2012-11-15T12:07:19-06:00 2011-12-31 ERNST & YOUNG US LLP 190 CARONDELET PLAZA SUITE 1300 CLAYTON MO 63105 990 2011-01-01 237379161 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC % SHARON OWENS SCL HEALTH SYS SIST 3038135190 2420 WEST 26TH AVE DENVER CO 80211 LYDIA W JUMONVILLE 2012-11-14 3142901000 2011 2016-02-24 21:20:13Z X LYDIA W JUMONVILLE 2420 WEST 26TH AVE STE 100-D DENVER CO 80211 126461371 false 0928 X www.sclhealthsystem.org X 1972 KS WE 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. 15 14 342 0 -108419 0 3100 1082 72582296 103634794 22559296 17743348 6098017 5082147 101242709 126461371 379320 278650 0 0 40263716 54088418 0 0 0 131032929 116581852 171675965 170948920 -70433256 -44487549 1480585187 1431133067 1477109961 1535000716 3475226 -103867649 X WE 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. false false 65090114 19120817 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. 10123329 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. 44477955 755817 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 ADDITION, A CLINICAL AND PATIENT ADMINISTRATIVE SYSTEM IS BEING INSTALLED THROUGHOUT THE HEALTH SYSTEM. 23823887 82769649 QUALITY, RISK MANAGEMENT, COMMUNICATIONS 491233 1154819 MEDICAL OFFICE BUILDING, DENVER, CO 148292 DEPRECIATION 278650 278650 GRANTS RELATED TO SCLHS MISSION 24742062 278650 83924468 144433460 true false false true true false false false false true true true true false true false false true false false true false 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 277 0 true 342 true true true true CJ UK CA 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 X 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 1124 KNUTE KNUDSON 3.0 X MATTHEW LAMBERT III MD 3.0 X X MAUREEN MAHONEY 3.0 X MARLON PRIEST MD 3.0 X 417 DENNIS PURTELL 3.0 X KENT RUSSELL 3.0 X VINOY SAHNEY PhD 3.0 X RONALD SPERLING 3.0 X MICHAEL A SLUBOWSKI 40.0 X X 1304791 0 10969 LYDIA W JUMONVILLE 40.0 X 588823 0 80777 EDWARD L BARKER 40.0 X 618049 0 87909 MARK A WILKINSON 40.0 X 177017 0 26043 PAMELA G LOGAN 40.0 X 114046 19372 ROBERT W LADENBURGER 40.0 X 1086761 0 84694 MARY JO GREGORY 40.0 X 1611431 0 1953275 WILLIAM M ANDERSON 40.0 X 552050 0 9582 ROBERT A BOYSEN 40.0 X 1098127 0 1044316 BRENDA S CHILMAN 40.0 X 38071 204285 17513 TODD A CONKLIN SR 40.0 X 316994 363459 75682 JILL W KENNELLY 40.0 X 362088 0 71371 RICHARD T LOPES 40.0 X 420106 0 43091 DAVID PECORARO 40.0 X 428616 0 58070 DEBORAH WELLE-POWELL 40.0 X 256889 36104 45642 LOURDES J LAZATIN X 1115556 0 40050 JAMES T PAQUETTE 40.0 X 738527 0 123111 ELEANOR L RAMIREZ X 648655 0 32217 CHERIE L GORBY X 560263 0 308477 BAIN J FARRIS X 553036 0 99532 WILLIAM M MURRAY X 1848716 0 23674 MARGARET J BREEN X 350968 0 122 14791121 603848 4255489 123 true true false Broadlane Inc 13727 NOEL RD DALLAS TX 75240 PROF/ADMIN PERSONNEL 5471772 Galloway Consulting 5330 CROSS ROADS MANOR ATLANTA GA 30327 Consulting 2798394 Catholic Healthcare Audit Network 231 SOUTH BEMISTON ST LOUIS MO 63105 INT AUDIT SERVICES 2097868 ERNST AND YOUNG LLP PO BOX 660401 DALLAS TX 75260 AUDIT & TAX SERVICES 1556928 MCKINSEY COMPANY INC PO BOX 7247-7255 PHILADELPHIA PA 191707255 CONSULTING 1527625 21 1082 1082 AFFILIATE MANAGEMENT FEES 541900 83370211 83340211 30000 PROGRAM RENTAL INCOME 532000 1173766 1173766 INTEREST INCOME FROM NOTES RECEIVABLE 900099 19090817 19090817 103634794 12060660 -138419 12199079 789686 789686 0 4652258 240744 4652258 240744 4893002 4893002 0 0 0 VENDOR ADMINISTRATION REBATE 900099 4915839 4915839 DEBT GUARANTEE FEES 900099 143611 143611 MISCELLANEOUS REVENUE 900099 22697 22697 5082147 126461371 103771102 -108419 22797606 212300 212300 66350 66350 0 0 9963765 9963765 0 37428802 22824078 14604724 3317685 353739 2963946 1173905 627009 546896 2204261 1664165 540096 0 881137 881137 3056280 3056280 75049 75049 0 1543195 1543195 10130465 9713090 417375 0 2384355 2026702 357653 8943732 7602172 1341560 0 1594859 1355630 239229 1329829 1329829 0 743698 743698 58121303 58121303 0 24206233 24206233 155795 132426 23369 PROFESSIONAL SERVICES 1443331 1443331 SYSTEM DUES 1228680 1228680 RENTAL LESS DEPRECIATION 739611 739611 SCHOLARSHIP ADMIN EXPENSE 4300 4300 170948920 144433460 26515460 0 988 128 0 0 0 0 22615441 38389891 0 0 0 0 60000 60000 0 0 2714583 5034475 214884730 123161968 77929574 91722762 481273610 539045966 340800910 260632603 511801418 475073655 0 0 43388663 21173587 1480585187 1431133067 48238199 123251945 0 0 0 0 1395010059 1361576377 0 0 0 0 0 0 0 0 33861703 50172394 1477109961 1535000716 X -32798405 -128252848 34273631 22385199 2000000 2000000 3475226 -103867649 1480585187 1431133067 X -44487549 -62855326 X X false true true X false X X X false false false PROVIDENCE MEDICAL CENTER INC 480784446 03 false true true 0 ST FRANCIS HEALTH CENTER INC 480547719 03 false true true 0 ST JAMES HEALTHCARE 810231785 03 false true true 0 SAINT JOHN HOSPITAL INC 480543768 03 false true true 0 SAINT JOHN'S HEALTH CENTER 951684082 03 false true true 0 SAINT JOSEPH HOSPITAL INC 840417134 03 false true true 0 EXEMPLA INC 841103606 03 false true true 0 ST MARY'S HOSPITAL AND MEDICAL CENTER INC 840425720 03 false true true 0 ST VINCENT HEALTHCARE 810232124 03 false true true 0 HOLY ROSARY HEALTHCARE 810231792 03 false true true 0 BETHANY COMMUNITY PLAZA INC 481207407 03 false true true 0 CARITAS CLINICS INC 481009910 03 false true true 0 MARIAN CLINIC INC 481046905 03 false true true 0 MARILLAC CLINIC INC 841085822 03 false true true 0 MOUNT ST VINCENT HOME INC 840405260 03 false true true 0 15 0 true true false true 25529 false false true 41059 true 207140 false 273728 false 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 23697877 23342511 355366 1922228 1651575 270653 152237814 98167882 54069932 0 0 91722762 REAL ESTATE 102760918 F ABSOLUTE RETURN FUNDS 79502693 F CORE HEDGE FUNDS 38521851 F PRIVATE EQUITY 17808620 F INSTITUTIONAL COMMINGLED FUNDS 22038521 F 260632603 PROVIDENCE MEDICAL CENTER 3948802 F ST. JOHN HOSPITAL, INC. 1473298 F ST. JAMES HEALTHCARE 17005666 F ST. MARY'S HOSPITAL & MEDICAL 39670889 F SAINT JOHN'S HEALTH CENTER 89000000 F EXEMPLA SYSTEM SERVICES 323975000 F 475073655 0 DEFERRED COMP 457 PLAN LIAB 8045869 INTEREST RATE SWAP LIABILITY 27697364 FROZEN DB PLAN 9864739 OTHER ACCRUED LIABILITIES 4564422 50172394 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. FORM 990, SCHEDULE D, PART X (ASC 740-10 FOOTNOTE DISCLOSURE) SCLHS DID NOT HAVE A DISCLOSURE OF ASC 740-10 - INCOME TAXES IN ITS DECEMBER 31, 2011 AUDITED FINANCIAL STATEMENTS AS IT WAS NOT MATERIAL. Central America and the Caribbean 0 0 Program Services CAPTIVE INSURANCE PREM 13444858 Central America and the Caribbean 0 0 Investments 109874138 Europe (Including Iceland and Greenland) 0 0 Investments 3035808 North America 0 0 Investments 0 0 0 0 0 126354804 126354804 true false true true true false Schedule F, Part I, Line 3 SCLHS' expenditures (premiums paid) for its captive insurance premiums was $13,444,858 net of premium discounts. true CRISTO REY KANSAS CITY SCHOOL 211 W LINWOOD BLVD KANSAS CITY MO 64111 436033728 501(c)(3) 46833 SCHOOL SUPPORT UNIVERSITY OF ST MARY 4100 SOUTH 4TH STREET LEAVENWORTH KS 66048 480547846 501(C)(3) 29500 FUNDRAISER SPONSOR AND SUPPORT MOUNT ST VINCENT HOME 4159 LOWELL BLVD DENVER CO 80211 840405260 501(c)(3) 40000 FUNDRAISER SPONSOR 3 0 SECONDARY EDUCATION SCHOLARSHIPS 36 65350 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 X true true X X X X X X true true false false false false false true false MICHAEL A SLUBOWSKI 913849 0 200000 0 190942 0 0 0 10969 0 1315760 0 0 0 LYDIA W JUMONVILLE 473951 0 57000 0 57872 0 65529 0 15248 0 669600 0 0 0 EDWARD L BARKER 467860 0 0 0 150189 0 71586 0 16323 0 705958 0 0 0 MARK A WILKINSON 143757 0 31990 0 1270 0 16466 0 9577 0 203060 0 0 0 ROBERT W LADENBURGER 607673 0 144615 0 334473 0 73845 0 10849 0 1171455 0 0 0 MARY JO GREGORY 631555 0 374000 0 605876 0 1942602 0 10673 0 3564706 0 85746 0 WILLIAM M ANDERSON 277212 0 0 0 274838 0 0 0 9582 0 561632 0 0 0 ROBERT A BOYSEN 379214 0 153560 0 565353 0 1028586 0 15730 0 2142443 0 0 0 BRENDA S CHILMAN 37817 171114 0 25571 254 7600 7404 3594 1090 5425 46565 213304 0 0 TODD A CONKLIN SR 306694 68644 0 196725 10300 98090 55893 3567 12205 4017 385092 371043 0 0 JILL W KENNELLY 346915 0 0 0 15173 0 60050 0 11321 0 433459 0 0 0 RICHARD T LOPES 304166 0 0 0 115940 0 36475 0 6616 0 463197 0 0 0 DAVID PECORARO 330346 0 81212 0 17058 0 47451 0 10619 0 486686 0 0 0 DEBORAH WELLE-POWELL 252819 8093 0 28011 4070 0 44100 162 1361 19 302350 36285 0 0 LOURDES J LAZATIN 504961 0 517166 0 93429 0 33652 0 6398 0 1155606 0 0 0 JAMES T PAQUETTE 418351 0 0 0 320176 0 107885 0 15226 0 861638 0 0 0 ELEANOR L RAMIREZ 312198 0 242266 0 94191 0 19600 0 12617 0 680872 0 54077 0 CHERIE L GORBY 276361 0 41545 0 242357 0 298052 0 10425 0 868740 0 145948 0 BAIN J FARRIS 428580 0 105122 0 19334 0 88843 0 10689 0 652568 0 0 0 WILLIAM M MURRAY 425764 0 0 0 1422952 0 19147 0 4527 0 1872390 0 0 0 MARGARET J BREEN 0 0 0 0 350968 0 0 0 122 0 351090 0 351090 0 SCHEDULE J SUPPLEMENTAL DISCLOSURES SCHEDULE J, PART I, LINE 1a (TRAVEL FOR COMPANION) SCLHS AND ITS AFFILIATES HAVE ANNUAL RETREATS FOR THEIR BOARDS OF DIRECTORS. THE BOARD MEMBERS AND MANAGEMENT ARE ALLOWED TO BE REIMBURSED IF THEY BRING A SPOUSE OR GUEST TO THESE RETREATS. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS LISTED THAT WERE TAXED FOR 2011 WERE: DONNA J KING MARLON PRIEST MD ---------------------------------------------------------------------- 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 2011 WERE: MICHAEL A SLUBOWSKI LYDIA W JUMONVILLE MARY JO GREGORY WILLIAM M ANDERSON RICHARD T LOPES JAMES T PAQUETTE ---------------------------------------------------------------------- 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 2011 WERE: LYDIA W JUMONVILLE JAMES T PAQUETTE ---------------------------------------------------------------------- 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 2011 WERE: MARY JO GREGORY-$221,398 ROBERT A BOYSEN-$67,714 CHERI L GORBY-$94,735 WILLIAM M MURRAY-$150,051 MARGARET J BREEN-$350,968 ---------------------------------------------------------------------- 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 2011 WERE: MICHAEL A SLUBOWSKI-$38,668 EDWARD L BARKER-$55,995 ROBERT W LADENBURGER-$116,293 WILLIAM M ANDERSON-$28,351 RICHARD T LOPES-$27,413 LOUREDS J LAZATIN-$29,494 JAMES T PAQUETTE-$105,270 ELEANOR L RAMIREZ-$42,023 IN ADDITION, VESTED AMOUNTS ARE PAYABLE UPON END OF EMPLOYMENT. THE VESTED AMOUNTS WITHDRAWN, NOT PREVIOUSLY TAXED, FOR THIS TYPE OF PAYMENT IN 2011 WERE: MARY JO GREGORY-$365,301 ROBERT A BOYSEN-$470,893 CHERI L GORBY-$145,948 WILLIAM M MURRAY-$1,258,479 ---------------------------------------------------------------------- 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. ---------------------------------------------------------------------- MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KBB6 2003-12-05 39210000 2/2/1994 REFINANCE+BLDGS+EQUP false false false CALIFORNIA HEALTH FACILITIES FINANCING AUTHORTIY 521643828 13033FQU7 2003-12-05 49755000 2/2/1994 REFINANCE false false false COLORADO HEALTH FACILITIES AUTHORITY 840752932 196474K58 2003-12-05 103035000 2/2/1994&9/9/1992 REFIN+BLDGS+equi false false false MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KBC4 2006-03-07 35000000 CONSTRUCT/REMODEL HOSPITAL FACILIT false false false 0 0 39210000 0 0 0 270531 0 0 7630591 0 0 2003 true false true true 0 0 49755055 0 0 0 346200 0 0 55 0 0 2003 true false true true 0 0 103035433 0 0 0 714438 0 0 22369995 0 0 2003 true false true true 0 0 35028997 0 0 0 325299 0 0 34703698 0 0 2006 false false true true false true true true false false 0.00000 0.00074 0.00074 true false true true true false false 0.00000 0.00000 0.00000 true false true true true false false 0.00000 0.02937 0.02937 true false true true true false false 0.00000 0.03093 0.03093 true true true true Merrill Lynch 20. false false false 0 false false true true true Merrill Lynch 20. false false false 0 false false true true true Merrill Lynch 20. false false false 0 false false true true true Deutsche Bank 25. false false false 0 false false X FORM 990, SCHEDULE K PART I, COLUMN (C), CUSIP # SCHEDULE K DISCLOSES THE COLORADO HEALTH FACILITIES AUTHORITY BONDS, ISSUED 12/05/2003, WITH AN ISSUE PRICE OF $103,035,000. THIS IS DISCLOSED AS ONE LINE ON SCHEDULE K DUE TO ONLY ONE FORM 8038 BEING ISSUED. THAT SAID, THERE ARE ACTUALLY TWO CUSIP NUMBERS, AS FOLLOWS: PER FORM 8038: CUSIP - 196474 K58 / K41 ACTUAL: CUSIP - 196474 K58 and CUSIP - 196474 K41 KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 48542KHB8 2006-03-07 60000000 CONSTRUCT/REMODEL HOSPITAL FAC false false false KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 48542KHA0 2006-03-07 25000000 CONSTRUCT/REMODEL HOSPITAL FAC false false false COLORADO HEALTH FACILITIES AUTHORITY 840752932 19648AST3 2010-05-20 605460143 3/24/98&11/13/02&7/18/02 REFI+HOSP false false false MONTANA FACILITY FINANCE AUTHORITY 810302402 61204KHV6 2010-05-20 217535868 3/24/98&5/25/00 REFI+HOSP FAC false false false 0 0 60070846 0 0 0 557655 0 0 59513191 0 0 2006 false false true true 0 0 25020732 0 0 0 232356 0 0 24788376 0 0 2006 false false true true 0 0 605500535 0 0 0 6836215 0 0 310645879 0 0 2010 true true true true 0 0 217587116 0 0 0 2529281 0 0 32824812 0 69000000 2010 true false false true false true true true false false 0.00002 0.00000 0.00002 true false true true true false false 0.00720 0.00130 0.00849 true false true true true false false 0.00000 0.00033 0.00033 true false true true true false false 0.02603 0.00135 0.02738 true true true true Deutsche Bank 25. false false false 0 false false true true true Deutsche Bank 25. false false false 0 false false false false false 0 false false false 0 false false false false false 0 false false false 0 false false KANSAS DEVELOPMENT FINANCE AUTHORITY 481066589 48542K5N5 2010-05-20 202625401 3/24/98&5/25/00 REFI+HOSP FAC false false false COLORADO HEALTH FACILITIES AUTHORITY 840752932 2011-06-15 62620000 REFI 7/18/02&2/4/09 false false false 0 0 202625401 0 0 0 2488006 0 0 77008019 0 0 2010 true false true true 0 0 62620000 0 0 0 420000 0 0 0 0 0 2011 true false true true false true true true false false 0.00269 0.00000 0.00269 true false true true true false false 0.00000 0.00000 0.00000 true false false false 0 false false false 0 false false false true false 0 false false false 0 false false 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 5: OTHER CHANGES IN NET ASSETS: UNREALIZED LOSS ON INVESTMENTS $(13,702,353) UNREALIZED LOSS ON SWAPS (14,172,902) FROZEN DEFINED BENEFIT RETIREMENT PLAN GAIN 6,520,813 EQUITY TRANSFERS FROM RELATED (3,572,913) FAS 158 LOSS ON DEFINED BENEFIT PLANS (33,548,100) SELF-INSURED LIABILITY REDUCTION (4,379,871) ----------- TOTAL $(62,855,326) =========== ------------------------------------------------------------------------- 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 926, STATEMENT PURSUANT TO TREASURY REG. SEC. 1.6038B-1(C): APPLICABLE TO ALL IRS FORMS 926 FILED WITH THIS RETURN. 1. TRANSFEROR NAME: SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND U.S. TAXPAYER IDENTIFICATION NUMBER: 23-7379161. 2. TRANSFEREE: A. NAME: VARIOUS, SEE IRS FORMS 926, PART II, LINE 3; TAXPAYER IDENTIFICATION NUMBER: VARIOUS, SEE IRS FORMS 926, PART II, LINE 4; ADDRESS: VARIOUS, SEE IRS FORMS 926, PART II, LINE 5; COUNTRY OF INCORPORATION: VARIOUS, SEE IRS FORMS 926, PART II, LINE 6. B. GENERAL DESCRIPTION OF THE TRANSFER: VARIOUS, GENERALLY CASH, SEE IRS FORMS 926, PART III. 3. CONSIDERATION RECEIVED: SEE AMOUNT ON IRS FORMS 926, PART III. 4. PROPERTY TRANSFERRED, INCLUDING THE ESTIMATED FAIR MARKET VALUE AND ADJUSTED BASIS OF THE PROPERTY: A. ACTIVE BUSINESS PROPERTY: SEE AMOUNT ON IRS FORMS 926, PART III. B. STOCK OR SECURITIES: SEE AMOUNT ON IRS FORMS 926, PART III. I. ACTIVE TRADE OR BUSINESS STOCK. II. APPLICATION OF SPECIAL RULES. C. DEPRECIATED PROPERTY: SEE AMOUNT ON IRS FORMS 926, PART III. D. PROPERTY TO BE LEASED: N/A E. PROPERTY TO BE SOLD: N/A F. TRANSFERS TO FSCS: N/A G. TAINTED PROPERTY: N/A I. INVENTORY, ETC.: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(B); II. INSTALLMENT OBLIGATIONS, ETC.: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(C); III. FOREIGN CURRENCY, ETC: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(D); IV. INTANGIBLE PROPERTY: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(E); V. LEASED PROPERTY: PROPERTY DESCRIBED IN SEC. 1.367(A)-5T(F). H. FOREIGN LOSS BRANCH: N/A I. OTHER INTANGIBLES: SEE AMOUNT ON IRS FORMS 926, PART III. 5. TRANSFER OF FOREIGN BRANCH WITH PREVIOUSLY DEDUCTED LOSSES: N/A A. BRANCH OPERATION. B. BRANCH PROPERTY. C. PREVIOUSLY DEDUCTED LOSSES. D. CHARACTER OF GAIN IN ACCORDANCE WITH SEC. 1.367(A)-6T(C)(1). N/A ------------------------------------------------------------------------- FORM 926, STATEMENT PURSUANT TO TREASURY REGS. SEC. 1.351-3T(A) AND SEC. 1.351-3T(B): APPLICABLE TO ALL IRS FORMS 926 WHERE SCLHS IS A SIGNIFICANT TRANSFEROR. BY: SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. EIN: 23-7379161 YEAR ENDED DECEMBER 31, 2011. 1. NAME AND EIN (IF ANY) OF TRANSFEREE CORPORATION(S): SEE FORMS 926, PART II, LINES 3 AND 4. 2. DATE(S) OF THE TRANSFER(S) OF ASSETS: VARIOUS DATES. SEE FORMS 926, PART III. 3. IMMEDIATELY BEFORE THE EXCHANGE, THE PROPERTY TRANSFERRED BY THE TRANSFEROR IN EXCHANGE HAD AN: (A) AGGREGATE FAIR MARKET VALUE OF: SEE FORMS 926, PART III 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 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, 2011. 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). ------------------------------------------------------------------------- HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LOURDES J LAZATIN TITLE:CEO SAINT JOHN'S SANTA MONICA HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ELEANOR L RAMIREZ TITLE:COO SAINT JOHN'S SANTA MONICA HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHERIE L GORBY TITLE:COO ST MARY'S GRAND JUNCTION HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BAIN J FARRIS TITLE:CEO SAINT JOSEPH DENVER HOURS:40 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 501(c)(3) 3 SCLHS true ST FRANCIS HEALTH CENTER FOUNDATION 1700 SW 7TH STREET TOPEKA KS 66606 481092520 SUPPORT 501C3 KS 501(c)(3) 11A-TYPE I SFHC true ST MARYS HOSPITAL & MEDICAL CENTER INC 2635 N 7TH STREET GRAND JUNCTION CO 81502 840425720 HEALTHCARE CO 501(c)(3) 3 SCLHS true ST MARYS HOSPITAL FOUNDATION 2635 N 7TH STREET GRAND JUNCTION CO 81502 237001007 SUPPORT 501C3 CO 501(c)(3) 11A-TYPE I SMHMC true SAINT JOSEPH HOSPITAL FOUNDATION 1835 FRANKLIN STREET DENVER CO 80218 840735096 SUPPORT 501C3 CO 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MONICA BLVD SANTA MONICA CA 90404 954291515 CANCER R&D CA 501(c)(3) 4 SJHHC true SAINT JOHNS HOSPITAL & HLTH CENTER FNDTN 2121 SANTA MONICA BLVD SANTA MONICA CA 904042091 956100079 SUPPORT 501C3 CA 501(c)(3) 11A-TYPE I SJHHC true EXEMPLA INC FKA LUTHERAN HOSPITAL 2420 W 26TH AVE SUITE 100D DENVER CO 80211 841103606 HEALTHCARE CO 501(c)(3) 3 SCLHS true EXEMPLA LUTHERAN MEDICAL CENTER FNDTN 2480 W 26TH AVESUITE 360B DENVER CO 80211 208846152 SUPPORT 501C3 CO 501(c)(3) 7 EXEMPLA INC true EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN 200 EXEMPLA CIRCLE LAFAYETTE CO 80026 841649162 SUPPORT 501C3 CO 501(c)(3) 7 EXEMPLA INC true LUTH MED CNTR PRO&GEN LIAB SELF-INS TRST 2480 W 26TH AVESUITE 360B DENVER CO 80211 742571584 INSURANCE CO 501(c)(3) 11A-TYPE I EXEMPLA INC true SAINT JOSEPH HOSPITAL 1835 FRANKLIN STREET DENVER CO 80218 840417134 HEALTHCARE CO 501(c)(3) 3 SCLHS true MOUNT ST VINCENT HOME INC 4159 LOWELL BOULEVARD DENVER CO 80211 840405260 RES CARE CO 501(C)(3) 11A-TYPE I SCLHS true 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