2012-11-15T12:07:10-06:00 2011-12-31 990 2011-01-01 480543792 CUSHING MEMORIAL HOSPITAL CORPORATION CUSH 9136841100 711 MARSHALL LEAVENWORTH KS 66048 RONALD BAKER 9136841100 2012-11-15 2011 2016-02-24 21:20:13Z ADELE DUCHARME 711 MARSHALL LEAVENWORTH KS 66048 30299290 0 X WWW.SAINTLUKESHEALTHSYSTEM.ORG X 1930 KS FAITH-BASED, NOT-FOR-PROFIT COMMUNITY HOSPITAL 9 5 433 152 17470 -12026 74347 96885 28886841 30120363 61677 80471 678 568 29023543 30298287 1260788 1201816 0 0 15768111 16359591 0 0 0 17403598 17124049 34432497 34685456 -5408954 -4387169 17700950 18393403 24064234 29265236 -6363284 -10871833 X CUSHING MEMORIAL HOSPITAL IS A FAITH-BASED, NOT-FOR-PROFIT COMMUNITY HOSPITAL COMMITTED TO THE HIGHEST LEVELS OF EXCELLENCE IN PROVIDING HEALTH CARE AND HEALTH RELATED SERVICES IN A CARING ENVIRONMENT. AS A MEMBER OF THE SAINT LUKE'S HEALTH SYSTEM, WE ARE DEDICATED TO ENHANCING THE PHYSICAL, MENTAL AND SPIRITUAL HEALTH OF THE COMMUNITIES WE SERVE. 0 0 29742478 1201816 30105200 AS A VOLUNTARY, NONPROFIT ORGANIZATION, CUSHING MEMORIAL HOSPITAL CORPORATION IS COMMITTED TO SERVING ALL WHO SEEK OUR SERVICES REGARDLESS OF THEIR SOCIOECONOMIC STATUS. THE HOSPITAL PARTICIPATES IN THE MEDICAID, TRICARE, AND MEDICARE PROGRAMS AND HAS CHARITY CARE POLICIES FOR ASSISTING PEOPLE WITHOUT ADEQUATE MEANS TO PAY FOR THEIR CARE. 29742478 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 0 0 0 0 1 1 0 0 0 0 1 X 0 0 1 433 1 1 1 0 0 0 0 0 0 0 0 0 X 9 5 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 0 0 X THE ORGANIZATION 9136841100 711 MARSHALL LEAVENWORTH KS 66048 X JULIE ANDERSON 1.00 X 0 0 0 MICHAEL CROW 1.00 X X 0 0 0 CAROL MEYER 1.00 X X 0 265163 36684 STEVEN RANZENBERGER 1.00 X 0 90153 0 RITA SWANN 1.00 X X 0 0 0 JOHN PETERSON 1.00 X 0 0 0 DON SIPES 1.00 X X 0 307191 53601 VICTORIA WELLS 1.00 X 0 0 0 JULIE MURPHY 1.00 X 0 226980 41108 RON BAKER 40.00 X 247782 0 50510 SALLY BORDER 40.00 X 103336 0 19604 ADELE DUCHARME 40.00 X 116480 0 8426 ROBERT KATZENBERGER 40.00 X 120420 0 20590 DALE DALENBERG 40.00 X 296738 0 29583 MARY BECK 40.00 X 101576 0 5944 LINDA ALDERMAN 40.00 X 100495 0 6146 1086827 889487 272196 7 0 1 0 EMERGENCY MEDICAL SERVICES KS LLC 920 MAIN STREET SUITE 300 KANSAS CITY MO 64105 EMERGENCY ROOM PHYSICIANS 1308978 P1 GROUP INC 16210 W 108TH ST LENEXA KS 66219 MAINTENANCE SERVICES 841670 HEARTLAND ANESTHESIA LLC PO BOX 7768 OVERLAND PARK KS 66207 ANESTHESIA SERVICES 423611 J E DUNN CONSTRUCTION CO INC 1001 LOCUST KANSAS CITY MO 64106 CONSTRUCTION 327347 NURSEFINDERS 524 E LAMAR BLVD SUITE 300 ARLINGTON TX 76011 TEMPORARY HELP SERVICES 265252 8 820 16274 79791 96885 NET PATIENT REVENUE 622110 29277888 29277888 RENTAL REVENUE 531120 380156 380156 REGIONAL LAB 541380 257302 239832 17470 OTHER PROGRAM SERVICES 622110 205017 205017 30120363 78164 78164 568 568 3310 1003 2307 2307 2307 30298287 30105200 17470 78732 1194616 1194616 7200 7200 546137 546137 13014355 11680708 1333647 370726 319328 51398 1447140 1223165 223975 981233 845192 136041 95157 95157 13575 13575 1024 1024 5044608 4398641 645967 34595 2498 32097 1136840 927793 209047 111242 12741 98501 699832 659963 39869 46742 26742 20000 36647 25426 11221 715028 615035 99993 1278398 1203344 75054 146760 133160 13600 MEDICAL SUPPLIES 4010638 4009085 1553 SHARED SERVICES-SLHS 1800000 529673 1270327 BAD DEBT 1395908 1395908 SWAP RELATED COSTS 216993 196855 20138 340062 335405 4657 34685456 29742478 4942978 0 866 2541772 2982969 247986 3133421 3497701 2000 1000 582845 646433 327768 273110 23077858 13324254 9427146 9753604 105221 665351 870275 337640 268439 428806 17700950 18393403 1994995 2210387 22069239 27054849 24064234 29265236 X -6452411 -10961219 64769 65028 24358 24358 -6363284 -10871833 17700950 18393403 X -4387169 -121380 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4817 0 0 0 4817 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: LINE F: PORTION OF DUES PAID TO THE KANSAS HOSPITAL ASSOCIATION USED FOR LOBBYING ACTIVITIES. 89127 8550 215 1500 7006 89386 76514 21606 307 1000 8300 89127 74358 3277 1121 76514 74358 74358 0.72750 0.27250 1 0 930183 930183 11758195 6156489 5601706 9848345 6432877 3415468 541135 734888 -193753 9753604 PAYABLE TO AFFILIATES 19263508 OTHER NONCURRENT LIABILITIES 56447 RESERVE FOR SELF INSURED RISKS 437000 ESTIMATED THIRD PARTY PAYOR SETTLEMENTS 517521 CAPITAL LEASES 196373 LONG TERM DEBT TO ST LUKES HEALTH SYSTEM 6320000 FIN 45 PHYSICIAN GUARANTEE 264000 27054849 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: THE INTENDED USE OF ENDOWMENT FUNDS INCLUDES BUT IS NOT LIMITED TO THE GENERAL OPERATIONS OF THE HOSPITAL AND CAPITAL EQUIPMENT PURCHASES FOR THE HOSPITAL. 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 200.000000000000 1 X 1 1 1 0 0 1855033 1855033 0.05570 4274372 4378472 0.00000 4164774 2556033 1608741 0.04830 10294179 6934505 3463774 0.10400 67163 67163 0.00200 392075 392075 0.01180 8213 8213 0.00000 19655 19655 0.00060 487106 487106 0.01440 10781285 6934505 3950880 0.11840 4 4 0.00000 4073 4073 0.00010 3109 3109 0.00010 2055 2055 0.00010 9241 9241 0.00030 0 1395908 0 7972999 9753796 -1780797 X 1 1 1 1 CUSHING MEMORIAL HOSPITAL CORPORATION

711 MARSHALL LEAVENWORTH KS 66048

X X X CUSHING MEMORIAL HOSPITAL CORPORATION 1 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 APPROPRITE COST TO CHARGE RATIO FROM THE ORGANIZATION'S COST REPORT. PART I, L7 COL(F): OUR TOTAL EXPENSE FROM FORM 990, PART IX, LINE 25, COLUMN (A) WAS $34,685,456. THE BAD DEBT EXPENSE INCLUDED IN THIS AMOUNT WAS $1,395,908. THIS LEFT US WITH A TOTAL EXPENSE OF $33,289,548 FOR PURPOSES OF CACLULATING LINE 7, COLUMN (F). PART II: CUSHING MEMORIAL HOSPITAL SPONSORS OR PARTICIPATES IN MANY COMMUNITY BUILDING ACTIVITIES WHICH PROMOTE THE HEALTH OF OUR COMMUNITY. ACTIVE PARTICIPATION IN MANY COMMUNITY ORGANIZATIONS INCLUDE LEAVENWORTH COUNTY DEVELOPMENT CORPORATION, CHAMBER OF COMMERCE, FORT LEAVENWORTH COMMUNITY RELATIONS AND PARTNERS, LEADERSHIP LEAVENWORTH LANSING CLASS, VOLUNTEER WORK WITH HARVESTERS TO FEED CHILDREN IN NEED AND MANY MORE. WE ENCOURAGE OUR EMPLOYEES TO SERVE ON COMMUNITY BOARDS AND VOLUNTEER FOR ACTIVITIES THAT PROMOTE HEALTH IN THE COMMUNITY. 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. CUSHING MEMORIAL HOSPITAL CORPORATION PART V, SECTION B, LINE 13G: THE HOSPITAL FOLLOWS THE SAINT LUKES 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 OBTAINS HIDI MARKET DATA AND OTHER OUTPATIENT MARKET DATA. WITH THIS DATA, THE HOSPITAL IDENTIFIES SERVICES RECEIVED BY THE RESIDENTS OF OUR COMMUNITY (DEFINED BY OUR PRIMARY AND SECONDARY SERVICE AREAS). ANY PREDOMINANT SERVICES NOT CURRENTLY OFFERED BY THE HOSPITAL ARE CONSIDERED AT THIS TIME.ANOTHER ELEMENT OF THE COMMUNITY ASSESSMENT CONSISTS OF ONGOING MEETINGS WITH FORT LEAVENWORTH, U.S. PENITENTIARY, AND LANSING STATE CORRECTIONAL FACILITY OFFICIALS. THROUGH FEEDBACK FROM THESE MEETINGS, COMMUNITY NEEDS ARE COMMUNICATED TO THE HOSPITAL AND CONSIDERED. PART VI, LINE 3: SEE RESPONSE TO PART V, LINE 13G. PART VI, LINE 4: CUSHING MEMORIAL HOSPITAL IS LOCATED IN LEAVENWORTH COUNTY, KANSAS, JUST OUTSIDE OF THE KANSAS CITY METROPOLITAN AREA. WE GENERALLY DESCRIBE OUR COMMUNITY AS A 31 ZIP CODE SERVICE AREA. PART VI, LINE 5: THE BOARD OF DIRECTORS CONSISTS OF MEDICAL PROFESSIONALS, BUSINESS PROFESSIONALS AND ACTIVE COMMUNITY MEMBERS NEARLY ALL OF WHOM RESIDE OR PRACTICE IN THE COMMUNITY. THE BOARD IS INVOLVED IN THE PLANNING AND COMMUNITY ASSESSMENT PROCESSES. THE MEDICAL STAFF IS OPEN FOR NEARLY ALL SPECIALTIES AND PRIVILEGES ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY.CUSHING MEMORIAL HOSPITAL DONATES EMERGENCY, LABORATORY, AND RADIOLOGY SERVICES TO PATIENTS OF SAINT VINCENT'S CLINIC, WHICH PROVIDES PRIMARY HEATH CARE SERVICES TO THE UNINSURED POOR OF LEAVENWORTH COUNTY.THE HOSPITAL ALSO PROVIDES SCHOLARSHIPS TO LOCAL STUDENTS INTERESTED IN PURSUING A DEGREE IN HEALTH CARE. IN ADDITION, MANY HOURS ARE DONATED BY STAFF IN ON-THE-JOB EDUCATION OF STUDENTS IN LOCAL COLLEGE HEALTH CARE CURRICULUM. 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 LUKES MEDICAL GROUP (501C3 AFFILIATE) 6750 ANTIOCH ROAD STE 210 SHAWNEE MISSION KS 66204 431598353 501(C)(3) 1182656 OPERATING FUNDS 1 SCHOLARSHIPS TO STUDENTS IN HEALTHCARE FIELD 9 7200 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: GRANTS ARE PROVIDED TO QUALIFIED 501(C)(3) CHARITIES. ALL DONEE INFORMATION IS KEPT AS PART OF THE ORGANIZATION'S BOOKS AND RECORDS 1 0 0 0 0 0 0 1 0 CAROL MEYER 0 188730 0 54139 0 22294 0 34479 0 2205 0 301847 0 8199 DON SIPES 0 224721 0 65480 0 16990 0 36374 0 17227 0 360792 0 0 JULIE MURPHY 0 178731 0 33768 0 14481 0 31868 0 9240 0 268088 0 12096 RON BAKER 186536 0 55011 0 6235 0 29820 0 20690 0 298292 0 4546 0 DALE DALENBERG 295152 0 50 0 1536 0 9800 0 19783 0 326321 0 0 0 PART I, LINE 4A SALARY CONTINUATION/SEVERANCE PAYMENT INCLUDED IN FORM 990, PART VII, COLUMN D: SALLY BORDER - $29,598 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 DON SIPES AND CAROL MEYER 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. NUMBER REPORTED IN BOX 3 OF FORM 1096 PART V, LINE 1A CUSHING MEMORIAL HOSPITAL IS PART OF SAINT LUKE'S HEALTH SYSTEM, AN INTEGRATED HEALTH SYSTEM. THE MAJORITY OF CUSHING MEMORIAL HOSPITAL VENDORS ARE PAID THROUGH A CENTRALIZED PAYMENT SYSTEM WITH 1099S ISSUED BY THE CENTRALIZED SERVICE ENTITY. FORM 990, PART VI, SECTION A, LINE 2 DON SIPES AND CAROL MEYER HAVE A BUSINESS RELATIONSHIP BECAUSE THEY ARE DIRECTORS, OFFICERS, AND/OR EMPLOYEES OF THE SAME AFFILIATED TAX-EXEMPT ORGANIZATION. 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 BEFORE FILING. THE 990 DRAFT WAS ALSO PRESENTED TO THE AUDIT COMMITTEE OF THE SYSTEM BOARD OF DIRECTORS FOR REVIEW PRIOR TO FILING. 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 15A ANNUALLY, THE SAINT LUKE'S HEALTH SYSTEM BOARD OF DIRECTORS' COMPENSATION COMMITTEE REVIEWS, DISCUSSES, SETS AND APPROVES COMPENSATION FOR THE ORGANIZATION'S TOP MANAGEMENT EXECUTIVE. 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 AND CAROL MEYER 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 RELATED ORGANIZATIONS. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED LOSSES ON INVESTMENTS: -35,343. PENSION LIABILITY TRANSFER TO SLHS -74,176. RRG SSA DIVIDEND -11,860. ROUNDING -1. TOTAL TO FORM 990, PART XI, LINE 5: -121,380. CUSHING HOSPITAL PHYSICIAN SERVICES LLC 711 MARSHALL LEAVENWORTH KS 66048 261440016 PHYSICIAN SERVICES-BILLING KS 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 NORTHLAND HOSPITAL CORPORATION 601 SOUTH 169 HWY SMITHVILLE MO 64089 440565393 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 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 INC 0 SAINT LUKES EAST HOSPITAL 100 NE SAINT LUKES BLVD LEES SUMMIT MO 64086 562488077 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 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 INC 0 CRITTENTON 10918 ELM AVENUE KANSAS CITY MO 64134 440545808 HEALTH CARE MO 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 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 INC 0 ST LUKES OF TRENTON 701 EAST FIRST TRENTON MO 64683 431707306 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 SAINT LUKES HOSPITAL OF GARNETT 421 SOUTH MAPLE GARNETT KS 66032 742849611 HEALTH CARE KS 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 0 CABOT WESTSIDE HEALTH CENTER 2121 SUMMIT KANSAS CITY MO 64108 440546280 HEALTH CARE MO 501(C)(3) 170B1AVI SAINT LUKES HEALTH SYSTEM INC 0 MIDWEST EAR INSTITUTE INC 4200 PENNSYLVANIA SUITE 100 KANSAS CITY MO 64111 480905027 HEALTH CARE KS 501(C)(3) 170B1AIII ST LUKES HOSPITAL OF KANSAS CITY 0 SAINT LUKES HOSPITAL OF CHILLICOTHE 100 CENTRAL STREET CHILLICOTHE MO 64601 431735565 HEALTH CARE MO 501(C)(3) 170B1AIII SAINT LUKES HEALTH SYSTEM INC 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 INC 0 SAINT LUKES CARE 10920 ELM AVENUE KANSAS CITY MO 64134 260185090 HEALTH CARE MO 501(C)(3) 509(A)(3) - TYPE 1 SAINT LUKES HEALTH SYSTEM INC 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 INC 0 SAINT LUKES COLLEGE OF HEALTH SCIENCES 8320 WARD PARKWAY STE 300 KANSAS CITY MO 64114 272716128 POST-SECONDARY NURSING EDUCATION MO 501(C)(3) 170B1AII ST LUKES HOSPITAL OF KANSAS CITY 0 SLCC INC 4330 WORNALL ROAD STE 2000 KANSAS CITY MO 64111 271994652 HEALTH CARE KS APPLYING FOR 501(C)( APPLYING FOR 170B1AI SAINT LUKES HEALTH SYSTEM INC 0 SLNC INC 4401 WORNALL ROAD KANSAS CITY MO 64111 451470888 HEALTH CARE KS APPLYING FOR 501(C)( APPLYING FOR 170B1AI SAINT LUKES HEALTH SYSTEM INC 0 MEDICAL PLAZA PARTNERS LP 4320 WORNALL ROAD SUITE 410 KANSAS CITY MO 64111 431357824 OWN AND OPERATE MEDICAL OFFICE BUILDING MO N/A MEDICAL PARK ASSOCIATES A LP 601 SOUTH 169 HWY SMITHVILLE MO 64089 431311049 OWN AND OPERATE MEDICAL OFFICE BUILDING MO N/A ST LUKES SURGICENTER-LEES SUMMIT LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 470853481 HEALTH CARE MO N/A SAINT LUKES SOUTH SURGERY CENTER LLC 11221 ROE AVE SUITE 230 OVERLAND PARK KS 66211 201721929 HEALTH CARE KS N/A FAMILY ADVOCATES LLC 10918 ELM AVENUE KANSAS CITY MO 64134 202739036 FOSTER CARE MO N/A SAINT LUKES CARDIOLOGY SERVICES LLC 10920 ELM AVENUE KANSAS CITY MO 64134 263726426 HEALTH CARE MO N/A SAINT LUKES-GI DIAGNOSTICS LLC 4321 WASHINGTON STE 5700 KANSAS CITY MO 64111 274142549 HEALTH CARE MO N/A SAINT LUKES HEALTH SYSTEM RISK RETENTION GROUP 10920 ELM AVENUE KANSAS CITY MO 64134 371471890 INSURANCE SC N/A C ST LUKES HEALTH VENTURES INC 4320 WORNALL ROAD SUITE 410 KANSAS CITY MO 64111 431278476 ACCOUNTING MO N/A C MEDICAL PLAZA MANAGEMENT INC 4320 WORNALL ROAD SUITE 410 KANSAS CITY MO 64111 431352317 MEDICAL OFFICE BUILDING MANAGEMENT MO N/A C VENTURE FINANCIAL SERVICES INC 9500 E 63RD STREET SUITE 202 RAYTOWN MO 64133 431605740 COLLECTIONS MO N/A C SPELMAN DEVELOPMENT CORPORATION 601 SOUTH 169 HWY SMITHVILLE MO 64089 431296007 HEALTH CARE MO N/A C 0 1 0 0 1 0 1 0 1 1 0 1 1 1 1 1 1 1