X X X true true false false false false false true false MICHAEL A SLUBOWSKI 993061 398970 121672 24119 12465 1550287 LYDIA W JUMONVILLE 499288 152073 13890 73035 16546 754832 EDWARD L BARKER 467636 158287 316946 1110850 16663 2070382 MARK A WILKINSON 212807 111240 45676 37814 11052 418589 ROBERT W LADENBURGER 660676 203467 511903 94171 12465 1482682 MARY JO GREGORY 165602 745456 10765 921823 756221 WILLIAM M ANDERSON 327692 94635 129931 22485 12465 587208 ROBERT A BOYSEN 382488 12511 394999 394999 BRENDA S CHILMAN 221342 38799 2941 34921 7196 305199 TODD A CONKLIN SR 377511 236016 13154 59483 16546 702710 JILL W KENNELLY 350422 117388 37302 653492 11396 1170000 RICHARD T LOPES 507612 96853 313140 43290 12465 973360 DAVID PECORARO 339727 110979 32827 96702 12465 592700 DEBORAH WELLE-POWELL 264936 48984 4356 44780 1956 365012 LOURDES J LAZATIN 600633 147483 91724 1281144 7379 2128363 JAMES T PAQUETTE 216774 908221 6515 7983 1139493 BAIN J FARRIS 441578 141476 35360 199364 12465 830243 STEVE CHYUNG 299429 84420 12230 35182 16546 447807 IRMA NAPOLI 307716 102630 210953 719323 7055 1347677 JASON BARKER 428530 147000 12841 54384 12861 655616 TAJQUAH J HUDSON 297474 0 54335 0 144269 0 18000 0 7373 0 521451 0 0 SCHEDULE J, PART I, LINE 1a TAX INDEMNIFICATION AND GROSS-UP PAYMENTS SCLHS ALLOWS FOR CERTAIN TAX INDEMNIFICATION AND GROSS-UP PAYMENTS IN THE INSTANCES OF RELOCATION AND TEMPORARY HOUSING. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2012 WERE: MARK A. WILKINSON, STEVEN CHYUNG, RICHARD T. LOPES SCHEDULE J, PART I, LINE 1a HOUSING ALLOWANCE OR RESIDENCE FOR PERSONAL USE SCLHS ALLOWS FOR CERTAIN HOUSING PAYMENTS IN THE INSTANCES OF RELOCATION AND TEMPORARY HOUSING. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2012 WERE: ED BARKER, JILL WILLEN KENNELLY, MARK A. WILKINSON, STEVEN CHYUNG, RICHARD T. LOPES SCHEDULE J, PART I, LINE 4a SEVERANCE PAYMENTS SCLHS PERIODICALLY INCURS SEVERANCE PAYMENTS RELATED TO FORMER EMPLOYEES. THE AMOUNTS PAID TO LISTED INDIVIDUALS FOR SEVERANCE IN 2012 WERE: MARY JO GREGORY-$745,456, ROBERT BOYSEN-$382,488 SCHEDULE J, PART I, LINE 4b PAYMENTS FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OTHER 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 REGULATORY 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. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2012 WERE: MICHAEL SLUBOWSKI-$41,506, ROBERT LADENBURGER-$195,770, ED BARKER-$97,643, WILLIAM ANDERSON-$42,283, IRMA NAPOLI-$83,249, RICHARD LOPES-$57,996. IN ADDITION, VESTED AMOUNTS ARE PAYABLE UPON END OF EMPLOYMENT. THE VESTED AMOUNTS WITHDRAWN, NOT PREVIOUSLY TAXED, FOR THIS TYPE OF PAYMENT IN 2012 WERE: JAMES PAQUETTE-$899,627 SCHEDULE J, PART I, LINE 7 OTHER 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. SCHEDULE J ADDITIONAL OFFICER AND BOARD DISCLOSURES THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS' BOARD OF DIRECTORS (BOARD) IS COMPENSATED FOR THAT SERVICE. SCLHS' BOARD COMPENSATION COMMITTEE (COMMITTEE) HAS RETAINED THE SERVICES OF SULLIVAN, COTTER AND ASSOCIATES, INC. (SULLIVAN COTTER), AS INDEPENDENT COMPENSATION ADVISORS. SULLIVAN COTTER IS RESPONSIBLE FOR ADVISING THE COMMITTEE ON ALL MATTERS RELATING TO EXECUTIVE COMPENSATION INCLUDING SUPPORTING THE COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED OFFICERS 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 BY SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. THE SISTERS WHO SERVE AS OFFICERS AND / OR BOARD MEMBERS OF THIS HEALTH SYSTEM ARE MEMBERS OF THE SISTERS OF CHARITY OF LEAVENWORTH (A RELIGIOUS ORDER OF WOMEN). AS MEMBERS OF THIS ORDER, THEY HAVE TAKEN VOWS OF POVERTY AND RECEIVE NO COMPENSATION, EXPENSE ACCOUNT ALLOWANCE, OR CONTRIBUTIONS TO BENEFIT PLANS FOR THEIR SERVICES TO THE HEALTH SYSTEM. HOWEVER, PAYMENT IS MADE DIRECTLY TO THE SISTERS OF CHARITY OF LEAVENWORTH FOR THE SERVICES OF THOSE WHO PERFORM PROFESSIONAL, ADMINISTRATIVE, AND OTHER SUCH SERVICES. PROFESSIONAL, ADMINISTRATIVE, AND OTHER SUCH SERVICES. A MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KBB6 2003-12-05 39210000 2/2/1994 REFINANCE+BLDGS+EQUP false false false B CALIFORNIA HEALTH FACILITIES 521643828 13033FQU7 2003-12-05 49755000 2/2/1994 REFINANCE false false false C COLORADO HEALTH FACILITIES AUTHORITY 840752932 196474K58 2003-12-05 103035000 2/2/1994&9/9/1992 REFIN+BLDGS+EQUI false false false D MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KBC4 2006-03-07 35000000 CONSTRUCT/REMODEL HOSPITAL FACILIT false false false A 635000 0 39210022 0 0 0 270531 0 0 7630591 31308900 0 2003 true false true true B 31560000 0 49755055 0 0 0 346200 0 0 55 49408800 0 2003 true false true true C 36000000 0 103035433 0 0 0 714438 0 0 22369995 79951000 0 2003 true false true true D 7830000 0 35028997 0 0 0 325299 0 0 34703698 0 0 2006 false false true true A false true true true false 0 0.00074 0.00074 false false false true B false true true true false 0 false false false true C false true true true false 0 0.02937 0.02937 false false false true D false true true true false 0 0.03093 0.03093 false false false true A false true true true MERRIL LYNCH 20. false false false 0 false true B false true true true MERRILL LYNCH 20. false false false 0 false true C false true true true MERRILL LYNCH 20. false false false 0 false true D false true true true DEUTSCHE BANK 25. false false false 0 false true A true B true C true D true PART IV LINE 2C 0 REBATE COMPLETION DATES: A. MONTANA FACILITY FINANCE AUTHORITY 2003 - 2/17/12 B. CALIFORNIA HEALTH FACILITIES FINANCE AUTHORITY 2003 - 2/17/12 C. COLORADO HEALTH FACILITIES AUTHORITY 2003 - 2/17/12 D. MONTANA FACILITY FINANCE AUTHORITY 2006 - 6/12/12 Part III KANSAS DEVELOPMENT AUTHORITY ISSUED 05/20/2010 0 lINE 4 COLUMN C: THE TEMPORARY SPIKE IN PRIVATE BUSINESS TO 11.3615% FOR CALENDAR YEAR 2012 WAS DRIVEN BY A NON-COMPLIANT CONTRACT FROM KANSAS EMERGENCY ROOM SERVICES AT PROVIDENCE MEDICAL CENTER SIGNED 08/25/11. THE PRIVATE BUSINESS USE PERCENTAGE OVER THE ENTIRE MEASUREMENT PERIOD IS WITHIN THE ALLOWABLE THRESHOLD. PROVIDENCE MEDICAL CENTER WAS SOLD IN APRIL 2013 AND REMEDIAL ACTIONS WERE TAKEN WITH RESPECT TO THE OUTSTANDING BONDS. PART I COLUMN (E) & PART II LINE 3 0 ANY DIFFERENCE BETWEEN ISSUE PRICE REPORTED ON PART I, COLUMN (E) AND TOTAL PROCEEDS REPORTED ON PART II, LINE 3 IS DUE TO INVESTMENT EARNINGS PART II LINE 12 0 THE $69,129,209 UNSPENT PROCEEDS ARE BEING HELD BY THE TRUSTEE IN THE MONTANA PROJECT FUND FOR FUTURE MONTANA CAPITAL PROJECTS. A COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AST3 2010-05-20 605460143 3/24/98&11/13/02&7/18/02 REFI+HOSP false false false B MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KHV6 2010-05-20 217535868 3/24/98&5/25/00 REFI+HOSP FAC false false false C KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 48542K5N5 2010-05-20 202625401 3/24/98&5/25/00 REFI+HOSP FAC false false false D COLORADO HEALTH FACILITIES AUTHORITY 840752932 2011-06-15 62620000 REFI 7/18/02&2/4/09 false false false A 21610000 0 605500535 0 0 0 6836215 0 0 310650923 288013397 0 2010 true true true true B 11070000 0 217655077 0 0 0 2529281 0 0 32824812 113181775 69129209 2010 true false false true C 9850000 0 202625401 0 0 0 2488006 0 0 77008019 123129376 0 2010 true false true true D 985000 0 62620000 0 0 0 420000 0 0 0 62200000 0 2011 true false true true A false true true true false 0 0.00033 0.00033 false false false true B false true true true false 0.02603 0.00135 0.02738 false false false true C false true true true false 0.11361 0.11361 true false false true D false true true true false 0 false false false true A false true false false 0 false false false 0 false true B false true false false 0 false false false 0 false true C false true false false 0 false false false 0 false true D false true true false 0 0 false true A true B true C true D true A KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 2012-04-04 76290000 REFI 3/7/06 false false false A 1755000 0 76290000 0 0 0 265000 0 0 0 76025000 0 2012 true false true true A false true true true false 0.00668 0.00042 0.00710 false false false true A false true true true DEUTSCHE BANK 25. false false false 0 false true A true FORM 990 GENERAL EXPLANATIONS_1 FORM 990 (DEFINITION) SCLHS = SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. ------------------------------------------------------------------------- FORM 990, PART VI (GOVERNANCE, MANAGEMENT, & DISCLOSURE) SECTION A. GOVERNING BODY AND MANAGEMENT 6., 7(A)., AND 7(B). SCLHS HAS MEMBERS WHO APPOINT THE BOARD OF DIRECTORS OF SCLHS. THROUGH SEPTEMBER 25, 2011, THE MEMBERS OF SCLHS WERE THE COMMUNITY DIRECTOR AND THOSE PERSONS WHO ARE MEMBERS OF THE COMMUNITY COUNCIL OF THE SISTERS OF CHARITY OF LEAVENWORTH RELIGIOUS COMMUNITY. ON SEPTEMBER 25, 2011, THE SISTERS TRANSFERRED SPONSORSHIP OF SCLHS TO A NEWLY-FORMED ENTITY, LEAVEN MINISTRIES, WHICH HAS BEEN APPROVED AND RECOGNIZED BY THE CATHOLIC CHURCH AS THE SPONSOR OF SCLHS. LEADERSHIP OF THE SISTERS OF CHARITY OF LEAVENWORTH RELIGIOUS COMMUNITY REMAIN INVOLVED IN LEAVEN MINISTRIES. THE MEMBERS OF LEAVEN MINISTRIES INCLUDE THREE SISTERS OF CHARITY OF LEAVENWORTH BOARD MEMBERS AND TWO LAY LEADERS. SECTION B. POLICIES 11(B). SCLHS' GOVERNING BODY, A BOARD OF DIRECTORS, REVIEWS THE FORM 990 BEFORE IT IS FILED WITH THE IRS. THIS PROCESS INVOLVES EACH BOARD MEMBER RECEIVING A DRAFT OF THE FORM 990 AND THE OPPORTUNITY TO REVIEW AND ASK QUESTIONS BEFORE IT IS FILED, THUS ENSURING THAT THE INFORMATION ACCURATELY REFLECTS SCLHS' MISSION, OPERATIONS, COMMUNITY BENEFITS, GOVERNANCE OVERSIGHT, ETC. 12(C). SCLHS REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES ITS CONFLICT OF INTEREST POLICY BY PROVIDING EDUCATION AND TRAINING FOR EACH OF ITS EMPLOYEES, STAFF, OFFICERS AND DIRECTORS, AS WELL AS HAVING EACH OF THESE INDIVIDUALS COMPLETE A CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS TO DISCLOSE ANY POTENTIAL CONFLICT ISSUES. THESE STATEMENTS ARE CAREFULLY REVIEWED AND A REPORT PROVIDED TO SCLHS' PRESIDENT/CEO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. IN THE EVENT OF A CONFLICT OF INTEREST WITH AN SCLHS BOARD MEMBER, THE CONFLICT SHALL PROMPTLY BE REPORTED TO THE SCLHS BOARD CHAIR WHO WILL PRESENT THE FACTS TO THE SCLHS GOVERNANCE COMMITTEE FOR EVALUATION AND PRESENTATION TO THE SCLHS BOARD OF DIRECTORS FOR ITS ACTION. 15(A) & 15(B). SCLHS' PROCESS FOR DETERMINING COMPENSATION FOR THE TOP MANAGEMENT, SENIOR LEADERSHIP, IS THE RESPONSIBILITY OF THE SCLHS COMPENSATION COMMITTEE. THIS COMMITTEE IS COMPOSED OF THREE OR MORE MEMBERS WHO ARE NOT CURRENT EMPLOYEES OF SCLHS, OR FORMER EMPLOYEES WITH NO ACTIVE INTEREST IN THE SCLHS' COMPENSATION PROGRAM, INCLUDING AT LEAST TWO MEMBERS OF THE SCLHS BOARD. SCLHS BELIEVES THAT THE INDEPENDENCE OF THESE MEMBERS IS VITAL TO THE INTEGRITY OF THE PROCESS. THE WORK OF THIS COMMITTEE INCLUDES BEING CONSTANTLY AWARE OF THE CURRENT COMPETITIVE MARKET FOR MANAGEMENT AND SENIOR LEADERS, AS WELL AS COMPILING AND MAINTAINING RECORDS OF COMPARABLE COMPENSATION AND BENEFITS DATA, INCLUDING SURVEYS AND OTHER ANALYSES, TO SUPPORT SCLHS' TOTAL COMPENSATION TO EACH INDIVIDUAL. MINUTES ARE KEPT CONTEMPORANEOUSLY FOR EACH MEETING OF THE COMMITTEE. LIKEWISE, THE COMMITTEE IS RESPONSIBLE FOR ENSURING THAT NO "EXCESS BENEFIT" IS CONFERRED ON AN INDIVIDUAL, OR THAT SUCH COMPENSATION DOES NOT CONSTITUTE PROHIBITED INUREMENT. THIS PROCESS IS COMPLETED FOR ALL SENIOR LEADERSHIP, AT THE AFFILIATE AND SYSTEM LEVEL, AND THE COMMITTEE'S RECOMMENDATION IS THEN SUBMITTED TO THE SCLHS BOARD FOR APPROVAL. THE CHARGE OF THIS COMMITTEE ADHERES TO SCLHS' CORE VALUE OF STEWARDSHIP, ENSURING THAT THE MINISTRY'S RESOURCES HELD IN TRUST ARE NOT WASTED OR MISUSED, AND ARE DEPLOYED TO EFFECTIVELY AND EFFICIENTLY ADVANCE THE MISSION. SECTION C. DISCLOSURE 19. SCLHS' GOVERNANCE MANUAL FOR BOARD MEMBERS IS AVAILABLE TO THE PUBLIC ON THE WEBSITE, WWW.GREATBOARDS.ORG. THE MANUAL SETS FORTH THE STANDARDS AND EXPECTATIONS OF EACH BOARD MEMBER INCLUDING THE FIDUCIARY DUTY OF LOYALTY WHICH REQUIRES THAT EACH MEMBER ABIDE BY SCLHS' CONFLICT OF INTEREST POLICY, DISCLOSE ANY ISSUES WHICH MAY PRESENT A CONFLICT, COMPLETE THE ANNUAL DISCLOSURE STATEMENT, REVIEW POLICIES AND PROCEDURES PERTAINING TO CONFLICTS OF INTEREST, AND PROVIDE OVERSIGHT OF SCLHS' RESPONSIBILITY PROGRAM. FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. ------------------------------------------------------------------------- FORM 990, PART XI (RECONCILIATION OF NET ASSETS) LINE 9: OTHER CHANGES IN NET ASSETS: UNREALIZED GAIN ON SWAPS 560,312 FROZEN DEFINED BENEFIT RETIREMENT PLAN GAIN 921,736 FAS 158 LOSS ON DEFINED BENEFIT PLANS (26,002,682) SELF-INSURED LIABILITY INCREASE 3,496,710 CFF PAYMENT (277,950,273) FAS 157 & OTHER AUDIT ADJUSTMENTS 516,014 ----------- TOTAL $(298,458,183) =========== ------------------------------------------------------------------------- FORM 990, PART XII, LINE 2 (FINANCIAL STATEMENTS & REPORTING) SCLHS HAS AN INDEPENDENT AUDIT COMPLETED AND REPORTED UPON ANNUALLY ON ITS CONSOLIDATED ORGANIZATION. THERE IS NO SEPARATE AUDIT REPORT FOR SCLHS. IN ADDITION, SCLHS' BOARD HAS AN AUDIT COMMITTEE WHICH HAS OVERSIGHT OF THE EXTERNAL AUDIT PROCESS AND RESULTS AS WELL AS SELECTION OF THE INDEPENDENT AUDITORS. CURRENT INDEPENDENT AUDITORS ARE ERNST & YOUNG, LLP. ------------------------------------------------------------------------- FORM 990 GENERAL EXPLANATIONS_2 ------------------------------------------------------------------------- FORM 5471, STATEMENT PURSUANT TO TREASURY REG. SEC. 1.351-3T(B): APPLICABLE TO ALL IRS FORMS 5471 FILED WITH THIS RETURN. BY: VARIOUS, SEE ALL FORMS 5471 FILED WITH THIS RETURN. EIN: VARIOUS, SEE ALL FORMS 5471 FILED WITH THIS RETURN. YEAR ENDED DECEMBER 31, 2012. 1. NAME AND EIN (IF ANY) OF TRANSFEREE CORPORATION(S): SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC.; 23-7379161. 2. DATE(S) OF THE TRANSFER(S) OF ASSETS: VARIOUS DATES. SEE FORMS 5471. 3. IMMEDIATELY BEFORE THE EXCHANGE, THE PROPERTY TRANSFERRED BY THE TRANSFEROR IN EXCHANGE HAD AN: (A) AGGREGATE FAIR MARKET VALUE OF: SEE FORMS 5471 WHERE CASH VALUE EXCHANGED WAS REPORTED. (B) AGGREGATE BASIS OF: SINCE CASH WAS EXCHANGED, BASIS IS EQUAL TO FAIR MARKET VALUE ABOVE. 4. DATE AND CONTROL NUMBER OF ANY PRIVATE LETTER RULING(S) ISSUED BY THE INTERNAL REVENUE SERVICE IN CONNECTION WITH THE SECTION 351 EXCHANGE: NOT APPLICABLE. ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3): SCLHS, A SHAREHOLDER OF THE RIVERVIEW MULTI-SERIES FUND SPC, LTD., IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM RIVERVIEW MULTI-SERIES FUND SPC, LTD. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3). ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II): SCLHS, A SHAREHOLDER OF THE JP MORGAN HEDGE FUND SPC, LTD -ACCESS MAR09 SEGREGATED PORTFOLIO, IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM JP MORGAN HEDGE FUND SPC, LTD -ACCESS MAR09 SEGREGATED PORTFOLIO. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; SCHEDULE E: THE INCOME, WAR PROFITS, AND EXCESS PROFITS TAXES PAID OR ACCRUED BY THE CORPORATION; SCHEDULE G: THE OTHER INFORMATION REGARDING THE CORPORATION. NOTE ALL BOXES ARE MARKED NO BY DEFAULT OF SCLHS' TAX SOFTWARE. ANSWERS MAY NOT BE ACCURATE; SCHEDULE H: THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION; SCHEDULE I: THE SUMMARY OF SHAREHOLDER'S INCOME FROM FOREIGN CORPORATION. SCHEDULE J: THE INFORMATION REGARDING THE ACCUMULATED EARNINGS AND PROFITS (E&P) OF THE CORPORATION; SCHEDULE M: THE INFORMATION REGARDING TRANSACTIONS BETWEEN CONTROLLED FOREIGN CORPORATIONS AND SHAREHOLDERS OR OTHER RELATED PARTIES; AND SCHEDULE O, PART II, SECTIONS B, E AND F: SOCIAL SECURITY NUMBERS OF U.S. DIRECTORS OF THE CORPORATION, INFORMATION REGARDING THE ORGANIZATION OR REORGANIZATION OF THE FOREIGN CORPORATION, AND THE ADDITIONAL INFORMATION. THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II). ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II): SCLHS, A SHAREHOLDER OF THE JP MORGAN HEDGE FUND SPC, LTD -ACCESS JUN09 SEGREGATED PORTFOLIO, IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM JP MORGAN HEDGE FUND SPC, LTD -ACCESS JUN09 SEGREGATED PORTFOLIO. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE B: THE IDENTITY, HOLDINGS AND INCOME OF OTHER U.S. SHAREHOLDERS AND THEIR PRO RATA SHARE OF SUBPART F INCOME; SCHEDULE E: THE INCOME, WAR PROFITS, AND EXCESS PROFITS TAXES PAID OR ACCRUED BY THE CORPORATION; SCHEDULE G: THE OTHER INFORMATION REGARDING THE CORPORATION. NOTE ALL BOXES ARE MARKED NO BY DEFAULT OF SCLHS' TAX SOFTWARE. ANSWERS MAY NOT BE ACCURATE; SCHEDULE H: THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION; SCHEDULE I: THE SUMMARY OF SHAREHOLDER'S INCOME FROM FOREIGN CORPORATION. SCHEDULE J: THE INFORMATION REGARDING THE ACCUMULATED EARNINGS AND PROFITS (E&P) OF THE CORPORATION; SCHEDULE M: THE INFORMATION REGARDING TRANSACTIONS BETWEEN CONTROLLED FOREIGN CORPORATIONS AND SHAREHOLDERS OR OTHER RELATED PARTIES; AND SCHEDULE O, PART II, SECTIONS B, E AND F: SOCIAL SECURITY NUMBERS OF U.S. DIRECTORS OF THE CORPORATION, INFORMATION REGARDING THE ORGANIZATION OR REORGANIZATION OF THE FOREIGN CORPORATION, AND THE ADDITIONAL INFORMATION. THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II). ------------------------------------------------------------------------- FORM 5471, STATEMENT OF REASONABLE CAUSE PURSUANT TO TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II): SCLHS, A 12.54% SHAREHOLDER WITH NO VOTING RIGHTS IN AUSTIN CAPITAL SAFE HARBOR OFFSHORE FUND, LTD., IS NOT IN POSSESSION OF CERTAIN INFORMATION REQUESTED BY THE IRS ON FORM 5471 AND IS UNABLE TO OBTAIN SUCH INFORMATION FROM AUSTIN CAPITAL SAFE HARBOR OFFSHORE FUND, LTD.. SPECIFICALLY, SCLHS IS NOT IN POSSESSION OF THE FOLLOWING INFORMATION REQUESTED IN FORM 5471: SCHEDULE H: THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION; SCHEDULE I: THE SUMMARY OF SHAREHOLDER'S INCOME FROM FOREIGN CORPORATION. SCHEDULE J: THE INFORMATION REGARDING THE ACCUMULATED EARNINGS AND PROFITS (E&P) OF THE CORPORATION; AS SCLHS IS NOT IN POSSESSION OF THE CURRENT EARNINGS AND PROFITS OF THE CORPORATION. THIS STATEMENT IS INTENDED TO SERVE AS A STATEMENT OF REASONABLE CAUSE IN ACCORDANCE WITH TREASURY REG. SEC. 301.6679-1(A)(3) AND 1.6038-2(K)(3)(II). ------------------------------------------------------------------------- CARITAS CLINICS INC 818 NORTH 7TH STREET LEAVENWORTH KS 66048 481009910 CLINIC SVCS KS 501(c)(3) 3 SCLHS true MARIAN CLINIC INC 1001 SW GARFIELD TOPEKA KS 66604 481046905 CLINIC SVCS KS 501(c)(3) 3 SCLHS true MARILLAC CLINIC INC 2333 N 6TH STREET GRAND JUNCTION CO 81501 841085822 CLINIC SVCS CO 501(c)(3) 3 SCLHS true PROVIDENCE MEDICAL CENTER 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 480784446 HEALTHCARE KS 501(c)(3) 3 SCLHS true ST JOHN HOSPITAL INC 3500 SOUTH FOURTH STREET LEAVENWORTH KS 66048 480543768 HEALTHCARE KS 501(c)(3) 3 PMC true BETHANY COMMUNITY PLAZA INC 15 NORTH 12TH STREET KANSAS CITY KS 66102 481207407 HEALTHCARE KS 501(c)(3) 3 PMC true PROVIDENCEST JOHN FOUNDATION INC 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 480925688 SUPPORT 501C3 KS 501(c)(3) 7 PMC true ST FRANCIS HEALTH CENTER INC 1700 SW 7TH STREET TOPEKA KS 66606 480547719 HEALTHCARE KS 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