2012-11-16T12:23:42-06:00 2011-12-31 BRUCE E BERNSTIEN & ASSOC PC 10440 N CENTRAL EXPRESSWAY STE 1040 DALLAS TX 75231 990 2011-01-01 480543768 SAINT JOHN HOSPITAL INC % DAVID DULNY SAIN 9136806000 3500 South Fourth Street Leavenworth KS 66048 RANDALL NYP 2012-11-14 true BRUCE E BERNSTIEN 2147060840 2011 2016-02-24 21:20:13Z dan sheehan 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 34260259 false 0928 X www.providence-health.org/sjh X 1974 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. 12 11 421 25 1089 9648 18088 34852121 34138182 23320 66039 31632 37950 34916721 34260259 14000 13500 0 0 18643171 17950092 0 0 0 19947890 18806249 38605061 36769841 -3688340 -2509582 19571211 17502627 4708432 4637644 14862779 12864983 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 25978164 34138182 IT IS THE PHILOSOPHY OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND AFFILIATED HOSPITALS TO TREAT PATIENTS IN A NON-DISCRIMINATORY MANNER, MINIMIZE HUMAN SUFFERING AS MUCH AS POSSIBLE; CREATE A PREFERENTIAL OPTION FOR THE POOR; AND PROVIDE ASSISTANCE TO THOSE PATIENTs WHO HAVE LIMITED FINANCIAL RESOURCES. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAMs AND AS SUCH PROVIDE CARE AT REIMBURSEMENT LEVELS LOWER THAN CHARGES. THE DIFFERENCE BETWEEN REIMBURSEMENT FROM THESE PROGRAMS AND CHARGES AT ESTABLISHED RATES Are INCLUDED IN THE HOSPITAL's MISSION In SERVICE TO the COMMUNITY WHICH IT OPERATES. TO THAT END, THE HOSPITAL HAS INSTITUTED AND PARTICIPATES IN THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES; PROVIDES LABORATORY, RADIOLOGICAL, AND PHARMACEUTICAL SERVICE AT DUCHESNE CLINIC. DUCHESNE CLINIC IS A CLINIC FOR THE CARE OF THE MEDICALLY INDIGENT. COMMUNITY HEALTH SERVICES are PROVIDED AT MINIMAL OR NO CHARGE: CHOLESTERAL SCREENING, BLOOD SUGAR SCREENING, SIBLING PREPARATION, LAMAZE CHILDBIRTH CLASSES, CANcER SUPPORT, GROUP STROKE SUPPORT GROUp, BREAST FEEDING SUPPORT, HEARING SCREENING, CESAREAN BIRTH CLASSES, FREEDOM FROM SMOKING, COLORECTAL SCREENING, NUTRITIONAL COUNSELING; HOSPITAL CARE: INPATIENT DAYS OF CARE, INPATIENT ADMISSIONS, NEWBORN DELIVERIES, OUTPATIENT REGISTRATIONS, EMERGENCY ROOM VISITS, CLINIC VISITS. 25978164 true true false false false false false false false true true true false false true false false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 55 0 true 421 true false false false false false false false false false false X 12 11 false true false false true true true true true false false true true true true true true false false false X DAVID DULNY 9135964835 8929 PARALLEL PARKWAY Kansas City KS 66112 X BRENDA CALVIN 1.0 X 0 0 0 DANIEL CRABTREE 1.0 X 0 0 0 DR L DUGAN MD 1.0 X 0 0 0 DORIS F GIVENS PHD 1.0 X 0 0 0 MARY LOU JARAMILLO 1.0 X 0 0 0 RANDALL NYP 1.0 X X 0 113865 164 DR MICHAEL PARRA MD 1.0 X 0 0 0 WILLIAM PETRIE 1.0 X 0 0 0 ROY L ROBINSON 1.0 X X 0 0 0 SABATO SISSILLO MD FCCP 1.0 X 0 0 0 DIANE MARIE STEELE SCL 1.0 X X 0 0 0 RICKY D TURNER 1.0 X X 0 0 0 JOE JEANS 10.0 X 0 179894 43730 DANIEL SHEEHAN 40.0 X 0 145712 32505 MICHAEL A DORSEY 9.5 X 0 352700 30440 JUANITA ROY 10.0 X 0 292006 35184 DR MARC LUCKETT 40.0 X 331039 0 0 CAROLYN BOWMER 10.0 X 0 171245 17211 JAN YERGAN 10.0 X 0 296171 17641 BARRY SOLOMON 40.0 X 0 286335 54345 GEORGE NOONAN 40.0 X 0 184328 27599 JAMES PAQUETTE 0.0 X 0 738527 123111 BAIN FARRIS X 0 553036 99532 331039 3313819 481462 5 true true false anesthesiology chartered 5600 W 95TH STREET SUITE 123 OVERLAND PARK KS 66207 ANESTHESIOLOGY SVCS 1755712 sisters of charity of leavenworth 9801 renner blvd ste 100 LENEXA KS 66219 mgmt & it support 1444920 covenant group pa 14400 COLLEGE BLVD STE 100 OVERLAND PARK KS 66215 er physician svcs 536659 horizon health 2941 south lake vista dr LEWISVILLE TX 75067 mgmt of gerio psych 415305 midwest vascular access 125325 6 18088 18088 PATIENT CARE REVENUE 621500 33734851 33733762 1089 CAFETERIA/VEND 722210 46732 46732 MOB RENTAL INCOME 531120 251823 251823 OTHER 900099 104776 104776 34138182 46754 46754 0 0 19285 19285 19285 19285 0 0 0 MEDICAL STAFF 541900 37950 37950 37950 34260259 33771712 1089 469370 13500 13500 0 0 0 0 0 14911856 13839198 1072658 0 551943 551943 1525554 1480319 45235 960739 937540 23199 1560470 25476 1534994 -3268 -3268 0 0 0 0 5533808 4922067 611741 203623 203623 116294 114234 2060 245205 213093 32112 0 223614 222673 941 21277 7010 14267 0 3737 3294 443 72877 72877 0 2065983 2065983 232123 22295 209828 BAD DEBTS 3244257 3244257 PHARMACEUTICALS 980099 933208 46891 UTILITIES 515361 515361 NON-MEDICAL SUPPLIES 186375 186375 3604414 3604414 36769841 25978164 10791677 0 0 0 -389413 908400 0 0 5738568 4273366 0 0 0 0 0 0 799051 776856 207488 202309 37391321 27363318 10455954 10028003 0 0 2697282 1247321 0 0 0 0 62281 66372 19571211 17502627 2683233 2991015 0 0 0 0 0 0 0 0 0 0 1605816 1473299 0 0 419383 173330 4708432 4637644 X 14862779 12864983 0 0 0 0 14862779 12864983 19571211 17502627 X -2509582 511786 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 926607 7655 17123 3000 948385 871512 3900 88300 37105 926607 736128 1250 138884 4750 871512 953198 1850 -209520 9400 736128 0.78950 0.21050 0.00000 false true true 110861 110861 19162256 12557103 6605153 17907253 14449001 3458252 210951 357214 -146263 10028003 INVESTMENTS 1247321 F 1247321 0 EST 3RD PARTY SETTLEMENT 173330 173330 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS Retained endowment funds are intended to support indigent care, provide nursing scholarships, and to be used for the general support of the hospital at the discretion of the board. Endowment funds are held by Providence/Saint John Foundation. true true X true X true X true true false true true 3715 1273936 0 1273936 0.03800 3864 4076251 4050802 25449 0.00010 7579 5350187 4050802 1299385 0.03810 3 152 12046 0 12046 0.00040 1 500 0 500 4 152 12546 0 12546 0.00040 4 7731 5362733 4050802 1311931 0.03850 true 1150470 10349534 12499524 -2149990 X true true 1 1 SAINT JOHN HOSPITAL INC

3500 SOUTH FOURTH STREET LEAVENWORTH KS 66048

X X X SAINT JOHN HOSPITAL INC 1 true true 200. true 200. true X true true X X true X X true X X X true X false true 5 SAINT JOHN MEDICAL OFFICE BUILDING

3550 SOUTH FOURTH STREET LEAVENWORTH KS 66048

MEDICAL OFFICE BUILDING associate in family healthcare

712 first terrace LANSING KS 66043

PRIMARY CARE PRACTICE/stat lab st john obgyn

3550 south 4th st leavenworth KS 66048

primary care practice primary care practice

1004 progress dr ste 200 lansing KS 66043

primary care practice st john rock creek imaging center

712 1st terrace b lansing KS 66043

outpatient imaging center determining eligibility form 990, sch h, part i, line 3c: PART I, LINE 7, METHODOLOGY FOR COMPUTING THE COST OF CHARITY AND UNREIMBURSED MEDICAID COST WAS BASED ON THE CATHOLIC HOSPITAL ASSOCIATION GUIDE FOR PLANNING AND REPORTING OF COMMUNITY BENEFITS, APPENDIX D, WORKSHEET 2. THIS METHODOLOGY COMPUTES A COST TO CHARGE RATIO USING TOTAL OPERATING EXPENSES INCLUDING BAD DEBT EXPENSE AND EXCLUDING MEDICAID PROVIDER TAXES. THIS AMOUNT IS REDUCED BY OTHER OPERATING REVENUE TO ARRIVE AT NET EXPENSE. NET EXPENSE AS A PERCENTAGE OF GROSS PATIENT REVENUE IS THE PERCENTAGE USED TO COMPUTE THE COST OF CHARITY AND UNREIMBURSED MEDICAID COST. OTHER BENEFITS (INCLUDING COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS ARE CALCULATED BASED ON THE ACTUAL COST TO DELIVER THESE SERVICES. FOR DONATIONS OTHER THAN MONETARY (IE STAFF TIME AND IN-KIND DONATIONS), THE COSTS ARE DETERMINED BASED ON FAIR MARKET VALUE OF THE DONATION. THIS INFORMATION IS TRACKED ON CBISA, A SOFTWARE DATABASE EXCLUSIVELY USED TO TRACK COMMUNITY BENEFIT REPORTING. NET COMMUNITY BENEFIT EXPENSE IS CALCULATED AS A PERCENTAGE OF TOTAL EXPENSES EXCLUDING BAD DEBT OF $3,448,832. community building activities form 990, sch h, part ii: OUR COMMUNITY BUILDING EXPENSES ARE THOSE IDENTIFIED IN OUR COMMUNITY HEALTH ASSESSMENT AS CONTRIBUTING TO THE HEALTH OF THE COMMUNITY, BUT NOT DIRECTLY PROVIDING HEALTH SERVICES. bad debt, medicare & collection practices form 990, sch h, part iii, section a, line 4: THE COSTING METHODOLOGY USED TO CALCULATE THE COST OF GROSS BAD DEBT EXPENSE WAS BASED ON THE COSTING METHODOLOGY IN THE INSTRUCTIONS TO SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. LINE 11 OF WORKSHEET 2 (RATIO OF PATIENT CARE COST TO CHARGES) WAS MULTIPLIED AGAINST THE GROSS BAD DEBT EXPENSE TO ARRIVE AT THE COST OF BAD DEBT EXPENSE. BAD DEBT EXPENSE REPRESENTS THE UNPAID PORTION OF THE GROSS CHARGES (AT ESTABLISHED RATES) LESS PAYMENTS FROM 3RD PARTY PAYORS AND THE PATIENT AND ANY CONTRACTUAL ADJUSTMENTS. THE HOSPITAL DOES NOT PROVIDE ANY PROMPT PAY DISCOUNTS FOR PAYING THE PATIENT PORTION OF THE BALANCE OF THEIR ACCOUNT WITHIN A SPECIFIED TIMEFRAME. SOME ACCOUNTS WRITTEN OFF TO BAD DEBTS WHICH ARE SENT TO THE HOSPITAL'S COLLECTION AGENCIES ARE SUBSEQUENTLY RECLASSIFIED TO CHARITY. ACCOUNTS THAT ARE CLOSED BY THE COLLECTION AGENCY BASED ON THE AGENCY'S ASSESSMENT OF THE PATIENT AND\OR GUARANTOR'S FINANCIAL POSITION (I.E. UNEMPLOYED, NO ASSETS, ETC.) ARE RECLASSIFIED TO CHARITY EXPENSE ONCE THAT DETERMINATION IS MADE. ACCOUNTS WRITTEN OFF TO BAD DEBT EXPENSE IN CY 2011 AND SUBSEQUENTLY RECLASSIFIED TO CHARITY IN CY 2012 WERE NOT QUANTIFIED AT DECEMBER 31, 2011. THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. WITHIN THE FINANCIAL STATEMENTS OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, BAD DEBT EXPENSE IS INCLUDED WITHIN OPERATING EXPENSES, AT THE VALUE OF UNCOLLECTED AND ESTIMATED UNCOLLECTIBLE CHARGES AFTER CONTRACTUAL ALLOWANCES AND SELF-PAY DISCOUNTS ARE APPLIED. bad debt, medicare & collection practices form 990, sch h, part iii, section b, line 8: THE MEDICARE ALLOWABLE COSTS WERE ARRIVED AT FROM VARIOUS WORKSHEETS C, D AND E OF THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED DECEMBER 31, 2011. THE MEDICARE SHORTFALL INDICATED IN PART III, LINE 7 WAS NOT INCLUDED IN PART I, LINE 7, COMMUNITY BENEFIT. bad debt, medicare & collection practices form 990, sch h, part iii, section c, line 9b: AN INTEGRAL COMPONENT OF OUR MISSION IS TO BE GOOD FINANCIAL STEWARDS. THIS REQUIRES US TO DETERMINE WHICH PATIENTS ARE IN NEED OF CHARITY CARE AND WHICH ARE ABLE TO CONTRIBUTE SOME PAYMENT FOR CARE RECEIVED. WE MAINTAIN A BALANCE THAT ENABLES US TO CONTINUE TO PROVIDE CHARITY CARE TO THOSE WHO NEED IT MOST, AND TO ENSURE THAT WE MANAGE OUR RESOURCES SO THAT WE CAN CONTINUE TO BE HERE WHEN PEOPLE NEED US MOST. SAINT JOHN HOSPITAL NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION, DISCHARGE AND IN COMMUNICATION REGARDING PATIENT BILLS. PATIENTS ARE CONTACTED MULTIPLE TIMES ABOUT UNPAID BALANCES PRIOR TO INITIATING ANY COLLECTION ACTION. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION PROCESS, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED. Measures to publize the policy form 990, sch h, part V, line 13g: The brochures which include policy will be provided to the patients How the hospital charged for emergency or other medically care form 990, sch h, part V, line 19: All patients are charged a standard rate at the time of service. The charge for FAP-eligible patients form 990, sch h, part V, line 21: All patients are charged a standard rate at the time of service. Gross charges are the charges for everyone. NEEDS ASSESSMENT form 990, sch h, part vi, line 2: AS PART OF OUR CORE VALUE OF RESPONSE TO NEED, WE TAKE STEPS TO DETERMINE WHERE THERE IS THE MOST NEED IN ORDER TO PROVIDE THE GREATEST GOOD. SAINT JOHN HAS REGULARLY PARTICIPATED IN NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN 2009, AND ONE IS SCHEDULED TO BE COMPLETED IN 2013. THIS ASSESSMENT STUDIES A DEFINED COMMUNITY SERVED BY SAINT JOHN, AND IS DONE BY PARTNERING WITH LOCAL GOVERNMENT AND SOCIAL AGENCIES; COMBINING EFFORTS WITH OTHER LOCAL HOSPITALS AND HEALTH CARE ORGANIZATIONS; AND CONDUCTING SURVEYS AND ASSESSMENTS WITH THE ASSISTANCE OF OUTSIDE CONSULTANTS. WE ALSO CONTINUOUSLY ASSESS THE NEEDS OF THE COMMUNITY THROUGH CLOSE WORKING RELATIONSHIPS AND PARTNERSHIPS WITH SERVICE AGENCIES IN THE COMMUNITY, AND BY EVALUATING STATE AND COUNTY HEATLH STATISTICS. EVERY YEAR AS A COMPONENT OF THE ANNUAL STRATEGIC PLANNING PROCESS, SAINT JOHN PARTNERS WITH COMMUNITY ORGANIZATIONS INCLUDING THE AMERICAN CANCER SOCIETY, THE AMERICAN HEART ASSOCIATION, THE LEAVENWORTH ECONOMIC DEVELOPMENT COUNCIL AND THE UNITED WAY TO REVIEW STATISTICS REGARDING THE POPULATION AND HEALTH-RELATED TRENDS. THE MOST RECENT SURVEY WAS CONDUCTED IN 2010 AND WILL BE UPDATED AS A PART OF THE 2012 PLANNING PROCESS. IN ADDITION, SAINT JOHN CONDUCTED A PHYSICIAN NEEDS ASSESSMENT OF LEAVENWORTH COUNTY UTILIZING QUANTITATIVE RESEARCH METHODS TO DETERMINE GAPS IN PHYSICIAN SPECIALTY COVERAGE IN THE MARKET. WE ALSO CONTINUOUSLY ASSESS THE NEEDS OF THE COMMUNITY THROUGH CLOSE WORKING RELATIONSHIPS AND PARTNERSHIPS WITH SERVICE AGENCIES IN THE COMMUNITY AND BY EVALUATING STATE AND COUNTY HEALTH STATISTICS. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3: SAINT JOHN HOSPITAL TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. SAINT JOHN HOSPITAL HAS A WRITTEN FINANCIAL ASSISTANCE POLICY THAT EXPLAINS ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE AT VARIOUS LEVELS, INCLUDING A 100% DISCOUNT, AND IS BASED ON FEDERAL POVERTY GUIDELINES. WE WORK WITH PATIENTS TO HELP THEM UNDERSTAND THEIR FINANCIAL RESPONSIBILITY FOR CARE RECEIVED, FINANCIAL ASSISTANCE AVAILABLE TO THEM, AND TO ESTABLISH PAYMENT PROGRAMS IN DEMONSTRATION OF OUR CORE VALUE OF RESPECT. AS PART OF OUR RESPONSIBILITY TO EDUCATE, WE INFORM OUR PATIENTS AND THEIR FAMILIES OF THE AVAILABILITY OF ASSISTANCE, INCLUDING GOVERNMENT PROGRAMS. WE COMMUNICATE THIS IN A VARIETY OF WAYS TO ENSURE THAT MESSAGES REACH MULTIPLE AUDIENCES. BEFORE, DURING AND/OR AFTER ADMISSION, WE ENCOURAGE OUR SELF PAY PATIENTS TO VISIT WITH A FINANCIAL COUNSELOR TO DISCUSS QUALIFICATIONS FOR FINANCIAL ASSISTANCE. THE FINANCIAL COUNSELOR WORKS WITH THE PATIENT TO COMPLETE A FINANCIAL ASSISTANCE FORM TO DETERMINE THE LEVEL OF DISCOUNT FOR WHICH THE PATIENT MAY BE ELIGIBLE. WE POST FINANCIAL ASSISTANCE INFORMATION IN EMERGENCY AND ADMISSIONS AREAS, ON BILLINGS INVOICES, IN VARIOUS AREAS AROUND THE HOSPITAL AND CLINIC SITES AND ON THE HOSPITAL WEBSITE. WE PROVIDE WRITTEN MATERIALS TO PATIENTS THAT DETAIL OUR FINANCIAL ASSISTANCE POLICY AND HOW IT IS ADMINISTERED. THIS COVERS ELIGIBILITY, STEPS TO FOLLOW TO DETERMINE IF A PATIENT QUALIFIES FOR ASSISTANCE, TYPICAL CHARGES A PATIENT MAY EXPECT FOR ROUTINE PROCEDURES, AND ASSISTANCE AVAILABLE BASED ON A PATIENT'S INCOME LEVEL. WE PROVIDE MATERIALS AND EDUCATION WHEN PATIENTS ARE DISCHARGED, AND INCLUDE INFORMATION IN BILLING STATEMENTS, INCLUDING PHONE NUMBERS AND OTHER METHODS TO CONTACT US WITH QUESTIONS. WE ENSURE THAT OUR FINANCIAL COUNSELORS, ADMISSION EMPLOYEES, SOCIAL WORKERS AND OTHER EMPLOYEES UNDERSTAND OUR POLICIES TO BE ABLE TO ASSIST PATIENTS IN THE MOST APPROPRIATE WAY. WE HAVE A PARTNERSHIP WITH THE MIDLAND GROUP TO PROVIDE EXTENDED PAYMENT PLANS. THIS HELPS PATIENTS MEET THEIR FINANCIAL OBLIGATIONS IN A REASONABLE AND DIGNIFIED MANNER BASED ON THEIR ABILITY TO PAY, AND ALLOWS THEM TO CONTINUE TO ENSURE THE ONGOING WELFARE OF THEIR FAMILIES. THIS IS DONE IN ACCORDANCE WITH OUR CORE VALUE OF RESPECT. COMMUNITY INFORMATION SCHEDULE H, PART VI, LINE 4: SAINT JOHN IS PART OF A NATIONAL SYSTEM OF FAITH-BASED HOSPITALS SPONSORED BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM LOCATED IN denver, colorado. THE HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF THE RESIDENTS IN ITS SERVICE AREAS INCLUDING LEAVENWORTH AND WYANDOTTE COUNTIES IN KANSAS. BASED ON RESEARCH FROM CLARITAS, INC., SAINT JOHN'S PRIMARY SERVICE AND SECONDARY SERVICE AREAS ARE EXPECTED TO INCREASE RAPIDLY OVER THE NEXT FIVE YEARS, INCREASING THE NEED FOR SERVICES THESE INDIVIDUALS HISTORICALLY NEED, SUCH AS CARDIOLOGY, NEUROLOGY, ONCOLOGY, ORTHOPAEDIC AND PULMONARY CARE. IN THE HOSPITAL'S PRIMARY SERVICE AREA, 78.1 PERCENT OF THE ETHNIC POPULATION IS WHITE; 12.5 PERCENT IS AFRICAN-AMERICAN; AND 4.2 PERCENT IS HISPANIC. THE HOSPITAL'S SECONDARY SERVICE AREA IS 92.5 PERCENT WHITE. ADDITIONALLY, IN LEAVENWORTH COUNTY, 10.6 PERCENT OF THE POPULATION IS UNINSURED, WITH 42 PERCENT OF THE UNINSURED FALLING UNDER 200 PERCENT OF THE FEDERAL POVERTY LINE. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5: WE ARE AN IMPORTANT PART OF OUR COMMUNITY AND SERVE IN MANY WAYS FROM DELIVERING CORE HEALTH CARE TO PREVENTIVE CARE TO SUPPORT OF OTHER CIVIC GROUPS. IN 2011, WE PROVIDED COMMUNITY BENEFIT TOTALING $1,311,931, INCLUDING TRADITIONAL CHARITY CARE AND THE UNPAID COST OF MEDICAID. OUR BOARD OF DIRECTORS REPRESENTS MEDICAL AND BUSINESS PROFESSIONALS AND ALL PROVIDE HOURS OF SERVICE IN SUPPORT OF OUR HOSPITAL. THEY ARE DEEPLY INVOLVED IN OUR NEEDS ASSESSMENT PROCESS, BUILDING PROGRAMS AND SERVICES, AND COMMUNITY OUTREACH TO ENSURE THAT PEOPLE KNOW ABOUT SERVICES AVAILABLE TO THEM THROUGH OUR HOSPITAL. WHEN SAINT JOHN HAS EXCESS REVENUE OVER OPERATING EXPENSES, WE USE THOSE FUNDS TO OBTAIN CURRENT HEALTH CARE TECHNOLOGIES AND EQUIPMENT, IMPROVE PATIENT CARE, PROVIDE MEDICAL TRAINING, EDUCATION AND RESEARCH, AND TO EXPAND ACCESS TO POINTS OF CARE. THESE INVESTMENTS ENSURE WE'LL BE HERE TO CARE FOR FUTURE GENERATIONS. WE EXTEND OUR CARE BEYOND OUR HOSPITAL'S WALLS IN ORDER TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR COMMUNITY ACTIVITIES DEMONSTRATE THIS COMMITMENT. DURING THIS YEAR, OUR COMMUNITY ACTIVITIES INCLUDED: -ATHLETIC TRAINERS-TEAM WORKS IS A SAINT JOHN-SPONSORED PROGRAM THAT WORKS WITH THE LEAVENWORTH AND LANSING AREA HIGH SCHOOLS TO PROVIDE CERTIFIED ATHLETIC TRAINERS TO THE SCHOOLS AT LITTLE COST. TEAM WORKS PROVIDES GAME EVENT COVERAGE, INJURY PREVENTION COUNSELING, EFFICIENT RUNNING ASSESSMENT PROGRAMS, PRE-GAME WORKOUTS, WELLNESS PROGRAMS, MANAGEMENT AND TREATMENT OF INJURIES ON THE FIELD, ATHLETIC TRAINING PROGRAMS, A COMPREHENSIVE REHABILITATION/RECONDITIONING PROGRAM FOR INJURIES, HEALTH INFORMATION AND COUNSELING, SPORTS PERFORMANCE/CONDITIONING AND INJURY TRACKING CAPABILITIES. THE PROGRAM'S GOALS INCLUDE EARLY DIAGNOSIS OF CONCUSSIONS ON THE FIELD TO PREVENT LONG-TERM AFFECTS, OR EVEN DEATH; AND TO PREVENT OR REHABILITATE INJURIES EARLY ON IN THESE STUDENTS SO THAT THESE INJURIES DO NOT BECOME LIFETIME HEALTH ISSUES. -CANCER SUPPORT GROUP-SAINT JOHN SPONSORS A CANCER SUPPORT GROUP THAT MEETS ON A REGULAR BASIS TO ASSIST PATIENTS AS THEY ARE UNDERGOING CANCER TREATMENT AND RECOVERY. ISSUES COVERED INCLUDE NUTRITION, CANCER-RELATED FATIGUE AND DISEASE RECURRENCE. -CHILDBIRTH PREPARATION COURSES-TO PROVIDE THE COMMUNITY'S NEWEST RESIDENTS WITH THE BEST STARTS POSSIBLE IN LIFE, SAINT JOHN OFFERS A WIDE RANGE OF CHILDBIRTH PREPARATION COURSES, INCLUDING BREASTFEEDING, PREPARED CHILDBIRTH, AND SIBLING PREPARATION. THE GOAL IS TO PROMOTE A HEALTHY FAMILY ENVIRONMENT, REDUCE THE RISK OF LOW-BIRTH WEIGHT BABIES AND IMPROVE THE SUCCESS OF BREASTFEEDING FOR NEW MOTHERS AND THEIR INFANTS. THESE INITIATIVES HAVE BEEN PROVEN TO LOWER HEALTH-RELATED COSTS ASSOCIATED WITH CHILDBIRTH, AND RELATED COMPLICATIONS. -DIABETES EDUCATION COURSES-SAINT JOHN OFFERS COURSES TO REDUCE COMPLICATIONS AND COSTS ASSOCIATED WITH DIABETES, INCLUDING A DIABETES DINING CLUB, DIABETES OUTPATIENT CLASSES AND DIABETES SUPPORT GROUP. THESE OFFERINGS ASSIST PATIENTS WITH SUCCESSFULLY MANAGING THEIR DISEASE, IMPROVING LONG-TERM HEALTH FOR THESE PATIENTS AND THE COMMUNITY. -HEART HEALTH EDUCATION-BY ENCOURAGING COMMUNITY PARTICIPATION IN ACTIVITIES SUCH AS BLOOD PRESSURE SCREENINGS, HEART HEALTH FAIRS, AND WALKS, SAINT JOHN ASSISTS INDIVIDUALS IN MAKING HEALTHIER LIFESTYLE CHOICES (EXERCISE AND SMOKING CESSATION) THAT CAN IMPROVE THEIR INDIVIDUAL HEALTH, AS WELL AS THE COMMUNITY'S HEALTH IN GENERAL. THE HOSPITAL ALSO HAS PARTNERED WITH THE AMERICAN HEART ASSOCIATION TO IMPLEMENT THE SEARCH YOUR HEART PROGRAM IN THE LEAVENWORTH COMMUNITY. SEARCH YOUR HEART IS AN EFFORT TO EDUCATE AREA CONGREGATIONS ON ISSUES RELATED TO HEART DISEASE AND STROKE. THE HOSPITAL ALSO SPONSORS HEALTH SCREENINGS, COOKING DEMONSTRATIONS AND OTHER AWARENESS ACTIVITIES FOR PARTICIPATING CHURCHES. -OTHER COMMUNITY EVENTS SAINT JOHN PARTICIPATED IN DURING 2011 INCLUDE: " BREASTFEEDING CLASSES " CANCER SUPPORT GROUP " CITY OF LEAVENWORTH HEALTH FAIR " CHILDBIRTH PREPARATION CLASSES " COVER THE UNINSURED WEEK " DIABETES DINING CLUB " DIABETES OUTPATIENT CLASSES " DIABETES SUPPORT GROUP " FT. LEAVENWORTH PAIR DAY " HALLMARK EMPLOYEE HEALTH FAIR " LEAVENWORTH COUNTY EMPLOYEES SAFETY DAY " LEAVENWORTH COUNTY HEALTH FAIR " LEAVENWORTH FIRST CITY FESTIVAL " LEAVENWORTH HEART WALK " NATIONAL HEALTH CARE DECISIONS DAY " RELAY FOR LIFE " SIBLING PREPARATION CLASSES " UNIVERSITY OF SAINT MARY HEALTH FAIR WE ALSO SUPPORT OUR EMPLOYEES IN VOLUNTEERING FOR COMMUNITY ORGANIZATIONS, INCLUDING SERVING ON COMMUNITY BOARDS AND PROVIDE OPPORTUNITIES FOR THEM TO SUPPORT CAUSES THROUGH HOSPITAL EVENTS SUCH AS: " CATHOLIC CHARITIES FOOD SUPPLIES DRIVE " CHRISTMAS IN OCTOBER " COMMUNITY BLOOD CENTER BLOOD DRIVE " CRISTO REY SCHOOL SUPPLIES DRIVE " HAITI RELIEF EFFORTS " HARVESTERS FOOD DRIVE " LENTEN FOOD FOR THOUGHT " UNITED WAY CAMPAIGN WE ARE GOOD CITIZENS AND PARTNER WITH OTHER ORGANIZATIONS AND AGENCIES TO SUPPORT A THRIVING COMMUNITY: " ALLIANCE AGAINST FAMILY VIOLENCE " AMERICAN CANCER SOCIETY " AMERICAN HEART ASSOCIATION " CARITAS CLINICS, INC. " FRIENDS OF LEAVENWORTH HIGH SCHOOL " GREATER KANSAS CITY MEDICAL SOCIETY " IMMACULATA HIGH SCHOOL " KANSAS CITY WIZARDS " LANSING BASKETBALL COMMITTEE " LANSING EDUCATIONAL FOUNDATION " LANSING HIGH SCHOOL OPERATION GRADUATION " LEAVENWORTH COUNTY CHILD ABUSE PREVENTION COUNCIL " LEAVENWORTH HIGH SCHOOL PIONEER FOOTBALL " LEAVENWORTH PARK AND COMMUNITY ACTIVITIES DEPARTMENT " LEAVENWORTH REGIONAL CATHOLIC SCHOOLS " LEAVENWORTH YAC " LEAVENWORTH-LANSING AREA CHAMBER OF COMMERCE " LEGENDS OF KANSAS CITY " MAKE-A-WISH FOUNDATION " METROPOLITAN MEDICAL SOCIETY " MOUNT SCHOLASTICA BENEDICTINE SISTERS " OLDER AMERICAN MONTH CELEBRATIONS " SAINT FRANCIS DE SALES " SAINT VINCENT CLINIC " T-BONES BASEBALL CLUB " UNIVERSITY OF SAINT MARY " USD 453 LEAVENWORTH SCHOOL DISTRICT " USD 469 LANSING SCHOOL DISTRICT " WOMEN'S FOUNDATION OF GREATER KANSAS CITY WE PROVIDE FOCUSED SUPPORT FOR CARITAS CLINICS, INC., (DUSCHENE AND SAINT VINCENT CLINICS) THE COMMUNITY'S HEALTH CLINICS FOR THE UNINSURED. WE WORK CLOSELY TOGETHER TO PROVIDE INTEGRATED CARE FOR THOSE WHO COME TO EITHER THE HOSPITAL OR THE CLINICS FOR THEIR HEALTH NEEDS. CARITAS CLINICS PROVIDE QUALITY PRIMARY HEALTH CARE SERVICES FOR UNINSURED, LOW-INCOME PATIENTS REGARDLESS OF ABILITY TO PAY. THE CLINICS ARE COMMITTED TO PROVIDING ACCESS TO COMPASSIONATE AND TRUSTWORTHY CARE FOR THE UNINSURED POOR. SERVICES THE CLINICS PROVIDE INCLUDE PRIMARY CARE, ONGOING MANAGEMENT OF CHRONIC DISEASES AND MEDICATION ASSISTANCE. IN ADDITION TO FINANCIAL SUPPORT, SAINT JOHN ASSISTS THE CLINICS IN MANY OTHER WAYS INCLUDING STRATEGY AND OPERATIONS GUIDANCE, DONATING SUPPLIES AND PROVIDING IT AND FINANCIAL SYSTEMS MANAGEMENT. COMMUNITY BENEFITS PROVIDED IN 2011 THROUGHOUT SCLHS TOTALED $220.5 MILLION. AS PART OF SCLHS, WE PROMOTE THE SHARED MISSION THAT "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." WE ARE COMMITTED TO LIVING AND DEMONSTRATING OUR CORE VALUES OF EXCELLENCE, RESPECT, RESPONSE TO NEED, STEWARDSHIP AND WHOLENESS. SCLHS SUPPORTS ITS HOSPITALS BY PROVIDING GUIDANCE, OVERSIGHT, AND RESOURCES TO HELP THEM ACCOMPLISH INITIATIVES THAT IMPROVE HEALTH IN ALL OUR COMMUNITIES. THIS INCLUDES COORDINATING COMMUNITY BENEFIT PROCESSES, PROVIDING GUIDANCE WITH COMMUNITY NEEDS ASSESSMENTS, AND ESTABLISHING CONSISTENT FINANCIAL ASSISTANCE AND CHARITY CARE POLICIES AND PROCEDURES. OTHER WAYS SCLHS BENEFITS ITS HOSPITALS INCLUDE QUALITY IMPROVEMENT AND PERFORMANCE EXCELLENCE INITIATIVES; SYSTEM-WIDE IT IMPLEMENTATION AND INFRASTRUCTURE; STRATEGIC AND OPERATIONS DIRECTION AND OVERSIGHT; SUPPLY CHAIN MANAGEMENT AND PURCHASING; BENEFITS ADMINISTRATION (INCLUDING A WELLNESS PROGRAM FREE TO EMPLOYEES THAT PROMOTES THEIR HEALTH AND WELL-BEING); RISK MANAGEMENT; DISASTER PLANNING AND CRISIS ASSISTANCE. BY SHARING THE WORK ACROSS OUR SYSTEM WE ARE ABLE TO LIGHTEN THE BURDEN FOR ALL IN ORDER TO FULFILL OUR MISSION OF IMPROVING HEALTH IN OUR COMMUNITIES. SCLHS IMPROVES OVERALL HEALTH IN OUR COMMUNITIES BY PROVIDING INFRASTRUCTURE TO SUPPORT AND SUSTAIN FOUR CLINICS FOR THE UNINSURED IN KANSAS AND COLORADO. THE SCLHS CLINICS FOR THE UNINSURED ARE OFTEN THE ONLY SAFETY NET CLINIC IN THEIR COMMUNITY AND PROVIDE VALUABLE SERVICES FOR THOSE WHO ARE MOST VULNERABLE. EACH HOSPITAL IS SUPPORTED BY A FOUNDATION TO ACCESS AND OPTIMIZE LOCAL PHILANTHROPIC ORGANIZATIONS AND INDIVIDUALS. THESE FOUNDATIONS RAISE FUNDS THROUGH OUTREACH, SPECIAL EVENTS, AND BUILDING DONOR RELATIONS THROUGHOUT THEIR COMMUNITY TO SUPPORT THE NEEDS OF THE HOSPITAL. AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6: SAINT JOHN HOSPITAL IS A CONTROLLED ENTITY OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS). SCLHS AND ITS AFFILIATED ENTITIES HAVE A COMMON CALLING AND MISSION "TO REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE." SAINT JOHN HOSPITAL PROMOTES THE HEALTH OF THE COMMUNITY BY DELIVERING DIRECT HIGH QUALITY HEALTHCARE SERVICES THAT ARE RESPONSIVE TO THE NEEDS OF ITS PATIENTS AND THEIR FAMILIES. SCLHS SUPPORTS THE EFFORTS OF THE HOSPITAL THROUGH STRATEGIC DIRECTION AND OPERATING OVERSIGHT. SCLHS SUPPLIES OVERHEAD SUPPORT SERVICES TO SAINT JOHN HOSPITAL, INCLUDING INFORMATION TECHNOLOGY SERVICES, CENTRAL CASH MANAGEMENT AND INVESTMENT, INTERNAL AUDIT, SUPPLY CHAIN MANAGEMENT, BENEFITS ADMINISTRATION, RISK MANAGEMENT AND INSURANCE AND QUALITY IMPROVEMENT LEADERSHIP. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7: THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM FILES A COMMUNITY BENEFIT REPORT IN THREE STATES: CALIFORNIA, KANSAS AND MONTANA. true PROVIDENCESAINT JOHN FOUNDATION 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 480925688 501(C)(3) 13500 OFFSET OPERATING COSTS AND GENERAL SUPPORT OF FOUNDATION'S MISSION 1 true true false false false false false false false DR MARC LUCKETT 331039 0 0 0 0 0 0 0 0 0 331039 0 0 0 CAROLYN BOWMER 0 88086 0 0 0 83159 0 12856 0 4355 0 188456 0 0 JAN YERGAN 0 190248 0 0 0 105923 0 11819 0 5822 0 313812 0 80928 JAMES PAQUETTE 0 418351 0 0 0 320176 0 107885 0 15226 0 861638 0 0 JOE JEANS 0 177565 0 0 0 2329 0 32656 0 11074 0 223624 0 0 JUANITA ROY 0 255416 0 0 0 36590 0 19600 0 15584 0 327190 0 0 DANIEL SHEEHAN 0 143663 0 0 0 2049 0 26489 0 6016 0 178217 0 0 BARRY SOLOMON 0 282421 0 0 0 3914 0 48113 0 6232 0 340680 0 0 GEORGE NOONAN 0 161076 0 0 0 23252 0 13608 0 13991 0 211927 0 0 MICHAEL A DORSEY 0 298162 0 0 0 54538 0 19000 0 11440 0 383140 0 0 BAIN FARRIS 0 428580 0 105122 0 19334 0 88843 0 10689 0 652568 0 0 PROCESS FOR DETERMINING COMPENSATION form 990, sch j, part i, line 3: SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACTS -COMPENSATION SURVEYS AND STUDIES -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.) IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY AT THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. SEVERANCE PAYMENTS form 990, sch j, part i, line 4A: THE AMOUNTS PAID FOR SEVERANCE IN 2011 WERE: CAROLYN S. BOWMER $76,100 SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN form 990, sch j, part i, line 4b: 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 IRS IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. ON THE ADVICE OF COUNSEL, SCLHS HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2011 WERE: JUANITA D. ROY $10,720 GEORGE M. NOONAN $5,891 JANIS L. YERGAN $41,156 JAMES T. PAQUETTE $105,270 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: MICHAEL A. DORSEY $25,268 CAROLYN S. BOWMER $5,477 SCHEDULE J, PART II THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND THREE CLINICS (AFFILIATES) IN FOUR STATES INCLUDING SAINT JOHN HOSPITAL (SAINT JOHN) IN LEAVENWORTH, KANSAS. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. BAIN J. FARRIS IS PRESIDENT & CHIEF EXECUTIVE OFFICER OF EXEMPLA SAINT JOSEPH HOSPITAL (ESJH) IN DENVER, COLORADO WHICH IS AN SCLHS AFFILIATE. AS A FORMER OFFICER OF SAINT JOHN'S, THIS DISCLOSURE IS REQUIRED FOR 990 REPORTING PURPOSES ONLY. THE COMPENSATION REFLECTED IS THAT OF MR. FARRIS' POSITION AS AN ESJH EXECUTIVE AND IS NOT RELATED TO SAINT JOHN'S. JAMES T. PAQUETTE IS A SYSTEM PROJECT LEADER OF SCLHS IN DENVER, COLORADO. AS A FORMER OFFICER OF SAINT JOHN'S, THIS DISCLOSURE IS REQUIRED FOR 990 REPORTING PURPOSES ONLY. THE COMPENSATION REFLECTED IS THAT OF MR. PAQUETTE'S POSITION AS AN SCLHS SYSTEM PROJECT LEADER AND IS NOT RELATED TO SAINT JOHN'S. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE. delegate control over management duties FORM 990, PART VI, SECTION A, LINE 3: ALTHOUGH THESE SERVICES MAY NOT ALL RISE TO THE LEVEL OF MANAGEMENT CONTROL AS DEFINED IN THE 990 INSTRUCTION, WE HAVE IN THE SPIRIT OF FULL TRANSPARENCY PROVIDED THE FOLLOWING DISCLOSURE. AS A MEMBER OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, THIS PROVIDER MAY HAVE INDIVIDUAL AND/OR SYSTEM CONTRACT(S) THAT HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES IN SOME OR ALL OF THE FOLLOWING AREAS: DIETARY AND FOOD SERVICE HOUSEKEEPING SUPPLY CHAIN REVENUE CYCLE SECURITY FORM 990, PART VI, SECTION A, LINE 6, 7A & 7B: MEMBERS OF THE ORGANIZATION PROVIDENCE MEDICAL CENTER, INC. IS THE SOLE MEMBER OF SAINT JOHN HOSPITAL, INC. form 990 review process FORM 990, PART VI, SECTION B, LINE 11B: COPIES OF THE 990 WERE DISTRIBUTED TO ALL BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING THE RETURN. THE FORM 990 IS ALSO REVIEWED BY FINANCE PERSONNEL AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM AND AN INDEPENDENT ACCOUNTING FIRM. conflict of interest policy FORM 990, PART VI, SECTION B, LINE 12C: CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ALL BOARD MEMBERS AND KEY EMPLOYEES. THESE STATEMENTS ARE CAREFULLY REVIEWED AND A REPORT PROVIDED TO THE CEO AND COO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. IF A CONFLICT OF INTEREST ARISES, THE CEO DETERMINES ANY ACTION TO BE TAKEN AT THAT TIME. PUBLIC AVAILABILITY OF FINANCIALS, GOVERNING DOCUMENTS, AND COI POLICIES form 990, part vi, section c, line 19: SCLHS' GOVERNANCE MANUAL FOR BOARD MEMBERS AND ITS AFFILIATE 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. SAINT JOHN HOSPITAL'S UNAUDITED FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. SAINT JOHN HOSPITAL IS A MEMBER OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM. THE AUDITED FINANCIAL STATEMENTS FOR THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM ARE AVAILABLE TO THE PUBLIC AT THEIR WEBSITE. other changes in net assets or fund balances FORM 990, PART XI, LINE 5: EQUITY TRANSFERS $ 568,750 CONTRIBUTIONS TO LONG LIVED ASSETS $ 9,245 MEDICAL STAFF EQUITY ADJUSTMENT $ 221 Net unREALIZED GAINS & LOSSES $(66,457) Rounding $ 27 STATEMENT OF CONTROLLED FOREIGN CORPORATION SAINT JOHN HOSPITAL, INC. PARTICIPATION CORPORATION EIN: 48-0543768 FOR THE TAX YEAR ENDED DECEMBER 31, 2011 THIS STATEMENT IS BEING FILED PURSUANT TO TREAS. REG. 1.6038-2(J)(3). SAINT JOHN HOSPITAL, INC.'S FILING REQUIREMENT FOR FORM 5471 FOR THE CONTROLLED FOREIGN CORPORATIONS LISTED BELOW HAS BEEN SATISFIED BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (FEIN:23-7379161). SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM HAS INCLUDED THE FORM 5471 WITH ITS FORM 990 WHICH WAS FILED ELECTRONICALLY. LEAVEN INSURANCE COMPANY, LTD. 98-0370522 23 LIMETREE BAY AVE., PO BOX 1051 GEORGETOWN, GRAND CAYMAN KY1-1102 CJ RIVERVIEW MULTI-SERIES FUND SPC, LTD. 510 THORNALL STREET, SUITE 220 EDISON, NJ 08837 JP MORGAN HEDGE FUND SPC-ACCESS MAR09 SEGREGATED 98-0680591 INT'L FUND SVCS LTD, 78 SIR JOHN ROGERSON'S QUAY DUBLIN, IRELAND 2 EI JP MORGAN HEDGE FUND SPC-ACCESS JUN09 SEGREGATED 98-0680582 INT'L FUND SVCS LTD, 78 SIR JOHN ROGERSON'S QUAY DUBLIN, IRELAND 2 EI HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RANDALL NYP TITLE:CHIEF EXECUTIVE OFFICER HOURS:39 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOE JEANS TITLE:REGION VICE PRESIDENT FINANCE HOURS:30 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL A DORSEY TITLE:former CEO HOURS:31 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JUANITA ROY TITLE:EXECUTIVE VP & COO HOURS:30 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CAROLYN BOWMER TITLE:Vice President- Human Resource HOURS:30 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAN YERGAN TITLE:VICE PRESIDENT STRATEGY & BUS HOURS:30 SISTERS OF CHARITY LEAVENWORTH HLTH SYST 9801 RENNER BLVD STE 100 LENEXA KS 66219 237379161 SUPPORT MMBRS KS 501(c)(3) 11B-TYPE II NA false 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 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 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501C3 MT 501(c)(3) 7 SVHC true NORTHWEST RESEARCH & EDUCATION INSTITUTE 315 NORTH 25TH STREET BILLINGS MT 59101 201343024 COMM HLTH RES MT 501(c)(3) 9 SVHC true ST JAMES HEALTHCARE 400 SOUTH CLARK STREET BUTTE MT 59701 810231785 HEALTHCARE MT 501(c)(3) 3 SCLHS true ST JAMES HEALTHCARE FOUNDATION 400 SOUTH CLARK STREET BUTTE MT 59701 651202190 SUPPORT 501C3 MT 501(c)(3) 11A-TYPE I SJHC true SAINT JOHNS HEALTH CENTER 1328 22ND STREET SANTA MONICA CA 90404 951684082 HEALTHCARE CA 501(c)(3) 3 SCLHS true JOHN WAYNE CANCER INSTITUTE 2000 SANTA MONICA BLVD SANTA MONICA CA 90404 954291515 CANCER R&D CA 501(c)(3) 4 SJHHC true SAINT JOHNS HOSPITAL & HLTH CENTER FNDTN 1328 22ND STREET SANTA MONICA CA 90404 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 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