2011-10-17T08:02:04-05:00 2010-12-31 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2010-01-01 610445850 St Elizabeth Medical Center Inc STEL 8596551642 One Medical Village Drive Edgewood KY 41017 Nathan VanLaningham 8596551642 2011-10-18 1 Alicia Janisch 5137847100 2010 2016-03-07 17:11:31Z St Elizabeth Healthcare John S Dubis One Medical Village Drive Edgewood KY 41017 837117674 0 0928 X www.stelizabeth.com X 1861 KY To provide quality healthcare & wellness services throughout the continuum of care for all patients. 17 6 6637 1110 3014260 0 5395417 4030667 819326952 796602023 4328325 8162714 27734403 26400583 856785097 835195987 0 0 0 0 414889135 392950985 42000 42000 550882 380415936 367166117 795347071 760159102 61438026 75036885 784783958 875944968 432827079 459266358 351956879 416678610 X As a Catholic healthcare ministry, St. Elizabeth Healthcare provides comprehensive and compassionate care that improves the health of the people we serve. St. Elizabeth Healthcare's vision is to be a national leader in healthcare excellence. 0 0 570311817 816279154 Founded in 1861, St. Elizabeth Healthcare is one of the oldest, largest and most respected medical providers in the Greater Cincinnati region. Within our thriving, multi-faceted organization, some of the nation's top medical professionals are working together to deliver the best care available to the Greater Cincinnati region.St. Elizabeth Healthcare has invested in our community for generations. St. Elizabeth believes that reaching out to help the underprivileged and improving the overall health of the community is the foundation of its mission to provide comprehensive and compassionate care to our neighborhood and our families. It is because of this belief that the Community Benefit Program helps others have access to St. Elizabeth's resources and services. It is St. Elizabeth's intention to always balance financial viability with compassionate care, staying true to its non-profit roots.St. Elizabeth Healthcare is sponsored by the Diocese of Covington, and every day we work to fulfill our healing mission by providing for those who cannot pay for care. In recent years, that's amounted to approximately $100 million in uncompensated care and benefits to the community annually.St. Elizabeth Healthcare is the largest healthcare provider in Northern Kentucky and has major facilities in Covington, Edgewood, Falmouth, Florence, Fort Thomas, and Grant County, as well as dozens of smaller, specialized service locations throughout Northern Kentucky. St. Elizabeth Healthcare is continually recognized as one of the nation's best. Time and again, our organization has been lauded for exceptional care by an array of respected sources. These awards and accolades only help to show that St. Elizabeth Healthcare and our community really are better together.HealthGrades, for instance, named St. Elizabeth a Distinguished Hospital for Clinical Excellence, putting us in the top 5 percent in the nation for quality of care for five consecutive years. We are also nationally recognized for heart, stroke, cancer, orthopedics, neurology, and respiratory care. For the past five years, for instance, we have been named both one of America's 50 Best Hospitals, by HealthGrades, and a 100 Top Hospital, by Thomson Reuters. We were the region's first hospital to receive Magnet status, nursing's highest honor, in 2006 and were re-designated Magnet status in September 2010 (at St. Elizabeth Edgewood, St. Elizabeth Grant, and St. Elizabeth Covington). And in 2008, we were inducted into Greater Cincinnati's Best Place to Work Hall of Fame after repeatedly winning that distinction from the Cincinnati Business Courier. 570311817 1 1 0 1 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 1 1 1 1 0 0 0 1 1 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 1 1 1 0 0 1 201 0 1 6637 1 1 1 0 0 0 0 1 1 0 0 0 0 X 17 6 0 0 0 0 0 0 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 KY X Nathan VanLaningham 8596551642 401 East 20th Street Covington KY 41014 Joseph W Gross 60.00 X X 1812592 0 23858 Thomas C Colvin 4.00 X 0 0 0 Michael A Conner 4.00 X 0 0 0 Barry L Dick MD 4.00 X 0 0 0 John S Domaschko 4.00 X 0 0 0 Michael J Gibbons 4.00 X 0 0 0 George S Hall MD Sch O 4.00 X 196563 0 32927 Shirley Howard 4.00 X 0 0 0 Ralph F Huller MD 4.00 X 0 0 0 Bari Joslyn 4.00 X 0 0 0 Fred A Macke Jr 4.00 X 0 0 0 Judge Gary W Moore 4.00 X 0 0 0 Heidi C Murley MD Sch O 4.00 X 317027 0 20398 Ted Robinson 4.00 X 0 0 0 Paul A Sartori 4.00 X 0 0 0 Jo Ann Simpson 4.00 X 0 0 0 Joan Wurtenberger 4.00 X 0 0 0 John Dubis 60.00 X 569959 0 118662 Garren Colvin 60.00 X 497558 0 106660 Barbara Krohman 60.00 X 111176 0 17366 Robert Prichard 40.00 X 421119 0 67182 Alexander Rodriguez 40.00 X 322479 0 54051 Christopher Carle 40.00 X 314150 0 68523 Thomas Saalfeld 40.00 X 306500 0 39559 Treva Jane Swaim 40.00 X 305125 0 22287 Martin Oscadal 40.00 X 303769 0 65835 Sarah Giolando 40.00 X 264996 0 37826 Douglas Chambers 40.00 X 250545 0 40858 Mark Reidinger 40.00 X 234337 0 55966 Michael Walters 40.00 X 2108320 0 37779 Raymond Will 40.00 X 497093 0 18850 Michael Gibson 40.00 X 484393 0 38832 Victor Schmelzer 40.00 X 484072 0 41462 Karl Ulicny 40.00 X 483304 0 42232 10285077 0 951113 235 0 1 0 Mills Sherman Gillian & Goodwin PSC 401 East 20th Street Covington KY 41014 Physician Fees 12721908 EPIC Systems Corporation 1979 Milky Way Verona WI 53593 Consulting Services 7562714 Frank Messer & Sons Contruction Service 7384 Turfway Rd Florence KY 41042 Construction Service 6404641 Dressman Benzinger & Lavelle PSC 2701 Turkeyfoot Road Covington KY 41017 Legal Fees 2894327 ARUP Laboratories PO Box 27964 Salt Lake City UT 84127 Laboratory Services 2378239 74 160600 1266541 2603526 102360 4030667 Net Patient Revenue 621400 796602023 796602023 796602023 7780479 7780479 1680774 1795321 -114547 -114547 -114547 426162 43927 382235 382235 382235 63549 160600 72852 -9303 -9303 15014 9587 5427 5427 Drug Prescription 621990 3827615 3827615 Lab 621500 2135441 2135441 Medical Village Pharma 446110 834972 834972 19720978 19677131 43847 26519006 835195987 816279154 3014260 11871906 6999753 6999753 297860260 233128711 64503136 228413 23856769 17666386 6175356 15027 43168758 31045795 12090425 32538 21065445 15897464 5153683 14298 2495831 11527 2484304 667880 45000 622880 38994 38994 42000 42000 775900 775900 85372764 44179583 41132219 60962 1842903 122101 1711729 9073 3927505 1379566 2532999 14940 7849163 1652368 6191434 5361 10152725 5558918 4584671 9136 239748 219515 19921 312 1898347 366762 1515426 16159 7307022 4338910 2958614 9498 46061985 30005012 16028445 28528 -370331 -3435535 3065204 Medical Supplies 101899224 101090376 808848 0 Bad Debt 58545147 58545147 0 0 General Supplies 22233727 14999812 7196162 37753 Provider Tax 12545892 12545892 0 0 Miscellaneous 3681691 948507 2706300 26884 760159102 570311817 189296403 550882 66574559 56714359 3020153 2876033 90663262 84669893 2417635 4272264 9441740 10099259 7239994 7192105 850323686 516809387 313621978 333514299 246430971 338878736 19412574 26363343 3618946 3664935 17861721 3756681 4480425 3943061 784783958 875944968 78147820 74365730 5740785 5898925 140000000 136975000 900000 208938474 241126703 432827079 459266358 X 347596812 414033462 4360067 2645148 351956879 416678610 784783958 875944968 X 75036885 -10315154 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 34181 1 4813 0 0 38994 0 Part IV, Supplemental Information: Part II-B, Line 1(f): The portion of the Kentucky Hospital Association dues attributable to lobbying activities is $34,181. Part II-B, Line 1(b) and 1(g): The portion of 2 St. Elizabeth Healthcare employees' salaries related to direct contact with legislators regarding legislation. St. Elizabeth Healthcare does not participate in or intervene in (including the publishing or distributing of statements), any political campaign on behalf of (or in opposition to) any candidate for public office. 2945631 406302 4659 3347274 2332334 618143 4846 2945631 3600819 -1262366 6119 2332334 1.00000 0 0 15105107 15105107 447283059 258439809 188843250 377042273 258369578 118672695 10893247 10893247 333514299 Accrued Pension Liability 147480900 Accrued Third Party 24910000 Interest Rate Swap 2977338 Self Insurance 40010907 Other Liabilities 25747558 241126703 835195987 760159102 75036885 28555526 -38870680 -10315154 64721731 866027973 28555526 4734120 33289646 832738327 775900 1681760 2457660 835195987 763917959 4560392 4560392 759357567 775900 25635 801535 760159102 Description of Intended Use of Endowment Funds: Part V, Line 4: The endowment funds include two funds that were part of the St. Elizabeth Healthcare's VISION campaign: one, to support technology for the Health of Excellence Program; two, to establish prenatal care for women without health care access. Description of Uncertain Tax Positions Under FIN 48: Part X: St. Elizabeth Healthcare is exempt from federal income taxes pursuant to Section 501(c)(3) of the Internal Revenue Code (IRC) and its related income is exempt from federal income tax under IRC Section 501(a). As required by the Income Tax Topic of the FASB ASC 740, St. Elizabeth Healthcare completed an analysis of its tax positions at December 31, 2010 and 2009, and determined that no material amounts were required to be recognized under ASC 740 in the consolidated financial statements at December 31, 2010 or 2009. Part XI, Line 8 - Other Adjustments: Change in FMV of Interest Rate Swap -1,656,125. Change in plan assets and benefit obligation -9,054,248. Amortization of previously hedged interest rate swap -1,704,752. Change in Value-Split Interest Agreement -9,759. Transfers to St. Elizabeth Physicians -10,797,026. PAL assets transferred to SEP -15,648,770. Part XII, Line 2d - Other Adjustments: Restricted Net Assets Released to Operations 173,728. Property Rent Expense netted against 990 Revenue 1,795,321. Fundraising Expense netted against 990 Revenue 72,852. Gaining Expense netted against 990 Revenue 9,587. Intercompany Revenue between SEH and SEPS eliminated in AFS 2,682,632. Part XII, Line 4b - Other Adjustments: Chnage in FMV of Interest Rate Swap 1,656,125. Non-Cash Contributions Excluded from AFS 25,635. Part XIII, Line 2d - Other Adjustments: Property Rent Expense netted against 990 Revenue 1,795,321. Fundraising Expense netted against 990 Revenue 72,852. Gaining Expense netted against 990 Revenue 9,587. Intercompany Revenue between SEH and SEPS eliminated in AFS 2,682,632. Part XIII, Line 4b - Other Adjustments: Non-Cash Contributions Excluded from AFS 25,635. X X X X X X X 1 Hillary Lyons Associates PO Box 99 Dimondale MI 48821 Consultant Fee 0 0 42000 0 42000 KY Golf Partee 193270 146100 47170 24278 13313 14582 4346 Style Show 19296 7011 12285 7887 3198 1 11583 7489 4094 835 2880 1533 224149 160600 63549 25113 24080 14582 9077 72852 -9303 15014 6000 2100 1487 0 15014 6000 2100 1487 9587 5427 KY 1 0 0 0 0.00000 1.00000 Janice Way 1 Medical Village Drive Edgewood KY 41017 0 0 1 1 X 1 X 0 1 1 1 0 1 1 44003481 11594284 32409197 0.04620 73167298 59473480 13693818 0.01950 117170779 71067764 46103015 0.06570 52 121606 3509184 2152 3507032 0.00500 18 2122 7602665 3825035 3777630 0.00540 23 72 3143585 3143585 0.00450 2 20672 20672 0.00000 42 28106 1001243 1001243 0.00140 137 151906 15277349 3827187 11450162 0.01630 137 151906 132448128 74894951 57553177 0.08200 1 1000 1000 0.00000 1 900 900 0.00000 4 147 6314 6314 0.00000 1 1401 1401 0.00000 2 739 2069 2069 0.00000 9 886 11684 11684 0 18494412 2496746 201289259 208685552 -7396293 X 1 1 1 Bluegrass Dialysis LLC Renal Dialysis 0.32000 0.17000 5 1 St Elizabeth Edgewood

One Medical Village Dr Edgewood KY 41017

X X X 2 St Elizabeth Florence

7380 Turfway Road Florence KY 41042

X X X 3 St Elizabeth Ft Thomas

85 N Grand Avenue Ft Thomas KY 41075

X X X 4 St Elizabeth Grant

238 Barnes Road Williamstown KY 41097

X X X X 5 St Elizabeth Falmouth

512 South Maple Avenue Falmouth KY 41040

X X Substance Abuse Services NA 1 20 St Elizabeth Covington

1500 James Simpson Jr Way Covington KY 41011

Ambulatory Care Center St Elizabeth Surgicenter-Edgewood

580 South Loop Drive Edgewood KY 41017

Ambulatory Surgery Center St Elizabeth Imaging Center-Edgewood

2904 Foltz Road Edgewood KY 41017

Imaging Center St Elizabeth Surgicenter-Crestview

Hills 2845 Chancellor Drive Edgewood KY 41017

Ambulatory Surgery Center St Elizabeth Imaging Center-Hebron

2200 Conner Road Hebron KY 41048

Imaging Center St Elizabeth Hospice

483 South Loop Road Edgewood KY 41017

Hospice Program St Elizabeth Imaging Center-Alexandria

7200 Alexandria Pike Alexandria KY 41001

Imaging Center St Elizabeth Sports Medicine

830 Thomas More Parkway Suite 101 Edgewood KY 41017

Sports Medicine St Elizabeth Physicians For Women

4900 Houston Road Florence KY 41075

Women's Health St Elizabeth Family Medicine

413 South Loop Road Edgewood KY 41017

Family Medicine St Elizabeth Business Health-Mt Zion

10095 Investment Way Florence KY 41042

Business Health Taylor Mill Physical Therapy Center

5522 Taylor Mill Road Taylor Mill KY 41015

Physical Therapy Center Burlington Physical Therapy Center

6159 First Financial Drive Burlington KY 41005

Physical Therapy Center Florence KY Sports Medicine

10095 Investment Way Suite 1 Florence KY 41042

Sports Medicine Hebron Physical Therapy Center

1980 Litton Lane Hebron KY 41048

Physical Therapy Center Bellevue Physical Therapy Center

103 Landmark Road Bellevue KY 41073

Physical Therapy Center St Elizabeth X-Ray

1974 Walton Nicholson Pike Independence KY 41051

Imaging Center St Elizabeth Union Diagnostic Center

10134 Old Union Road Union KY 41091

Diagnostic Test & Therapy Southgate KY Sports Medicine

525 Alexandria Pike Suite 100 Southgate KY 41071

Sports Medicine St Elizabeth Women's Heart Center

210 Thomas More Parkway Crestview Hills KY 41017

Heart Center Part I, Line 3c: The St. Elizabeth Healthcare organization uses Federal Poverty Guidelines as the criteria to determine eligibility for free care.St. Elizabeth Healthcare discounts all private pay patients whose income is above the 200% of Federal Poverty Guidelines at 47% of their charges. Part I, Line 7: St. Elizabeth Healthcare used cost/charge ratios for determining costs related to financial assistance. Costs related to Unreimbursed Medicaid were determined by using St. Elizabeth Healthcare's cost accounting system. Other costs in Sections 7(g-i) were taken using the actual costs or direct and indirect costs. Part I, Line 7, Column (f): The Bad Debt expense included on Form 990, Part IX, Line 25, Column (A), but subtracted for purposes of calculating the percentage in this column is $ 58545147. Part II: St. Elizabeth Healthcare provides a broad range of programs and services to address the needs identified by our patients and the community that contribute to the improved health of Northern Kentucky. St. Elizabeth Healthcare provides programs and services that enable people to make changes in their health but making those decisions to change relies on the individual. In addition, changing the health status of a community requires multiple systemic changes that are beyond the control of one organization. Therefore, the hospital took a three-pronged approach where it could make a difference and focusing on outcomes that are within its control. Each of these prongs has established measures to monitor progress and success. The three-pronged approach includes:1. Providing free or discounted care to our community, as appropriate;2. Providing educational programs and resources for both health professionals and community members; and3. Focusing on one clinical program that relates to a specific need identified as important to our community, which in this plan is a Diabetes Center of Excellence. Part III, Line 4: St. Elizabeth incorporated the Bad Debt expense amounts calculated by taking the organization's cost/charge ratio as requested in the instructions to Schedule H and multiplying this number to the total bad debts of the organization. The percentage of bad debts that could likely be Charity Care if enough information were obtained up front was developed with the help of our largest collection agency who determined based on the accounts reviewed who may not have had the financial ability to pay. St. Elizabeth Healthcare also believes that many patients fall into the category where they do not meet the poverty guidelines but yet have no insurance and cannot afford the cost of the services provided. St. Elizabeth Healthcare therefore believes these non reimbursed costs should also be counted as a benefit to the community we serve. The American Hospital Association's position is also that Bad Debts should be counted as Community benefit. Part III, Line 8: St. Elizabeth Healthcare uses the step down methodology to determine costs for Medicare. The reports were then completed by following the guidance provided in the instructions for Part III. St. Elizabeth Healthcare believes Medicare losses should be an allowable Community benefit. St. Elizabeth Healthcare provides needed services to the elderly and disabled Medicare population at a financial loss to the organization to help these individuals get the care they need in the community we serve. The American Hospital Association's position is also that Medicare losses should be counted as Community Benefit. Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. Part VI, Line 2: In 2009, St. Elizabeth Healthcare participated in a community-wide effort to complete a community health assessment. The process was coordinated through the Northern Kentucky Independent Health District and Vision 2015 using a national planning process called Mobilizing for Action through Planning and Partnerships (MAPP). Using this framework, the assessment process involved more than 200 participants with 10 representatives serving on four different committees to assess the health status of our community. St. Elizabeth Healthcare also reviewed the statistics and incidence of disease in its community. These data sources were used to develop St. Elizabeth Healthcare's Community Benefit Plan. Part VI, Line 3: The hospitals have policies in place detailing its financial assistance program and provides support to eligible patients in obtaining financial assistance benefits through federal, state and hospital programs. This information is provided to the patient during the registration and billing processes. The information is also available on the institution's website. In most cases, a financial counselor personally follows up with the patient after registration to assist them through the process. Part VI, Line 4: St. Elizabeth Healthcare serves the Northern Kentucky region, consisting of 12 counties (Boone, Campbell, Grant, Kenton, Owen, Pendleton, Bracken, Carroll, Gallatin, Harrison, Mason, and Robertson Counties). The service area includes urban, suburban, and rural areas. The total population of the area is over 500,000. Two of the counties are the fastest growing counties in the state with Boone County projected to grow at 12.5% over the next five years and Grant County at 6%, which presents great challenges to serve the increasing health care needs of this growing population. Other parts of the service area are growing steadily with a few of the urban cities projected to decline. St. Elizabeth Healthcare has been expanding services in Dearborn County, Indiana.The area is predominantly white with an increasing number of persons with Hispanic backgrounds moving into the area, almost 10,000 people in the 2010 census, growing over 100% from the 2000 census. Minority populations represent approximately 6% of the population. Approximately 11.1% of the population is 65+ with the highest growing age groups being the 45-64 and 65+ groups. The percent of persons in poverty varies by county with the lowest at 6.2% in Boone County and the highest at 15.6% in Grant County. Overall, the percent below poverty is 11.5% for the area. Approximately 11.1% of the Northern Kentucky population is uninsured. Part VI, Line 6: St. Elizabeth furthers its exempt purposes in improving community health by:1. Encouraging and supporting staff to participate on various community boards/activities that support and/or develop programs that address community health needs and workforce development. Hospital associates served on 42 various community, academic and social services board/committees.2. The hospital's Board of Directors is made up of community representatives to ensure the organization adheres to its Mission to improve the health of the people we serve.3. Through its Primewise senior services for age 50+ persons, the institution subsidizes course offerings to senior citizens including Driver's Safety, Low Impact Exercise, Computer Skills, Medication Review and Health Screenings, along with providing literature pertinent to this age group.4. On a quarterly basis, the hospital produces and distributes to more than 60,000 households throughout Northern Kentucky, literature on various healthcare issues and schedules pertaining to area health events and programs. Part VI, Line 7: St. Elizabeth Healthcare is a system that features five facilities throughout Northern Kentucky - St. Elizabeth Edgewood, St. Elizabeth Falmouth, St. Elizabeth Florence, St. Elizabeth Fort Thomas, and St. Elizabeth Grant. Each of these facilities addresses the specific needs of its locale as identified by the patients in that community. The service areas vary from rural areas to suburban communities to urban areas in Greater Cincinnati and Northern Kentucky. St. Elizabeth Healthcare offers 1,192 licensed beds, more than 6,100 employees, more than 900 physicians with admitting privileges, a physician organization which includes 60 primary care and specialty office locations, and three freestanding imaging centers. St. Elizabeth Healthcare is sponsored by the Diocese of Covington.Specific service locations and specialties are available on stelizabeth.com and many are located adjacent to or near one of the five primary hospital locations. Part I, Line 6 and Part VI, Line 7: St. Elizabeth Healthcare is not required to file a community benefit report with any of the states in which it operates. St. Elizabeth does produce an annual community benefit report which is posted on the web site, distributed to stakeholders, and available upon request to the public in general. X 1 1 X X X X X X 0 1 0 0 0 0 0 0 0 Joseph W Gross 772086 0 323300 0 717206 0 0 0 23858 0 1836450 0 0 0 George S Hall MD Sch O 170975 0 21047 0 4541 0 11058 0 21869 0 229490 0 0 0 Heidi C Murley MD Sch O 316397 0 0 0 630 0 0 0 20398 0 337425 0 0 0 John Dubis 469448 0 83235 0 17276 0 93613 0 25049 0 688621 0 0 0 Garren Colvin 404249 0 68144 0 25165 0 81521 0 25139 0 604218 0 0 0 Robert Prichard 356195 0 63072 0 1852 0 44195 0 22987 0 488301 0 0 0 Alexander Rodriguez 283027 0 38509 0 943 0 32439 0 21612 0 376530 0 0 0 Christopher Carle 244176 0 38263 0 31711 0 44470 0 24053 0 382673 0 0 0 Thomas Saalfeld 260248 0 42450 0 3802 0 16500 0 23059 0 346059 0 0 0 Treva Jane Swaim 254586 0 46800 0 3739 0 0 0 22287 0 327412 0 0 0 Martin Oscadal 260967 0 40325 0 2477 0 46517 0 19318 0 369604 0 0 0 Sarah Giolando 263060 0 637 0 1299 0 25533 0 12293 0 302822 0 0 0 Douglas Chambers 212086 0 37410 0 1049 0 23667 0 17191 0 291403 0 0 0 Mark Reidinger 209859 0 23429 0 1049 0 38489 0 17477 0 290303 0 0 0 Michael Walters 287857 0 48372 0 1772091 0 15796 0 21983 0 2146099 0 0 0 Raymond Will 482557 0 750 0 13786 0 0 0 18850 0 515943 0 0 0 Michael Gibson 482557 0 750 0 1086 0 15600 0 23232 0 523225 0 0 0 Victor Schmelzer 480825 0 750 0 2497 0 16498 0 24964 0 525534 0 0 0 Karl Ulicny 480057 0 750 0 2497 0 16500 0 25732 0 525536 0 0 0 Part I, Line 1a Health and Social Club Dues - St. Elizabeth Healthcare does pay for social club dues for three executives. Such membership is to facilitate St. Elizabeth Healthcare's business purposes, and may also be used personally. The employee is required to provide documentation as to business and personal use of the club, and any personal use is treated as compensation on the Form W-2. Part I, Line 4b Executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. Nonqualified Plan Contributions for 2010: John Dubis: $77,113 Garren Colvin: $65,100 Christopher Carle: $27,970 Robert Prichard: $44,195 Alexander Rodriguez: $32,439 Martin Oscadal: $30,017 Sarah Giolando: $25,533 Douglas Chambers: $23,667 Mark Reidinger: $21,989 Supplemental Information Part III Part II: Any persons employed by St. Elizabeth Healthcare are eligible to receive the standard employee benefits in addition to compensation and retirement plan contributions. Compensation and benefits for executives are reviewed annually by independent consultants to ensure total compensation packages are at fair market rates. Kentucky Economic Development Finance Authority 521643102 49126KGH8 2009-12-09 101960448 Construction of hospital facilities/partial refund of bonds issued 6/11/03 0 0 0 Kentucky Economic Development Finance Authority 521643102 2009-12-09 38150000 Partial refunding of bonds issued 6/11/03 0 0 0 1975000 101960448 1430179 29195269 71335000 2009 1 0 1 1 1050000 38150000 360000 37790000 1 0 1 1 0 1 1 0 1 0.02890 0.02890 1 0 0 0 0 1 0 0 0 0 0 1 0 1 0 0 0 1 Schedule K, Part III, Column B: Part III, Column B is not required, but is completed due to software limitations. Rumpke A board member is a board member of Rumpke 152861 Utilities 0 Northern Kentucky Water District A board member is a board member of Northern Kentucky Water District 530731 Utilities 0 ChamplinHaupt Inc A board member is a partner of Champlin/Haupt Inc. 832732 Services 0 Internal Medicine Associates A board member is an owner of Internal Medicine Associates 210909 Services 0 DGHK Realty LLC An officer/board member is an owner of DGHK Realty LLC 3156934 Realty 0 Schiff Kriedler Shell A board member is an officer of Schiff, Kreidler-Shell 826536 Insurance 0 Sch L, Part IV, Business Transactions Involving INterested Persons: All transactions reported on Part IV are reported as arms-length for fair market value. X 13 76725 Cost/Selling Price X Med. Supplies 2 16000 Cost/Selling Price X Food/Prizes 84 9635 Cost/Selling Price 0 0 0 Form 990, Part VI, Section A, line 7b Most Reverend Catholic Bishop of Covington, KY has certain reserved powers in regards to major transactions. Form 990, Part VI, Section B, line 11 St. Elizabeth Healthcare's process to review the Form 990 consists of review and approval by the certain members of management and the Finance Committee. The Form 990 is provided to the Board of Trustees for their review prior to filing, and management is available for any questions or comments. Form 990, Part VI, Section B, line 12c The organization regularly and consistently monitors and enforces compliance with its conflict of interest policy. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. In addition, any of these persons who have a direct or indirect financial interest must disclose the existence of the financial interest and disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. Form 990, Part VI, Section B, line 15 In determining compensation of the organization's CEO, an evaluation is done by the Compensation Committee and Executive Committee using appropriate comparable data, and then a compensation recommendation is presented to the Board for approval. Other key executives are reviewed and the CEO makes recommendations for their compensation to the Compensation Committee. This committee then evaluates and approves the compensation for the other key executives. For both the CEO and other key executives, the process included a review and approval by independent persons, review of comparability data, and contemporaneous substantiation of the deliberation and decision. Form 990, Part VI, Section C, line 19 The organization will provide documents open to public inspection upon request. Changes in Net Assets or Fund Balances: Form 990, Part XI, line 5: Net unrealized gains on investments: 28,555,526. Change in FMV of Interest Rate Swap -1,656,125. Change in plan assets and benefit obligation -9,054,248. Amortization of previously hedged interest rate swap -1,704,752. Change in Value-Split Interest Agreement -9,759. Transfers to St. Elizabeth Physicians -10,797,026. PAL assets transferred to SEP -15,648,770. Total to Form 990, Part XI, Line 5: -10,315,154. Form 990, Part IV, Line 20b: If the organization operated one or more hospital facilities at any time during the tax year, then it must attach a copy of its most recent audited financial statements if its tax year began after March 23, 2010. The tax year covered by this return is January 1, 2010 through December 31, 2010. Therefore, no audited financial statements are attached to this return. Form 990, Part VII, Section A: Compensation for George S. Hall and Heidi C. Murley is for their services as physicians of St. Elizabeth Medical Center and not for their role as a trustee. Form 990, Part VII, Section B: Frank Messer & Sons Construction Service received $6,404,641 for construction service. This amount includes services, labor, and materials. St Elizabeth Physician Services 334 Thomas More Parkway Suite 200 Crestview Hills KY 41017 611339639 Physician Management Services KY -358819 4328121 St Elizabeth Medical Center Summit Medical Group Inc 401 East 20th Street 6A Covington KY 41014 611300608 Physician Practice KY Section 501(c)(3) Schedule A, Line 3 St Elizabeth Medical Center 1 Transcare of Kentucky Inc 2169 Chamber Centre Drive Lakeside Park KY 41017 611318755 Ambulance Services (Dissolved 4/2010) KY Section 501(c)(3) Schedule A, Line 3 St Elizabeth Medical Center 1 Northern KY Children's Medical Services LLC c/o CHMC 3333 Barnet Avenue Cincinnati OH 45202 260084305 Medical Services KY Children's Hospital Medical Center Related 679334 234119 0 0 0.50000 St Elizabeth's Home Care Services LLC 1000 Summit Drive Suite 300 Milford OH 45150 261236191 Home Health KY St Elizabeth Medical Center Related 634500 677000 0 0 0.50000 Vescent Aesthetic Skin and Laser Center 210 Thomas More Parkway Crestview Hills KY 41017 273137980 Cosmetic Services KY St Elizabeth Medical Center Related -45634 0 0 0.50000 JLD Management LLC 207 Thomas More Parkway Crestview Hills KY 41017 205361603 Real Estate Purchases KY St Elizabeth Medical Center C -5954 1.00000 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 0 JLD Management LLC J 110262 Cash Transaction JLD Management LLC Q 116216 Cash Transaction Summit Medical Group Inc J 219238 Cash Transaction Summit Medical Group Inc Q 20841376 Cash Transaction Summit Medical Group Inc P 950000 Cash Transaction Amsurg Center of Northern KY GI LLC 340 Thomas More Parkway Suite 160B Crestview Hills KY 41017 621719097 Ambulatory Surgery Center KY 0 488789 0 0