2012-08-10T11:24:25-05:00 2011-09-30 Deloitte Tax LLP 225 W Santa Clara St San Jose CA 95113 990 2010-10-01 562570686 St Luke's Magic Valley Regional Medical Center Ltd STLU 2083813790 801 Pole Line Road Twin Falls ID 83301 Pete DiDio 2083813790 2012-08-10 1 4087044000 2010 2016-02-24 21:20:13Z James Angle 801 Pole Line Road Twin Falls ID 83301 254252135 0 X www.stlukesonline.org/magic valley X 2006 ID Provide health care services 13 9 2030 168 326153 -60865 1253976 1246650 216093432 248735920 341850 65352 675355 505222 218364613 250553144 248509 480619 0 0 92234468 99113712 0 0 504486 117181645 128364073 209664622 227958404 8699991 22594740 253359937 317937789 200030353 247728091 53329584 70209698 X Delivery of Health Care Services 0 0 202593785 480619 240911265 Medical & Surgical:St. Luke's Magic Valley is a 186-bed hospital,700,000 square foot health care facility with acute care and acute rehabilitation as well as St. Luke's Canyon View Behavioral Health Services. With more than 1,900 employees and more than 200 physicians with 28 specialties, St. Luke's Magic Valley provides the most comprehensive health care services in south central Idaho, including: general acute care services, Inpatient Rehabilitation services, Behavioral Health Services, cancer services with St. Luke's Mountain States Tumor Institute (MSTI), Cardiopulmonary and Cardiac Catheterization, CARES (Children At Risk Evaluation Services), Community Connection information and referral database, Diabetes and Nutrition Services, Diagnostic Imaging, Radiology and Women's Imaging Services, Emergency Services, Home Health and Hospice Care, Intensive Care and Newborn Intensive Care Units, Laboratory Services, Medical Library (open to the public), Maternal-Child Services (OB, Pediatrics and Women's Services), Pharmacy, Occupational Health, Adult and Pediatric Rehabilitation (Speech, Occupational, Physical Therapy), Comprehensive Surgical Services, Magic Valley SAFE KIDS Coalition, Social Services and Pastoral Care, Volunteer Services and Auxiliary, and St. Luke's Magic Valley Foundation for gift-giving. St. Luke's Magic Valley is fully accreditied by the Joint Commission and is a participant in the Institute for Healthcare Improvement's 5 Million Lives Campaign.At St. Luke's Magic Valley Medical Center, we take great pride in the high quality, skilled, and compassionate care we provide to our patients. This focus on excellence has resulted in honors from national entities, such as Qualis Health and Solucient. These awards recognize that our commitment to safety and performance improvement means enhanced and safer care, and an overall better experience for you, your family, and everyone we serve.During FY'11, St. Luke's Magic Valley Regional Medical Center provided qualified inpatient care for 10,624 admissions covering 38,458 patient days. The hospital also provided care associated with 190,623 outpatient visits. 2563576 0 4563774 Behavioral Health:St. Luke's Canyon View Behavioral Health Services, a 28-bed inpatient facility, provides treatment for adolescents, adults, and seniors. St. Luke's Canyon View offers intensive inpatient programs that address acute psychiatric issues in addition to medical detoxification from alcohol and drugs. Canyon View utilizes individual, family, and group counseling to address personal, family, emotional, psychiatric, behavioral, and addiction-related problems. Our wide variety of services allows Canyon View to carefully match the needs of each person who comes to us for help with the most appropriate, cost-effective level of care. Outpatient services are scheduled at convenient hours. The common goal of our programs is to help people find positive solutions to resolve the challenges and crises in their lives. The hospital is staffed with a diverse group of dedicated, caring professionals. Psychiatrists and other physicians, psychologists, social workers, nurses, therapists, nutritionists, and alcohol/drug counselors work as a team to provide comprehensive, personalized care to each person who comes to us for help.During FY'11, Canyon View had 671 admissions covering 3,877 patient days. 2630621 0 3260881 Comprehensive Rehabilitation and Therapy ServicesThe Gwen Neilson Anderson Rehabilitation Center at St. Luke's Magic Valley is a licensed,comprehensive,14-bed acute inpatient rehabilitation center. Our inpatient unit provides state-of-the-art, evidenced-based rehabilitation care for patients requiring:--Intensive physicial,occupational,and/or speech therapy (at least three hours per day). --Specialized 24-hour rehabilitative nursing in an inpatient setting--Daily oversight by a medical doctor who specializes in physical medicine and rehabilitation(a physiatrist). --Individualized case management provided by a licensed social workerOur rehabilitation services are highly coordinated to optimize clinical outcomes and maximize a patient's independence. All members of the rehabilitation team(physicians,therapists,nurses,case workers.etc.)meet daily to ensure that treatments are tailored to each patient's specific diagnosis and unique needs. Our inpatient programs include:--Spinal cord injury--Stroke--Brain injury--Neuromuscular diseases, such as multiple sclerosis,Guilain-Barre syndrome, and cerebral palsy--Orthopedics--Major multiple trauma--Amputation--Arthritis--Medically complex conditionsAll 14 inpatient rehabilitation rooms at St. Luke's are private, and designed specifically to enhance the safety,comfort,and independence of patients recovering from and adapting to a variety of injuries and illnesses. Room features include ADA design,bed-side environmental controls(lights,nurse call light,window shades,etc.),free wireless,broadband internet access,pull-out couch and reclining chair for visiting family members,and video surveillance capability for patients with confusion due to brain injury,stroke,or other illness.The rehabilitation gymnasium in the Gwen Neilson Anderson Rehabilitation Center contains state-of-the-art equipment and design features. The spacious gym includes private treatment rooms for one-on-one therapy sessions and a large,open space for wheelchair training,advanced mobility training,and group interaction.The rehabilitation gym includes the latest in equipment:--LiteGait gait trainer--Bioness Neuroprostheses: H200,L300,and L300 Plus--Saeboflex Inpatient kit--Dynavision D2--Dynavox Vmax Plus--Empi Vitai Stim--60-inch LCD television with Blu-Ray player and Wii game consoleThe transitional apartment is a fully functional apartment in which patients can practice basic activities of daily living under the supervision of a trained therapist.The activity area offers a place for patients and their visitors to gather and engage in therapeutic recreation.During FY'11,the inpatient rehabilitation unit provided qualified inpatient care for 224 admissions covering 2,558 patient days) 207787982 1 1 0 0 0 0 0 0 0 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 1 0 0 0 1 0 0 0 0 1 1 0 0 0 0 1 203 0 1 2030 1 0 0 0 0 0 0 0 0 0 0 X 13 9 0 0 0 0 1 0 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X Pete DiDio Vice-PresidentController 2083713790 190 E Bannock Boise ID 83712 X Russ Newcomb MD 5.00 X 0 0 0 Mr Tom Ashenbrener 4.00 X 0 0 0 Mr Gary Babbel 4.00 X 0 0 0 Mr Shawn Barigar 4.00 X 0 0 0 Eric CassidyDO 4.00 X 30000 0 0 Jeff Fox MD 4.00 X 0 0 0 Ms Cindy Collins 3.00 X 0 0 0 Ben Katz MD 3.00 X 0 0 0 Mr Terry Kramer 3.00 X 0 0 0 Mr Robert Alexander 3.00 X 0 0 0 Robert Ward MD 3.00 X 0 0 0 Mark Wright DDS 3.00 X 51360 0 0 Ron McGarrigle MD 3.00 X 0 0 0 Mr James Angle 40.00 X X 0 0 0 Mr Mike Reno 40.00 X X 0 0 0 Mr John Groesbeck 40.00 X 211763 0 15741 Amy Bearden 40.00 X 141514 0 18985 Steven F Johnson MD 40.00 X 448860 0 14408 Randall Skeem MD 40.00 X 331338 0 16723 Jonathan D Myers MD 40.00 X 315464 0 25329 David A McClusky MD 40.00 X 250989 0 22870 Julian Nicholson MD 40.00 X 229600 0 6309 Mark A Schwartz 0.00 X 480849 0 14077 2350223 0 115457 33 1 1 0 Physician Center 630 Addison Ave W Ste 100 Twin Falls ID 83301 Medical Services 6611622 Emergency Physicians of Southern Idaho 2188 Addison Avenue East Twin Falls ID 83301 Emergency Room Physicians 5061260 RMJ Safari PLLC 714 N College Road Ste A Twin Falls ID 83301 Medical Services 3614600 Magic Valley Women's Health 630 Addison Ave W Ste 210 Twin Falls ID 83301 Medical Services 3601933 Blue Lakes Gastroenterology 660 Shoshone St East Twin Falls ID 83301 Medical Services 3224654 44 232288 1014362 1246650 Net Patient Revenue 900099 244027837 244027837 VHA Rebate 900099 273750 273750 4434333 4434333 248735920 270997 270997 403914 224845 179069 179069 179069 3268501 3474146 -205645 -205645 -205645 MSO Admin & Billing Se 561000 210287 210287 Information Technology 541519 70798 70798 Transcription Services 541900 44270 44270 798 798 326153 250553144 248735920 326153 244421 480619 480619 859313 859313 78961968 70551860 8080303 329805 2194217 1951948 233144 9125 11835751 10519661 1266914 49176 5262463 4667397 573248 21818 34910837 34688853 221984 563058 563058 19973 19973 361636 170222 191414 474026 45084 423015 5927 1944128 245487 1695659 2982 3184747 3154199 30548 2322105 411821 1910284 261478 138341 123015 122 115806 115806 13830157 13479921 350236 825663 825663 Supplies 33032156 32733017 293000 6139 Provision For Bad Debt 16260370 16260370 Contract Services 7236954 6006786 1182769 47399 Repairs 2378826 2301466 77360 Patient Transport 1403627 1403627 9238526 7635834 1570699 31993 227958404 207787982 19665936 504486 14630407 18989045 1814128 1992708 37311769 37774762 25158 2788978 3018403 729871 642424 272864798 20780096 191590096 252084702 142514 101560 2358475 1570776 1993699 1738251 253359937 317937789 28765293 20921590 2569568 2191794 168695492 224614707 200030353 247728091 X 53257186 70142115 72398 67583 53329584 70209698 253359937 317937789 X 22594740 -5714626 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 185000 8917886 9102886 152492736 3709418 148783318 9155689 1699569 7456120 97549750 15371109 82178641 4563737 4563737 252084702 Due to Related Organizations 192772250 Third Party settlement 14096680 Capital Lease 405839 Pension Liability 17339938 224614707 Form 990 Schedule D, Part X, Line 2: Footnote disclosure-Uncertain tax positions under FIN #48 (Source: Consolidated Financial Statements-St. Luke's Health System) "The Health System is subject to federal excise tax on its unrelated business taxable income(UBTI). For the period ended September 30,2011, the Company had approximately $4,160 of UBTI Net Operating Losses from operating losses incurred from 1997 to 2011, which expire in years 2012 to 2026. The Health System does not believe it is more likely than not they will utilize these losses prior to their expiration and as such has provided a full valuation allowance against these losses." 1 1 X 1 X 400.000000000000 1 X 1 1 1 0 1 1 4458131 4458131 0.02110 29644476 24095975 5548501 0.02620 9568355 7582564 1985791 0.00940 43670962 31678539 11992423 0.05670 1203285 0 1203285 0.00570 855078 0 855078 0.00400 367963 0 367963 0.00170 776 0 776 0.00000 844662 0 844662 0.00400 3271764 3271764 0.01540 46942726 31678539 15264187 0.07210 3908 3908 0.00000 239 239 0.00000 13150 13150 0.00010 538 538 0.00000 17835 17835 0.00010 0 7935389 53327048 56526751 -3199703 X 1 1 1 Magic Valley Facial ImagingLLC Facial Imaging Services 0.50000 2 Magic Valley Paramedic ServicesLtd Paramedic Services 1.00000 3 St Luke's Clinic LLC Physician Services 1.00000 4 Magic Health Partners LLC Admin. Services for non provider-based groups 1.00000 1 1 StLuke's Magic Valley Regional Medical

801 Pole Line Road Twin Falls ID 83301

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

775 Pole Line Rd W Twin Falls ID 83301

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

228 Shoup Avenue W Twin Falls ID 83301

Psychiatric and Addiction St Luke's Clinic-Physician Center

2550 Addison Avenue E Twin Falls ID 83301

Family Medicine,Internal Medicine, & Pediatric Physician Clinics St Luke's Clinic-Physician Center

730 N College Road Suite A Twin Falls ID 83301

Family Medicine & ENT Physician Clinics St Luke's Woman's Imaging Center

762 N College Road Twin Falls ID 83301

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

746 N College Road Twin Falls ID 83301

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

714 N College Road Suite A Twin Falls ID 83301

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

738 N College Road Suite C Twin Falls ID 83301

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

708 Shoshone Twin Falls ID 83301

Ground Paramedic Services Magic Valley Paramedics

285 Martin St Twin Falls ID 83301

Ground Paramedic Services Magic Valley Paramedics

121 Aspenwood Twin Falls ID 83301

Ground Paramedic Services St Luke's Clinic-Physician Center

550 Polk Suite A Twin Falls ID 83301

Family Medicine-Physician Clinic Part I, Line 3c: (A) St. Luke's does provide charity care services to patients who meet one or both of the following guidelines based on income and expenses: 1. Income. Patients whose family income is equal to or less than 400% of the then current Federal Poverty Guideline are eligible for possible fee elimination or reduction on a sliding scale. 2. Expenses. Patients may be eligible for charity care if his or her allowable medical expenses have so depleted the family's income and resources that he or she is unable to pay for eligible services. The following two qualifications must apply: a. Expenses-The patients allowable medical expenses must be greater than 30% of the family income. Allowable medical expenses are the total of the family medical bills that, if paid, would qualify as deductible medical expenses for Federal income tax purposes without regard to whether the expenses exceed the IRS-required threshold for taking the deduction. Paid and unpaid bills may be included. b. Resources-The patient's excess medical expenses must be greater than available assets. Excess medical expenses are the amount by which allowable medical expenses exceed 30% of the family income. Available assets do not include the primary residence, the first motor vehicle, and a resource exclusion of the first $4,000 of other assets for an individual, or $6,000 for a family of two, and $1,500 for each additional family member. (B) Service Exclusions: 1. Services that are not medically necessary (e.g. cosmetic surgery) are not eligible for charity care. 2. Eligibility for charity care for a patient whose need for services arose from injuries sustained in a motor vehicle accident will be considered only if the patient, driver, and/or owner of the motor vehicle had a motor vehicle liability policy and has properly submitted a claim for payment to the motor vehicle liability insurer, where applicable.(C) Eligibility Approval Process: 1. St. Luke's screens patient for other sources of coverage and eligibility in government programs. St. Luke's documents the results of each screening. If St. Luke's determines that a patient is potentially eligible for Medicaid or another government program. St. Luke's shall encourage the patient to apply for such a program and shall assist the patient in applying for benefits under such a program. 2. The patient must complete a Financial Assistance Application and provide required supporting documentation in order to be eligible. 3. St. Luke's verifies reported family and compares to the latest Poverty Guidelines published by the U.S. Department of Health and Human Services. 4. St. Luke's verifies reported assets. 5. St. Luke's provides a written notice of determination of eligibility to the patient or the responsible party within 10 business days of receiving a completed application and the required supporting documentation. 6. St. Luke's reserves the right to run a credit report on all patients applying for charity care services. (D) Eligibility Period. The determination that an individual is approved for charity care will be effective for six months from the date the application is submitted, unless during that time the patient's family income or insurance status changes to such an extent that the patient becomes ineligible. Part I, Line 6a: St. Luke's Magic Valley Regional Medical Center, Ltd. does not include the activities of any of its other related organizations within its community benefit report. Part I, Line 7: The cost to charge ratio was used for the calculation of charity care at cost, unreimbursed Medicaid and other means-tested programs. Part I, L7 Col(f): Bad Debt is defined as expenses resulting from services provided to a patient and/or guarantor who, having the requisite financial resources to pay for health care services, has demonstrated an unwillingness to do so. Amount of bad debt expense included in Part IX, line 25, is $16,260,370. Part II: Physical Improvement & Housing: Participation in various rehabilitation projectsLeadership Development and Training:Training within the community to develop and stengthen various skills in the areas of conflict resolution,cultural and language.Coalition Building:Activities for Coalition Building include involvement of physicianin:-Chamber of Commerce Leadership-Tobacco-Free Coalition-State Board of Medicine-IMA-President of South Central Idaho Community Health Improvement Advocacy Support for Serenity Garden project. The Serenity garden Project was established on June 6,2009 to provide a dignified burial for fetal remains and give the community a place to visit and grieve their loss. Part III, Line 4: St. Luke's Magic Valley Regional Medical Center, Ltd. grants credit without collateral to its patients, most of whom are local residents and many of whom are insured under third-party agreements. The allowance for estimated uncollectible amounts is determined by analyzing both historical information(write-offs by payor classification), as well as current economic conditions. Part III, Line 8: 100% of the shortfall in Medicare reimbursement is considered a community benefit.The source of the information is the Medicare Cost Report for fiscal year 2011. The amount is calculated by comparing the total Medicare apportioned costs(allowable costs) to the interim payments received during FY'11. Part III, Line 9b: All subsidiaries within the St. Luke's Health System have policies in place to provide financial assistance to those who meet established criteria and need assistance in paying for the amounts billed for their provided health care services. In addition, the collection policies and practices in place within the St. Luke's Health system provide guidance to patients on how to apply for this assistance. Collection of amounts due may be pursued in cases where the patient is unable to qualify for charity care or financial assistance and the patient has the financial resources to pay for the billed amounts. Part VI, Line 2: St. Luke's Magic Valley utilizes internal information and reports from Idaho Vital Statistics,data from the Centers for Disease Control and Prevention Behavioral Risk Factors Surveillance System (BRFSS),and South Central Public Health District to determine community health priorities. As we continue to develop community partnerships,identify opportunities to provide needed services close to home,fund uncompensated and under-compensated care,and provide resources for services in the community, we are committed to the long-term health care needs of the Magic Valley. Part VI, Line 3: (A) St. Luke's Magic Valley Regional Medical Center provides notice of the availability of financial assistance via: 1. Signage 2. Patient brochure 3. Billing Statement 4. Written collection action letter 5. Online at www.stlukesonline.org/billing(B) All notices are translated into the following language: Spanish(C) St. Luke's provides individual notice of the availability of financial assistance to a patient expected to incur charges that may not be paid in full by third party coverage, along with an estimate of the patient's liability.(D) For cases in which St. Luke's independently determines patient eligibility for patient care, St. Luke's provides written notice of determination that the patient is or is not eligible within 10 business days of receiving a completed application and the required supporting documentation. Part VI, Line 4: St. Luke's Magic Valley provides service for eight counties of south central Idaho and Elko County, Nevada. Part VI, Line 6: The people who serve on the various boards for subsidiaries within the St. Lukes Health System are local citizens who have a vested interest in the health of their communities. These committed leaders volunteer on our boards because they are dedicated to ensuring tht the people of southern Idaho and the surrounding area have access to the most advanced, most comprehensive health care possible. St. Luke's believes that locally owned and governed hospitals can take the best measure of community health care needs. We are grateful to our board leadership for giving generously of their time and talents and bringing to the table their unique perspectives and intimate knowledge of their communities. St. Luke's would not be the organization it is today without our volunteer board members. The vision of dedicated community leaders has guided St. Luke's for many decades, and will continue to guide us well into the future.As a not-for-profit organization, 100% of St. Luke's revenue after expenses is reinvested in the organization to serve the community in the form of staff,buildings, or new technology.Also,St. Luke's Magic Valley Regional Medical Center,Ltd(SLMV) maintains an open medical staff. Any physician can apply for practicing privileges as long as they meet the criteria for SLMV. Part VI, Line 7: As the only Idaho-based not-for-profit health system, St. Luke's Health System is part of the communities we serve, with local physicians and boards who further our organization's mission "To improve the health of the people in our region." Working together, we share resources, skills, and knowledge to provide the best possible care, no matter which of our hospitals provide that care. Each St. Luke's Health System hospital is nationally recognized for excellence in patient care, with prestigious awards and designations reflecting the exceptional care that is synonymous with the St. Luke's name. St. Luke's Health System provides facilities and services across the region, covering a 150-mile radius that encompasses southern and central Idaho, northern Nevada, and eastern Oregon-bringing care close to home and family. The following entities are part of the St. Luke's Health System:(1) St. Luke's Regional Medical Center,Ltd., with the following locations: --St. Luke's Boise Hospital --St. Luke's Meridian Hospital --St. Luke's Childrens Hospital --St. Luke's Boise/Meridian Physician Clinics --St. Luke's Eagle Urgent Care(2) St. Luke's Wood River Medical Center,which consists of a critical access hospital located in Ketchum,Idaho as well as various physician clinics(3) St. Luke's Magic Valley Regional Medical Center, Ltd. which consists of the following: --St. Luke's Magic Valley Hospital-Twin Falls,Idaho --Various St. Luke's Physician Clinics in Twin Falls. --Canyon View-(Behavioral Health)(4) St. Luke's McCall Hospital, which consists of a critical access hospital located in McCall, Idaho, as well as various physician clinics.(5) Mountain States Tumor Institute(MSTI)is the region's largest provider of cancer services and a nationally recognized leader in cancer research. MSTI provides advanced care to thousands of cancer patients each year at clinics in Boise,Fruitland,Meridian,Nampa, and Twin Falls,Idaho. MSTI is home to Idaho's only cancer treatment center for children, only federally sponsored center for hemophilia, and only blood and marrow transplant program. MSTI's services and therapies include breast care services, blood and marrow transplant, chemotherapy, genetic counseling, hematology, hemophilia treatment,hospice,integrative medicine,marrow donor center, mobile mammography, mole mapping, nutritional counseling, PET/CT scanning,patient/family support,pediatric oncology,radiation therapy,rehabilitation,research and clinincal trials, Schwartz Center Rounds for Caregivers, spiritual care, support groups/classes, tumor boards,and Wound,Ostomy,and Continence Nursing. MSTI is expanding as rapidly as today's cancer treatment. Patients can now visit a MSTI clinic or Breast Cancer detection center at 12 different locations in southwest Idaho and Eastern Oregon. Locations include Boise,Meridian,Nampa,Twin Falls,and Fruitland.(6) St. Luke's Humphreys Diabetes Center,Inc.(SLHDC)provides education in diabetes self-management and prevention to people with or at-risk for diabetes, their families and health care professionals. Trusted by over 600 Treasure Valley referring physicians,SLHDC provides services to more than 4,000 clients each year. Working with our experienced Certified Diabetes Educators, clients learn how to manage diet,exercise and medication to stay healthy and prevent complications such as heart attacks,strokes,blindness,kidney failure, and amputations. SLHDC programs are recognized by the American Diabetes Assocation. SLHDC also particpates in national research trials for both Type 1 and Type 2 diabetes. A community program of St. Luke's Health System, SLHDC is one of the largest free-standing diabetes centers in the United States. St. Luke's physician clinics and services are provided in partnership with area physicians and other health care professionals. These include:Cardiovascular;Child Abuse and Neglect Evaluation;Endocrinology;Ear, Nose,and Throat;Family Medicine; Gastroenterology; General Surgery;Hypertensive Disease;Internal Medicine;Maternal/Fetal Medicine;Medical Imaging;Metabolic and Bariatric Surgery;Nephrology;Neurology;Neurosurgery;Obstetrics/Gynecology;Occupational Medicine;Orthopedics;Outpatient Rehabilitation;Plastic Surgery;Psychiatry and Addiction;Pulmonary Medicine;Sleep Disorders;and Urology. In addition, St. Luke's partners with other regional facilities through management service contracts. These partners include:(1) Challis Area Health Center(2) Elmore Medical Center(3) North Canyon Medical Center(4) Salmon River Clinic(5) Weiser Memorial Hospital Reports Filed With States Part VI, Line 7 ID 1 Mustard Seed Community Wellness Clinic 676 Shoup Avenue W Suite 2 Twin Falls ID 83301 261249939 501(c)(3) 35000 Women's health program for the underinsured and uninsured working women of the community. Interfaith Volunteer Caregivers of Magic Valley 252 Deere Street Suite A Twin Falls ID 83301 841417706 501(c)(3) 10572 Funding to help the organization to offer services and products to senior citizens, such as geriatric, health, and social service. Volunteers Against ViolenceInc(Crisis Center) PO Box 2444 Twin Falls ID 83303 820372006 501(c)(3) 19000 Provide places of safety, shelter, and legal services for victims of domestic violence. College of Southern Idaho 315 Falls Ave Twin Falls ID 83303 820261628 501(c)(3) 157928 Head Start program, nursing grant funds, employee wellness programs, senior programs Harmony PSR Services(Holistic Drug Rehab) 420 Main Avenue South Twin Falls ID 83301 030466279 501(c)(3) 10000 Funds are used for continuing mental health exercise, diabetes prevention, weight maintenance and healthy cooking skills. Family Health Services Corp 794 Eastland Drive Twin Falls ID 83301 820371093 501(c)(3) 156794 Funding to support Health Care Services for Family Health Jubilee House Attn Kathryn Bausman 315 Grandview Drive Twin Falls ID 83301 208750670 501(c)(3) 10000 Christian 12 mo recover program for women. Personnel costs for 24/7 coverage Twin Falls County 425 Shoshone St N Twin Falls ID 83301 826000318 Government Grant 13000 Funds were used to Improve care for sexual assault victims and collections of forensic evidence, set up a Sexual Assault Nurse Examiner program at the College of Southern Idaho. Salvation Army 348 4th Ave N Twin Falls ID 83301 132923701 501(c)(3) 7000 Funds were used to purchase youth specific weight equipment, misc. fitness equipment, and instructor costs. Hospice Visions 209 Shoup Ave W Twin Falls ID 83301 820483284 501(c)(3) 20000 Funds will be used to defray the costs for access to end of life indigent and uninsured patients. Southern Idaho Learning Center 564 Shoup Ave W Twin Falls ID 83301 262511898 501(c)(3) 7700 Provide funding to support local teachers. St Benedicts Family Medical Center PO Box 586 Jerome ID 83338 820227163 501(c)(3) 10000 General sponsorship St Luke's Magic Valley Health Foundation 650 Addison Ave W Suite 270 Twin Falls ID 83303 820342863 501(c)(3) 15275 Fund programs for children with special needs and diabetes. United Way PO Box 65 Twin Falls ID 83303 820256978 501(c)(3) 7000 Mobilize the caring power of the community to improve lives. 14 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: The organization endeavors to monitor its grants to ensure that such grants are used for proper purposes and not otherwise diverted from their intended use. This is accomplished by requesting recipient organizations to affirm that funds must be used solely in accordance with the grant request and budget on which the grant was based and that funds not expended for the stated purpose are to be returned to the organization. Reports are requested from time to time as deemed appropriate. X X X X 1 0 0 0 0 0 0 0 0 Mr John Groesbeck 203416 0 685 0 7662 0 0 0 15741 0 227504 0 7232 0 Steven F Johnson MD 422275 0 0 0 26585 0 2093 0 12315 0 463268 0 0 0 Randall Skeem MD 188608 0 119956 0 22774 0 11025 0 5698 0 348061 0 0 0 Jonathan D Myers MD 277379 0 14117 0 23968 0 2595 0 22734 0 340793 0 0 0 David A McClusky MD 210369 0 0 0 40620 0 11025 0 11845 0 273859 0 0 0 Julian Nicholson MD 195559 0 29821 0 4220 0 0 0 6309 0 235909 0 0 0 Mark A Schwartz 318227 0 31346 0 131276 0 2538 0 11539 0 494926 0 122857 0 Part I, Line 4a Part I, Line 4a: Form 990-Schedule J,Part 1,Question 4a During CY'10, Mark Schwartz, former CEO, received severance payments totaling $204,288. Supplemental Information Part III Part II-Column (f) Explanation of Prior Compensation: Reportable compensation is based on the total amount paid during calendar year 2010,including current year payments of amounts reported in prior years as contributions to employee benefit plans and deferred compensation, together with investment earnings from those prior year contributions. As a result,certain amounts have been reported twice,both in prior years when earned or accrued,and again in the current year paid. Jonathan D Myers MD Residency,Housing,and Tuition Assistance X 40000 25158 0 0 1 25158 First Federal Savings Common Board Member 3249100 First Federal Savings purchases patient accounts receivable from St. Luke's Magic Valley Regional Medical Center,Ltd. 0 Magic Valley Anesthesiology Associa Board Member is a member of Magic Valley Anesthesiolgy Association 297148 Exclusive contract to provide anesthesia services to the hospital. 0 RWD Technologies Former Interim CEO is partner for RWD Technologies 242760 RWD Technologies provided management consulting services to St. Luke's Magic Valley Regional Medical Center, Ltd. Compensation for Mike Reno,former interim CEO, was paid to RWD Technologies. 0 Emergency Physicians of Southern Idaho Board Member has ownership interest 5068338 Emergency Medicine of Southern Idaho has an Exclusive Service Agreement with St. Luke's Magic Valley Regional Medical Center to provide emergency medical services. 0 Schedule L Part II-Loans To and From Interested Persons Physician Loan Policy As part of its overall physician recruiting program, St. Luke's will offer various incentives for employment, including:(1) Net Income Guarantee(2) Housing Assistance(3) Relocation Assistance(4) Tail Coverage for Malpractice Claims, and(5) Sign-on BonusThese incentives are structured as a physician loan to the prospective employee, bearing a reasonable rate of interest reflecting market conditions. As the physician fulfills the terms of the employment agreement, the amount advanced is forgiven over the term of the loan. If the physician does not fulfill the terms of the agreement, the physician must repay a liquidated damages amount specified in the loan agreement.Emergency Physicians of Southern Idaho:During FY'10, Emergency Physicians(Emergency Physicians) of Southern Idaho should have been reported as an interested person on Schedule L, Part IV, since a board member during that same fiscal year had an ownership interest in this group. During FY'10, St. Luke's Magic Valley paid Emergency Physicians $5,041,965. Form 990, Part VI, Section A, line 6 St. Luke's Health System, Ltd. is the sole member of St. Luke's Magic Valley Regional Medical Center,Ltd. Form 990, Part VI, Section A, line 7b St. Luke's Health System,Ltd.(Member) maintains approval and implementation authority over St. Luke's Magic Valley Regional Medical Center,Ltd.(Corporation). Actions requiring approval authority may be initiated by either the Corporation or its Member, but must be approved by both the Corporation (by action of its Board of Directors)and the Member. Actions requiring approval authority of the Member include: (a) Amendment to the Articles of Incorporation; (b) Amendment to the Bylaws of the Corporation; (c) Appointment of members of the Corporation's Board of Directors, other than ex officio directors; (d) Removal of an individual from the Corporation's Board of Directors if and when removal is requested by the Corporation's Board of Directors, which request may only be made if the Director is failing to meet the reasonable expectations for service on the Corporation's Board of Directors that are established by the Member and are uniform for the Corporation and for all of the other hospitals for which the Member then serves as the sole corporate member. (e) Approval of operating and capital budgets of the Corporation, and deviations to an approved budget over the amounts established from time to time by the Member; and (f) Approval of the strategic/tactical plans and goals and objectives of the Corporation. Implementation Authority means those actions which the Member may take without the approval or recommendation of the Corporation. This authority will not be utilized until there has been appropriate communication between the Member and the Corporation's Board of Directors and its Chief Executive Officer. Actions requiring implementation authority include: (a) Changes to the Statements of mission, philosophy, and values of the Corporation; (b) Removal of an individual from the Corporation's Board of Directors if and when the Member determines in good faith that the Director is failing to meet the Approved Board of Member Expectations. This authority to remove Directors shall not be used merely becuase there is a difference in business judgment between the Director and the Corporation or the Member, and shall never be used to remove one or more Directors from the Corporation's Board of Directors in order to change a decision made by the Corporation's Board of Directors; (c) Employment and termination of the Chief Executive Officer of the Corporation; (d) Appointment of the auditor for the Corporation and the coordination of the Corporation's annual audit; (e) Sales, lease, exchange, mortgage, pledge, creation of a security interest in or other disposition of real or personal property of the Corporation if such property has a fair market value in excess of a limit set from time to time by the Member and that is not otherwise contained in an Approved Budget; (f) Sale, merger, consolidation, change of membership, sale of all or substantially all of the assets of the corporation, or closure of any facility operated by the Corporation; (g) The dissolution of the Corporation; (h) Incurrence of debt by or for the Corporation in accordance with requirements established from time to time by the Member and that is not otherwise contained in an Approved Budget; and (i) Authority to establish policies to promote and develop an integrated, cohesive health care delivery system across all corporations for which the Member serves as the corporate member. Form 990, Part VI, Section B, line 11 The Form 990 is prepared by an independent public accounting firm based on audited financial statements and with the assistance of the organization's finance and accounting staff. The final draft of the 990 is made available for review to the Chief Financial Officer and the Finance Committee of the Board of Directors. The Board receives the final version of the Form prior to filing. Form 990, Part VI, Section B, line 12c The organization annually reviews the conflict of interest policy with each board member and also with new board members. Persons covered under the policy include officers, directors, senior executives, non-director members of Board committees and others as identified by a senior executive. At all levels the board is responsible for assessing, reviewing, and resolving any conflicts of interest that have been disclosed by a covered person, or a conflict of interest disclosed by a covered person with respect to a covered person other than himself/herself. Where a conflict exits, the affected parties must excuse themselves from participating in the situation. Form 990, Part VI, Section B, line 15 Executive compensation is set by St. Luke's board of directors and is reviewed annually. Compensation levels are based on an independent analysis of comparable pay packages offered at similar institutions across the country, with the goal of placing executives in the 50th percentile of those surveyed. Similar analysis is also completed for physicians and other health care specialties such as nurses and pharmacists. These surveys are usually done every two years, with the most recent compensation survey completed during calendar year 2010. St. Luke's Health System is committed to providing the highest quality medical care to all people regardless of their ability to pay. To keep that commitment, St. Luke's puts a great deal of time and effort into recruiting and retaining the top physicians in a variety of medical fields. Our relationships with physicians range from having privileges at the hospital to full employment. For those physicians who choose to be employed, St. Luke's must offer competitive pay and benefits. Physician compensation is based on a range of criteria and can be influenced by a number of variables including: -Community need for medical specialty -Experience -Productivity -Geography -National surveys adjusted for local conditions -Willingness to serve regardless of patients' ability to pay -Duration of relationship and contractual terms To ensure physician compensation and benefits remain within industry standards and legal requirements for not-for-profit institutions, St. Luke's has a Physician Arrangements policy that specifies circumstances requiring a third-party valuation and also periodically uses third-party consulting firms to review St. Luke's physician compensation arrangements. Given the growing national shortage of physicians, recruiting and retaining physicians is more critical than ever to guarantee that people seeking care at St. Luke's will continue to have access to the physicians and specialists they need regardless of their insurance status or insurance provider. Form 990, Part VI, Section C, line 19 Form 990, Part VI, Section C, Line 19: The organization's governing documents,conflict of interest policy,and financial statements are not available to the public. Form 990 is available for public inspection,which contains financial information. Five Highest Paid Independent Contractors Form 990 Part VII Section B For FY'10 and FY'09, Emergency Medicine of Idaho was reported incorrectly in the list of Five Highest Paid Independent Contractors. The contractor name should have been reported as Emergency Physicians of Southern Idaho. The amounts reported in the listing,however,were correct. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized losses on investments: -30,165. Minimum Liability Adj.-Defined Benefit Plan -5,684,461. Total to Form 990, Part XI, Line 5: -5,714,626. Program Expense Form 990 Part III-Statement of Program Accomplishments Please note that the program expense amounts reported in Statement III-Statement of Program Accomplishments, do not include an allocation of certain administrative and functional support costs. These costs are classified as Management and General within Part IX-Statement of Functional Expenses. Allocation of Compensation and Hours: Form 990 Part VII Section A It should be noted that the hours reported for the officers,key employees,and highest-paid employees are based on a minimum 40 hour work week. However,due to the demands of their roles,the hours worked by these individuals often exceed the minimum required 40 hours. Magic Valley Paramedics Services Ltd PO Box 409 Twin Falls ID 83301 205461983 Paramedic Services ID 2894898 0 St Luke's Magic Valley Regional Medical CenterLtd St Luke's ClinicLLC PO Box 409 Twin Falls ID 83301 820527710 Physician Services ID 47086003 18064999 St Luke's Magic Valley Regional Medical CenterLtd Magic Health PartnersLLC PO Box 409 Twin Falls ID 83301 820507483 Admin.Services for Non-Provider Based Physician Groups ID 527149 115057 St Luke's Magic Valley Regional Medical CenterLtd St Luke's Health SystemLtd 190 E Bannock Boise ID 83712 562570681 Health Care Services ID 501(c)(3) 11-3 St Luke's Health SystemLtd 0 Mountain States Tumor Institute 100 E Idaho Boise ID 83712 820295026 Health Care Services ID 501(c)(3) 3 St Luke's Regional Medical CenterLtd 0 St Luke's Wood River Medical Center Ltd 190 E Bannock Boise ID 83712 841421665 Health Care Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's Health Foundation Ltd 190 E Bannock Boise ID 83712 810600973 Solicit Donations ID 501(c)(3) 7 St Luke's Regional Medical CenterLtd 0 St Luke's Regional Medical CenterLtd 190 E Bannock Boise ID 83712 820161600 Health Care Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's McCall Ltd 190 E Bannock Boise ID 83712 273311774 Health Care Services ID 501(c)(3) 3 St Luke's Health SystemLtd 0 St Luke's Humphreys Diabetes CenterInc 1226 River Street Boise ID 83702 820491110 Diabetes Prev.-Self-Mgmt. ID 501(c)(3) 9 St Luke's Regional Medical CenterLtd 0 Magic Valley Facial Imaging LLC 590 Falls Avenue Twin Falls ID 83301 208025041 Health Care ID N/A Related 9091 35000 0 1 0.50000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 1