2012-11-15T12:13:34-06:00 2011-12-31 990 2011-01-01 440565393 SAINT LUKES NORTHLAND HOSPITAL CORPORATION SAIN 8165327164 601 SOUTH 169 HIGHWAY SMITHVILLE MO 64089 KEVIN TRIMBLE 8165327164 2012-11-15 2011 2016-02-24 21:20:13Z KEVIN TRIMBLE 601 SOUTH 169 HIGHWAY SMITHVILLE MO 64089 115950042 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1989 MO HOSPITAL 12 10 1162 197 35917 -25449 222762 332673 112607841 115467999 71767 149370 0 0 112902370 115950042 14188789 4267171 0 0 49147500 53972125 0 0 29944 52925429 53259612 116261718 111498908 -3359348 4451134 96862596 101409607 55210702 56089317 41651894 45320290 X SAINT LUKE'S NORTHLAND HOSPITAL CORPORATION IS A PART OF SAINT LUKE'S HEALTH SYSTEM, A FAITH BASED, NOT-FOR-PROFIT ALIGNED HEALTH SYSTEM COMMITTED TO THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE AND HEALTH RELATED SERVICES IN A CARING ENVIRONMENT. WE ARE DEDICATED TO ENHANCING THE PHYSICAL, MENTAL, AND SPIRITUAL HEALTH OF THE COMMUNITIES WE SERVE. 0 0 99678221 4267171 115432082 ALL PROGRAM SERVICE EXPENSES WERE INCURRED IN FURTHERANCE OF OUR MISSION, WHICH IS TO ENSURE THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE SERVICES TO ALL PATIENTS IN A CARING ENVIRONMENT. IN 2011, THERE WERE 27,504 PATIENT DAYS AND 1,746 NEWBORN DAYS. IN ADDITION, THE HOSPITAL PROVIDED 88,058 OUTPATIENT AND EMERGENCY SERVICES.AS A VOLUNTARY, NONPROFIT, COMPREHENSIVE ORGANIZATION, SAINT LUKE'S NORTH HOSPITAL IS COMMITTED TO SERVING ALL WHO SEEK OUR SERVICES REGARDLESS OF THEIR SOCIOECONOMIC STATUS. THE HOSPITAL PARTICIPATES IN THE MEDICAID AND MEDICARE PROGRAMS AND HAS CHARITY CARE POLICIES FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE.THE BARRY ROAD CAMPUS IS AN 84-BED ACUTE CARE FACILITY LOCATED IN KANSAS CITY, MISSOURI. THE SMITHVILLE CAMPUS PROVIDES URGENT CARE SERVICES TO THE COMMUNITY, AS WELL AS REHABILITATION, MENTAL HEALTH, AND POST-ACUTE CARE SERVICES. BOTH CAMPUSES SERVE THE NORTHERN KANSAS CITY AREA. 99678221 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 1 1 1 1 0 0 1 X 12 0 1 1162 1 1 1 0 0 0 0 0 0 0 0 0 X 12 10 0 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X THE ORGANIZATION 8165327164 601 SOUTH 169 HIGHWAY SMITHVILLE MO 64089 X THOMAS L BROWN 1.00 X X 0 0 0 EUGENE RUIZ 1.00 X X 0 0 0 RAHUL JOSHI 1.00 X 0 0 0 GAYDEN F CARRUTH 1.00 X X 0 0 0 H D CLEBERG 1.00 X 0 0 0 MICHELLE DEW MD 1.00 X 0 561081 34091 KELLEY M MARTIN 1.00 X 0 0 0 WILLIAM PARKS 1.00 X 0 0 0 GINA LAWSON 1.00 X 0 370122 42000 LORA CHEATUM 1.00 X 0 0 0 MICHAEL SHORT 1.00 X 0 0 0 CYNTHIA A TODD-TAKEYAMA 1.00 X 0 0 0 KEVIN TRIMBLE 40.00 X 282701 0 60855 JULIE MURPHY 40.00 X 226980 0 41109 JEFF EYE 40.00 X 149492 0 13271 DON SIPES 5.00 X 0 307191 53601 N GARY WAGES 40.00 X 286519 0 15364 DANIEL WEED 40.00 X 433118 0 21764 SAMIRAN PATEL 40.00 X 301202 0 21137 JENNIFER SVETLECIC 40.00 X 321919 0 27762 VANCE JERNSTROM 40.00 X 360659 0 17059 SALVATORE MICELI 40.00 X 367886 0 29672 2730476 1238394 377685 27 0 1 0 P1 GROUP INC 16210 W 108TH ST LENEXA KS 66219 MAINTENANCE 1518966 JE DUNN 929 HOLMES KANSAS CITY MO 64106 CONSTRUCTION & CONST MGMT 1093947 MOBILE CATARACT CARE OF KANSAS CITY LLC 5844 NW BARRY RD SUITE 200 KANSAS CITY MO 64154 MEDICAL SERVICES 863187 AD VIVUM ANESTHESIOLOGY PC 8646 N OREGON AVE KANSAS CITY MO 64154 MEDICAL SERVICES 687500 DAVID E ROSS CONSTRUCTION COMPANY 10201 E 75TH ST RAYTOWN MO 64138 CONSTRUCTION 487357 19 332673 60000 332673 NET PATIENT REVENUE 622110 112398265 112398265 OTHER PROGRAM SERVICES 622110 1163429 1163429 REGIONAL LAB SERVICES 621500 690760 654843 35917 MEDICAL OFFICE RENT 531120 611080 611080 RENT FROM AFFILIATES 531120 604465 604465 115467999 149370 149370 115950042 115432082 35917 149370 4254563 4254563 12608 12608 1076293 1076293 42519775 41294827 1224948 1569427 1486584 82843 5889117 5557711 331406 2917513 2763511 154002 95180 95180 42278 42278 10613599 9606090 1007509 23608 4751 18857 3332425 2661314 641167 29944 279871 174500 105371 2008769 1927814 80955 86584 67526 19058 85768 60574 25194 2267592 2154212 113380 6767027 6351956 415071 689190 463400 225790 MEDICAL SUPPLIES 12464447 12462089 2358 SHARED SERVICES- SLHS 8576912 2657783 5919129 BAD DEBT 4913477 4913477 EICU EXPENSES 223940 223940 788945 578991 209954 111498908 99678221 11790743 29944 45147 100594 9958964 16140065 13210221 13798385 2153346 1993881 1374187 1500969 139223409 75502938 64892292 63720471 105753 885039 1218247 438961 3904439 2831242 96862596 101409607 6503078 6829381 45328658 43896482 3378966 5363454 55210702 56089317 X 40978147 44891122 673747 429168 41651894 45320290 96862596 101409607 X 4451134 -782738 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 10210 0 0 0 10210 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LINE F-PORTION OF DUES PAID TO HOSPITAL ASSOCIATIONS AND MEDICAL ORGANIZATIONS USED TOWARD LOBBYING ACTIVITIES. 100371 68525 416 74540 94772 74120 93625 482 67856 100371 72833 70450 605 69768 74120 95720 48400 1010 72297 72833 1.00000 1 0 2433226 2433226 63542861 35553159 27989702 68313610 36155126 32158484 4933712 3794653 1139059 63720471 ESTIMATED 3RD PARTY PAYOR SETTLEMENTS 1575157 RESERVE SELF INSURED RISKS 1233000 OTHER NONCURRENT LIABILITIES 450703 OTHER CURRENT LIABILITIES 611994 PAYABLES TO AFFILIATES 1492600 5363454 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF ENDOWMENT FUNDS INCLUDES BUT IS NOT LIMITED TO MEDICAL STAFF DEVELOPMENT, GENERAL OPERATIONS OF THE HOSPITAL, AND STUDENT SCHOLARSHIPS. THE ASSETS HELD AT THE UNRELATED ORGANIZATION REPRESENTS THE ORGANIZATION'S SHARE OF NET ASSETS AT SPELMAN MEDICAL FOUNDATION PER SFAS 136. SUCH ASSETS ARE REPORTED IN PART X, LINE 15. PART XI, XII, AND XIII, THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN THE CONSOLIDATED AUDIT OF SAINT LUKE'S HEALTH SYSTEM. 1 1 X 1 X 1 X 1 1 1 0 0 7197674 0 7197674 0.06750 15803061 14721770 1081291 0.01010 23000735 14721770 8278965 0.07760 364290 364290 0.00340 31256 31256 0.00030 172075 172075 0.00160 567621 567621 0.00530 23568356 14721770 8846586 0.08290 0 4913477 24399456 32126822 -7727366 X 1 1 2 1 SAINT LUKES NORTHLAND HOSPITAL-BARRY

5830 NW BARRY ROAD KANSAS CITY MO 64154

X X X 2 SAINT LUKES NORTHLAND HOSPITAL-SMV

601 S 169 HIGHWAY SMITHVILLE MO 64089

X X REHABILITATION AND BEHAVIORAL HEALTH SAINT LUKES NORTHLAND HOSPITAL-BARRY 1 1 1 200.000000000000 1 400.000000000000 1 X X X 1 1 X X X 1 0 1 X 0 0 SAINT LUKES NORTHLAND HOSPITAL-SMV 2 1 1 200.000000000000 1 400.000000000000 1 X X X 1 1 X X X 1 0 1 X 0 0 PART I, LINE 7: COST OF CHARITY CARE AND UNREIMBURSED HEALTH SERVICES WERE CALCULATED USING THE APPROPRIATE COST TO CHARGE RATIO FROM THE HOSPITAL'S COST REPORT. PART I, L7 COL(F): OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) WAS $111,498,908. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $4,913,477. THIS LEFT US WITH A TOTAL EXPENSE OF $106,585,431 FOR PURPOSES OF CALCULATING LINE 7, COLUMN (F). PART III, LINE 4: BAD DEBT EXPENSE IS REPORTED IN ACCORDANCE WITH GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP). HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION STATEMENT 15 IS FOLLOWED TO THE EXTENT IT ALIGNS WITH GAAP.FINANCIAL STATEMENT FOOTNOTE REGARDING BAD DEBT EXPENSE: THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, CONSIDERING BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. FOR RECEIVABLES ASSOCIATED WITH SERVICES PROVIDED TO PATIENTS WHO HAVE THIRD-PARTY COVERAGE (INCLUDING COPAYMENT AND DEDUCTIBLE AMOUNTS FROM PATIENTS), THE SYSTEM ANALYZED CONTRACTUALLY DUE AMOUNTS AND PROVIDES AN ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS AND A PROVISION FOR BAD DEBTS. FOR RECEIVABLES ASSOCIATED WITH SELF-PAY PATIENTS, THE SYSTEM RECORDS A SIGNIFICANT PROVISION FOR BAD DEBTS IN THE PERIOD OF SERVICE ON THE BASIS OF ITS PAST EXPERIENCE, WHICH INDICATES THAT MANY PATIENTS ARE UNABLE OR UNWILLING TO PAY THE PORTION OF THEIR BILL FOR WHICH THEY ARE FINANCIALLY RESPONSIBLE. ACCOUNTS ARE WRITTEN OFF WHEN ALL REASONABLE INTERNAL AND EXTERNAL COLLECTION EFFORTS HAVE BEEN PERFORMED. THESE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS AND ARE ADJUSTED AS NEEDED IN FUTURE PERIODS. ACCOUNTS RECEIVABLE ARE CHARGED TO THE ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS WHEY THEY ARE DEEMED UNCOLLECTIBLE.BAD DEBT IS REPORTED CONSISTENT WITH FINANCIAL STATEMENTS. PART III, LINE 8: MEDICARE ALLOWABLE COSTS WERE CALCULATED USING A COST-TO-CHARGE RATIO DIRECTLY FROM THE MEDICARE COST REPORT. SHORTFALLS ARISE FROM PAYMENTS THAT ARE LESS THAN WHAT IT COSTS TO PROVIDE THE CARE AND SERVICES. WE ACCEPT ALL MEDICARE PATIENTS KNOWING THE COST OF PROVIDING THE CARE MAY EXCEED THE FUNDS WE RECEIVE FROM MEDICARE FOR THE SERVICE. OUR SHORTFALL IS CONSIDERED TO BE COMMUNITY BENEFIT. MEDICARE SHORTFALLS MUST BE ABSORBED BY THE HOSPITAL IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITY. ADDITIONALLY, IT IS IMPLIED IN INTERNAL REVENUE SERVICE REVENUE RULING 69-545 THAT TREATING MEDICARE PATIENTS IS A COMMUNITY BENEFIT. REVENUE RULING 69-545, WHICH ESTABLISHED THE COMMUNITY BENEFIT STANDARD FOR TAX-EXEMPT HOSPITALS, INDICATES THAT PARTICIPATION IN PUBLICLY-FINANCED PROGRAMS, SUCH AS MEDICARE, IS EVIDENCE THAT A HOSPITAL MEETS THE COMMUNITY BENEFIT STANDARD. PART III, LINE 9B: IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE THE ACCOUNT IS ADJUSTED ACCORDINGLY. ANY REMAINING BALANCE WOULD BE COLLECTED UNDER THE DEBT COLLECTION POLICY. OUR COLLECTION POLICIES ARE THE SAME FOR ALL PATIENTS. ALTHOUGH WE ARE NOT LEGALLY BOUND BY THE FAIR DEBT COLLECTION PRACTICES ACT, THE PRINCIPLES ADDRESSED ARE GENERALLY FOLLOWED. SAINT LUKES NORTHLAND HOSPITAL-BARRY PART V, SECTION B, LINE 13G: THE HOSPITAL FOLLOWS THE SAINT LUKE'S HEALTH SYSTEM POLICIES FOR FINANCIAL ASSISTANCE. THE HOSPITAL PROVIDES EDUCATION ON FINANCIAL ASSISTANCE ELIGIBILITY TO PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES THROUGH MANY SOURCES INCLUDING THE SLHS WEB SITE, INFORMATION ON BILLING STATEMENTS NOTIFYING PATIENTS THAT THE HOSPITAL HAS FINANCIAL ASSISTANCE FOR WHICH THEY MAY QUALIFY, INFORMATION UPON CHECK-IN LOCATED IN THE ADMITTING PATIENT PACKETS, ON OUR B-131 RELEASE TO TREAT FORMS SIGNED BY ALL PATIENTS REQUESTING SERVICES, VISITS WITH INPATIENTS BY SOCIAL WORKER TEAMS, AND FOLLOW-UP CALLS TO PATIENTS AFTER DISCHARGE. FINANCIAL ASSISTANCE APPLICATIONS OR MEDICAID APPLICATIONS ARE REQUESTED ON ALL UNINSURED INPATIENTS PRIOR TO DISCHARGE. THE HOSPITAL ALSO CONTRACTS WITH ELIGIBILITY ENROLLMENT COMPANIES TO SCREEN ALL UNINSURED PATIENTS WITH A BALANCE OVER $2,000, ANY PATIENTS IDENTIFIED BY OUR SOCIAL WORKER TEAMS, AND ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR MEDICAID OR OTHER GOVERNMENT COVERAGE. SAINT LUKES NORTHLAND HOSPITAL-SMV PART V, SECTION B, LINE 13G: THE HOSPITAL FOLLOWS THE SAINT LUKE'S HEALTH SYSTEM POLICIES FOR FINANCIAL ASSISTANCE. THE HOSPITAL PROVIDES EDUCATION ON FINANCIAL ASSISTANCE ELIGIBILITY TO PATIENTS AND PERSONS WHO MAY BE BILLED FOR SERVICES THROUGH MANY SOURCES INCLUDING THE SLHS WEB SITE, INFORMATION ON BILLING STATEMENTS NOTIFYING PATIENTS THAT THE HOSPITAL HAS FINANCIAL ASSISTANCE FOR WHICH THEY MAY QUALIFY, INFORMATION UPON CHECK-IN LOCATED IN THE ADMITTING PATIENT PACKETS, ON OUR B-131 RELEASE TO TREAT FORMS SIGNED BY ALL PATIENTS REQUESTING SERVICES, VISITS WITH INPATIENTS BY SOCIAL WORKER TEAMS, AND FOLLOW-UP CALLS TO PATIENTS AFTER DISCHARGE. FINANCIAL ASSISTANCE APPLICATIONS OR MEDICAID APPLICATIONS ARE REQUESTED ON ALL UNINSURED INPATIENTS PRIOR TO DISCHARGE. THE HOSPITAL ALSO CONTRACTS WITH ELIGIBILITY ENROLLMENT COMPANIES TO SCREEN ALL UNINSURED PATIENTS WITH A BALANCE OVER $2,000, ANY PATIENTS IDENTIFIED BY OUR SOCIAL WORKER TEAMS, AND ALL PATIENTS THAT REQUEST ASSISTANCE IN APPLYING FOR MEDICAID OR OTHER GOVERNMENT COVERAGE. PART VI, LINE 2: THE HOSPITAL ASSESSES COMMUNITY NEEDS ON AN ANNUAL BASIS IN NUMEROUS WAYS, INCLUDING THROUGH ITS COMPREHENSIVE, DATA DRIVEN, ANNUAL STRATEGIC PLANNING PROCESS. THE HOSPITAL MEETS WITH STAFF, VOLUNTEERS, PATIENTS, BOARD MEMBERS AND PHYSICIANS. THE FEEDBACK PROVIDED BY THESE GROUPS IS COMMUNICATED TO HOSPITAL MANAGEMENT AND CONSIDERED WHEN DETERMINING THE NEEDS OF THE COMMUNITY.THE HOSPITAL ALSO WORKS WITH THE PATIENT ADVOCATE AND MARKETING DEPARTMENTS TO DETERMINE FEEDBACK RECEIVED FROM THE COMMUNITY REGARDING ITS NEEDS. THIS FEEDBACK IS ALSO COMMUNICATED TO HOSPITAL MANAGEMENT AND EVALUATED DURING THE ANNUAL BUDGET AND STRATEGIC PLANNING PROCESS. PART VI, LINE 3: SEE RESPONSE TO SCHEDULE H, PART V, LINE 13G. PART VI, LINE 4: THE BARRY ROAD CAMPUS IS AN 84-BED ACUTE CARE FACILITY LOCATED IN KANSAS CITY, MISSOURI. THE SMITHVILLE CAMPUS PROVIDES URGENT CARE SERVICES TO THE COMMUNITY, AS WELL AS REHABILITATION, MENTAL HEALTH, AND POST-ACUTE CARE SERVICES. BOTH CAMPUSES SERVE THE NORTHERN KANSAS CITY AREA. PART VI, LINE 5: THE BOARD OF DIRECTORS IS MADE UP OF MEDICAL AND BUSINESS PROFESSIONALS, ALMOST ALL OF WHOM RESIDE IN THE HOSPITAL'S PRIMARY SERVICE AREA. THEY ARE INVOLVED IN THE COMMUNITY NEEDS ASSESSMENT PROCESS, IN FUNDRAISING, AND IN GENERAL STEWARDSHIP.MEDICAL STAFF PRIVILEGES ARE OFFERED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. PART VI, LINE 6: THE HOSPITAL IS AFFILIATED WITH SAINT LUKE'S HEALTH SYSTEM, WHICH CONSISTS OF 11 AREA HOSPITALS AND SEVERAL PRIMARY AND SPECIALTY CARE PRACTICES, AND PROVIDES A RANGE OF INPATIENT, OUTPATIENT, AND HOME CARE SERVICES. FOUNDED AS A FAITH-BASED, NOT-FOR-PROFIT ORGANIZATION, OUR MISSION INCLUDES A COMMITMENT TO THE HIGHEST LEVELS OF EXCELLENCE IN HEALTH CARE AND THE ADVANCEMENT OF MEDICAL RESEARCH AND EDUCATION. THE HEALTH SYSTEM IS AN ALIGNED ORGANIZATION IN WHICH THE PHYSICIANS AND HOSPITALS ASSUME RESPONSIBILITY FOR ENHANCING THE PHYSICAL, MENTAL, AND SPIRITUAL HEALTH OF PEOPLE IN THE METROPOLITAN KANSAS CITY AREA AND THE SURROUNDING REGION. 1 SAINT LUKE'S MEDICAL GROUP - AFFILIATED 501(C)(3) 6750 ANTIOCH SUITE 210 SHAWNEE MISSION KS 66204 431598353 501(C)(3) 2115328 OPERATING FUNDS SPELMAN MEDICAL FOUNDATION 5810 NW BARRY ROAD KANSAS CITY MO 64154 431270223 501(C)(3) 11550 CONTRIBUTION SLNC INC 4401 WORNALL ROAD KANSAS CITY MO 64111 271994652 501(C)(3) 49495 OPERATING FUNDS SLCC INC 4330 WORNALL ROAD SUITE 2000 KANSAS CITY MO 64111 271994652 501(C)(3) 2038192 OPERATING FUNDS NORTHLAND HEALTHCARE ACCESS PO BOX 14414 PARKVILLE MO 64152 431578121 501(C)(3) 20000 CONTRIBUTION 5 0 ADVANCED EDUCATION IN MEDICAL FIELD - SCHOLARSHIP 12 12000 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: SCHOLARSHIPS ARE GIVEN TO HIGH SCHOOL GRADUATES PURSUING ADVANCED EDUCATION IN THE MEDICAL FIELD BASED ON ACADEMICS. GRANTS ARE ALSO PROVIDED TO QUALIFIED 501(C)(3) CHARITIES. ALL DONEE INFORMATION IS KEPT AS PART OF THE HOSPITAL BOOKS AND RECORDS. 0 0 0 0 0 0 0 1 0 MICHELLE DEW MD 0 520852 0 14954 0 25275 0 11025 0 23066 0 595172 0 0 GINA LAWSON 0 221580 0 145424 0 3118 0 18375 0 23625 0 412122 0 0 KEVIN TRIMBLE 226476 0 40638 0 15587 0 38800 0 22055 0 343556 0 9408 0 JULIE MURPHY 178731 0 33768 0 14481 0 31869 0 9240 0 268089 0 12096 0 JEFF EYE 148558 0 50 0 884 0 6749 0 6522 0 162763 0 0 0 DON SIPES 0 224721 0 65480 0 16990 0 36374 0 17227 0 360792 0 0 N GARY WAGES 148691 0 90409 0 47419 0 9800 0 5564 0 301883 0 0 0 DANIEL WEED 430575 0 50 0 2493 0 4900 0 16864 0 454882 0 0 0 SAMIRAN PATEL 255044 0 45450 0 708 0 4900 0 16237 0 322339 0 0 0 JENNIFER SVETLECIC 318377 0 2550 0 992 0 9800 0 17962 0 349681 0 0 0 VANCE JERNSTROM 358148 0 50 0 2461 0 9800 0 7259 0 377718 0 0 0 SALVATORE MICELI 233621 0 133070 0 1195 0 11025 0 18647 0 397558 0 0 0 PART I, LINE 7 THE ORGANIZATION HAS ADOPTED A MANAGEMENT INCENTIVE COMPENSATION PLAN FOR CERTAIN MEMBERS OF SENIOR AND MIDDLE MANAGEMENT TO PROMOTE EFFECTIVE MANAGEMENT OF OPERATIONS, QUALITY OF CARE AND SERVICE, AND OPTIMAL USE OF RESOURCES. THE INCENTIVES ARE CALCULATED AS A PERCENTAGE OF BASE SALARY CONTINGENT ON ACHIEVING QUALITY, PATIENT SATISFACTION, EMPLOYEE RETENTION, FINANCIAL AND OTHER OPERATIONAL PERFORMANCE TARGETS ESTABLISHED BY THE BOARD'S COMPENSATION COMMITTEE ON AN ANNUAL BASIS. INCENTIVE AWARDS ARE PAID AT THE DISCRETION OF THE BOARD OF DIRECTORS. THIS INCENTIVE COMPENSATION IS EVALUATED AS PART OF THE REVIEW OF MARKET COMPETITIVE DATA AND REASONABLENESS OF OVERALL COMPENSATION AND BENEFITS. SUPPLEMENTAL INFORMATION PART III PART II: DON SIPES, GINA LAWSON, AND MICHELLE DEW DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. THE COMPENSATION REPORTED FOR GARY WAGES IS FOR DUTIES AS CEO OF THE FILING ORGANIZATION THROUGH MARCH OF 2011 AND DUTIES AS INTERIM CEO AT A RELATED 501C3 ORG FOR JUNE THROUGH NOVEMBER OF 2011. TOTAL COMPENSATION AND BENEFITS OF $211,256 IS ATTRIBUTABLE TO THE FILING ORG AND $90,357 TO THE RELATED 501C3 ORG. X MEDICAL EQUIPMENT 1 60000 MARKET VALUE 0 0 0 0 NUMBER REPORTED IN BOX 3 OF FORM 1096 FORM 990, PART V, LINE 1A SAINT LUKE'S NORTHLAND HOSPITAL CORPORATION (SLNH) IS PART OF SAINT LUKE'S HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM. THE MAJORITY OF SLNH VENDORS ARE PAID THROUGH A CENTRALIZED PAYMENT SYSTEM WITH 1099S ISSUED BY THE CENTRALIZED SERVICE ENTITY. FORM 990, PART VI, SECTION A, LINE 3 AS PART OF AN INTEGRATED HEALTH SYSTEM, THE ORGANIZATION ROUTINELY DELEGATED VARIOUS MANAGEMENT AND SUPPORT FUNCTIONS TO RELATED ENTITIES. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE CORPORATE MEMBER IS SAINT LUKE'S HEALTH SYSTEM, A 501(C)(3) ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A THE GOVERNING BODY IS ELECTED BY THE SOLE CORPORATE MEMBER, FORM 990, PART VI, SECTION A, LINE 7B THE SOLE MEMBER HAS SPECIFIED RESERVE POWERS OVER MAJOR DECISIONS SUCH AS AMENDMENTS TO ARTICLES AND BYLAWS, DEBT, BUDGETS, CAPITAL EXPENDITURES AND STRATEGIC OPERATING DECISIONS. FORM 990, PART VI, SECTION B, LINE 11 THE 990 IS PREPARED JOINTLY BY ACCOUNTING STAFF OF THE ENTITY AND SAINT LUKE'S HEALTH SYSTEM (SYSTEM) TAX STAFF. THE RETURN IS REVIEWED BY THE ENTITY'S CFO OR CEO. THE 990 DRAFT WAS ALSO PRESENTED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS FOR REVIEW. THE 990 WAS MADE AVAILABLE TO THE ORGANIZATION'S BOARD MEMBERS FOR VIEWING BEFORE FILING WITH THE IRS. FORM 990, PART VI, SECTION B, LINE 12C SAINT LUKE'S HEALTH SYSTEM AND ITS AFFILIATES, INCLUDING THE FILING ORGANIZATION, HAVE COMPREHENSIVE WRITTEN CONFLICT OF INTEREST POLICIES APPLICABLE TO ALL DIRECTORS, OFFICERS, AND EMPLOYEES. ANY ACTUAL, POSSIBLE OR PERCEIVED CONFLICT OF INTEREST IS EXPECTED TO BE HANDLED THROUGH FULL AND TIMELY DISCLOSURE OF ANY SUCH INTEREST, TOGETHER WITH ABSENCE OF PERSUASION IN ANY DISCUSSION AND IN ANY VOTE WHEREIN THE INTEREST IS INVOLVED. DISCLOSURE IS TO BE MADE WHEN THE INTEREST ARISES, AT ANY TIME THE INTEREST BECOMES A MATTER OF GOVERNING BOARD ACTION, AND THEN ANNUALLY THROUGH COMPLETION OF A CONFLICT OF INTEREST QUESTIONNAIRE. THE SYSTEM COMPLIANCE OFFICER OR THE SYSTEM VICE PRESIDENT OF HUMAN RESOURCES REVIEWS COMPLETED QUESTIONNAIRES AND FURTHER INVESTIGATES POSSIBLE CONFLICTS OF INTEREST. A REPORT IS PROVIDED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS AND ANY IDENTIFIED CONFLICT OF INTEREST IS REPORTED TO THE APPLICABLE ENTITY. FORM 990, PART VI, SECTION B, LINE 15 ANNUALLY, THE SAINT LUKE'S HEALTH SYSTEM BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS, DISCUSSES, SETS AND APPROVES COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT EXECUTIVES. INDEPENDENT, EXTERNAL DIRECTORS SERVE ON THE COMPENSATION COMMITTEE. AN INDEPENDENT COMPENSATION CONSULTING FIRM ANNUALLY PROVIDES A WRITTEN REPORT AND REASONABLENESS OPINION. THE CONSULTANT REVIEWS THE SYSTEM'S EXECUTIVE TOTAL COMPENSATION PHILOSOPHY AND ANALYZES MARKET COMPETITIVENESS (IN TOTAL AND BY EACH COMPENSATION ELEMENT) FOR THE EXECUTIVES USING APPROPRIATE COMPARABILITY DATA. COMPENSATION COMMITTEE ACTIONS ARE CONTEMPORANEOUSLY DOCUMENTED. THE PROCESS SATISFIES THE REBUTTABLE PRESUMPTION PROCEDURE. COMPENSATION FOR OFFICERS NOT REVIEWED BY THE COMPENSATION COMMITTEE IS SET/APPROVED ANNUALLY BY SAINT LUKE'S HEALTH SYSTEM EXECUTIVE MANAGEMENT BASED ON MARKET COMPENSATION SURVEYS AND COMPARABILITY DATA PROVIDED BY AN INDEPENDENT COMPENSATION CONSULTING FIRM. FORM 990, PART VI, SECTION C, LINE 19 GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS ARE NOT PUBLICLY AVAILABLE. FORM 990, PART VII, COLUMN E DON SIPES, GINA LAWSON, AND MICHELLE DEW DID NOT RECEIVE COMPENSATION FOR DUTIES AS A DIRECTOR OR OFFICER OF THE FILING ORGANIZATION BUT RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS FOR SERVICES RENDERED TO THE RELATED ORGANIZATIONS. THESE INDIVIDUALS WORKED 40 HOURS OR MORE PER WEEK FOR ALL RELATED ORGANIZATIONS. THE COMPENSATION REPORTED FOR GARY WAGES IS FOR DUTIES AS CEO OF THE FILING ORGANIZATION THROUGH MARCH OF 2011 AND DUTIES AS INTERIM CEO AT A RELATED 501C3 ORG FOR JUNE THROUGH NOVEMBER OF 2011. TOTAL COMPENSATION AND BENEFITS OF $211,256 IS ATTRIBUTABLE TO THE FILING ORG AND $90,357 TO THE RELATED 501C3 ORG. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: RISK RETENTION GROUP SSA DIVIDENDS -112,556. PENSION LIABILITY TRANSFER TO SAINT LUKE'S HEALTH SYSTEM -343,762. EQUITY IN AFFILIATES -87,440. CHANGE IN INTEREST IN ASSETS OF THE FOUNDATION - SFAS 136 -238,980. TOTAL TO FORM 990, PART XI, LINE 5: -782,738. JOINT VENTURE FORM 990, PART VI, SECTION B, LINE 16B THE ORGANIZATION HAS PROCEDURES IN PLACE TO ENSURE THE VENTURE OPERATES IN A MANNER CONSISTENT WITH THE ORGANIZATION'S EXEMPT MISSION AND FOR THE VENTURE TO NOT ENGAGE IN POLITICAL CANDIDATE CAMPAIGN ACTIVITY OR OTHER ACTIVITIES THAT WOULD JEOPARDIZE THE ORGANIZATION'S EXEMPTION. TAX EXEMPT BOND LIABILITIES FORM 990, PART X, BALANCE SHEET, LINE 20 THE AMOUNT REPORTED AS TAX-EXEMPT BONDS IS THE PORTION OF SAINT LUKE'S HEALTH SYSTEM BONDS ALLOCATED TO SAINT LUKE'S NORTHLAND HOSPITAL. REQUIRED INFORMATION FOR THE BONDS, INCLUDING SCHEDULE K, IS REPORTED IN THE SAINT LUKE'S HEALTH SYSTEM (EIN: 43-1747502) IRS FORM 990. SLN MEDICAL SPECIALISTS LLC 5830 NW BARRY ROAD KANSAS CITY MO 64154 260178220 PHYSICIAN SERVICES - BILLING MO -1492220 1476678 SAINT LUKES NORTHLAND HOSPITAL SAINT LUKES HEALTH SYSTEM 10920 ELM AVENUE KANSAS CITY MO 64134 431747502 HEALTH SYSTEM KS 501(C)(3) 509(A)(3) - TYPE 1 ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKES HOSPITAL OF KANSAS CITY 4401 WORNALL ROAD KANSAS CITY MO 64111 440545297 HEALTH CARE MO 501(C)(3) 170B1AIII 0 SAINT LUKES SOUTH HOSPITAL INC 12300 METCALF AVE OVERLAND PARK KS 66213 481203262 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES EAST HOSPITAL 100 NE ST LUKES BLVD LEES SUMMIT MO 64086 562488077 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES MEDICAL GROUP 6750 ANTIOCH SUITE 210 SHAWNEE MISSION KS 66204 431598353 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 CRITTENTON 10918 ELM AVE KANSAS CITY MO 64134 440545808 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HOSPITAL 0 SAINT LUKES HEALTH SYSTEM HOME CARE AND HOSPICE 3100 BROADWAY SUITE 1000 KANSAS CITY MO 64111 431127200 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES HOSPITAL OF TRENTON 701 EAST FIRST TRENTON MO 64683 431707306 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES HOSPITAL OF GARNETT 421 SOUTH MAPLE GARNETT KS 66032 742849611 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 CABOT WESTSIDE HEALTH CENTER 2121 SUMMIT KANSAS CITY MO 64108 440546280 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 MIDWEST EAR INSTITUTE INC 4200 PENNSYLVANIA SUITE 100 KANSAS CITY MO 64111 480905027 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HOSPITAL 0 SAINT LUKES HOSPITAL OF CHILLICOTHE 100 CENTRAL STREET CHILLICOTHE MO 64601 431735565 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 CUSHING MEMORIAL HOSPITAL CORP 711 MARSHALL LEAVENWORTH KS 66048 480543792 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES CANCER INSTITUTE LLC 4323 WORNALL RD PEET 1 KANSAS CITY MO 64111 431933950 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES CARE 10920 ELM AVENUE KANSAS CITY MO 64134 260185090 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 MEDICAL PLAZA IMAGING ASSOCIATES LLC 4401 WORNALL ROAD KANSAS CITY MO 64111 431609584 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM 0 SAINT LUKES COLLEGE OF HEALTH SCIENCES 8320 WARD PARKWAY SUITE 300 KANSAS CITY MO 64114 272716128 POST SECONDARY NURSING EDUCATION MO 501(C)(3) 170B1AIII SAINT LUKES HOSPITAL 0 SLCC INC 4330 WORNALL ROAD SUITE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS APPLYING FOR 501(C)( APPLYING FOR 170B1AI SAINT LUKES HEALTH SYSTEM 0 SLNC INC 4401 WORNALL RD KANSAS CITY MO 64111 451470888 HEALTH CARE KS APPLYING FOR 501(C)( APPLYING FOR 170B1AI SAINT LUKES HEALTH SYSTEM 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL RD SUITE 410 KASAS CITY MO 64111 431357824 OWN AND OPERATE MEDICAL OFFICE BUILDING MO N/A MEDICAL PARK ASSOCIATES A LP 601 S 169 HWY SMITHVILLE MO 64089 431311049 OWN AND OPERATE MEDICAL OFFICE BUILDING MO SPELMAN DEVELOPMENT CORP INVESTMENT 12503 979286 0 0 0.08250 ST LUKE'S SURGICENTER-LEE'S SUMMIT LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 470853481 HEALTH CARE MO N/A SAINT LUKE'S SOUTH SURGERY CENTER LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 201721929 HEALTH CARE KS N/A FAMILY ADVOCATES LLC 10918 ELM AVE KASAS CITY MO 64134 202739036 FOSTER CARE MO N/A SAINT LUKE'S CARDIOLOGY SERVICES 10920 ELM AVE KASAS CITY MO 64134 263726426 HEALTH CARE MO N/A SAINT LUKE'S-GI DIAGNOSTICS LLC 4321 WASHINGTON SUITE 5700 KASAS CITY MO 64111 274142549 HEALTH CARE MO N/A SPELMAN DEVELOPMENT CORPORATION 601 S 169 HIGHWAY SMITHVILLE MO 64089 431296007 MEDICAL OFFICE BUILDING RENTALS MO SAINT LUKES NORTHLAND HOSPITAL C -96050 756577 1.00000 SAINT LUKE'S HEALTH SYSTEM RISK RETENTION GROUP 1327 C ASHLEY RD SUITE 200 CHARLESTON SC 29407 371471890 INSURANCE SC N/A C ST LUKE'S HEALTH VENTURES INC 4320 WORNALL RD SUITE 410 KANSAS CITY MO 64111 431278476 ACCOUNTING MO N/A C MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL RD SUITE 410 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A C VENTURE FINANCIAL SERVICES INC 6158 RAYTOWN TRAFFICWAY RAYTOWN MO 64133 431605740 COLLECTIONS MO N/A C 0 1 0 0 0 0 0 0 1 1 0 0 0 1 1 1 0 0 MEDICAL PARK ASSOCIATES J 187297 PAID FMV RENT TO MPA FOR OFFICES SPELMAN DEVELOPMENT CORPORATION R 1336500 APPRAISED VALUE OF LP UNIT TRSFR TRANSACTIONS WITH RELATED ORGANIZATIONS SCHEDULE R, PART V, LINE 1 SAINT LUKE'S HEALTH SYSTEM (SYSTEM) AND ITS AFFILIATED ENTITIES OPERATE AS A HIGHLY INTEGRATED HEALTH CARE DELIVERY SYSTEM. THE SYSTEM MANAGES AND OPERATES RELATED HOSPITALS AND THEIR AFFILIATES AS A COMMON MISSION ORIENTED HEALTH CARE SYSTEM IN ORDER TO BETTER SERVE THE HEALTH-RELATED NEEDS OF GREATER KANSAS CITY AND SURROUNDING AREAS. AS A RESULT, THERE ARE NUMEROUS INTERCOMPANY INTERACTIONS INCLUDING CENTRALIZED SUPPORT SERVICES AND SHARING OF RESOURCES AND COSTS.