2012-11-15T20:53:59-06:00 2011-12-31 ERNST & YOUNG US LLP 190 CARONDELET PLAZA SUITE 1300 CLAYTON MO 63105 990 2011-01-01 810231792 HOLY ROSARY HEALTHCARE % MARK PETESCH DIR OF FINANCE HOLY 4062373318 2600 WILSON STREET MILES CITY MT 59301 PAUL LEWIS 2012-11-15 3142901000 2011 2016-02-24 21:20:13Z RON WEBB 2600 WILSON STREET MILES CITY MT 59301 39712173 false 0928 X WWW.HRH-MT.ORG X 1997 MT 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. 13 11 446 69 117610 -3941 472754 180948 36138027 39089244 -46267 -17832 487877 459813 37052391 39712173 46119 46193 0 0 20682130 20522665 0 0 0 17921156 19642049 38649405 40210907 -1597014 -498734 21970302 21832173 3029198 3406568 18941104 18425605 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 26894305 32581410 HOLY ROSARY HEALTHCARE PROVIDES INPATIENT AND OUTPATIENT HOSPITAL SERVICES TO THE POPULATIONS OF EASTERN MONTANA. THESE SERVICES INCLUDE SURGICAL, ONCOLOGY, AND MATERNITY SERVICES, AS WELL AS 24- HOUR EMERGENCY ROOM AND DIAGNOSTIC AND THERAPUTIC SERVICES. 2858128 3757714 HOLY ROSARY HEALTHCARE'S EXTENDED CARE UNIT PROVIDES SHORT-TERM TRANSITIONAL CARE AFTER ILLNESS, INJURY, OR SURGERY, AS WELL AS, LONG-TERM CARE FOR THOSE UNABLE TO LIVE INDEPENDENTLY. 3894587 3207586 HOLY ROSARY HEALTHCARE CLINIC PROVIDES PRIMARY CARE SERVICES. THE CLINIC ALSO MAKES AVAILABLE VARIOUS SPECIALTY SERVICES OFFERED BY VISITING PROVIDERS. 46193 Mission expenses 46193 33693213 true true false true false false false false true true false false true false 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 80 0 true 446 true true true false false false false false false false false false X 13 11 false true false false true true true true true false false true true true true true true false false false X MARK PETESCH DIR OF FINANCE 4062373318 PO BOX 35200 BILLINGS MT 591075200 MONTY LESH 2.0 X X 0 0 0 SISTER MARIE DAMIAN GLATT 2.0 X 0 0 0 DR J R GRIERSON 2.0 X X 0 0 0 JANETTE JONES 2.0 X X 0 0 0 SISTER JUDITH JACKSON 2.0 X 0 0 0 TRACI SCHELL 2.0 X 0 0 0 RON WEBB 40.0 X X 0 240215 348323 PAUL LEWIS 40.0 X X 0 134939 35911 BILL OFTEDAL 2.0 X 0 0 0 RACHEL ARMSTRONG 2.0 X 0 0 0 THOMAS BEESON MD 2.0 X 0 0 0 SISTER KATHERINE FRANCHETT 2.0 X 0 0 0 STEFANI HICSWA MD 2.0 X 0 0 0 JASON BARKER 40.0 X X 0 437097 52347 Steve Ballock 40.0 X 0 245842 33952 CALVIN CAREY 40.0 X 0 3920 17 JAMES MACMILLIAN 40.0 X 307250 0 6288 JEFF WILLIAMS 40.0 X 294685 0 22632 DORTHY BRADBURY 40.0 X 225368 0 8157 DANIEL TAILLEUR 40.0 X 210943 0 15884 CHRISTOPHER LIEB 40.0 X 197296 0 27862 JAMES T PAQUETTE X 0 738527 123111 RICHARD LOPES X 0 420106 43091 1235542 2220646 717575 14 true true false ARAMARK CORPORATION PO BOX 651009 CHARLOTTE NC 282651009 FOOD SERVICES 724198 MEDEFIS INC 10826 OLD MILL ROAD SUITE 101 OMAHA NE 68154 TEMPORARY STAFFING 646577 CONIFER HEALTH SOLUTIONS 1500 SOUTH DOUGLASS ROAD ANAHEIM CA 92806 PATIENT BILLING SERV 1601142 ROCKY MOUNTAIN HEALTH NETWORK 315 NORTH 25TH STREET BILLINGS MT 59101 PATIENT BILLING SERV 247777 HOSPITAL LAUNDRY SERVICES 45 SOUTH 7TH STREET WEST BILLINGS MT 59102 LAUNDRY SERVICE 181391 10 180948 180948 NET PATIENT SERVICE 900099 38973981 38973981 PROGRAM SERVICE RENTAL INCOME 532000 115263 115263 39089244 -30774 -30774 0 0 12942 12942 12942 12942 0 0 0 NON-PATIENT FOOD SERVICES 722320 343636 341289 2347 DEPARTMENT OTHER OPERATING REVENUE 900099 102295 102295 MANAGEMENT FEES 900099 12422 12422 1460 1460 459813 39712173 39431447 117610 -17832 46193 46193 0 0 0 1532563 1532563 0 15082980 14764771 318209 726595 726595 2092203 2092203 1088324 976253 112071 3681476 2165426 1516050 87243 87243 0 1656 1656 0 1699 1699 3486245 2895075 591170 131019 131019 1153451 934814 218637 1078607 1078607 0 654152 605857 48295 205858 95750 110108 0 0 0 0 2099619 2099619 321007 321007 BAD DEBTS 1830714 1830714 MEDICAID PROVIDER TAXES 409659 409659 RECRUITING EXPENSES 173129 48792 124337 MEDICAL EXPENSES 4010038 4009350 688 316477 80794 235683 40210907 33693213 6517694 0 -1603867 -754125 217457 219612 0 0 5578927 4565306 0 0 0 0 0 22783 816603 902468 376160 436985 40188110 26745928 14967086 13442182 0 0 0 0 780897 662381 0 0 837039 2334581 21970302 21832173 3029198 3406568 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 3029198 3406568 X 18941104 18425605 0 0 0 0 18941104 18425605 21970302 21832173 X -498734 -16765 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false true 1656 false false 1656 false Schedule C, Part II-B Lobbying Activity Explanation Holy Rosary Healthcare pays dues to the Montana Hospital Association, of which $1,656 is charged for lobbying. 152032 8504 2500 600 157436 170256 -15721 2500 3 152032 126507 46785 3000 36 170256 152571 -23564 2500 126507 1.00000 false true true 135511 135511 13590797 6522937 7067860 24745590 18882109 5863481 1716212 1340882 375330 13442182 OTHER RECEIVABLES 2162851 2162851 SCH. D, PART V, LINE 4 ENDOWMENT FUNDS THE INTENDED USE FOR THE KENNETH HOM TRUST ENDOWMENT FUND IS TO PROVIDE NURSING SCHOLARSHIPS. EACH YEAR A SCHOLARSHIP IS AWARDED TO AN INDIVIDUAL WITH EASTERN MONTANA TIES WHO IS PURSUING HIS OR HER NURSING EDUCATION. IN 2011, ONE SCHOLARSHIP WAS AWARDED. Endowment funds are held by the Holy Rosary Healthcare Foundation. true true true X true X true true false true true 393 1699001 1699001 0.04430 393 1699001 1699001 0.04430 30 3980 257277 22762 234515 0.00610 13 428 171081 171081 0.00450 2 151249 151249 0.00390 11 2208 31904 31904 0.00080 56 6616 611511 22762 588749 0.01530 56 7009 2310512 22762 2287750 0.05960 1 1 149 149 3 164 1357 1357 1 960 960 3 17 781 781 1 7 143 143 2 116 111741 111741 0.00290 1 588 6811 6811 0.00020 12 893 121942 121942 0.00310 false 1159888 11329749 15793030 -4463281 X true true 1 1 Holy Rosary Healthcare

2600 Wilson Street Miles City MT 59301

X X X Holy Rosary Healthcare 1 true true 200. true 400. true X X X X X X true true X X X X X true false X X X true X false false 1 POWDER RIVER MEDICAL CLINIC

507 NORTH LINCOLN AVENUE BROADUS MT 59317

AMBULATORY CARE CLINIC SCHEDULE H, PART VI SUPPLEMENTAL INFORMATION PART I, LINE 3C ELIGIBILITY IS BASED ON FEDERAL POVERTY GUIDELINES. PART I, LINE 6A THE ANNUAL COMMUNITY BENEFIT REPORT IS INCLUDED IN THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM REPORT TO THE COMMUNITY. WE SUBMIT COMMUNITY BENEFIT ACTIVITIES AS NEWS TO LOCAL MEDIA AND REPORT THEM ON OUR WEBSITE AS THEY OCCUR. A SEPARATE PUBLICATION SPECIFICALLY DEDICATED TO COMMUNITY BENEFIT WAS NOT RELEASED IN 2011. PART I, LINE 7G PHYSICIAN CLINICS ACCOUNT FOR $31,649 OF TOTAL SUBSIDIZED SERVICE EXPENSE; THIS IS A CLINIC IN A REMOTE RURAL AREA WITH NO OTHER ACCESS TO HEALTHCARE WITHIN AN 80 MILE RADIUS. PART I, LINE 7, COLUMN F THE AMOUNT OF BAD DEBT EXPENSE DELETED FROM THE DENOMINATOR BEFORE CALCULATING PERCENTAGES IN COLUMN (F) IS $1,830,714. PART I, LINE 7 COST TO CHARGE RATIO IS USED FOR ALL REMAINING CATEGORIES OF COMMUNITY BENEFIT. THE COST TO CHARGE RATIO USED WAS DERIVED FROM WORKSHEET 2. PART II THE MOST SIGNIFICANT EXPENSE IN COMMUNITY BUILDING ACTIVITIES IS THE COST OF PHYSICIAN RECRUITMENT TO OUR MEDICALLY UNDERSERVED AREA. PART III, LINE 4 DISCOUNTS AND PAYMENTS APPLIED TO ACCOUNTS REDUCE BAD DEBT EXPENSE. NO METHOD IS USED TO DETERMINE THE AMOUNT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO WOULD LIKELY QUALIFY FOR FINANCIAL ASSISTANCE, HOWEVER, THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY ALLOWS FINANCIAL ASSISTANCE AWARDS TO BE MADE PRESUMPTIVELY TO INDIVIDUALS WHO HAVE NOT ADEQUATELY COMPLETED THE APPLICATION PROCESS IF THE INDIVIDUAL IS HOMELESS OR IF THE INDIVIDUAL IS NON-RESPONSIVE AND HAS A CREDIT SCORE LESS THAN 600. BAD DEBT EXPENSES INCLUDE ACTUAL WRITE OFFS AND ANY ASSOCIATED ACCRUAL BASED ON ACCOUNTS RECEIVABLE. THE COSTING METHODOLOGY USED TO CALCULATE THE COST OF BAD DEBT INCLUDED ON PART III LINE 2 WAS THE COST TO CHARGE RATIO DERIVED USING THE METHODOLOGY FROM WORKSHEET 2. PART III, LINE 8 THE ORGANIZATION DOES NOT BELIEVE THAT MEDICARE SHORTFALLS SHOULD BE INCLUDED AS COMMUNITY BENEFIT. MEDICARE ALLOWABLE COSTS WERE DERIVED FROM THE MEDICARE COST REPORT'S SCHEDULE D PART V, PART VI AND SCHEDULE D-1. PART III, 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. HOLY ROSARY HEALTHCARE 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. NEEDS ASSESSMENT: AS PART OF OUR ORGANIZATIONAL MISSION TO RESPOND TO THE HEALTH NEEDS OF THE PEOPLE AND COMMUNITIES SERVED, WE TAKE STEPS TO DETERMINE WHERE THERE IS THE MOST NEED IN ORDER TO PROVIDE THE GREATEST GOOD. HOLY ROSARY HEALTHCARE HAS REGULARLY PARTICIPATED IN COMMUNITY HEALTH NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN 2011. THIS ASSESSMENT STUDIED MILES CITY, MONTANA, AND THE NINE-COUNTY SURROUNDING AREA SERVED BY HOLY ROSARY HEALTHCARE. THE ASSESSMENT, COMPLETED BY A THIRD-PARTY RESEARCH FIRM SPECIALIZING IN RURAL COMMUNITY RESEARCH, INCLUDES COLLABORATIVE PARTNERSHIPS WITH LOCAL GOVERNMENT AND SOCIAL AGENCIES; COMBINING EFFORTS WITH OTHER LOCAL HOSPITALS AND HEALTH CARE ORGANIZATIONS; AND CONDUCTING SURVEYS, FOCUS GROUPS, AND ASSESSMENTS WITH THE ASSISTANCE OF THE OFFICE OF RURAL HEALTH. COMMUNITY EDUCATION WAS COMPLETED UTILIZING THE MEDIA, INTERNET, AND MAILINGS TO BUILD AWARENESS AND ENCOURAGE PARTICIPATION IN THIS PROJECT. RESULTS WERE RECEIVED IN EARLY 2012, INFORMATION SHARED WITH KEY STAKEHOLDER GROUPS IN THE COMMUNITY AND REGION, AND RESPECTIVE PRIORITIES IDENTIFIED AND ACTION PLANS PURSUED. IN 2011, WE ADDED A NEW APPROACH TO IDENTIFY COMMUNITY HEALTH NEEDS BY CREATING THE CONSENSUS BUILDING FORUM: IDENTIFYING PRIORITIES IN HEALTHCARE DELIVERY IN EASTERN MONTANA. THIS IS PROVING TO BE AN INFORMATIVE APPROACH TO IDENTIFYING ISSUES AND PRIORITIZING SOLUTIONS. 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: HOLY ROSARY HEALTHCARE TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. HOLY ROSARY HEALTHCARE 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 BILLING 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. COMMUNITY INFORMATION: HOLY ROSARY HEALTHCARE - THE LARGEST HEALTHCARE FACILITY BETWEEN BILLINGS, MONTANA, AND BISMARCK, NORTH DAKOTA - PROVIDES A COMPLETE CONTINUUM OF CARE THROUGH OUR 25-BED ACUTE CARE HOSPITAL, 87-BED EXTENDED CARE LIVING COMMUNITY, OUTPATIENT MEDICAL ARTS CENTER, AND HOSPICE AND PALLIATIVE CARE PROGRAMS. WHILE THE ORGANIZATION DRAWS PATIENTS FROM A 13-COUNTY REGION IN THE STRONGEST SERVICE-LINES, HOLY ROSARY HEALTHCARE'S PRIMARY AND SECONDARY SERVICE AREAS INCLUDE A NINE-COUNTY CORE REGION WITH APPROXIMATELY 45,000 PEOPLE. THE DEMOGRAPHIC MAKE-UP OF OUR PRIMARY AND SECONDARY SERVICE AREAS INCLUDES: - OVERALL DECLINING POPULATION OF 3% IN MOST COUNTIES WIH THE EXCEPTION OF TWO, ROSEBUD AND FALLON COUNTIES. - LARGE GEOGRAPHIC AREA WITH SPARSE POPULATION, AVERAGING 1.4 PEOPLE/SQUARE MILE. - AGING POPULATION WITH AVERAGE AGE OF 43 AND AVERAGE LIFE EXPECTANCY OF 79; EXCEPTION IS ROSEBUD COUNTY WITH AVERAGE AGE OF 36. - PRIMARY INDUSTRIES ARE AGRICULTURE, STATE/LOCAL GOVERNMENT, AND RETAIL. AVERAGE HOUSEHOLD INCOME IS $49,000, $20,000 BELOW THE NATIONAL AVERAGE. PROMOTION OF COMMUNITY HEALTH: WE EXTEND OUR CARE BEYOND OUR HOSPITAL'S WALLS IN ORDER TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR COMMUNITY BUILDING ACTIVITIES DEMONSTRATE THIS COMMITMENT. IN 2011, THE MOST SIGNIFICANT EXPENSE IN COMMUNITY BUILDING ACTIVITIES IS THE COST OF PHYSICIAN RECRUITMENT TO OUR MEDICALLY UNDERSERVED AREA. WE ARE ALSO INVOLVED IN MANY COMMUNITY ORGANIZATIONS THAT VARY IN SCOPE INCLUDING CRITICAL INCIDENT STRESS MANAGEMENT, COMMUNITY HEALTH ALLIANCE (WHICH PARTNERS WITH ALL LOCAL HEALTH ORGANIZATION TO CREATE COMMUNITY HEALTH IMPROVEMENT), AND OTHER CIVIC MINDED ORGANIZATIONS. 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. 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 HOLY ROSARY HEALTHCARE HAS EXCESS REVENUE OVER OPERATING EXPENSES, WE USE THOSE FUNDS TO OBTAIN CURRENT HEALTH CARE TECHNOLOGIES AND EQUIPMENT, IMPROVE PATIENT CA true HOLY ROSARY FOUNDATION 2600 WILSON MILES CITY MT 59301 202270238 501(C)(3) 34466 ASSIST IN CHARITABLE EXEMPT PURPOSE 1 Description of Organization's Procedures for Monitoring the Use of Grants Form 990, Schedule I, Part I, Line 2 GRANTS ARE MONITORED THROUGH THE HOLY ROSARY HEALTHCARE FOUNDATION. THE FOUNDATION FOLLOWS A TWO-STEP PROCESS IN PREPARING THE SCHEDULE OF EXPENDITURES OF FEDERAL AWARDS (SEFA). THE GRANT PROJECT DIRECTOR IS RESPONSIBLE TO SUBMIT THE INVOICES FOR EACH MONTH'S ACTIVITY TO THE FOUNDATION DIRECTOR. THESE ARE THEN REVIEWED FOR COMPLIANCE WITH FEDERAL STANDARDS AND GUIDELINES AND ARE SUBMITTED TO THE FEDERAL GOVERNMENT FOR REIMBURSEMENT OR APPLIED TO GRANT IF AWARDED UPFRONT. THE AMOUNTS ARE THEN DRAWN DOWN BY THE FOUNDATION ADMINISTRATOR AND THE MONEY IS WIRED TO THE FOUNDATION'S BANK ACCOUNT OR REIMBURSED TO THE HOSPITAL IF THE EXPENDITURES WERE PAID BY THE HOSPITAL AND THE FUNDS MADE AVAILABLE TO THE FOUNDATION IN ADVANCE. THIS INFORMATION IS COMPILED QUARTERLY BY THE DIRECTOR OF FINANCE AND IS TRACKED BY GRANT NAME AND CEDA NUMBER. THE FOUNDATION DIRECTOR ALSO PROVIDES THE FINANCE DIRECTOR WITH THE AWARD LETTER AND ANY COMMUNICATIONS RELATED TO THE GRANT AS WELL AS SUPPORTING INVOICES AND EXPENDITURES. AT THE END OF THE YEAR, QUARTERLY WORKSHEETS ARE USED TO PREPARE THE SEFA. THE SEFA IS PREPARED BY THE DIRECTOR OF FINANCE, REVIEWED BY THE GRANTS ADMINISTRATOR AND FORWARDED TO THE SYSTEM OFFICE AND ERNST AND YOUNG CPA FIRM. true true false false false false false true false RON WEBB 0 187500 0 0 0 52715 0 337237 0 11086 0 588538 0 0 PAUL LEWIS 0 134023 0 0 0 916 0 20458 0 15453 0 170850 0 0 JASON BARKER 0 408132 0 0 0 28965 0 42237 0 10110 0 489444 0 0 Steve Ballock 0 214525 0 0 0 31317 0 18210 0 15742 0 279794 0 0 JAMES T PAQUETTE 0 418351 0 0 0 320176 0 107885 0 15226 0 861638 0 0 RICHARD LOPES 0 304166 0 0 0 115940 0 36475 0 6616 0 463197 0 0 JAMES MACMILLIAN 307250 0 0 0 0 0 6145 0 143 0 313538 0 0 0 JEFF WILLIAMS 294685 0 0 0 0 0 17093 0 5539 0 317317 0 0 0 DORTHY BRADBURY 196798 0 28570 0 0 0 4507 0 3650 0 233525 0 0 0 DANIEL TAILLEUR 112405 0 98538 0 0 0 4219 0 11665 0 226827 0 0 0 CHRISTOPHER LIEB 196496 0 800 0 0 0 12232 0 15630 0 225158 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 SEE FORM 990, SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, LINES 15A & B REGARDING THE PROCESS USED BY SCLHS TO DETERMINE EXECUTIVE COMPENSATION WHICH IS RELIED UPON BY THIS ORGANIZATION. FORM 990, SCHEDULE J, PART I, LINE 4A SEVERANCE PAYMENTS THE AMOUNTS PAID FOR SEVERANCE IN 2011 WERE: RONALD W. WEBB-$40,000 FORM 990, SCHEDULE J, PART I, LINE 4B PAYMENTS FROM 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 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: JAMES T. PAQUETTE-$105,270 STEVEN A. BALLOCK-$9,198 RICHARD T. LOPES-$27,413 FORM 990, SCHEDULE J, PART I, LINE 7 (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. FORM 990 SCHEDULE J, PART II AND FORM 990 PART VII THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES INCLUDING HOLY ROSARY HEALTHCARE (HOLY ROSARY) IN MILES CITY, MONTANA. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. JASON L. BARKER IS PRESIDENT AND CHIEF EXECUTIVE OFFICER FOR ST. VINCENT HEALTHCARE. HE FORMERLY SERVED AS A MEMBER OF HOLY ROSARY HEALTHCARE'S BOARD. STEVEN A. BALLOCK IS VICE PRESIDENT, CHIEF FINANCIAL OFFICER FOR ST. VINCENT HEALTHCARE. THEY ALSO SERVE AS MEMBERS OF HOLY ROSARY HEALTHCARE'S BOARD. THE COMPENSATION REFLECTED IS THAT OF MR. BARKER'S AND MR. BALLOCK'S POSITIONS AS ST. VINCENT HEALTHCARE EXECUTIVES AND IS NOT RELATED TO HOLY ROSARY HEALTHCARE. JAMES T. PAQUETTE IS A SYSTEM PROJECT LEADER OF SCLHS IN DENVER, COLORADO. HE FORMERLY SERVED AS PRESIDENT AND CHIEF EXECUTIVE OFFICER OF ST. VINCENT HEALTHCARE AND ON THE HOLY ROSARY HEALTHCARE BOARD. THE COMPENSATION REFLECTED IS THAT OF MR. PAQUETTE'S POSITION AS AN SCLHS SYSTEM PROJECT LEADER AND IS NOT RELATED TO HOLY ROSARY HEALTHCARE. RICHARD T. LOPES IS SENIOR VICE PRESIDENT AND CHIEF TRANSFORMATION OFFICER AT SCLHS. AS A FORMER OFFICER OF HOLY ROSARY HEALTHCARE, THIS DISCLOSURE IS REQUIRED FOR 990 REPORTING PURPOSES ONLY. THE COMPENSATION REFLECTED IS THAT OF MR. LOPES' POSITION AS AN SCLHS EXECUTIVE AND IS NOT RELATED TO HOLY ROSARY HEALTHCARE. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE. DISCLOSURES FORM 990, PART III, LINE 4D PROGRAM SERVICE ACCOMPLISHEMENTS HOLY ROSARY HEALTHCARE (HOSPITAL) PROVIDES QUALITY MEDICAL HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR ABILITY TO PAY. THE HOSPITAL PROVIDES CARE TO INDIVIDUALS COVERED BY GOVERNMENTAL PROGRAMS, OTHER BENEFITS, AND ACCOMPLISHMENTS INCLUDE: -ASSISTING EDUCATORS BY WORKING WITH HEALTHCARE INTERNS -PRESENT SPEAKING ENGAGEMENTS TO THE COMMUNITY COVERING HEALTHCARE ISSUES SUCH AS TELEMEDICINE, ARTHRITIS, HOSPICE PROGRAM, SLEEP DISORDERS, ETHICS, JOINT SEMINARS, EAR, NOSE, AND THROAT ISSUES, PSYCHOLOGY, AND DIABETES -PARTICIPATED IN HEALTH FAIRS TO PROMOTE HEALTH EDUCATION AND FOSTER PREVENTION TECHNIQUES -PROVIDE HOSPICE PROGRAM TO COMMUNITY -PROVIDE DENTAL CARE FOR CHILDREN THROUGH SMILE SAVERS -PROVIDE HEALTH RELATED ARTICLES TO LOCAL PRESS TO EDUCATE PUBLIC ON VARIOUS TOPICS -PROVIDE WELLNESS SCREENS TO SCHOOL DISTRICT AT DISCOUNTED RATE -PROVIDE FREE TOURS TO AREA SCHOOL CHILDREN AND OTHER COMMUNITY GROUPS TO TEACH THEM ABOUT THE HOSPITAL -PROVIDE MEDICAL EXPLORERS PROGRAM TO PROMOTE CAREERS IN HEALTHCARE -SPONSOR AFFORDABLE ACCESS ADVANTAGE FOR OUR EMPLOYEES -SPONSOR BLOOD DRIVES, CHARITY WALKS, 55 ALIVE, SCHOOL NURSE PROGRAM, AND OTHER GROUPS FORM 990 PART VI, SEC A, LINE 3 MANAGEMENT COMPANIES MANAGEMENT DUTIES DELEGATED BY HOLY ROSARY HEALTHCARE TO MANAGEMENT COMPANIES WERE IN THE FOLLOWING AREAS: (1) CONIFER HEALTH SOLUTIONS: REVENUE CYCLE SERVICES THAT INCLUDES PATIENT ACCESS, CHARGE CAPTURE AND ACCOUNTS RECEIVABLE MANAGEMENT (2) ARAMARK CORPORATION: FOOD SERVICES (3) BROADLANE: SUPPLY CHAIN MANAGEMENT FORM 990 PART VI, SEC A, LINES 6, 7A & 7B CLASS OF MEMBER, NATURE OF RIGHTS, ELECTION OF BOARD MEMBERS, DECISIONS SUBJECT TO APPROVAL THE SOLE MEMBER AND CONTROLLING MEMBER OF THE HOLY ROSARY HEALTHCARE (HRH) CORPORATION IS THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC (SCLHS), A KANSAS NON-FOR-PROFIT CORPORATION. SOME OF THE EXCLUSIVE POWERS OF SCLHS INCLUDE: - TO APPOINT, AFTER CONSULTATION WITH THE HRH CORPORATE BOARD, THE BOARD OF DIRECTORS OF HRH AND APPOINT MEMBERS OF SCLHS TO THE HRH BOARD OF DIRECTORS; - TO REMOVE, WITH OR WITHOUT CAUSE, AFTER CONSULTATION WITH THE HRH CORPORATE BOARD, ANY MEMBER OF THE HRH BOARD OF DIRECTORS; - TO APPOINT OR REMOVE, WITH OR WITHOUT CAUSE, THE CHIEF EXECUTIVE OFFICER AND THE CHIEF ADMINISTRATIVE OFFICER OF HRH; - TO IMPLEMENT CORPORATE GOALS, POLICIES, AND PROCEDURES OF HRH; - TO APPROVE FOR HRH THE ACQUISITION OF ASSETS, THE INCURRENCE OF INDEBTEDNESS, OR THE LEASE, SALE, TRANSFER, ASSUMPTION, OR ENCUMBERING OF HRH ASSETS; - TO APPROVE THE MERGER, DISSOLUTION, OR CORPORATE RESTRUCTURING OF HRH; AND - TO APPROVE HRH ANNUAL STRATEGIC PLANS AND OPERATING AND CAPITAL BUDGETS. THE HRH BOARD OF DIRECTORS HAVE THE POWERS TO EXERCISE GENERAL MANAGEMENT AND CONTROL OF THE BUSINESS AFFAIRS OF HRH WITH DUE REGARD FOR THE POWERS RESERVED BY SCLHS. THE POWERS OF THE HRH BOARD OF DIRECTORS INCLUDE NOMINATION OF BOARD MEMBERS FOR APPOINTMENT BY SCLHS. FORM 990 PART VI, SEC B, LINE 11B PROCESS THE ORGANIZATION USES TO REVIEW FORM 990 THE 990 FOR HOLY ROSARY HEALTHCARE WILL BE REVIEWED AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM AND THE HOLY ROSARY HEALTHCARE BOARD MEETINGS BEFORE THE RETURN IS FILED WITH THE IRS. THE 990 TAX RETURN IS REVIEWED BY AN INDEPENDENT ACCOUNTING FIRM. FORM 990, PART VI, SEC B, LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST ALL HOLY ROSARY HEALTHCARE EXECUTIVES, DIRECTORS, AND MANAGERS, BOARD MEMBERS AND BOARD COMMITTEE MEMBERS, MEDICAL EXECUTIVE COMMITTEE (MEC) MEMBERS AND OTHER PHYSICIANS IN DECISION MAKING ROLES OR SERVING ON HRH COMMITTEES, COMPLETE A NEW CONFLICT OF INTEREST (COI) DISCLOSURE FORM ANNUALLY. A COPY OF THE POLICY IS DISTRIBUTED ALONG WITH THE COI FORMS. IN THE EVENT OF A CHANGE OF CIRCUMSTANCE, EACH INDIVIDUAL WHO HAS ALREADY SIGNED A COI IS EXPECTED TO NOTIFY THE ORGANIZATION OF THE CHANGE AND UPDATE THE CONFLICT OF INTEREST INFORMATION. THE STATEMENTS ARE REVIEWED AND COI ISSUES ARE ADDRESSED BY THE ORGANIZATION RESPONSIBILITY OFFICER (ORO) AND LEADERSHIP AT THE APPROPRIATE LEVEL: - BOARD BY BOARD CHAIR - PHYSICIANS BY THE MEC PRESIDENT - HRH DIRECTORS AND MANAGERS BY THE HRH ADMINISTRATION - HRH EXECUTIVES BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM THE SIGNED COI FORMS ARE MAINTAINED IN HRH ADMISTRATION. THE CONFLICT OF INTEREST DISCLOSURE STATEMENTS FOR HRH EXECUTIVES ARE MAINTAINED AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AT THE BEGINNING OF BOARD AND BOARD COMMITTEE MEETINGS, THE QUESTION OF COI IS ASKED OF THOSE IN ATTENDANCE. WHEN AN ACTUAL CONFLICT IS IDENTIFIED, THE INDIVIDUAL ASKS TO BE EXCUSED FROM PARTICIPATING IN THE DISCUSSIONS AND DECISION-MAKING. FORM 990, PART VI, LINES 15A & B 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. FORM 990 PART VI, SEC C, LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO GEN PUBLIC THE CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE AT HOSPITAL ADMINISTRATION UPON REQUEST. THE SISTERS OF CHARITY CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE AVAILABLE ON THE SISTERS OF CHARITY WEBSITE WWW.SCLHEALTHSYSTEM.ORG. FORM 990, PART VII AND SCHEDULE J, PART II AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS ESTIMATE OF AVERAGE HOURS PER WEEK, IF ANY, DEVOTED TO RELATED ORGANIZATIONS FOR WHICH COMPENSATION WAS REPORTED IN COLUMNS (E) OR (F) OF PART VII: - JAMES PAQUETTE 36 HOURS/WEEK ON RELATED ORGANIZATIONS - STEVE BALLOCK 35 HOURS/WEEK ON RELATED ORGANIZATIONS - RON WEBB 1 HOUR/WEEK ON WORK FOR HRH FOUNDATION - RICHARD LOPES 1 HOUR/WEEK ON WORK FOR HRH FOUNDATION - PAUL LEWIS 1 HOUR/WEEK ON WORK FOR HRH FOUNDATION FORM 990, PART XI, LINE 5 RECONCILIATION OF NET ASSETS THE CHANGES IN NET ASSETS SHOWN ON LINE 5 OF PART XI ($16,765) STEM FROM THE UNREALIZED LOSS ON INVESTMENTS NOT RECORDED IN THE TAX RETURN STATEMENT OF CONTROLLED FOREIGN CORPORATION HOLY ROSARY HEALTHCARE, PARTICIPATION CORPORATION EIN: 81-0231792 FOR THE TAX YEAR ENDED DECEMBER 31, 2011 THIS STATEMENT IS BEING FILED PURSUANT TO TREAS. REG. 1.6038-2(J)(3). HOLY ROSARY HEALTHCARE'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 GEORGE TOWN, GRAND CAYMAN KY1-1102 CJ RIVERVIEW MULTI-SERIES FUND SPC, LTD. 510 THORNALL STREET, SUITE 220 EDISON, NJ 08837 AUSTIN CAPITAL SAFE HARBOR OFFSHORE FUND, LTD. 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