2012-11-14T17:30:19-06:00 2011-12-31 ERNST & YOUNG US LLP TWO NORTH CENTRAL AVENUE STE 2300 PHOENIX AZ 85004 990 2011-01-01 840417134 ST JOSEPH HOSPITAL % EXEMPLA INC C/O SHARON OWENS STJO 3034674145 1835 FRANKLIN STREET DENVER CO 80218 TODD CONKLIN 2012-11-13 6023223000 2011 2016-02-24 21:20:13Z BAIN FARRIS 455281035 false 0928 X WWW.EXEMPLA.ORG X 1873 CO THE JOINT MISSION OF EXEMPLA AND ST JOSEPH HOSPITAL IS TO FOSTER HEALING AND HEALTH FOR THE GREATER DENVER COLORADO METROPOLITAN SERVICE AREA. 10 9 2522 350 697216 254821 1044496 902306 416572921 444377719 5997458 5090490 -1290702 -1534411 422324173 448836104 112811 79324 0 0 188531515 196755615 0 0 0 206938815 219789321 395583141 416624260 26741032 32211844 456254669 489755294 95082292 98287851 361172377 391467443 X THE JOINT MISSION OF EXEMPLA AND ST JOSEPH HOSPITAL IS TO FOSTER HEALING AND HEALTH FOR THE GREATER DENVER COLORADO METROPOLITAN SERVICE AREA. false false 321438370 0 406526966 Provision of hospital based healthcare services, including charity care and unreimbursed Medicaid - see description in Schedule O. 16464527 0 12540216 Health professions education - See detailed descriptions in Schedule O. 16122438 0 21720624 COMPREHENSIVE CANCER CENTER - See detailed descriptions in Schedule O. 929207 79324 3589913 354954542 true true false true false false false false false false true false true true true true false true false false false false false false false false true true true false true false false false false false false false true false false false false false true true true false false true X 0 0 2522 true true false false false false false false false false false X 10 9 false true true false true true true true true false false true true true true true true true true false X EXEMPLA INC CO SHARON OWENS 3038135280 2480 W 26TH AVE 200B DENVER CO 80211 X KOGER PROPST 2.0 X X 0 0 0 FELIX W COOK SR 2.0 X 0 0 0 MICHAEL CHASE MD 2.0 X 0 0 0 JOHN V MCDERMOTT 2.0 X 0 0 0 KATHRYN A PAUL 2.0 X 0 0 0 BRUCE WARING MD 2.0 X 0 0 0 SISTER AMY WILLCOTT 2.0 X 0 0 0 MICHAEL A SLUBOWSKI 2.0 X X 0 1304791 10969 MARLA J WILLIAMS 2.0 X 0 0 0 SALLY WOOLSEY 2.0 X 0 0 0 TODD A CONKLIN 25.0 X 0 681316 87081 DAVID HAMM 50.0 X 0 673388 95182 DAVID C PECORARO 25.0 X 0 428616 58070 KATHRYN LOUISE BALLINGER 50.0 X 0 768828 34536 LISA S KETTERING 50.0 X 0 167272 23882 BAIN FARRIS 50.0 X 0 553036 99532 GRANT WICKLUND 50.0 X 0 504239 77959 ROBERT LADENBURGER 25.0 X 0 1086761 84694 BRADLEY KEITH LUDFORD 50.0 X 245341 0 39408 MARY E SHEPLER 50.0 X 213764 0 36681 BARBARA A JAHN 50.0 X 242480 0 32414 VANITA BELLEN 50.0 X 146644 0 10870 ALWIN F STEINMANN 50.0 X 300644 0 19127 SHAWN P DUFFORD 50.0 X 198383 0 8001 ROBERT GIBBONS 50.0 X 321726 0 37863 JOHN T MOORE 50.0 X 285642 0 34682 CHRISTINE RUTH GIESING 50.0 X 226123 0 31856 G EDWARD KIMM JR 50.0 X 249496 0 16587 RACHEL A GAFFNEY 50.0 X 233718 0 28666 WILLIAM M MURRAY 0.0 X 0 1848716 23674 2663961 8016963 891734 148 true true false 0 902306 902306 NET PATIENT REV. 622110 429995900 429298684 697216 EDUCATION & OTHER 611600 9798219 9798219 ADMIN MISC INCOME 900003 1392130 1392130 MEANINGFUL USE INCENTIVE 622110 3191470 3191470 444377719 4409108 4409108 0 0 3056843 3489308 -432465 -432465 -432465 892002 60950 271570 892002 -210620 681382 681382 0 0 1582107 2684053 -1101946 -1101946 0 448836104 442578557 697216 4658025 79324 79324 0 0 0 1055325 928900 126425 0 0 156169041 137460468 18708573 7814324 6878192 936132 20905169 18400794 2504375 10811756 9516541 1295215 4528701 2310914 2217787 601680 0 601680 159628 0 159628 0 0 0 28394493 21072955 7321538 762488 0 762488 2788944 1611469 1177475 4179403 178495 4000908 0 10136854 7093533 3043321 446581 333539 113042 0 273420 204343 69077 2087252 0 2087252 0 38720821 27389650 11331171 3013413 623368 2390045 BAD DEBT EXPENSE 9999326 9999326 MEDICAID PROVIDER FEE 17369602 17369602 MEDICAL SUPPLIES 70411370 69631427 779943 SYSTEM EQUALIZATION EXPENSE 20082262 20082262 5833083 4412808 1420275 416624260 355577910 61046350 0 7902871 2365144 608178 10792526 0 0 55326421 50169401 0 0 0 0 60000000 60000000 5390429 5273610 1080529 1521771 543306318 301372088 208265281 241934230 51585500 55740467 0 0 39170249 34968252 0 0 26925211 26989893 456254669 489755294 33350686 27887243 0 0 4224 4266 0 0 0 0 0 0 0 0 0 0 61727382 70396342 95082292 98287851 X 360990781 391282077 181596 185366 0 0 361172377 391467443 456254669 489755294 X 32211844 -1916778 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 2565 2565 false LOBBYING EXPENDITURES SCHEDULE C, PART II-B, QUESTION 1I ST JOSEPH HOSPITAL INCURRED $2,565 IN LOBBYING EXPENDITURES. THIS INCLUDES PORTIONS OF VARIOUS MEMBERSHIP DUES THAT ARE DESIGNATED AS LOBBYING EXPENSE BY THOSE ORGANIZATIONS IN WHICH ST JOSEPH HOSPITAL IS A MEMBER. 13543038 13543038 156245581 57898130 98347451 30925426 6866198 24059228 287270855 234048210 53222645 55321418 2559550 52761868 241934230 INVESTMENT IN SYSTEM 34968252 C 34968252 INTEREST RCVBLE FROM EXEMPLA 23830316 DEFERRED COMPENSATION ANNUITY 1802487 PHARMACY SUPPLY DEPOSIT 1357090 26989893 0 ESTIMATED THIRD PARTY PAYER SETTLEMENT 599035 ACCRUED INTEREST PAYABLE TO SCLHS 1298657 OTHER INTERCOMPANY S-T PAYABLES 10924548 ASBESTOS MITIGATION LIABILITY 3301005 MALPRACTICE LIABILITY 1844737 NOTES PAYABLE TO SCLHS 52355862 OTHER LIABILITIES 72498 70396342 LIABILITY FOR UNCERTAIN TAX POSITIONS SCHEDULE D PART X EXEMPLA ACCOUNTS FOR UNCERTAINTY IN TAX POSITIONS IN ACCORDANCE WITH THE ACCOUNTING STANDARDS CODIFICATION (ASC) 740, INCOME TAXES, WHICH PRESCRIBES CRITERIA FOR THE FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, CLASSIFICATION, INTEREST AND PENALTIES, ACCOUNTING IN INTERIM PERIODS, DISCLOSURE, AND TRANSITION. MANAGEMENT HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS AS OF DECEMBER 31, 2011 AND 2010. TAX YEARS 2008 THROUGH 2011 REMAIN SUBJECT TO EXAMINATION BY FEDERAL AND STATE JURISDICTIONS. true true X true X true X true true true false true true 1 20061062 20061062 0.04930 1 20660481 16620159 4040322 0.00990 2 40721543 16620159 24101384 0.05920 9 811352 811352 0.00200 6 19454108 4538118 14915990 0.03670 12 41085818 25053875 16031943 0.03940 6 129177 129177 0.00030 33 61480455 29591993 31888462 0.07840 35 102201998 46212152 55989846 0.13760 2 24415 24415 0.00010 1 9214 9214 3 33629 33629 0.00010 true 3908025 0 16198661 18388371 -2189710 X true true 1 1 ST JOSEPH HOSPITAL

1835 FRANKLIN STREET DENVER CO 80218

X ST JOSEPH HOSPITAL 1 true true 200. true 400. true X X X X X X true true X X X true false true X false false COMMUNITY BENEFIT REPORT PART I, LINE 6A COMMUNITY BENEFITS OF ST JOSEPH HOSPITAL (ESJH) ARE INCLUDED IN A REPORT PREPARED BY EXEMPLA HEALTHCARE. COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS PART I, LINE 7G THE ORGANIZATION DID NOT INCLUDE AS SUBSIDIZED HEALTH SERVICES ANY COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS. BAD DEBT EXPENSE PART I, LINE 7G, COLUMN (F) BAD DEBT EXPENSE INCLUDED ON PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE OF TOTAL EXPENSES IN SCHEDULE H PART I, LINE 7, COLUMN (H) IS $9,999,326. COSTING METHODOLOGY PART I, LINE 7 THE COST ACCOUNTING SYSTEM WAS USED AS THE BASIS TO CALCULATE THE AMOUNTS REPORTED AS CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS. THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS. THE COST OF SUBSIDIZED SERVICES WAS CALCULATED AS THE NET LOSS OF THE RELEVANT DEPARTMENT USING THE DEPARTMENTAL EXPENSES AND ALLOCATED OVERHEAD EXPENSES, AND THE DEDUCTION RATIO PER THE COST ACCOUNTING SYSTEM. FOR SUBSIDIZED SERVICES, THE COST OF CHARITY, MEDICAID, AND SELF PAY PATIENTS WERE REMOVED IN THE CALCULATION. COMMUNITY BUILDING ACTIVITIES PART II ST JOSEPH HOSPITAL INITIATED AND HOSTS A COMMUNITY BUILDING ACTIVITY CALLED THE COMMUNITY RESOURCES FORUM. THE PRIMARY PURPOSE OF THE COMMUNITY RESOURCES FORUM IS TO IMPROVE HEALTH IN THE COMMUNITY. IT CREATES AND FOSTERS NETWORKS OF PARTNERSHIPS ACROSS AGENCIES WITH A SPECIAL EMPHASIS ON SERVING VULNERABLE POPULATIONS AND MAXIMIZING SUPPORT AND RESOURCES FOR THESE COMMUNITY MEMBERS. EACH MONTH BETWEEN SEVENTY-FIVE AND ONE HUNDRED REPRESENTATIVES FROM COMMUNITY AGENCIES, ORGANIZATIONS, GOVERNMENTAL SERVICE PROGRAMS, BUSINESSES AND HEALTH CARE PARTNERS MEET AT THE HOSPITAL TO NETWORK AND SHARE INFORMATION ABOUT HOW THEIR SERVICES BENEFIT THE COMMUNITY AND INDIVIDUALS. DURING THESE MEETINGS, FIVE AGENCIES PRESENT MORE DETAILED INFORMATION WITH TIME FOR QUESTIONS AND COMMENTS FROM THE AUDIENCE. THE COMMUNITY RESOURCES FORUM IS NOT DESIGNED TO PROVIDE ANY ADDITIONAL BENEFIT TO THE HOSPITAL AND WAS NOT CREATED AS A MARKETING ACTIVITY OR TO INCREASE REFERRALS OF PATIENTS. THE HOSPITAL PROVIDES THE MEETING ROOM LOCATION, CONTINENTAL BREAKFAST AND STAFF COORDINATION OF THE FORUM AS THE HOSTS OF A SERVICE TO THE GREATER DENVER METRO COMMUNITY. OVER 700 ORGANIZATIONS ARE LISTED IN THE COMMUNITY RESOURCE FORUM DATABASE AS HAVING MADE CONTACT WITH THE FORUM. THE DATABASE IS NOT USED FOR ANY PURPOSE OTHER THAN NOTIFICATION OF UPCOMING COMMUNITY RESOURCE FORUM MEETINGS AND EVENTS. BAD DEBT EXPENSE COSTING METHODOLOGY AND OTHER INFO PART III, LINE 4 A COST TO CHARGE RATIO IS USED AS THE METHODOLOGY FOR DETERMINING THE AMOUNTS REPORTED AS COST OF BAD DEBT EXPENSE. FOR ALL SELF-PAY ACCOUNTS, A STANDARD 40% DISCOUNT IS FIRST APPLIED TO CHARGES AS A DEDUCTION OF REVENUE. BAD DEBT EXPENSE IS REFLECTED NET OF DISCOUNTS APPLIED AND PAYMENTS RECEIVED. THE ORGANIZATION DOES NOT INCLUDE IN BAD DEBT EXPENSE ANY AMOUNT THAT COULD REASONABLY BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S CHARITY CARE POLICY. THE FOLLOWING ARE THE RELEVANT PORTIONS OF THE COMPANY'S FOOTNOTE TO THE FINANCIAL STATEMENTS RELATED TO BAD DEBT: INCLUDED IN NET RECEIVABLES IS THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES. THE ALLOWANCE FOR UNCOLLECTIBLE RECEIVABLES IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS AND TAKES INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT PERIODICALLY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE ASSESSMENTS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. COSTING METHODOLOGY FOR MEDICARE COSTS PART III, LINE 8 INPATIENT AND OUTPATIENT MEDICARE COSTS ARE CALCULATED ON THE COST REPORT. INPATIENT COSTS ARE A PRODUCT OF ROUTINE SERVICE COSTS BASED ON PER DIEMS AND ANCILLARY COSTS BASED ON INPATIENT MEDICARE CHARGES FACTORED BY INPATIENT COST TO CHARGE RATIOS. OUTPATIENT COSTS ARE BASED ON MEDICARE OUTPATIENT CHARGES FACTORED BY OUTPATIENT COST TO CHARGE RATIOS. ST JOSEPH HOSPITAL DOES NOT RECOGNIZE THE MEDICARE SHORTFALL AS A COMMUNITY BENEFIT. DEBT COLLECTION POLICY PART III, 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. ST JOSEPH HOSPITAL NOTIFIES PATIENTS OF ITS 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. PUBLICIZING THE FINANCIAL ASSISTANCE POLICY PART V, LINE 13G ST JOSEPH HOPSITAL TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. ST JOSEPH 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. WE POST FINANCIAL ASSISTANCE INFORMATION IN THE FORM OF A FINANCIAL ASSISTANCE BROCHURE IN EMERGENCY AND ADMISSIONS AREAS, ON BILLINGS INVOICES, IN VARIOUS AREAS AROUND THE HOSPITAL AND CLINIC SITES AND ON THE HOSPITAL WEBSITE. THE BROCHURE EXPLAINS 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 THESE 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 ALSO PROVIDE THE DETAILED FINANCIAL ASSISTANCE POLICY TO INDIVIDUALS UPON REQUEST AND POST THE POLICY TO OUR WEBSITE TO ENSURE THE ENTIRE COMMUNITY HAS ACCESS TO SUCH INFORMATION. AMOUNTS BILLED TO UNINSURED INDIVIDUALS PART V, LINE 19D THE FACILITY AUTOMATICALLY APPLIES A 40% DISCOUNT FOR ANY PATIENT WITHOUT INSURANCE. IF AN INDIVIDUAL QUALIFIES FOR FINANCIAL ASSISTANCE AND HAS INCOME BELOWW 200% OF THE FEDERAL POVERTY GUIDELINES, THE FULL ACCOUNT BALANCE IS ADJUSTED TO ZERO. IF INCOME IS BETWEEN 200% AND 400% OF THE FEDERAL POVERTY GUIDELINES OR IS DETERMINED TO BE MEDICALLY INDIGENT EVEN IF THEIR INCOME IS ABOVE 400% OF THE FEDERAL POVERTY GUIDELINES, A MODEST PATIENT FINANCIAL RESPONSIBILITY IS DETERMINED FOLLOWING A COPAY GRID. THE GRID TAKES INTO CONSIDERATION INCOME AND FAMILY SIZE, AND IS DESIGNED TO RESULT IN AN AMOUNT THAT IS LOWER THAN THE LOWEST COMMERCIAL PAYER RATES. NEEDS ASSESSMENT 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. ST JOSEPH HOSPITAL (ESJH) HAS REGULARLY PARTICIPATED IN NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN DECEMBER 2009, AND ONE IS SCHEDULED TO BE COMPLETED IN 2012. THIS ASSESSMENT STUDIES A DEFINED COMMUNITY SERVED BY ST JOSEPH HOSPITAL, AND IS DONE BY PARTNERING WITH LOCAL GOVERNMENT AND SOCIAL AGENCIES, 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 HEALTH STATISTICS. IN 2009 ESJH FORMED A COMMUNITY OUTREACH COUNCIL FOR THE FOLLOWING PURPOSES: TO EMPOWER COMMUNITY MEMBERS, PARTICULARLY THE UNDERSERVED, TO ACHIEVE IMPROVED HEALTH AND WELLNESS; TO COLLABORATE WITH EXTERNAL PARTNERS AND RESOURCES TO ADDRESS IDENTIFIED NEEDS; AND TO FOSTER AN APPRECIATION FOR COMMUNITY SERVICE AND ENGAGEMENT IN SERVICE ACTIVITIES AMONG HOSPITAL EMPLOYEES. THE COMMUNITY OUTREACH COUNCIL WAS CHARGED TO DEVELOP AND OVERSEE THE COMMUNITY BENEFIT PROGRAMS FOR THE HOSPITAL. TO DEVELOP THE COMMUNITY BENEFIT PLAN FOR 2009, THE COMMUNITY OUTREACH COUNCIL COMPLETED A NEEDS ASSESSMENT OF COMMON COMMUNITY HEALTH INDICATORS AND REVIEWED INTERNAL CHARITY CARE PATIENT DATA. ADDITIONALLY, THE COUNCIL REVIEWED CURRENT COMMUNITY BENEFIT PROGRAMMING TO ASSESS OPPORTUNITIES TO ALIGN CURRENT COMMUNITY BENEFIT EFFORTS WITH IDENTIFIED NEEDS. THE INITIAL NEEDS ASSESSMENT INDICATED THREE AREAS OF CONCERN FOR CERTAIN SUBPOPULATIONS OF THE UNDERSERVED: POOR HEALTH INDICATORS, POOR PERI-NATAL HEALTH AND POOR ACCESS TO CARE. USING THESE INDICATORS, THE COUNCIL CREATED FOUR GOALS: - DEVELOP THE NEWLY FORMED COUNCIL INTO A HIGHLY EFFECTIVE AND ENGAGED COMMUNITY OUTREACH COUNCIL - MAXIMIZE COMMUNITY PARTNERSHIPS WITH A FOCUS ON THE MEDICALLY UNDERSERVED GEOGRAPHIC AREAS OF THE HOSPITAL - INTEGRATE THE FAMILY CENTERED CARE MODEL IN OUTPATIENT SETTING FOR VULNERABLE PREGNANT WOMEN, THEIR SUPPORT SYSTEMS AND THEIR CHILDREN FROM CONCEPTION THOUGH AGE THREE - PROVIDE CANCER PREVENTION, SCREENING AND TREATMENT TO UNDERSERVED POPULATIONS IN THE AREAS OF GYNECOLOGICAL, BREAST AND COLORECTAL CANCERS THE COMMUNITY OUTREACH COUNCIL REALIZED THE FOLLOWING OUTCOMES: - TEN TOURS CONDUCTED WITH LOCAL AGENCIES FOR ANALYSIS OF SYNCHRONICITY BETWEEN HOSPITAL AND LOCAL PARTNER. THE AGENCIES WERE EVALUATED WITH A WEIGHTED PRIORITY MATRIX AND DECISIONS WERE MADE TO SUPPORT THESE AGENCIES BASED ON THE POTENTIAL OUTCOMES FOR IMPROVED HEALTH. - RESEARCH AND DEFINITION OF FAMILY CENTERED CARE MODEL INCLUDING PATIENT AND EMPLOYEE SURVEYS. STRATEGIC ENGAGEMENT OF KEY PARTNERS TO MOVE THIS WORK FORWARD INCLUDING THE WOMEN'S AND CHILDREN'S SERVICE LINE TEAM. - IMPROVED COORDINATION AND PROCESSES FOR CONNECTING UNDERSERVED CANCER PATIENTS WITH AVAILABLE RESOURCES AND CARE. MAXIMIZED THE USE OF AVAILABLE FINANCIAL RESOURCES FOR CANCER PATIENTS AND INCREASED THE NUMBER OF UNDERSERVED WOMEN RECEIVING SERVICE FROM THE ESJH MOBILE MAMMOGRAPHY VAN. PATIENT EDUCATION OF ELIGIBILITY ASSISTANCE PART VI, LINE 3 ST JOSEPH HOSPITAL TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. ST JOSEPH 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 ALSO PROVIDE PAYMENT PLAN OPTIONS TO OUR PATIENTS. 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 PART VI, LINE 4 ST JOSEPH HOSPITAL (ESJH) IS LOCATED IN AN URBAN AREA AND SERVES A BROAD GEOGRAPHIC AREA, INCLUDING URBAN AND SUBURBAN COMMUNITIES. THE HOSPITAL'S PRIMARY SERVICE AREA IS 26.6% HISPANIC, 61% WHITE, AND 6.4% BLACK. THE POPULATION OF PEOPLE OVER 65 YEARS OF AGE IS 11.0% AND THE POPULATION OF CHILDREN UNDER AGE 14 IS 20.4%. THE POPULATION OF THE PRIMARY SERVICE AREA IS OVER 1.7 MILLION PEOPLE WITH OVER 700,000 HOUSEHOLDS. THOSE WITH AN ANNUAL INCOME UNDER $25,000 CONSTITUTE 18.6% OF THE POPULATION, WHILE APPROXIMATELY 54% OF THE HOUSEHOLDS HAVE AN ANNUAL INCOME GREATER THAN $50,000. THE ESJH COMMUNITY NEEDS ASSESSMENT USED UNITED STATES CENSUS DATA FOR THE CITY OF DENVER AND FOUND THAT 17.4% OF PERSONS LIVE BELOW POVERTY LEVEL. THE 2008-2009 COLORADO HOUSEHOLD SURVEY SPONSORED BY THE COLORADO DEPARTMENT OF HEALTH CARE POLICY AND FINANCING FOUND THAT 18.4% OF THOSE IN THE CITY AND COUNTY OF DENVER ARE UNINSURED AND 11.2% DO NOT HAVE A USUAL SOURCE OF CARE. COMPETITORS IN THE DENVER METROPOLITAN AREA INCLUDE THREE INVESTOR-OWNED HOSPITALS, A NONPROFIT SYSTEM-AFFILIATED HOSPITAL, AND TWO INDEPENDENT HOSPITALS INCLUDING THE PRIMARY CITY HOSPITAL. PROMOTION OF COMMUNITY HEALTH PART VI, LINE 5 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. DURING THIS YEAR, OUR COMMUNITY BUILDING ACTIVITIES INCLUDED COMMUNITY HEALTH EDUCATION WITH A PARTICULAR EMPHASIS ON PRENATAL CARE FOR POOR AND VULNERABLE POPULATIONS INCLUDING THE BABY BOUTIQUE PROGRAM, TEEN CHILDBIRTH EDUCATION AND TEEN BREASTFEEDING CLASSES. THESE OUTREACH EFFORTS ARE FOCUSED ON DECREASING THE OCCURRENCE OF LOW-BIRTH WEIGHT INFANTS BY INCREASING HEALTHY BEHAVIORS AND PROMOTING HEALTH LITERACY. ST JOSEPH HOSPITAL (ESJH) ALSO SERVES THE ENTIRE COMMUNITY THROUGH THE CONSUMER LIBRARY AND PROVIDES PACKETS OF INFORMATION ON HEALTH CONDITIONS RESEARCHED BY MEDICAL LIBRARIANS TO ANYONE AT NO CHARGE. ACCESS TO CANCER CARE SERVICES IS AN IDENTIFIED NEED THROUGH THE COMMUNITY NEEDS ASSESSMENT. ESJH PARTNERS WITH CANCER SUPPORT COMMUNITY COLORADO BY OFFERING IN-KIND OFFICE SPACE AND ADMINISTRATIVE SUPPORT FOR THIS COMMUNITY AGENCY THAT OFFERS FREE-OF-CHARGE PSYCHOSOCIAL SERVICES TO ALL THOSE IMPACTED BY CANCER. 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 $56,023,474, 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 ST JOSEPH HOSPITAL 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 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 FOOD DRIVES FOR LOCAL FOOD BANKS, HYGIENE SUPPLY DRIVES FOR LOCAL HOMELESS SHELTERS, SCHOOL SUPPLY DRIVES FOR LOCAL SCHOOLS, AMERICAN HEART WALK AND KOMEN RACE FOR THE CURE. WE ARE GOOD CITIZENS AND PARTNER WITH OTHER ORGANIZATIONS AND AGENCIES TO SUPPORT A THRIVING COMMUNITY. WE ARE MEMBERS OF THE DENVER CHAMBER OF COMMERCE, CAPITOL HILL UNITED NEIGHBORHOODS, INC., AND CAPITOL HILL UNITED MINISTRIES. WE PROVIDE FOCUSED OPERATIONAL AND STRATEGIC SUPPORT FOR BRUNER FAMILY MEDICINE CENTER, CARITAS CLINIC, SETON WOMEN'S CENTER AND A CERTIFIED NURSE MIDWIVES CLINIC. THESE CLINICS SERVE THE HEALTH NEEDS FOR THE UNINSURED. WE WORK CLOSELY TOGETHER TO PROVIDE INTEGRATED CARE FOR THOSE WHO COME TO EITHER THE HOSPITAL FACILITY OR THE OUTPATIENT CLINICS FOR THEIR HEALTH NEEDS. BRUNER FAMILY MEDICINE CENTER, CARITAS CLINIC, SETON WOMEN'S CENTER AND THE CERTIFIED NURSE MIDWIVES CLINIC PROVIDE QUALITY PRIMARY HEALTH CARE SERVICES FOR UNINSURED, LOW-INCOME PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE CLINICS ARE COMMITTED TO PROVIDING ACCESS TO COMPASSIONATE AND TRUSTWORTHY CARE FOR THE UNINSURED POOR. SERVICES THE CLINIC PROVIDES INCLUDE PRIMARY CARE, ONGOING MANAGEMENT OF CHRONIC DISEASES, AND MEDICATION ASSISTANCE. COMMUNITY BENEFITS PROVIDED IN 2011 THROUGHOUT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (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 PART VI, LINE 6 ST JOSEPH 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." ST JOSEPH 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 ST JOSEPH HOSPITAL, INCLUDING INFORMATION TECHNOLOGY SERVICES, CENTRAL CASH MANAGEMENT AND INVESTMENT, RISK MANAGEMENT AND INSURANCE AND QUALITY IMPROVEMENT LEADERSHIP. STATE FILING OF COMMUNITY BENEFIT REPORT PART VI, LINE 7 THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM FILES A COMMUNITY BENEFIT REPORT IN FOUR STATES: CALIFORNIA, COLORADO, KANSAS AND MONTANA. true SUSAN G KOMEN BREAST CANCER FOUNDATION 1835 FRANKLIN ST DENVER CO 80218 841199858 501(c)(3) 25000 PINK TIE AFFAIR SPONSORSHIP ARRUPE CORPORATE WORK STUDY PROGRAM 4343 UTICA DENVER CO 80212 460508814 501(c)(3) 21000 SUPPORT FOR WORK STUDY PROGRAM OF THE SCHOOL 2 0 DESCRIPTION OF ORGANIZATION'S PROCEDURES FOR MONITORING THE USE OF GRANTS SCHEDULE I, PART I - THE ORGANIZATION KEEPS RECORDS TO SUPPORT THE AMOUNTS PROVIDED OR REASON FOR SUCH SUPPORT. SUPPORT IS NOT CONSIDERED GRANTS, BUT RATHER MISCELLANEOUS DONATIONS AND SPONSORSHIPS. ELIGIBILITY FOR FUNDING IS DETERMINED ON AN INDIVIDUAL BASIS, CONSIDERING THE USE OF THE FUNDS AND HOW THE USE RELATES TO THE ORGANIZATION'S MISSION. X true true true true false false false false false true false TODD A CONKLIN 0 445252 0 196725 0 39339 0 70956 0 16125 0 768397 0 0 DAVID HAMM 0 429314 0 84637 0 159437 0 84994 0 10188 0 768570 0 138018 DAVID C PECORARO 0 330346 0 81212 0 17058 0 47451 0 10619 0 486686 0 0 KATHRYN LOUISE BALLINGER 0 314897 0 139314 0 314617 0 24060 0 10476 0 803364 0 0 LISA S KETTERING 0 116384 0 41474 0 9414 0 17519 0 6363 0 191154 0 0 ROBERT GIBBONS 301769 0 9561 0 10396 0 27892 0 9971 0 359589 0 0 0 JOHN T MOORE 285605 0 0 0 37 0 16396 0 18286 0 320324 0 0 0 CHRISTINE RUTH GIESING 226086 0 0 0 37 0 19820 0 12036 0 257979 0 0 0 BRADLEY KEITH LUDFORD 206482 0 27426 0 11433 0 20837 0 18571 0 284749 0 0 0 MARY E SHEPLER 187901 0 18816 0 7047 0 18227 0 18454 0 250445 0 0 0 BARBARA A JAHN 215176 0 23373 0 3931 0 19926 0 12488 0 274894 0 0 0 VANITA BELLEN 127381 0 16547 0 2716 0 9115 0 1755 0 157514 0 0 0 BAIN FARRIS 0 428580 0 105122 0 19334 0 88843 0 10689 0 652568 0 0 GRANT WICKLUND 0 388425 0 97200 0 18614 0 62642 0 15317 0 582198 0 0 ROBERT LADENBURGER 0 607673 0 144615 0 334473 0 73845 0 10849 0 1171455 0 0 MICHAEL A SLUBOWSKI 0 913849 0 200000 0 190942 0 0 0 10969 0 1315760 0 0 ALWIN F STEINMANN 295577 0 0 0 5067 0 4900 0 14227 0 319771 0 0 0 G EDWARD KIMM JR 249459 0 0 0 37 0 4448 0 12139 0 266083 0 0 0 RACHEL A GAFFNEY 233681 0 0 0 37 0 18627 0 10039 0 262384 0 0 0 SHAWN P DUFFORD 198346 0 0 0 37 0 147 0 7854 0 206384 0 0 0 WILLIAM M MURRAY 0 425764 0 0 0 1422952 0 19147 0 4527 0 1872390 0 0 SOCIAL CLUB DUES SCH J, PART I, QUESTION 1A SOCIAL CLUB DUES WERE PAID BY EXEMPLA, A RELATED NOT-FOR-PROFIT ORGANIZATION, ON BEHALF OF TODD A CONKLIN IN THE AMOUNT OF $518 DURING 2011, AND WAS INCLUDED AS TAXABLE INCOME TO MR. CONKLIN. TAX INDEMNIFICATION AND GROSS UP PAYMENTS SCH J, PART I, QUESTION 1A 13 INDIVIDUALS RECEIVED GROSS UP PAYMENTS FOR GIFTS OR OTHER ITEMS THAT WERE TAXABLE TO THE INDIVIDUAL IN THEIR W-2'S. THESE TOTALED $568 IN THE AGGREGATE. COMPENSATION OF THE ORGANIZATION'S CEO SCHEDULE J, PART I, QUESTION 3 THE ORGANIZATION'S CEO IS COMPENSATED BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS), A RELATED ORGANIZATION. SCLHS USED ALL OF THE METHODS DESCRIBED IN SCHEDULE J, PART I TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO. SEVERANCE AND CHANGE OF CONTROL PAYMENTS SCHEDULE J, PART I, QUESTION 4A A CHANGE OF CONTROL PAYMENT WAS MADE TO KATHRYN BALLINGER IN THE AMOUNT OF $314,580 IN 2011. SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) PERIODICALLY INCURS SEVERANCE PAYMENTS RELATED TO FORMER EMPLOYEES. A SEVERANCE PAYMENT WAS MADE TO WILLIAM M. MURRAY IN THE AMOUNT OF $150,051 IN 2011. SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS SCHEDULE J, PART I, QUESTION 4B EXEMPLA HAS A 457(F) SUPPLEMENTAL NONQUALIFIED DEFERED COMPENSATION PLAN, IN WHICH CERTAIN KEY OFFICERS PARTICIPATE. DAVID HAMM RECEIVED A DISTRIBUTION FROM THE PLAN DURING 2011 IN THE AMOUNT OF $138,018. FURTHER, 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: ROBERT W. LADENBURGER-$116,293 MICHAEL A. SLUBOWSKI-$38,668 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: WILLIAM M MURRAY-$1,258,479 INCENTIVE PLANS SCHEDULE J, PART I, QUESTION 7 THE MANAGEMENT INCENTIVE PLANS 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 DIVISION IN WHICH THE INDIVIDUAL WORKS, OR IN THE CASE OF SYSTEM SERVICES SENIOR MANAGEMENT, THE NET EARNINGS OF THE COMPANY. COMPENSATION OF BOARD MEMBER SCHEDULE J, PART II SCLHS CONSISTS OF ELEVEN HOSPITALS AND THREE CLINICS (AFFILIATES) IN FOUR STATES INCLUDING ST. JOSEPH HOSPITAL. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. MICHAEL A. SLUBOWSKI IS PRESIDENT & CHIEF EXECUTIVE OFFICER FOR SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS). HE ALSO SERVES AS A MEMBER OF THE EXEMPLA, INC.'S (EXEMPLA) BOARD AND AS CHAIRMAN. THE COMPENSATION REFLECTED IS THAT OF MR. SLUBOWSKI'S POSITION AS AN SCLHS EXECUTIVE AND NOT AS A MEMBER OF EXEMPLA'S BOARD. WILLIAM M. MURRAY WAS PRESIDENT & CHIEF EXECUTIVE OFFICER FOR SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS). HE ALSO SERVED AS A MEMBER OF THE EXEMPLA, INC.'S (EXEMPLA) BOARD AND AS CHAIRMAN. THE COMPENSATION REFLECTED IS THAT OF MR. MURRAY'S POSITION AS AN SCLHS EXECUTIVE AND NOT AS A MEMBER OF EXEMPLA'S BOARD. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE. MIDTOWN INPATIENT MEDICINE PARTNER / EXEMPLA KEY EMP 3939484 HOSPITALIST SVCS AGREEMENT false HOSPITAL SHARED SERVICES BOD / EXEMPLA KEY EMP 3780603 CONTRACTED SERVICES false BUSINESS TRANSACTION RELATIONSHIPS PART IV LISA KETTERING, A KEY EMPLOYEE, IS A GREATER THAN 5% PARTNER IN MIDTOWN INPATIENT MEDICINE. BRADLEY LUDFORD, A KEY EMPLOYEE, SERVES ON THE BOARD OF DIRECTORS OF HOSPITAL SHARED SERVICES. EXEMPT PURPOSE ACHIEVEMENTS FORM 990, PART III, LINES 4A - 4D ST JOSEPH HOSPITAL (ESJH) IS OWNED BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS). EXEMPLA HEALTHCARE (EXEMPLA) IS A HEALTH CARE DELIVERY SYSTEM FORMED ON JANUARY 1, 1998, BY A JOINT OPERATING AGREEMENT AMONG SCLHS, ESJH, LMC COMMUNITY FOUNDATION (CURRENTLY COMMUNITY FIRST FOUNDATION) AND EXEMPLA, INC. (EXEMPLA). EXEMPLA OPERATES EXEMPLA LUTHERAN MEDICAL CENTER, EXEMPLA GOOD SAMARITAN MEDICAL CENTER AND OTHER AFFILIATED MEDICAL SERVICES INCLUDING THE EXEMPLA PHYSICIAN NETWORK. THE SYSTEM'S COLLECTIVE PROGRAM SERVICES ACCOMPLISHMENTS INCLUDE BUT ARE NOT LIMITED TO THE FOLLOWING: THE MEDICAL SERVICES ARE PROVIDED TO ALL WHO SEEK SERVICE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE, OR ABILITY TO PAY. ALTHOUGH REIMBURSEMENT FOR SERVICES IS CRITICAL FOR THE OPERATION AND STABILITY OF EXEMPLA AND ESJH, IT IS RECOGNIZED THAT NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES. THEREFORE, IN KEEPING WITH EXEMPLA'S AND ESJH'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, FREE CARE AND/OR SUBSIDIZED CARE WILL BE CONSIDERED AND PROVIDED WHERE THE NEED AND/OR AN INDIVIDUAL'S INABILITY TO PAY EXIST. IN ADDITION, EXEMPLA AND ESJH RECOGNIZE THE ESSENTIAL NEED TO BE EXCEPTIONAL STEWARDS OF MEDICARE, MEDICAID AND COMMUNITY/PRIVATE FUNDING DOLLARS. FOR 2011, ESJH PROVIDED BENEFIT TO THE COMMUNITY AT A COST OF $56.0 MILLION, INCLUDING CHARITY CARE, UNREIMBURSED MEDICAID, OTHER SUBSIDIZED HEALTH SERVICES AND EDUCATION. EXEMPLA AND ESJH ALSO RECOGNIZE THE ESSENTIAL NEED TO ENHANCE AND IMPROVE MEDICAL OUTCOMES, QUALITY, AND SERVICES. IN RESPONSE, A BEST IN THE NATION STRATEGY AND PROGRAM WAS IMPLEMENTED. THE OBJECTIVES OF THE PROGRAM ARE TO BE THE BEST IN THE NATION ON PREDEFINED QUALITIES, SERVICE AND COST INDICATORS. THE QUALITY INDICATORS ARE IN ALIGNMENT WITH MAJOR PUBLICLY COMPARABLE DATABASES INCLUDING THE COLORADO HEALTH AND HOSPITAL ASSOCIATION AND CENTERS FOR MEDICARE AND MEDICAID SERVICES. CURRENTLY, THE PROGRAM IS IN THE NINTH YEAR OF THIS INITIATIVE. WITH ITS 565 LICENSED BEDS, ESJH SERVED THE COMMUNITY WITH 19,809 INPATIENT ADMISSIONS, 169,701 OUTPATIENT VISITS AND 49,495 EMERGENCY ROOM VISITS. SERVICES - COMPREHENSIVE MEDICAL SERVICES INCLUDE, BUT ARE NOT LIMITED TO, CARDIOLOGY, ONCOLOGY, ORTHOPEDIC, WOMEN AND FAMILY, PEDIATRICS, EMERGENCY AND TRAUMA, NEONATAL INTENSIVE CARE, NEUROLOGY, OB/GYN AND GENERAL SURGICAL AND MEDICAL. - ESJH IS A LEADING HEART HOSPITAL IN DENVER PERFORMING APPROXIMATELY 400 OPEN-HEART SURGERIES ANNUALLY, MORE THAT ANY OTHER COLORADO HOSPITAL. - ESJH DELIVERS MORE BABIES THAT ANY OTHER COLORADO HOSPITAL WITH 4,650 BIRTHS IN 2010. ALONG WITH NORMAL DELIVERIES, THE HOSPITAL ALSO CARES FOR CRITICALLY ILL NEWBORNS AND HIGH-RISK MOTHERS. - ESJH IS AMONG THE TOP THREE COLORADO HOSPITALS FOR NEWLY DIAGNOSED CANCER CASES. IN ORDER TO MEET THE SPECIAL NEEDS OF THESE PATIENTS, THE COMPREHENSIVE CANCER CENTER BRINGS TOGETHER IN ONE PLACE THE ESJH BREAST CARE CENTER, CANCER PSYCHOSOCIAL SERVICES, MEDICAL AND SURGICAL ONCOLOGY, A LABORATORY, A RESEARCH DEPARTMENT, A NEW CANCER PHARMACY AND THE INFUSION CENTER. THIS MEANS THAT THE PROFESSIONALS FROM ONCOLOGISTS TO LAB TECHNICIANS TO PSYCHOTHERAPISTS TO INFUSION SPECIALISTS, PHARMACIST AND RADIOLOGISTS -HAVE ACCESS TO LEADING-EDGE TECHNOLOGY AND CAN BETTER INTERACT WITH ONE ANOTHER TO PROVIDE FULLY COORDINATED CARE TO EACH OF OUR PATIENTS. - THE HIGHLY TRAINED PHYSICIANS, NURSES AND SUPPORT STAFF IN THE EMERGENCY DEPARTMENT TREAT MORE THAN 136 PATIENTS PER DAY FOR A WIDE RANGE OF EMERGENCY MEDICAL CONDITIONS. PROGRAMS A STRONG COMMITMENT TO THE HEALTH OF THE COMMUNITY IS FURTHER EXEMPLIFIED, BUT NOT LIMITED TO, THE FOLLOWING PROGRAMS: - THE GRADUATE MEDICAL EDUCATION PROGRAM TRAINS 104 MEDICAL RESIDENTS EACH YEAR IN THE FIELDS OF FAMILY PRACTICE, INTERNAL MEDICINE, OBSTETRICS/GYNECOLOGY AND GENERAL SURGERY. IN 2010, THE INTERNAL MEDICINE RECEIVED THE HIGHEST LEVEL OF ACCREDITATION FOR FIVE YEARS BY THE AMERICAN COLLEGE OF GRADUATE MEDICAL EDUCATION. ALL FOUR PROGRAMS CONTINUED TO ENHANCE MEDICAL KNOWLEDGE THROUGH ADVANCED SCHOLARSHIP INCLUDING OVER TWENTY PUBLISHED PAPERS AND SEVERAL NATIONAL PRESENTATIONS. - THE CARITAS CLINIC, SISTER JOANNA BRUNER FAMILY MEDICINE CENTER, EXEMPLA FAMILY MEDICAL CENTER, AND SETON WOMEN'S CENTER PROVIDE A CONTINUUM OF CARE FROM PREVENTIVE THROUGH ACUTE CARE TO MEDICALLY UNDERSERVED INDIVIDUALS IN A PHYSICIAN OFFICE SETTING. THE THREE ON-CAMPUS CLINICS PROVIDE MORE THAN 40,000 PATIENT VISITS EACH YEAR AND OFFER PAYMENT FOR SERVICES VIA A SLIDING FEE PROGRAM. NO PATIENT IS DENIED SERVICE DUE TO AN INABILITY TO PAY. - BOOT CAMP FOR NEW DADS IS AN INNOVATIVE PROGRAM DESIGNED TO BUILD CONFIDENCE AND PREPARE FIRST-TIME DADS FOR THE CHALLENGES OF PARENTHOOD. VETERAN DADS AND THEIR NEWBORNS ORIENT ROOKIE DADS. IT SERVED APPROXIMATELY 1,200 EXPECTANT FATHERS IN 2010. - THE BABY BOUTIQUE IS AN AWARD-WINNING INCENTIVE PROGRAM THAT ENCOURAGES PRENATAL CARE AMONG EXPECTANT FAMILIES. BY FOLLOWING APPROPRIATE PRENATAL CARE AND REGULAR OFFICE VISIT SCHEDULES AND ATTENDING PRENATAL EDUCATIONAL CLASSES, EXPECTANT FAMILIES EARN COUPONS FOR NECESSARY BABY SUPPLIES, CLOTHES AND EQUIPMENT. IN 2010, APPROXIMATELY 760 FAMILIES WERE SERVED, WITH MOST FAMILIES RETURNING REGULARLY TO THE BABY BOUTIQUE AS THE COURSE OF PREGNANCY PROCEEDED. INCIDENCE OF LOW BIRTH WEIGHT WAS LESS IN PARTICIPATING FAMILIES THAN IN NON-PARTICIPATING FAMILIES. - THE ST JOSEPH HOSPITAL FOUNDATION RAISES AND MANAGES FUNDS FOR THE BENEFIT OF THE HOSPITAL AND ITS COMMUNITY PROGRAMS. FUNDS RAISED BY THE FOUNDATION ENABLE THE HOSPITAL TO OFFER A VARIETY OF HEALTH CARE PROGRAMS TO THE COMMUNITY, PARTICULARLY THE MEDICALLY UNDERSERVED. - ESJH MOBILE MAMMOGRAPHY - THROUGH SUPPORT FROM THE DENVER AFFILIATE OF THE KOMEN FOUNDATION AND ST JOSEPH HOSPITAL FOUNDATION, ESJH PROVIDES DIAGNOSTIC CARE FOR MEDICALLY UNDERSERVED, AT RISK WOMEN. INTRODUCED IN SEPTEMBER 2005, THE MOBILE MAMMOGRAPHY UNIT SERVES SOME 2,000 COLORADO WOMEN ANNUALLY. - THE WILLIAM V. GERVASINI MEMORIAL LIBRARY IS A HEALTH INFORMATION RESOURCE FOR PATIENTS, THEIR FAMILIES, AND THE COMMUNITY. THE LIBRARY COLLECTION FOCUSES ON UNDERSTANDABLE, OBJECTIVE INFORMATION ABOUT MEDICAL ISSUES AND CONDITIONS. MAILING SERVICES ARE AVAILABLE FOR THOSE WHO ARE UNABLE TO VISIT THE LIBRARY. - THE SCHOOL AT WORK PROGRAM, WHICH IS PART OF ESJH'S WORKFORCE DEVELOPMENT INITIATIVE, OFFERS PROFESSIONAL DEVELOPMENT OPPORTUNITIES TO HIGH PERFORMING EMPLOYEES WHO WISH TO ENHANCE THEIR COMPUTER SKILLS AND HEALTH CARE KNOWLEDGE FOR ENTRY INTO HEALTH CARE CAREERS. THE STUDENTS TAKE CLASSES AT THE HOSPITAL FOR SEVERAL HOURS A WEEK FOR EIGHT MONTHS. THEY ARE PROVIDED WITH TEXT BOOKS AND MATERIALS AND ARE EXPECTED TO COMPLETE SEVERAL HOURS OF HOMEWORK ON-LINE. - THE WOMEN'S PAVILION OFFERS COMMUNITY HEALTH EDUCATION FOCUSED ON PRENATAL CARE, PARENTING AND WOMEN'S HEALTH. IN 2010, THE WOMEN'S PAVILION PROVIDED HEALTH EDUCATION TO OVER 6,100 WOMEN AND THEIR SPOUSES AND SUPPORT PERSONS. PAVILION PROVIDED HEALTH EDUCATION TO OVER 6,100 WOMEN AND THEIR SPOUSES AND SUPPORT PERSONS. DELEGATION OF BOARD AUTHORITY TO AN EXECUTIVE COMMITTEE PART VI, QUESTION 1A PURSUANT TO THE BYLAWS, THE EXECUTIVE COMMITTEE OF THE ORGANIZATION HAS THE POWER TO TRANSACT ALL REGULAR BUSINESS OF THE ORGANIZATION DURING THE INTERIM BETWEEN MEETINGS OF THE BOARD, PROVIDED THAT ANY ACTION TAKEN BY THE EXECUTIVE COMMITTEE DOES NOT CONFLICT WITH THE ARTICLES OF INCORPORATION, THE BYLAWS OR THE POLICIES OR EXPRESSED WISHES OF THE BOARD. THE EXECUTIVE COMMITTEE SHALL REPORT ALL MATTERS ACTED UPON TO THE BOARD AT THE BOARD'S NEXT MEETING. THE EXECUTIVE COMMITTEE CONSISTS OF AT LEAST THREE MEMBERS, ALL OF WHOM SHALL BE MEMBERS OF THE BOARD OF DIRECTORS, AND INCLUDE THE CHAIRPERSON OF THE BOARD, THE PRESIDENT/CEO AND OTHERS AS DESIGNATED BY THE CHAIRPERSON. FORM W-3 FORM 990, PART V, LINE 2A ALL FORMS W-2 ARE ISSUED BY EXEMPLA, INC., A RELATED TAX-EXEMPT ORGANIZATION. DELEGATION OF CONTROL OVER MANAGEMENT DUTIES FORM 990, PART VI, QUESTION 3 IN JUNE 2008, EXEMPLA, INC., AS MANAGER OF ST JOSEPH HOSPITAL (ESJH), ENTERED INTO A MANAGEMENT AGREEMENT WITH INSIGHT ONCOLOGY FOR THE MANAGEMENT OF THE HOSPITAL'S COMPREHENSIVE CANCER CENTER SERVICES. EXEMPLA, INC. MANAGES AND GOVERNS ST JOSEPH HOSPITAL UNDER A JOINT OPERATING AGREEMENT. IN JULY 2009, ESJH CONTRACTED WITH INSIGHT ONCOLOGY TO MANAGE A BREAST CENTER, SURGICAL SERVICES, RADIATION ONCOLOGY, OUTPATIENT INFUSION SERVICES, A PHARMACY, INPATIENT SERVICES, AND OTHER SPECIALIZED CARE TO PATIENTS WITH ONCOLOGY DISEASES AND DISORDERS. CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PART VI, QUESTION 4 EFFECTIVE OCTOBER 1, 2012, SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS) AND COMMUNITY FIRST FOUNDATION AGREED TO AMEND AND RESTATE THE BYLAWS OF EXEMPLA. UNDER THE AMENDMENTS, COMMUNITY FIRST FOUNDATION'S INTEREST IN THE JOINT OPERATING AGREEMENT AND OTHER RIGHTS OF COMMUNITY FIRST FOUNDATION RELATED TO EXEMPLA WERE TERMINATED. IN RETURN, SCLHS COMMITTECD TO PROVIDE $275 MILLION TO COMMUNITY FIRST FOUNDATION OVER A PERIOD OF 20 YEARS. THE BOARD OF DIRECTORS OF EXEMPLA WILL CONTINUE TO CONSIST OF 10 MEMBERS, 9 OF WHICH ARE APPOINTED BY SCLHS AND 1 OF WHICH IS APPOINTED BY COMMUNITY FIRST FOUNDATION. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, QUESTION 6 ST JOSEPH HOSPITAL HAS ONE MEMBER, SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM. ST JOSEPH HOSPITAL IS MANAGED AND GOVERNED BY EXEMPLA, INC. EXEMPLA, INC. HAS TWO MEMBERS: COMMUNITY FIRST FOUNDATION (CFF) AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS). ELECTION OF MEMBERS OF GOVERNING BODY FORM 990, PART VI, QUESTION 7A SISTERS OF CHARITY LEAVENWORTH HEALTH SYSTEMS, THE SOLE MEMBER OF SAINT JOSEPH HOSPITAL APPOINTS MEMBERS OF THE SAINT JOSEPH HOSPITAL BOARD OF DIRECTORS. SAINT JOSEPH HOSPITAL IS MANAGED AND GOVERNED BY EXEMPLA, INC. EXEMPLA, INC HAS TWO MEMBERS, SISTERS OF CHARITY LEAVENWORTH HEALTH SYSTEMS AND COMMUNITY FIRST FOUNDATION. CFF APPOINTS 5 OF THE DIRECTORS AND SCLHS APPOINTS 5 OF THE DIRECTORS. DECISIONS OF GOVERNING BODY SUBJECT TO APPROVAL FORM 990, PART VI, QUESTION 7B BOTH MEMBERS (COMMUNITY FIRST FOUNDATION AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, SCLHS) HAVE CERTAIN RESERVE POWERS TO APPROVE CHANGES TO THE BYLAWS REGARDING APPOINTMENT OF BOARD MEMBERS. SCLHS ALSO HAS EXTENSIVE RESERVE POWERS OVER ANY CHANGE IN MISSION, CHANGES TO THE ARTICLES OF INCORPORATION OR BYLAWS, ACQUISITION OF ASSETS, INCURRENCE OF DEBT, MERGER OR DISSOLUTION, APPROVAL OF STRATEGIC PLANS AND BUDGETS, AND APPOINTMENT OF AUDITORS. 990 REVIEW PROCESS FORM 990, PART VI, QUESTION 11 ALL 990 REPORTING WAS REVIEWED INTERNALLY WITH SENIOR MANAGEMENT. ALL QUESTIONS AND CHANGES PROPOSED WERE ADDRESSED PRIOR TO FILING FORM 990. A DRAFT 990 WAS PROVIDED TO THE MEMBERS OF THE FINANCE COMMITTEE AND OF THE BOARD FOR REVIEW. A COMPLETE COPY OF THE FINAL FORM 990 WAS THEN PROVIDED ELECTRONICALLY TO EACH VOTING MEMBER OF THE EXEMPLA BOARD OF DIRECTORS PRIOR TO ITS SUBMISSION TO THE INTERNAL REVENUE SERVICE. MONITORING COMPLIANCE WITH CONFLICT OF INTEREST POLICY FORM 990, PART VI, QUESTION 12C THE ORGANIZATION 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 BY THE LEGAL DEPARTMENT. WHEN A CONFLICT IS IDENTIFIED, THE LEGAL DEPARTMENT COMPILES ALL REPORTED CONFLICTS, AND EVALUATES THE DISCLOSURES FOR ACTUAL CONFLICTS. A REPORT IS PROVIDED TO ORGANIZATION'S PRESIDENT/CEO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. THOSE WITH IDENTIFIED CONFLICTS OF INTEREST MUST RECUSE THEMSELVES FROM ANY MEETING DURING THE DISCUSSION AND VOTE THEREOF. PROCESS FOR DETERMINING COMPENSATION OF CEO, OFFICERS, OR KEY EMPLOYEES FORM 990, PART VI, QUESTION 15A & 15B COMPENSATION FOR THE CEO IS PAID BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, A RELATED NON-PROFIT ORGANIZATION. COMPENSATION OF OTHER OFFICERS AND KEY EMPLOYEES IS PAID BY EITHER EXEMPLA, INC. OR SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, BOTH OF WHICH ARE RELATED NON-PROFIT ORGANIZATIONS. WHEN REVIEWING AND SETTING COMPENSATION FOR 'DISQUALIFIED PERSONS', EXEMPLA'S PROCESS INCLUDES: THE COMPENSATION COMMITTEE OF THE BOARD IS CHARGED WITH THE RESPONSIBILITY FOR SETTING THE OVERALL COMPENSATION PHILOSOPHY AND FOR EVALUATING THE TOTAL COMPENSATION PROGRAMS FOR DISQUALIFIED PERSONS. THE BOARD MEMBERS ARE INDEPENDENT MEMBERS AND IN THESE DISCUSSIONS THE CEO RECUSES HIMSELF FROM THE DISCUSSIONS AROUND HIS OWN COMPENSATION. THE COMMITTEE OBTAINS VALID, COMPARABLE MARKET DATA (FROM INDEPENDENTLY PUBLISHED SOURCES) FOR COMPARABLE POSITIONS AND FROM FORM 990 FILINGS. THIS COMMITTEE ENGAGES THE SERVICES OF AN INDEPENDENT EXPERT IN EXECUTIVE COMPENSATION TO REVIEW THE MARKET DATA AND PROVIDE AN OPINION AS TO THE REASONABLENESS OF THE TOTAL COMPENSATION PROGRAM. FOR THE PAST SEVERAL YEARS, THE INDEPENDENT FIRM HAS BEEN WATSON WYATT. WATSON WYATT VALIDATES THE PROCESS USED BY MANAGEMENT FOR IDENTIFYING 'DISQUALIFIED PERSONS' AND THEN CONDUCTS A COMPARABILITY STUDY/ANALYSIS OF PAY AT SIMILAR TYPES AND SIZES OF ORGANIZATIONS AND REVIEWS BASE SALARY, INCENTIVE (OR OVER-BASE PROGRAMS), BENEFITS, RETIREMENT PLANS AND PERQUISITES. WATSON WYATT REVIEWS THE FINDINGS WITH THE BOARD COMMITTEE AND MINUTES ARE PREPARED AND SHARED WITH ALL THE VOTING BOARD MEMBERS EACH YEAR THAT DOCUMENTS THE DISCUSSION AND ANY ACTIONS THAT MAY HAVE BEEN TAKEN. A COPY OF A FORMAL OPINION LETTER PREPARED BY WATSON WYATT FOLLOWING THE DISCUSSION WITH THE COMPENSATION COMMITTEE IS PROVIDED TO THE BOARD CHAIR AND SHARED WITH THE FULL BOARD. THIS PROCESS IS UNDERTAKEN EACH YEAR. SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES, INCLUDING EXEMPLA. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: 1) COMPENSATION COMMITTEE, 2) INDEPENDENT COMPENSATION CONSULTANT, 3) FORM 990 OF OTHER ORGANIZATIONS, 4) WRITTEN EMPLOYMENT CONTRACTS, 5) COMPENSATION SURVEYS AND STUDIES, 6) 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. AVAILABILITY OF GOVERNING DOCS, CONFLICT OF INTEREST POLICY, FINANCIALS FORM 990, PART VI, QUESTION 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND RELATED DOCUMENTATION ARE PROVIDED UPON REQUEST AS DEEMED APPROPRIATE. INDEPENDENT CONTRACTORS PART V, QUESTION 1A AND PART VII, SECTION B, QUESTION 2 NO VENDOR PAYMENTS ARE PAID BY ST JOSEPH HOSPITAL. THEY ARE ALL PAID BY EXEMPLA, INC. AND THE NUMBER OF INDEPENDENT CONTRACTORS PAID OVER $100,000 ARE REFLECTED IN THE EXEMPLA, INC. FORM 990 AS THE TOTAL PAID FOR ALL ENTITIES OWNED/MANAGED BY EXEMPLA, INC. OTHER CHANGES IN NET ASSETS PART XI, LINE 5 REFLECTED AS OTHER CHANGES IN NET ASSETS ARE NET TRANSFERS UNREALIZED LOSSES ON INVESTMENTS IN THE AMOUNT OF ($1,920,552) AND CONTRIBUTIONS OF TEMPORARILY RESTRICTED NET ASSETS OF $3,774. STATEMENT OF CONTROLLED FOREIGN CORPORATION ST JOSEPH HOSPITAL, PARTICIPATION CORPORATION EIN: 84-0417134 FOR THE TAX YEAR ENDED DECEMBER 31, 2011 THIS STATEMENT IS BEING FILED PURSUANT TO TREAS. REG. 1.6038-2(J)(3). ST JOSEPH HOSPITAL'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. PO BOX 31106, 89 NEXUS WAY, 2ND FLOOR CAMANA BAY GEORGE TOWN, GRAND CAYMAN KY1-1205 CJ 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:MICHAEL A SLUBOWSKI TITLE:CHAIRMAN HOURS:50 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TODD A CONKLIN TITLE:SVP & CFO, TREASURER HOURS:25 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID C PECORARO TITLE:SVP & CIO HOURS:25 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT LADENBURGER TITLE:PRESIDENT&CEO-EXEMPLA HOURS:25 SISTERS OF CHARITY LEAVENWORTH HLTH SYST 2420 W 26TH AVE SUITE 100D DENVER CO 80211 237379161 SUPPORT MMBRS KS 501(C)(3) 11B-TYPE II NA false CARITAS CLINICS INC 818 NORTH 7TH STREET LEAVENWORTH KS 66048 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SCHEDULE R TRANSACTIONS SCHEDULE R, PART V, LINE 2 COLUMN D THE ORGANIZATION USED THE AMOUNT RECOGNIZED ON THE BOOKS AND RECORDS OF THE ORGANIZATION OF CASH RECEIVED OR PROVIDED, ADJUSTED TO THE ACCRUAL BASIS, TO DETERMINE THE VALUE OF SCHEDULE R TRANSACTIONS, WHICH APPROXIMATES FAIR MARKET VALUE.