2012-04-11T16:40:52-05:00 2011-05-31 Eide Bailly LLP 800 Nicollet Mall Ste 1300 Minneapolis MN 554027033 990 2010-06-01 810233121 St Peter's Hospital STPE 4064442100 2475 Broadway Helena MT 59601 Tom Gregg 4064442100 2012-04-09 1 Kim C Hunwardsen 6122536500 2012-04-09 2010 2016-02-24 21:20:13Z Tom Gregg 2475 Broadway Helena MT 59601 242056103 0 X www.stpetes.org X 1883 MT Provide exceptional and compassionate health care. 16 13 1219 92 645972 0 882438 2080000 134569173 144987588 3656103 3813556 81866 75646 139189580 150956790 0 50458 0 0 59650206 65776330 0 0 326920 69810304 73975436 129460510 139802224 9729070 11154566 216324765 233863046 74218407 75498434 142106358 158364612 X St. Peter's Hospital partners with our patients, community, and medical staff to provide exceptional and compassionate health care. 1 0 89302961 50458 116885704 St. Peter's Hospital is a 122-bed acute care hospital facility serving residents of Lewis and Clark County and portions of Jefferson, Broadwater, Meagher and Powell Counties. St. Peter's is the sole facility in the primary service area. During the year ended May 31, 2011 the Hospital provided at cost a total of $15,538,985 in community benefit. Of this total $4,642,272 was for medical services to individuals who were determined unable to purchase such services under the Hospital's charity care policy. In addition to free care and/or subsidized care, care is also provided at below cost rates to persons covered by governmental programs. The total operating loss for providing care to Medicaid patients was $1,626,539. The Hospital provided $8,819,976 in subsidized health services during the year, including acute patient care for medical, surgical, pediatric and behavioral health patients, outpatient pharmacy, pulmonary rehab, dialysis, clinical nutrition, anticoagulation, and hospitalists services, physician clinics and in-home nursing and oxygen services. To fulfill its mission of community service, the Organization provides care to patients who meet certain criteria under its charity care policy without charge or at amounts less than its established rates. Because the Organization does not pursue collection of amounts determined to qualify as charity care, they are not reported as patient service revenue. 23999528 27455912 The Hospital operates several physician clinics, employing 39 physicians. Without the Hospital's assistance, Lewis and Clark County would be without many needed medical and surgical specialties. Physicians in the specialties of Family Practice, Internal Medicine, Neurology, Rheumatology, Gastroenterology, ENT, Cardiology, Radiation and Medical Oncology had approximately 79,800 patient encounters. 113302489 1 1 0 1 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 1 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 124 0 1 1219 1 1 1 0 0 0 0 0 0 0 0 0 X 16 13 0 0 0 0 0 1 0 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X John Green CFO 4064442100 2475 Broadway Helena MT 59601 X Tom Harlen 1.00 X X 0 0 0 Peter Johnson 1.00 X X 0 0 0 Patty Nelson 1.00 X X 0 0 0 Candace Cain 1.00 X X 0 0 0 John Solheim 40.00 X X 485191 0 96902 Rick Hayes 1.00 X 0 0 0 Dr Thomas Weiner 40.00 X 1330645 0 44004 Dr David Lechner 40.00 X 214978 0 28739 Kate McIvor 1.00 X 0 0 0 Mary Sheehy-Moe 1.00 X 0 0 0 John Flink 1.00 X 0 0 0 Mathew Rude 1.00 X 0 0 0 Andrew O'Neill 1.00 X 0 0 0 Tom Strizich 1.00 X 0 0 0 Maria Braman 1.00 X 0 0 0 Roger Stone 1.00 X 0 0 0 Dr John Michelotti 1.00 X 0 0 0 John Green 40.00 X 217054 0 31969 Dr Michael Lee 40.00 X 715721 0 27760 Dr John Ribic 40.00 X 499698 0 16993 Dr Carla Kingsley 40.00 X 463785 0 28324 Dr Scott Pargot 40.00 X 636368 0 28554 Dr Kris Godlewski 40.00 X 547807 0 10505 5111247 0 313750 61 0 1 0 Horizon Mental Health Management PO Box 840839 Dallas TX 75284 Management Services 1561712 Capital Medical Anesthesia PO Box 5179 Helena MT 59601 Anesthesia Services 705000 Dick Anderson Construction 3424 Highway 12 E Helena MT 59601 General Contractor 558144 Arup Laboratories 500 Chipeta Way Salt Lake City UT 84108 Lab Testing Services 500798 Medical Information Technology Meditech Circle Westwood MA 02090 Software Support 340409 29 1975000 90000 15000 2080000 Patient service revenu 622110 96161731 96161731 Pharmacy 446110 46001821 46001821 Income from joint vent 900099 648547 685870 -37323 Cafeteria 722210 581619 569408 12211 Other services 900099 567504 567504 1026366 922786 103580 144987588 1261489 1261489 211961 123056 201991 57380 9970 65676 75646 75646 93392009 90734749 105193 2657260 -105193 2552067 2552067 150956790 144341616 645972 3889202 50458 50458 2457332 1482234 975098 49925772 40475002 9234599 216171 3750133 2839919 897423 12791 6331155 4777305 1509358 44492 3311938 2553129 743778 15031 1329952 1329952 244970 51073 193897 66105 66105 36000 36000 394972 394972 8757352 6036812 2714743 5797 229538 25953 188842 14743 1592926 655878 929344 7704 1080677 258112 822565 2068166 559541 1504995 3630 227815 85670 140588 1557 223222 95819 127403 2137292 2137292 8758025 6109581 2648444 2204368 1971850 232518 Medical Supplies, other 35442794 34875154 562636 5004 Bad Debt Expense 7732051 7732051 Bed Tax 1138250 1138250 Other Taxes 221219 162810 58409 89742 35936 53806 139802224 113302489 26172815 326920 13010037 18987821 17824816 16266602 3039728 3544429 2574744 2546358 170377521 71675407 95238018 98702114 65080629 69687326 19094926 23688744 0 461867 439652 216324765 233863046 10376622 14234992 47537585 44942031 16304200 16321411 74218407 75498434 X 130700567 147252230 3752011 3384821 7653780 7727561 142106358 158364612 216324765 233863046 X 11154566 5103688 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 1 500 0 0 1 1000 0 1 29500 31000 0 Explanation of Other Lobbying Activities: Part II-B, Line 1i: The hospital hired a consultant to provide lobbying services in connection with governmental affairs representation to ensure hospital, community, and employee interests and needs are represented. 9692852 127911 1052329 163165 10709927 7514363 1405761 928225 155497 9692852 9393554 630667 -2297705 212153 7514363 0.79000 0.21000 0 1 1 3751023 3751023 95186658 22177354 73009304 67334001 48207982 19126019 4105839 1290071 2815768 98702114 Investment in Joint Ventures 6971208 F Interest in St. Peter's Foundation 11355818 F LTD Class Investments 3802241 F Partnership Investments 1559477 F 23688744 Estimated third-party settlements 2132312 Liability for Pension benefits 14189099 16321411 Description of Intended Use of Endowment Funds: Part V, Line 4: Endowment funds are restricted for support of hospital programs and services and for capital purchases and improvements in accordance with board policies and/or donor restrictions. Description of Uncertain Tax Positions Under FIN 48: Part X: The Organization undergoes an annual analysis of its various tax positions for all entities, assessing the likelihood of those positions being upheld upon examination with relevant tax authorities. As of May 31, 2011 and 2010, the unrecognized tax accrual benefit is zero. The Organization will recognize future accrued interest and penalties related to unrecognized tax benefits in income tax expense, if incurred. The Organization is no longer subjet to Federal or state tax examinations by tax authorities for years before 2008. 1 1 X 1 X 1 X 1 1 1 0 1 1 15829 5069301 427029 4642272 0.03320 13493 7620761 5994222 1626539 0.01160 29322 12690062 6421251 6268811 0.04480 53121 671153 297995 373158 0.00270 210 77040 77040 0.00060 39542933 30722957 8819976 0.06310 47479 47479 0.00030 53331 40338605 31020952 9317653 0.06670 82653 53028667 37442203 15586464 0.11150 1 2977667 0 44312057 49864969 -5552912 X 1 1 1 Helena Surgicenter LLC Surgery Center 0.50000 0.09150 0.05290 1 1 St Peter's Hospital

2475 Broadway Helena MT 59601

X X X Physician clinics & Urgent Care Services Not required 1 2 Hospice and Homelink of St Peter's Hosp

201 South California Helena MT 59601

Hospice and home health APEX of St Peter's Hospital

201 South California Helena MT 59601

Home oxygen services Part I, Line 6a: The organization's community benefit report can be found on its website at www.stpetes.org. Part I, Line 7: Charity Care, Unreimbursed Medicaid and Subsidized Health Services are converted to cost using the cost to charge ratio derived from the Hospital's cost allocation system. The cost allocation system addresses all patient segments. The costs are estimated by allocating departmental costs based on direct costs less any other operating revenue then an allocation of benefits, depreciation and other overhead costs. Community health improvement services, health professions education and cash and in-kind contributions is derived from the CBISA program. Part I, Line 7g: Subsidized health services includes $23,976,079 of costs attributable to a physician clinic. Part I, L7 Col(f): The amount of bad debt expense removed from the denominator of the calculations was $7,732,051. Part III, Line 4: Bad debt expense is calculated at cost using the cost of charge ratio derived from Worksheet 2.Bad debt expense is reported net of discounts and contractual allowances. A payment on an account previously written off reduces bad debt expense in the current year.Financial statement footnote:Patient receivables are uncollateralized patient and third-party payor obligations. The Organization charges interest at 10 percent per annum on past due accounts after 90 days. Payments of patient receivables are allocated to the specific claims identified on the remittance advice or, if unspecified, are applied to the earliest unpaid claim. The carrying amount of patient receivables is reduced by a valuation allowance that reflects management's best estimate of amounts that will not be collected from patients and third-party payors. Management reviews patient receivables by payor class and applies percentages to determine estimated amounts that will not be collected from third parties under contractual agreements and amounts that will not be collected from patients due to bad debts. Management considers historical write off and recovery information in determining the estimated bad debt provision. Part III, Line 8: These expenses represent an overall shortfall of the direct Medicare patient population. The costs themselves are therefore a community benefit as the community would not receive these services if we did not provide them. Total Medicare revenue and Medicare allowable costs of care are calculated using a cost allocation method. Part III, Line 9b: St. Peter's Hospital recognizes its responsibility to render necessary health care services to all persons in need of such care, regardless of race, creed, color or economic circumstances. St. Peter's Hospital recognizes that payment for services rendered is due and payable at the time of service. The hospital accepts insurance assignments and some other approved arrangements for delayed payment. Financial assistance is available for all qualified patients. Patients not covered by insurance or unable to pay in full for services rendered must contact the appropriate Patient Account Representative who will assist the patient and/or family in determining if he/she qualifies for patient assistance. Collection activity will be suspended while a financial assistance application is under review. Part VI, Line 2: St. Peter's Hospital conducts a Community Survey every two years. The Community Survey is performed by an independent contractor that selects an adequate sample size for the area. The homes of St. Peter's Hospital employees are excluded from the survey. The survey includes questions related to evaluating the community's experience and ability to access Healthcare. The survey helps to identify specialty areas of concern. The results of the surveys are reviewed by the Senior Management team as well as the Board to identify the areas of focus. Part VI, Line 3: St. Peter's Hospital (1) posts its charity care policy on its web site as well as at the Admitting Desk, Emergency Room and Cashier areas in which eligible patients are likely to be present; (2) offers a summary of our policy and application to self pay patients with contact information to patients as part of the intake process; (3) provides a copy of financial assistance contact information to patients with discharge materials; (4) Financial counselors discuss with patients expecting to owe more than $500 the availability of patient assistance and various government benefits, such as Medicaid or state programs, and assists the patient with qualification for such programs, where applicable. Part VI, Line 4: St. Peter's Hospital is a 122-bed acute care hospital facility serving residents of Lewis and Clark County and portions of Jefferson, Broadwater, Meagher and Powell Counties. St. Peter's is the sole facility in the primary services area. The hospital financial payor mix consisted of 6.4% self pay patients, 6.9% of Medicaid patients and 44.4% Medicare patients. Approximately 15.6% of the population is age 65 and older. The average per capita income is $27,583 and approximately 12.1% of the population is below the federal poverty level. The nearest hospital in the area is approximately 35 miles from St. Peter's campus. Part VI, Line 6: The organization's governing body members reside in the community. Medical staff priviledges are extended to all qualified physicians in the community. Surplus funds are used to make capital purchases and upgrades to the facilities.St. Peter's Hospital is the sole acute care provider in the primary service area made up of Lewis & Clark County and the northern portion of Jefferson County. There is a population of approximately 74,800. Out-migration is generally limited to tertiary services not available at St. Peter's Hospital including cardiac surgery and neo-natal care. St. Peter's Hospital provides care to all patients regardless of their ability to pay. St. Peter's Hospital maintains charges as one of the lowest Hospitals within the State depending on the services being provided. St. Peter's Hospital sponsors several wellness screenings, health fairs and educational lectures, classes, and events throughout the year to promote better living, nutrition and good health. Continuing education is also provided to the members of the medical community on an on-going basis. In addition, St. Peter's Hospital had 14,037 volunteer hours from the community assisting in a variety of roles within the organization.St. Peter's Hospital made $47,479 of cash and in-kind donations to a variety of organizations within the community. This includes but is not limited to CR Anderson Middle School for its honor student program, Angel Fund to purchase clothing and school supplies for youth, Helena High School for Soccer Tent, Healthy Mother's/Healthy Babies, HOSA, Friendship Center, Florence Crittenton, YMCA, God's Love, Carroll College Athletics with emergency services at events, Carroll College Nursing Department with medical supplies needed for learning labs, Exploration Works with medical supplies needed for student science experiments, United Way to assist low-income and homeless residents with basic needs, Spirit of Service Campaign by providing supplies and volunteers to help elderly residents and others with special needs improve their homes and yards, Kay McKenna Youth Foundation to provide safe summer youth activities, Archie Bray Foundation, Helena Food Share program for back pack program in the schools and Big Brothers and Sisters. The donations were made to assist these Community Sponsors in their various programs. 1 X Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: As determined by the Public Relations Director and the CEO, the organization financially supports other community organizations in support of their programs that enrich health and safety to the community. Due to knowledge of the recipients and the purpose of the grants, further monitoring on the use of the funds was not deemed necessary. X X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 John Solheim 342270 0 114987 0 27934 0 61925 0 34977 0 582093 0 0 0 Dr Thomas Weiner 1328490 0 0 0 2155 0 14700 0 29304 0 1374649 0 0 0 Dr David Lechner 204424 0 10000 0 554 0 13406 0 16827 0 245211 0 0 0 John Green 169414 0 37572 0 10068 0 13435 0 26634 0 257123 0 0 0 Dr Michael Lee 714887 0 0 0 834 0 14700 0 14780 0 745201 0 0 0 Dr John Ribic 497718 0 0 0 1980 0 14700 0 3160 0 517558 0 0 0 Dr Carla Kingsley 462771 0 0 0 1014 0 14700 0 14541 0 493026 0 0 0 Dr Scott Pargot 630368 0 6000 0 0 0 14700 0 14856 0 665924 0 0 0 Dr Kris Godlewski 486935 0 60000 0 872 0 0 0 11162 0 558969 0 0 0 Part I, Line 1a President/CEO receives reimbursement for membership dues paid to a social club, an annual community support allowance and a car allowance. The President/CEO is taxed on the personal mileage that he uses. All amounts are reported as taxable compensation. Part I, Line 4b John Solheim, Tom Weiner, and Kris Godlewski participate in a nonqualified retirement plan under 457(f). Amounts from their base wages were deferred into their plan at their discretion. The organization did not contribute money into the plan on behalf of the individuals named above. Montana Facility Finance Authority 810302402 61204JBR4 2004-05-06 29748183 To fund expansion and renovation of existing Hospital facility. 0 0 0 Montana Facility Finance Authority 810302402 61204JBY9 2007-03-22 22826511 To fund new Medical Office Building and Women and Children's Unit Bed Wing. 0 0 0 2720000 29748183 2242316 2973582 422346 27111925 2008 0 0 1 1 5245000 22826511 2509328 465447 7154609 353863 14743608 2009 1 0 1 1 0 0 0 0 0.00000 0.00000 0.00000 1 0 0 0 0 0.00000 0.00150 0.00150 1 0 0 0 0 0 0 0 0 0 0 0 0 New West Healthcare Services Mr. Solheim is Hospital representative on the New West Board 5690718 Hospital pays health insurance premiums to New West. 0 New Program Services Form 990, Part III, line 2 During the current year two Orthopedic Surgeons from the Helena area, sought employment with St. Peter's Hospital. One of the surgeon's is a pediatric surgeon. In addition, St. Peter's Hospital recruited a Pain Management Physician. Form 990, Part VI, Section A, line 1 The Executive Committee consists of the officers of the Board of Directors, Past Chair of the Board provided he/she continues to be a Director, and the Chief of Staff. If the Past Chair of the Board is unable to serve, the Board Chair may appoint another member to the Executive Committee. The Executive Committee has the power to transact all regular business of the Hospital during the interim between meetings of the Board of Directors, provided that any action does not conflict with the policies of the Board of Directors and all matters of major importance are referred to the Board of Directors. Should any matter of extreme urgency arise between the regular meetings of the Board of Directors, it is the duty of the Executive Committee to request the President call a special meeting of the Board of Directors. Minutes of the Executive Committee are submitted to the Board of Directors and its actions are subject to approval or disapproval at the next regular Board meeting. The Committee is responsible for conducting the President's evaluation, setting the President's compensation and negotiating the terms of the President's employment contract. Form 990, Part VI, Section A, line 7a The Nominating Committee solicits qualified candidates for membership on the Board of Directors and presents a slate to the Board of Directors with one candidate for each position to be filled. Members of the Board of Directors may submit the names of potential candidates to the Nominating Committee for the Committee's consideration. The Nominating Committee's slate of potential candidates is submitted to the Board at the Board of Director's Annual Meeting. Six members of the Board of Directors serve by virtue of the offices and for the duration of the time they remain in office; The Bishop of the Episcopal Diocese of Montana or his designee; the President and Chief Executive Officer of the Hospital, the Chief-of-Staff of the Hospital, the St. Peter Medical Group President, and the St. Peter's Foundation Chair. Form 990, Part VI, Section B, line 11 A rough draft of the Form 990 is reviewed by the CEO and CFO as well as the Finance Committee prior to full board approval of the final Form 990 prior to filing. Form 990, Part VI, Section B, line 12c The conflict of interest policy covers all board members, officers, senior administration and key employees. The Board identifies potential conflicts and determines if voting on related items would be a conflict of interest If a conflict is determined to exist, the conflicted individual is excluded from voting on the conflicted item. Form 990, Part VI, Section B, line 15 An independent compensation consultant performs a review of salaries and benefits using data from comparable healthcare facilities. A report is prepared and presented to the Executive Committee of the Board of Directors, which uses the report to determine officer and senior management compensation. The information is then reviewed with the Board of Directors. The annual process was performed during 2010. Form 990, Part VI, Section C, line 19 The governing documents, conflict of interest policy, and financial statements are made available to the public upon request. Form 990, Part VII: Mathew Rude and John Solheim serve a related organization 1 hour per week. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 6,191,541. Minimum pension liability adjustment -474,876. Change in permanently and temporarily restricted net assets of foundation -293,409. Book/Tax adjustment for partnerships -319,568. Total to Form 990, Part XI, Line 5: 5,103,688. Listing of all CUSIP#'s associated with bond issuance Schedule K, Part I, Bond A, CUSIP#'s for Series 2007 Bond 61204J BY9, 61204J BS2, 61204J BTO, 61204J BU7, 61204J BV5, 61204J BW3 Listing of all CUSIP#'s associated with bond issuance Schedule K, Part I, Bond A, CUSIP#'s for Series 2004 Bond 61204J BR4, 61204J AX2, 61204J AY0, 61204J AZ7, 61204J BA1, 61204J BB9, 61204J BC7, 61204J BD5, 61204J BE3, 61204J BF0, 61204J BG8, 61204J BH6, 612047J BL7 Form 8621, Part IV St. Peter's Hospital is filing Form 8621 as a shareholder in passive foreign investments companies. St. Peter's Hospital distribution is not taxable and therefore not included on Part IV of Form 8621. The amount of non-taxable distribution from each fund is identified below. Coast Access Ltd $0 Cyrus Access Ltd $0 Detour Gold Corporation $61 Gabriel Resources LTD $185 Osisko Mining Corporation $17 Western Copper Corp $5 Douban, Inc. $0 St Peter's Hospital Foundation 2475 Broadway Helena MT 59601 810392270 Raise funds to support St. Peter's Hospital MT 501(c)(3) Line 11a, I St Peter's Hospital 1 Peak Health LLC 2475 Broadway Avenue Helena MT 59601 271863807 Health club MT N/A Unrelated 1768 1989117 0 1768 0 0.65000 Peak Health Realty LLC 2475 Broadway Avenue Helena MT 59601 272492966 Rental property MT N/A Unrelated -20754 62437 0 -20754 0 0.65000 Peak Health Helena LLC 2475 Broadway Avenue Helena MT 59601 271863807 Health club MT N/A Unrelated -18337 -16042 0 -18337 0 0.65000 0 0 1 0 0 0 0 0 1 0 0 1 0 1 1 1 0 1 St Peter's Hospital Foundation C 1975000 Contributions received St Peter's Hospital Foundation N 288485 Employee compensation and benefit Peak Health LLC N 144270 Employee compensation and benefit Peak Health Realty LLC Peak Health Helena LLC