2011-11-15T11:35:34-06:00 2010-12-31 ERNST & YOUNG US LLP 190 CARONDELET PLAZA SUITE 1300 CLAYTON MO 63105 990 2010-01-01 480784446 PROVIDENCE MEDICAL CENTER PROV 9135964000 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 RANDALL G NYP 2011-11-11 3142901000 2010 2016-03-07 17:11:31Z Mike Dorsey 8929 Parallel Parkway Kansas City KS 66112 171127901 false 0928 X WWW.PROVIDENCE-HEALTH.ORG X 1971 KS WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE. 13 12 1407 126 3580496 0 582684 51888 142598776 170581397 466248 353361 90166 106531 143737874 171093177 0 77275 0 0 72890930 72986199 0 0 0 76059538 114825435 148950468 187888909 -5212594 -16795732 104109078 72255991 45384568 31810360 58724510 40445631 X WE WILL, IN THE SPIRIT OF THE SISTERS OF CHARITY, REVEAL GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR OR VULNERABLE. false false 160341768 170687928 AS PART OF THE HEALING MISSION OF THE CATHOLIC CHURCH, THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND ITS AFFILIATES WITNESS TO THE GOSPEL OF JESUS BY STRIVING TO PROVIDE QUALITY HEALTH CARE IN A SPIRIT OF JUSTICE AND CHARITY. 1. IT IS THE PHILOSOPHY OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AND AFFILIATED HOSPITALS TO TREAT PATIENTS IN A NON-DISCRIMINATORY MANNER, MINIMIZE HUMAN SUFFERING AS MUCH POSSIBLE; CREATE A PREFERENTIAL OPTION FOR THE POOR; AND PROVIDE ASSISTANCE TO THOSE PATIENTS WHO HAVE LIMITED FINANCIAL RESOURCES. THE HOSPITAL PARTICIPATES IN THE MEDICARE AND MEDICAID PROGRAM AND AS SUCH PROVIDES CARE AT REIMBURSEMENT LEVELS LOWER THAN CHARGES. THE DIFFERENCE BETWEEN REIMBURSEMENT FROM THESE PROGRAMS AND CHARGES AT ESTABLISHED RATES AMOUNTED TO $164,162,403. 2. INCLUDED IN THE HOSPITAL MISSION IS SERVICE TO COMMUNITY WHICH IT OPERATES. TO THAT END, THE HOSPITAL HAS INSTITUTED AND PARTICIPATES IN THE FOLLOWING COMMUNITY BENEFIT ACTIVITIES: PROVIDES LABORATORY, RADIOLOGICAL, AND PHARMACEUTICAL SERVICE AT DUCHESNE CLINIC. DUCHESNE CLINIC IS A CLINIC FOR THE CARE OF THE MEDICALLY INDIGENT. COMMUNITY HEALTH SERVICES PROVIDED AT MINIMAL OR NO CHARGE: CHOLESTEROL SCREENING BLOOD SUGAR SCREENING SIBLING PREPARATION LAMAZE CHILDBIRTH CLASSES CANCER SUPPORT GROUP STROKE SUPPORT GROUP BREAST FEEDING SUPPORT HEARING SCREENING CESAREAN BIRTH CLASSES FREEDOM FROM SMOKING COLORECTAL SCREENING NUTRITIONAL COUNSELING HOSPITAL CARE: INPATIENT DAYS OF CARE 37,034 INPATIENT ADMISSIONS 8,173 NEWBORN DELIVERIES 1,010 OUPATIENT REGISTRATIONS 33,430 EMERGENCY ROOM VISITS 34,224 CLINIC VISITS 51,160 160341768 true true false true false false false false true true false false false true false false true false false false false false false false false true false true false true false false false false false false false false false false false false true true true true false false true 136 0 true 1407 true true true false false false false false false false false false X 13 12 false true false false true true true true true false true true true true true true true true false false true true X DAVID DULNY 9135964835 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 X MICHAEL A DORSEY 28.5 X X 0 428871 41097 IRENE CAUDILLO 0.0 X 0 0 0 SISTER MARY RACHEL FLYNN 0.0 X 0 0 0 PETER CRISTIANO MD 0.0 X 0 0 0 MARY JO GREGORY 0.0 X 0 0 0 WILLIAM D PETRIE 0.0 X X 0 0 0 DIANE MARIE STEELE 0.0 X 0 0 0 ROY L ROBINSON 0.0 X X 0 0 0 PASTOR RICKY D TURNER 0.0 X X 0 0 0 SISTER PAM HINKLE 0.0 X 0 0 0 BERNICE COGBURN 0.0 X 0 0 0 DR MICHAEL PARRA MD 0.0 X 0 0 0 DANIEL CRABTREE 0.0 X 0 0 0 CLAY PATTERSON 0.0 X 0 0 0 JOE JEANS 30.0 X 0 191248 31615 JUANITA ROY 30.0 X 0 313707 34539 DR MARIA JAVAID MD 40.0 X 399365 0 0 DR MICHAEL MEURER MD 40.0 X 383923 0 0 DR BARRY SOLOMON MD 30.0 X 0 307525 54966 DR JASON WILTSHIRE MD 40.0 X 274981 0 0 DR FRANK SLOVICK MD 40.0 X 240590 0 0 JAMES PAQUETTE 0.0 X 0 768909 97940 1298859 2010260 260157 40 true true false SISTERS OF CHARITY OF LEAVENWORTH 9801 RENNER BOULEVARD LENEXA KS 66219 MANAGEMENT & IT FEES 5001944 MIDWEST CARDIOLOGY ASSOCIATES 8919 PARALLEL PARKWAY KANSAS CITY KS 66112 CARDIOLOGY SERVICES 3321040 ANESTHESIA CHARTERED 1715 DEER TRACKS TRAIL ST LOUIS MO 63131 ANESTHESIA SVCS 3541283 COVENANT GROUP 14400 COLLEGE BLVD STE 100 OVERLAND PARK KS 66215 ER PHYSICIANS 966912 SIEMENS 7850 COLLECTIONS DR CHICAGO IL 60693 SOFTWARE MGMT 1192915 29 51888 51888 PATIENT REV-NET 621500 165200391 165200391 FOOD SERVICE FROM RELATED PARTIES 722320 626423 626423 CAFETERIA/VENDING 722210 566611 566611 PHARMACY SALES 900099 5300 5300 RENTAL INCOME 531120 671123 671123 3511549 30384 2954073 527092 170581397 364624 364624 0 0 23461 34724 -11263 -11263 -11263 0 0 0 MEDICAL STAFF REVENUE 541900 106531 106531 106531 171093177 165337306 3580496 2123487 77275 77275 0 0 0 1044089 1044089 0 58099171 53004039 5095132 3413885 3181367 232518 6153018 5566422 586596 4276036 3898696 377340 2746172 2746172 193547 193547 17500 17500 12657 12657 0 0 34469727 30482861 3986866 1157834 1157834 588002 491330 96672 1264587 1000352 264235 0 1098789 962707 136082 163649 75371 88278 0 56134 50667 5467 494655 494655 0 8098354 8098354 1352119 108503 1243616 BAD DEBTS 27595121 27595121 ORTHOPEDIC SUPPLIES 6025103 6025103 OTHER MEDICAL SUPPLIES 7945197 7938636 6561 PHARMACEUTICALS 6363154 6363125 29 OTHER NON-MEDICAL SUPPLIES 2393341 2333852 59489 12789793 11186341 1603452 187888909 160341768 27547141 0 1733705 -27814400 20877610 30140245 3641015 3746626 711604 1538764 174342391 115747060 59026872 58595331 17260941 4106136 491751 823213 365580 1120076 104109078 72255991 29637100 27861301 15747468 3949059 45384568 31810360 X 58724510 40445631 58724510 40445631 104109078 72255991 X -16795732 -1483147 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 12657 12657 false OTHER ACTIVITIES SCHEDULE C, PART II-B, LINE 1I A PORTION OF PROVIDENCE MEDICAL CENTER'S KANSAS HOSPITAL ASSOCIATION DUES IS RELATED TO LOBBYING ACTIVITIES AND AMOUNTED TO $12,657. 871512 3900 88300 37105 926607 736128 1250 138884 4750 871512 953198 1850 -209520 9400 736128 0.78950 0.21050 false true true 1572067 1572067 94142564 56296998 37845566 607827 218236 389591 74755853 56460879 18294974 3264080 2770947 493133 58595331 0 LONG-TERM NOTES PAYABLE- SCLHS 3949059 3949059 SCHEDULE D, PART V, LINE 4 ENDOWMENT FUNDS Retained endowment funds are intended to support indigent care, provide nursing scholarships, and to be used for the general support of the hospital at the discretion of the board. Endowment funds are held by Providence/Saint John Foundation. true true true X true X true true false true true 17188 8149498 8149498 0.05080 14923 23776028 19611393 4164635 0.02600 32111 31925526 19611393 12314133 0.07680 23 5480 16086 520 15566 0.00010 6 2443 19627 19627 0.00010 29 7923 35713 520 35193 0.00020 29 40034 31961239 19611913 12349326 0.07700 true 7908741 40315613 47623705 -7308092 X true true Kansas City Imaging Outpatient Imaging Center 0.50000 0.00000 0.50000 HEART OF AMERICA SUR Outpatient Surgery 0.50000 0.00000 0.50000 Hospital Linen Svcs Laundry Service Cooperative 0.11000 0.00000 0.00000 1 1 Providence Medical Center

8929 Parallel Parkway Kansas City KS 66112

X X X Providence Medical Center 1 18 HEART OF AMERICA SURGERY CENTER

8935 STATE AVENUE KANSAS CITY KS 66112

OUTPATIENT SURGERY CENTER OUTPATIENT REHAB CENTER

8919 PARALLEL PARKWAY SUITE 455 KANSAS CITY KS 66112

OUTPATIENT REHAB SERVICES PAIN TREATMENT CENTER

8919 PARALLEL PARKWAY SUITE 416 KANSAS CITY KS 66112

PAIN TREATMENT WYANDOT MEDICAL OFFICE BUILDING

8919 PARALLEL PARKWAY KANSAS CITY KS 66112

MEDICAL OFFICE BUILDING LIVING WATER CLINIC

8919 PARALLEL PARKWAY SUITE 440 KANSAS CITY KS 66112

PRIMARY CARE CLINIC GENERAL SURGERY PRACTICE

8919 PARALLEL PARKWAY SUITE 206 KANSAS CITY KS 66112

GENERAL SURGERY SERVICES PROVIDENCE CARDIOTHORACIC

8919 PARALLEL PARKWAY SUITE 455 KANSAS CITY KS 66112

CARDIOTHORACIC SURGICAL SERVICES BONNER SPRINGS CLINIC

913 SHEIDLEY BONNER SPRINGS KS 66012

PRIMARY CARE CLINIC OBGYNECOLOGY PRACTICE

8919 PARALLEL PARKWAY SUITE 580 KANSAS CITY KS 66112

OBGYN SERVICES ONCOLOGY CLINIC

8919 PARALLEL PARKWAY SUITE 455 KANSAS CITY KS 66112

HEMATOLOGY, ONCOLOGY CLINIC TONGANOXIE CLINIC

508 EAST 4TH STREET TONGANOXIE KS 66086

PRIMARY CARE CLINIC MIDTOWN CLINIC

1202 NORTH 38TH STREET KANSAS CITY KS 66102

PRIMARY CARE CLINIC CARDIOLOGY PRACTICE

5701 STATE AVENUE KANSAS CITY KS 66102

CARDIOLOGY SERVICES CARDIOVASCULAR PRACTICE

712 FIRST TERRACE SUITE C LANSING KS 66043

CARDIOVASCULAR SERVICES INTENSIVE DIABETES MANAGEMENT

8919 PARALLEL PARKWAY SUITE 403 KANSAS CITY KS 66112

DIABETES CLINIC KANSAS CITY IMAGING CENTER

11011 HASKELL AVENUE KANSAS CITY KS 66112

OUTPATIENT IMAGING CENTER DIABETES PROGRAM

8919 PARALLEL PARKWAY SUITE 560 KANSAS CITY KS 66112

DIABETES CARE AND EDUCATION WESTGLEN CLINIC

7255 RENNER ROAD SHAWNEE KS 66203

PRIMARY CARE CLINIC PART I, LINE 3C N/A PART I, LINE 6A N/A PART I, LINE 7 METHODOLOGY FOR COMPUTING THE COST OF CHARITY AND UNREIMBURSED MEDICAID COST WAS BASED ON THE CATHOLIC HOSPITAL ASSOCIATION GUIDE FOR PLANNING AND REPORTING OF COMMUNITY BENEFITS, APPENDIX D, WORKSHEET 2. THIS METHODOLOGY COMPUTES A COST TO CHARGE RATIO USING TOTAL OPERATING EXPENSES INCLUDING BAD DEBT EXPENSE AND EXCLUDING MEDICAID PROVIDER TAXES. THIS AMOUNT IS REDUCED BY OTHER OPERATING REVENUE TO ARRIVE AT NET EXPENSE. NET EXPENSE AS A PERCENTAGE OF GROSS PATIENT REVENUE IS THE PERCENTAGE USED TO COMPUTE THE COST OF CHARITY AND UNREIMBURSED MEDICAID COST. OTHER BENEFITS (INCLUDING COMMUNITY HEALTH IMPROVEMENT SERVICES AND COMMUNITY BENEFIT OPERATIONS) ARE CALCULATED BASED ON THE ACTUAL COST TO DELIVER THESE SERVICES. FOR DONATIONS OTHER THAN MONETARY (IE STAFF TIME AND IN-KIND DONATIONS), THE COSTS ARE DETERMINED BASED ON FAIR MARKET VALUE OF THE DONATION. THIS INFORMATION IS TRACKED ON CBISA, A SOFTWARE DATABASE EXCLUSIVELY USED TO TRACK COMMUNITY BENEFIT REPORTING. NET COMMUNITY BENEFIT EXPENSE IS CALCULATED AS A PERCENTAGE OF TOTAL EXPENSES EXCLUDING BAD DEBT OF $27,595,121. PART II OUR COMMUNITY BUILDING EXPENSES ARE THOSE IDENTIFIED IN OUR COMMUNITY HEALTH ASSESSMENT AS CONTRIBUTING TO THE HEALTH OF THE COMMUNITY, BUT NOT DIRECTLY PROVIDING HEALTH SERVICES. PART III, LINE 4 THE COSTING METHODOLOGY USED TO CALCULATE THE COST OF GROSS BAD DEBT EXPENSE WAS BASED ON THE COSTING METHODOLOGY IN THE INSTRUCTIONS TO SCHEDULE H, WORKSHEET 2, RATIO OF PATIENT CARE COST TO CHARGES. LINE 11 OF WORKSHEET 2 (RATIO OF PATIENT CARE COST TO CHARGES) WAS MULTIPLIED AGAINST THE GROSS BAD DEBT EXPENSE TO ARRIVE AT THE COST OF BAD DEBT EXPENSE. BAD DEBT EXPENSE REPRESENTS THE UNPAID PORTION OF THE GROSS CHARGES (AT ESTABLISHED RATES) LESS PAYMENTS FROM 3RD PARTY PAYORS AND THE PATIENT AND ANY CONTRACTUAL ADJUSTMENTS. THE HOSPITAL DOES NOT PROVIDE ANY PROMPT PAY DISCOUNTS FOR PAYING THE PATIENT PORTION OF THE BALANCE OF THEIR ACCOUNT WITHIN A SPECIFIED TIMEFRAME. SOME ACCOUNTS WRITTEN OFF TO BAD DEBTS WHICH ARE SENT TO THE HOSPITAL'S COLLECTION AGENCIES ARE SUBSEQUENTLY RECLASSIFIED TO CHARITY. ACCOUNTS THAT ARE CLOSED BY THE COLLECTION AGENCY BASED ON THE AGENCY'S ASSESSMENT OF THE PATIENT AND\OR GUARANTOR'S FINANCIAL POSITION (I.E. UNEMPLOYED, NO ASSETS, ETC.) ARE RECLASSIFIED TO CHARITY EXPENSE ONCE THAT DETERMINATION IS MADE. ACCOUNTS WRITTEN OFF TO BAD DEBT EXPENSE IN CY 2010 AND SUBSEQUENTLY RECLASSIFIED TO CHARITY IN CY 2011 WERE NOT QUANTIFIED AT DECEMBER 31, 2010. THE ORGANIZATION'S CONSOLIDATED FINANCIAL STATEMENTS DO NOT CONTAIN A FOOTNOTE THAT DESCRIBES BAD DEBT EXPENSE. WITHIN THE FINANCIAL STATEMENTS OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, BAD DEBT EXPENSE IS INCLUDED WITHIN OPERATING EXPENSES, AT THE VALUE OF UNCOLLECTED AND ESTIMATED UNCOLLECTIBLE CHARGES AFTER CONTRACTUAL ALLOWANCES AND SELF-PAY DISCOUNTS ARE APPLIED. PART III, LINE 8 THE MEDICARE ALLOWABLE COSTS WERE ARRIVED AT FROM VARIOUS WORKSHEETS C, D AND E OF THE FILED MEDICARE COST REPORT FOR THE YEAR ENDED DECEMBER 31, 2010. THE MEDICARE SHORTFALL INDICATED IN PART III, LINE 7 WAS NOT INCLUDED IN PART I, LINE 7, COMMUNITY BENEFIT. 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. PROVIDENCE MEDICAL CENTER NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION, DISCHARGE AND IN COMMUNICATION REGARDING PATIENT BILLS. PATIENTS ARE CONTACTED MULTIPLE TIMES ABOUT UNPAID BALANCES PRIOR TO INITIATING ANY COLLECTION ACTION. IF A PATIENT IS DETERMINED TO BE ELIGIBLE FOR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION PROCESS, THE ACCOUNT IS RECLASSIFIED AS FINANCIAL ASSISTANCE AND DEBT COLLECTION EFFORTS ARE CEASED. NEEDS ASSESSMENT AS PART OF OUR CORE VALUE OF RESPONSE TO NEED, WE TAKE STEPS TO DETERMINE WHERE THERE IS THE MOST NEED IN ORDER TO PROVIDE THE GREATEST GOOD. PROVIDENCE MEDICAL CENTER HAS REGULARLY PARTICIPATED IN NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. THE MOST RECENT SURVEY WAS CONDUCTED IN 2010, AND ONE IS SCHEDULED TO BE COMPLETED BY 2012. THIS ASSESSMENT STUDIES A DEFINED COMMUNITY SERVED BY PROVIDENCE MEDICAL CENTER, AND IS DONE BY PARTNERING WITH LOCAL GOVERNMENT AND SOCIAL AGENCIES; COMBINING EFFORTS WITH OTHER LOCAL HOSPITALS AND HEALTH CARE ORGANIZATIONS; 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 HEATLH STATISTICS. EVERY YEAR AS A COMPONENT OF THE ANNUAL STRATEGIC PLANNING PROCESS, PROVIDENCE MEDICAL CENTER PARTNERS WITH COMMUNITY ORGANIZATIONS INCLUDING SWOPE PARK HEALTH SERVICES, THE WYANDOTTE COUNTY HEALTH DEPARTMENT, THE WYANDOTTE COUNTY ECONOMIC DEVELOPMENT CORPORATION, THE AMERICAN CANCER SOCIETY, THE AMERICAN HEART ASSOCIATION AND THE UNITED WAY TO REVIEW STATISTICS REGARDING THE POPULATION AND HEALTH-RELATED TRENDS. THE MOST RECENT SURVEY WAS CONDUCTED IN 2010 AND WILL BE UPDATED AS A PART OF THE 2011 PLANNING PROCESS. IN ADDITION, PROVIDENCE MEDICAL CENTER CONDUCTED A PHYSICIAN NEEDS ASSESSMENT OF WYANDOTTE COUNTY IN 2010 UTILIZING QUANTITATIVE RESEARCH METHODS TO DETERMINE GAPS IN PHYSICIAN SPECIALTY COVERAGE IN THE MARKET. 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, INCLUDING THE KANSAS CITY METROPOLITAN HEALTH ACCESS POLICY ASSESSMENT, THE WYANDOTTE COUNTY DEPARTMENT OF HEALTH, THE KANSAS DEPARTMENT OF HEALTH, SG2 AND THOMPSONS/MEDSTAT. PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE SCHEDULE H, PART VI, LINE 3 PROVIDENCE MEDICAL CENTER TREATS PATIENTS WITH RESPECT AND DIGNITY REGARDLESS OF THEIR ABILITY TO PAY. PROVIDENCE MEDICAL CENTER 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 HAVE A PARTNERSHIP WITH THE MIDLAND GROUP TO PROVIDE EXTENDED PAYMENT PLANS. 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 SCHEDULE H, PART VI, LINE 4 PROVIDENCE MEDICAL CENTER IS PART OF A NATIONAL SYSTEM OF FAITH-BASED HOSPITALS SPONSORED BY THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM LOCATED IN LENEXA, KANSAS. THE HOSPITAL IS COMMITTED TO IMPROVING THE HEALTH OF THE RESIDENTS IN ITS SERVICE AREAS INCLUDING WYANDOTTE, LEAVENWORTH AND NORTHEASTERN JOHNSON COUNTIES IN KANSAS. THE HOSPITAL SERVES A DIVERSE COMMUNITY. ACCORDING TO A REPORT FROM CLARITAS, INC., IN THE HOSPITAL'S PRIMARY SERVICE AREA, THE ETHNIC MIX IS 51.7 PERCENT WHITE; 25.7 PERCENT AFRICAN-AMERICAN; AND 18.2 PERCENT HISPANIC. ADDITIONALLY, HOSPITAL ADMISSIONS REVEAL APPROXIMATELY 40 PERCENT OF INFANTS BORN AT PROVIDENCE MEDICAL CENTER ARE HISPANIC. BASED ON THE KANSAS CITY METROPOLITAN HEALTH ACCESS POLICY ASSESSMENT, GREATER KANSAS CITY'S HEALTH STATUS IS COMPARABLE TO NATIONAL BENCHMARKS, BUT WITH MORE PROFOUND RACIAL DISPARITIES BETWEEN AFRICAN AMERICAN AND WHITE RESIDENTS THAN ARE OBSERVED NATIONALLY. SPECIFICALLY, AFRICAN AMERICANS ARE MORE LIKELY TO LOSE YEARS OF LIFE DUE TO CHRONIC CONDITIONS AND EXPERIENCE WORSE MATERNAL AND CHILD HEALTH OUTCOMES THAN WHITE RESIDENTS. RESEARCH FROM CLARITAS, INC., REVEALS THAT PROVIDENCE MEDICAL CENTER'S PRIMARY SERVICE AREA IS PROJECTED TO SLOWLY DECLINE OVER THE NEXT FIVE YEARS, WITH THE NUMBER OF WOMEN AGE 18 TO 45 MODERATELY DECLINING, LIKELY DIMINISHING THE NEED FOR OBSTETRICS/GYNECOLOGY AND PEDIATRIC SERVICES OVER THE NEXT FIVE YEARS. THE SECONDARY SERVICE AREA, NORTHEAST JOHNSON COUNTY, WILL SEE ITS TOTAL POPULATION GROW MODERATELY OVER THE NEXT FIVE YEARS. SPECIFICALLY, THE POPULATION OF INDIVIDUALS 65 AND OLDER IS EXPECTED TO GROW, INCREASING THE NEED FOR SERVICES TYPICALLY ACCESSED BY THIS DEMOGRAPHIC, INCLUDING CARDIOLOGY, NEUROLOGY, ONCOLOGY, ORTHOPAEDIC SERVICES AND PULMONARY SERVICES. THE KANSAS DEPARTMENT OF LABOR ESTSIMATES THE AVERAGE UNEMPLOYMENT RATE FOR THE KANSAS CITY METROPOLITAN SERVICE AREA IS SLIGHTLY HIGHER THAN THE STATE AVERAGE, CONTRIBUTING TO THE NEED TO PROVIDE CHARITY AND SUBSIDIZED MEDICAL CARE. ACCORDING TO A STUDY COMPLETED BY HEALTH MANAGEMENT ASSOCIATES, IN WYANDOTTE COUNTY KANSAS, PROVIDENCE MEDICAL CENTER'S PRIMARY SERVICE AREA, 15.6 PERCENT OF THE POPULATION IS UNINSURED, WITH 70 PERCENT OF THE UNINSURED POPULATION FALLING UNDER 200 PERCENT OF THE FEDERAL POVERY LEVEL. IN ADDITION, ACCORDING TO THE COMMUNITY HEALTH COUNCIL OF WYANDOTTE COUNTY EXECUTIVE REPORT, APPROXIMATELY 28 PERCENT OF THE VISITS MADE TO KANSAS CITY, KANSAS HOSPITAL EMERGENCY ROOMS WERE MADE BY PEOPLE WITHOUT INSURANCE. BASED ON HOSPITAL ADMISSIONS, 60 PERCENT OF ALL PATIENTS ADMITTED TO PROVIDENCE MEDICAL CENTER COME THROUGH THE HOSPITAL'S EMERGENCY SERVICES DEPARTMENT, MAKING THIS AN IMPORTANT HEALTH SERVICE TO OUR COMMUNITY. WYANDOTTE COUNTY HAS THE HIGHEST INCIDENCE OF DIABETES IN THE 11-COUNTY METROPOLITAN AREA AT 8.8 PERCENT. THE PROVIDENCE DIABETES CENTER IS ONE OF ONLY TWO ACCREDITED PROGRAMS THAT SERVE PATIENTS IN THIS COMMUNITY, WITH COMPREHENSIVE DIABETES EDUCATION PROGRAMS INCLUDING GROUP CLASSES ON BASIC SELF-MANAGEMENT, GESTATIONAL DIABETES, AND NUTRITION/ CARBOHYDRATE COUNTING. DIABETES SUPPORT GROUPS AND WEIGHT MANAGEMENT SUPPORT GROUPS WERE OFFERED MONTHLY AT PROVIDENCE MEDICAL CENTER. ONGOING SUPPORT FOR PERSONS WHO HAVE TAKEN CLASSES AT THE PROVIDENCE DIABETES CENTER WERE PROVIDED THROUGH A MONTHLY NEWSLETTER AND QUARTERLY DIABETES DINING CLUB EVENTS. THE KANSAS CANCER REIGSTRY STATES THAT FROM 1997 TO 2004, WYANDOTTE AND JOHNSON COUNTIES HAD THE HIGHEST INCIDENCE OF BREAST CANCER IN THE STATE OF KANSAS. IN RESPONSE TO THAT NEED, PROVIDENCE MEDICAL CENTER RECENTLY OPENED A BREAST CENTER FOR WOMEN LIVING IN WYANDOTTE COUNTY AND THE SURROUNDING COMMUNITIES. THE PROVIDENCE MEDICAL CENTER BREAST CENTER OFFERS A CENTRALIZED LOCATION WHERE WOMEN CAN RECEIVE THEIR MAMMOGRAMS WITH EASIER AND MORE CONVENIENT ACCESS TO SERVICES. THE CENTER IS LOCATED NEAR THE HOSPITAL'S EMERGENCY SERVICES FACILITY AND FEATURES A DEDICATED WAITING AREA AND PRIVATE CHANGING ROOMS. THE NEW CENTER ALSO PROVIDES CARE FOR THOSE WHO ARE UNDERSERVED AND AT HIGHER RISK FOR THIS DEVASTATING DISEASE. PROMOTION OF COMMUNITY HEALTH SCHEDULE H, PART VI, LINE 5 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 2010, WE PROVIDED COMMUNITY BENEFIT TOTALING $12,349,326.00, 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 PROVIDENCE 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 EXTEND OUR CARE BEYOND OUR HOSPITAL'S WALLS IN ORDER TO IMPROVE THE HEALTH OF OUR COMMUNITY. OUR COMMUNITY ACTIVITIES DEMONSTRATE THIS COMMITMENT. DURING THIS YEAR, OUR COMMUNITY ACTIVITIES INCLUDED: ATHLETIC TRAINERS-TEAM WORKS IS A PROVIDENCE-SPONSORED PROGRAM THAT WORKS WITH THE KANSAS CITY, KANSAS AREA HIGH SCHOOLS TO PROVIDE CERTIFIED ATHLETIC TRAINERS TO THE SCHOOLS AT LITTLE COST. TEAM WORKS PROVIDES GAME EVENT COVERAGE, INJURY PREVENTION COUNSELING, EFFICIENT RUNNING ASSESSMENT PROGRAMS, PRE-GAME WORKOUTS, WELLNESS PROGRAMS, MANAGEMENT AND TREATMENT OF INJURIES ON THE FIELD, ATHLETIC TRAINING PROGRAMS, A COMPREHENSIVE REHABILITATION/RECONDITIONING PROGRAM FOR INJURIES, HEALTH INFORMATION AND COUNSELING, SPORTS PERFORMANCE/CONDITIONING AND INJURY TRACKING CAPABILITIES. THE PROGRAM'S GOALS INCLUDE EARLY DIAGNOSIS OF CONCUSSIONS ON THE FIELD TO PREVENT LONG-TERM AFFECTS, OR EVEN DEATH; AND TO PREVENT OR REHABILITATE INJURIES EARLY ON IN THESE STUDENTS SO THAT THESE INJURIES DO NOT BECOME LIFETIME HEALTH ISSUES. CANCER SUPPORT GROUPS AND COMMUNITY SCREENINGS-PROVIDENCE'S SERVICE AREA HAS ONE OF THE HIGHEST INCIDENTS OF BREAST CANCER IN THE STATE OF KANSAS. THAT IS WHY PROVIDENCE SPONSORS A BREAST CANCER SUPPORT GROUP THAT MEETS ON A REGULAR BASIS TO ASSIST PATIENTS AS THEY ARE UNDERGOING BREAST CANCER TREATMENT AND RECOVERY. ISSUES COVERED INCLUDE NUTRITION, CANCER-RELATED FATIGUE AND DISEASE RECURRENCE. PROVIDENCE SUPPORTED PINK HEALS, A NEW INITIATIVE TO ENHANCE CANCER AWARENESS IN THE COMMUNITY. COMMUNITY EDUCATION PROVIDED AT HEALTH FAIRS AND OTHER PUBLIC EVENTS ALSO RAISES AWARENESS OF THE NEED TO DETECT CANCER AT ITS EARLIEST STAGES, WHEN IT CAN MOST EFFECTIVELY BE TREATED. CHILDBIRTH PREPARATION COURSES-TO PROVIDE THE COMMUNITY'S NEWEST RESIDENTS WITH THE BEST STARTS POSSIBLE IN LIFE, PROVIDENCE OFFERS A WIDE RANGE OF CHILDBIRTH PREPARATION COURSES, INCLUDING BREASTFEEDING, PREPARED CHILDBIRTH AND SIBLING PREPARATION. THE GOAL IS TO PROMOTE A HEALTHY FAMILY ENVIRONMENT, REDUCE THE RISK OF LOW-BIRTH WEIGHT BABIES AND IMPROVE THE SUCCESS OF BREASTFEEDING FOR NEW MOTHERS AND THEIR INFANTS. THESE INITIATIVES HAVE BEEN PROVEN TO LOWER HEALTH-RELATED COSTS ASSOCIATED WITH CHILDBIRTH, AND RELATED COMPLICATIONS. PROVIDENCE ALSO PROVIDES NEW PARENTS AND THE COMMUNITY WITH FREE CAR SEAT SAFETY CHECKS. STATISTICS SHOW EIGHT OUT OF 10 CAR SEATS ARE IMPROPERLY INSTALLED. THESE CAR SEAT SAFETY CHECKS ARE PERFORMED BY CERTIFIED PASSENGER SAFETY TECHNICIANS FREE OF CHARGE AND REDUCE THE RISK THAT A CHILD WILL BE INJURED IN AN AUTOMOBILE ACCIDENT. DIABETES EDUCATION COURSES-BECAUSE WYANDOTTE COUNTY HAS THE HIGHEST INCIDENCE OF DIABETES IN THE 11-COUNTY METROPOLITAN KANSAS CITY AREA, PROVIDENCE OFFERS COURSES TO REDUCE COMPLICATIONS AND COSTS ASSOCIATED WITH DIABETES, INCLUDING A DIABETES DINING CLUB, DIABETES OUTPATIENT CLASSES AND DIABETES SUPPORT GROUP. THESE OFFERINGS ASSIST PATIENTS WITH SUCCESSFULLY MANAGING THEIR DISEASE, IMPROVING LONG-TERM HEALTH FOR THESE PATIENTS AND THE COMMUNITY. HEART HEALTH EDUCATION-BY ENCOURAGING COMMUNITY PARTICIPATION IN ACTIVITIES SUCH AS BLOOD PRESSURE SCREENINGS, HEART HEALTH FAIRS, WALKS AND SMOKING CESSATION CLASSES, PROVIDENCE ASSISTS INDIVIDUALS IN MAKING HEALTHIER LIFESTYLE CHOICES (EXERCISE AND SMOKING CESSATION) THAT CAN IMPROVE THEIR INDIVIDUAL HEALTH, AS WELL AS THE COMMUNITY'S HEALTH IN GENERAL. THE HOSPITAL ALSO HAS PARTNERED WITH THE AMERICAN HEART ASSOCIATION TO IMPLEMENT THE SEARCH YOUR HEART PROGRAM IN THE KANSAS CITY, KANSAS COMMUNITY. SEARCH YOUR HEART IS AN EFFORT TO EDUCATE AREA FAITH-BASED CONGREGATIONS ON ISSUES RELATED TO HEART DISEASE AND STROKE. THE HOSPITAL ALSO SPONSORS HEALTH SCREENINGS, COOKING DEMONSTRATIONS AND OTHER AWARENESS ACTIVITIES FOR PARTICIPATING CHURCHES. OTHER COMMUNITY ACTIVITIES WHICH PROVIDENCE MEDICAL CENTER SUPPORTED IN 2010 INCLUDED: AARP 55 ALIVE BEREAVEMENT SUPPORT GROUP BI-NATIONAL HEALTH FAIR BREAST CANCER AWARENESS PROGRAM BREAST CANCER SUPPORT GROUP BREASTFEEDING CLASSES CARDIAC ARRHYTHMIA SCREENINGS CARDIAC DINING CLUB CARDIAC REHAB SUPPORT GROUP CAR SEAT SAFETY CHECKS CHILDBIRTH PREPARATION AND REFRESHER CLASSES CRISTO REY KANSAS CITY HEALTH FAIR COMMUNITY BABY SHOWER CONGESTIVE HEART FAILURE CLASS COVER THE UNINSURED WELLNESS FAIR CRISTO REY HEALTH FAIR CPR CLASSES DIABETES DINING CLUB DIABETES SUPPORT GROUP KANSAS CITY, KANSAS CHAMBER BUSINESS EXPO KANSAS CITY, KANSAS WOMEN'S HEALTH FAIR KAW VALLEY RELAY FOR LIFE KIWANIS BIKE RODEO (WYANDOTTE COUNTY) LYMPHEDEMA SUPPORT GROUP MAYORS' PRAYER BREAKFAST MOTHER/DAUGHTER TEA (PUBERTY AWARENESS) MULTICULTURAL FESTIVAL NATIONAL HEALTH CARE DECISIONS DAY OPERATION TOUCH PARADE OF HEROES (VETERANS) PINK HEALS TOUR (BREAST CANCER AWARENESS) RACE FOR THE CURE "KOMEN" SANTUARY OF HOPE RACE SEASONAL FLU VACCINATIONS SIBLING PREPARATION CLASSES STROKE SUPPORT GROUP TOBACCO FREE (SMOKING CESSTION) CLASSES TONGANOXIE SCHOOL DISTRICT EMPLOYEE HEALTH FAIR UNIFIED GOVERNMENT, KCK AND WYANDOTTE COUNTY EMPLOYEE HEALTH FAIR WEIGHT MANAGEMENT SUPPORT GROUP 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: CATHOLIC CHARITIES FOOD SUPPLIES DRIVE CHRISTMAS IN OCTOBER COMMUNITY BLOOD CENTER BLOOD DRIVE CRISTO REY SCHOOL SUPPLIES DRIVE HAITI RELIEF EFFORTS HARVESTERS FOOD DRIVE LENTEN FOOD FOR THOUGHT UNITED WAY CAMPAIGN WE ARE GOOD CITIZENS AND PARTNER WITH OTHER ORGANIZATIONS AND AGENCIES TO SUPPORT A THRIVING COMMUNITY: 68 INSIDE SPORTS AMERICAN CANCER SOCIETY AMERICAN HEART ASSOCIATION ARROWHEAD ELEMENTARY SCHOOL ASSOCIATION OF FUNDRAISING PROFESSIONALS BANK OF BLUE VALLEY BETHANY NEIGHBORHOOD CENTER BIBLE TEMPLE BAPTIST CHURCH BOYS & GIRLS CLUBS OF GREATER KANSAS CITY BUSINESS WEST CAMP MITIOG CANCER ACTION CARITAS CLINICS, INC. CATHOLIC CHARITIES FOUNDATION OF NORTHEAST KANSAS CENTER FOR PRACTICAL BIOETHICS CHRIST THE KING SCHOOL CHURCH OF CHRIST COMMUNITIES IN SCHOOLS-KANSAS CITY, KANSAS COMMUNITY SAFETY NET DELAWARE RIDGE ELEMENTARY DONNELLY COLLEGE EL CENTRO, INC. FRIENDS OF YATES GENESIS CHRISTIAN ACADEMY GREATER KANSAS CITY INTERFAITH COUNCIL GREATER KANSAS CITY MEDICAL SOCIETY HOLY FAMILY CATHOLIC CHURCH INGRAM'S MAGAZINE KANSAS CITY HOSPICE & PALLIATIVE CARE KANSAS CITY, KANSAS CHAMBER KANSAS CITY WIZARDS KBS CONSTRUCTORS KANSAS CITY, KANSAS SCHOOL FOUNDATION LEAVENWORTH ROAD ASSOCIATION LEGENDS OF KANSAS CITY LIVING GRACE FELLOWSHIP MAIN STREET PARKVILLE ASSOCIATION MAKE-A-WISH FOUNDATION MOTHER & CHILD HEALTH COALITION MOUNT SCHOLASTICA BENEDICTINE SISTERS NATIONAL CHILD SAFETY COUNCIL NATIONAL EDUCATION ASSOCIATION, KANSAS CITY, KANSAS OAK RIDGE FREEDOM SCHOOL PLEASANT RIDGE HIGH SCHOOL SAINT JAMES ACADEMY SANCTUARY OF HOPE SERRA CLUBS OF METROPOLITAN KANSAS CITY SHAWNEE MISSION NORTH HIGH SCHOOL SUMNER ALUMNI ASSOCIATION SUNFLOWER HOUSE T-BONES BASEBALL CLUB THE GREATER KANSAS CITY INTERFAITH COUNCIL TONGANOXIE HIGH SCHOOL TONGANOXIE PARENT-TEACHER ASSOCIATION TURNER RECREATION COMMISSION UNITED WAY OF WYANDOTTE COUNTY UNIVERSITY OF KANSAS ENDOWMENT AND ALUMNI ASSOCIATION UNIVERSITY OF SAINT MARY USD 500 KANSAS CITY, KANSAS SCHOOL DISTRICT USD 203 PIPER SCHOOL DISTRICT USD 204 BONNER SCHOOL DISTRICT USD 202 TURNER SCHOOL DISTRICT WARD HIGH SCHOOL YMCA WE PROVIDE FOCUSED SUPPORT FOR CARITAS CLINICS, INC., (DUSCHENE AND SAINT VINCENT CLINICS), THE COMMUNITY'S HEALTH CLINICS FOR THE UNINSURED. WE WORK CLOSELY TOGETHER TO PROVIDE INTEGRATED CARE FOR THOSE WHO COME TO EITHER THE HOSPITAL OR THE CLINICS FOR THEIR HEALTH NEEDS. CARITAS CLINICS PROVIDE QUALITY PRIMARY HEALTH CARE SERVICES FOR UNINSURED, LOW-INCOME PATIENTS REGARDLESS OF ABILITY TO PAY. THE CLINICS ARE COMMITTED TO PROVIDING ACCESS TO COMPASSIONATE AND TRUSTWORTHY CARE FOR THE UNINSURED POOR. SERVICES THE CLINICS PROVIDE INCLUDE PRIMARY CARE, ONGOING MANAGEMENT OF CHRONIC DISEASES AND MEDICATION ASSISTANCE. IN ADDITION TO FINANCIAL SUPPORT PROVIDENCE ASSISTS THE CLINICS IN MANY OTHER WAY AFFILIATED HEALTH CARE SYSTEM SCHEDULE H, PART VI, LINE 6 PROVIDENCE MEDICAL CENTER 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." PROVIDENCE MEDICAL CENTER 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 PROVIDENCE MEDICAL CENTER, INCLUDING INFORMATION TECHNOLOGY SERVICES, CENTRAL CASH MANAGEMENT AND INVESTMENT, INTERNAL AUDIT, SUPPLY CHAIN MANAGEMENT, BENEFITS ADMINISTRATION, RISK MANAGEMENT AND INSURANCE AND QUALITY IMPROVEMENT LEADERSHIP. STATE FILING OF COMMUNITY BENEFIT REPORT SCHEDULE H, 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. PROVIDENCESAINT JOHN FOUNDATION 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 480925688 77275 OFFSET OPERATING COSTS AND GENERAL SUPPORT OF FOUNDATION'S MISSION false true false false false false false false false MICHAEL A DORSEY 0 314954 0 48554 0 65363 0 26077 0 15020 0 469968 0 0 JUANITA ROY 0 254740 0 27230 0 31737 0 19600 0 14939 0 348246 0 0 JAMES PAQUETTE 0 416920 0 66462 0 285527 0 87072 0 10868 0 866849 0 0 JOE JEANS 0 177416 0 2587 0 11245 0 20933 0 10682 0 222863 0 0 DR MARIA JAVAID MD 399365 0 0 0 0 0 0 0 5791 0 405156 0 0 0 DR MICHAEL MEURER MD 383923 0 0 0 0 0 0 0 5567 0 389490 0 0 0 DR BARRY SOLOMON MD 0 280473 0 23715 0 3337 0 48642 0 6324 0 362491 0 0 DR JASON WILTSHIRE MD 274981 0 0 0 0 0 0 0 3987 0 278968 0 0 0 DR FRANK SLOVICK MD 240590 0 0 0 0 0 0 0 3489 0 244079 0 0 0 FORM 990, SCHEDULE J, PART I, LINE 3 SCLHS EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -FORM 990 OF OTHER ORGANIZATIONS -WRITTEN EMPLOYMENT CONTRACTS -COMPENSATION SURVEYS AND STUDIES -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.) IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY AT THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS' EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. FORM 990, SCHEDULE J, PART I, LINE 4B 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 2010 WERE: MICHAEL A. DORSEY-$14,220 JUANITA D. ROY-$10,720 JAMES T. PAQUETTE-$108,797 FORM 990, SCHEDULE J, PART II THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES INCLUDING PROVIDENCE MEDICAL CENTER (PROVIDENCE) IN KANSAS CITY, KANSAS. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. JAMES T. PAQUETTE IS PRESIDENT & CHIEF EXECUTIVE OFFICER OF ST. VINCENT HEALTHCARE (ST. VINCENT) IN BILLINGS, MONTANA WHICH IS AN SCLHS AFFILIATE. AS A FORMER OFFICER OF PROVIDENCE, THIS DISCLOSURE IS REQUIRED FOR 990 REPORTING PURPOSES ONLY. THE COMPENSATION REFLECTED IS THAT OF MR. PAQUETTE'S POSITION AS A ST. VINCENT EXECUTIVE AND IS NOT RELATED TO PROVIDENCE. IN KEEPING WITH SCLHS' CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE. FORM 990, PART VI, SECTION A, LINE 3 DELEGATE CONTROL OVER MANAGEMENT DUTIES ALTHOUGH THESE SERVICES MAY NOT ALL RISE TO THE LEVEL OF MANAGEMENT CONTROL AS DEFINED IN THE 990 INSTRUCTION, WE HAVE IN THE SPIRIT OF FULL TRANSPARENCY PROVIDED THE FOLLOWING DISCLOSURE. AS A MEMBER OF SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, THIS PROVIDER MAY HAVE INDIVIDUAL AND/OR SYSTEM CONTRACT(S) THAT HAS DELEGATED CONTROL OVER MANAGEMENT DUTIES IN SOME OR ALL OF THE FOLLOWING AREAS: DIETARY AND FOOD SERVICE HOUSEKEEPING SUPPLY CHAIN REVENUE CYCLE SECURITY FORM 990, PART VI, SECTION A, LINE 6, 7A AND B Board Member Nomination and Approval SISTERS OF CHARITY OF LEAVENWORTH IS THE SOLE CORPORATE MEMBER OF PROVIDENCE MEDICAL CENTER. BOARD MEMBERS ARE NOMINATED BY THE PROVIDENCE MEDICAL CENTER NOMINATING COMMITTEE. THEY ARE THEN APPROVED BY THE CURRENT BOARD MEMBERS TO BE RECOMMENDED TO THE SYSTEM BOARD. THE SYSTEM BOARD THEN APPROVES THEIR ELECTION TO THE BOARD. CURRENT BOARD MEMBERS TO BE RECOMMENDED TO THE SYSTEM BOARD. THE SYSTEM BOARD THEN APPROVES THEIR ELECTION TO THE BOARD. FORM 990, PART VI, SECTION A, LINE 8A AND B BOARD MINUTES MINUTES ARE KEPT, DOCUMENTED, AND FILED FOR ALL BOARD AND COMMITTEE MEETINGS HELD. ALL MAJOR DECISIONS AND DISCUSSIONS ARE DOCUMENTED WITHIN. FORM 990, PART VI, SECTION B, LINE 11B 990 REVIEW BY THE BOARD OF DIRECTORS ON OCTOBER 25, 2011 COPIES OF THE 990 WERE DISTRIBUTED TO ALL BOARD MEMBERS FOR THEIR REVIEW PRIOR TO FILING THE RETURN. THE FORM 990 IS ALSO REVIEWED BY FINANCE PERSONNEL AT SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM AND AN INDEPENDENT ACCOUNTING FIRM. FORM 990, PART VI, SECTION B, LINE 12C Conflict of Interest Statements CONFLICT OF INTEREST FORMS ARE SENT OUT ANNUALLY TO ALL BOARD MEMBERS AND KEY EMPLOYEES. THESE STATEMENTS ARE CAREFULLY REVIEWED AND A REPORT PROVIDED TO THE CEO AND COO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. IF A CONFLICT OF INTEREST ARISES, THE CEO DETERMINES ANY ACTION TO BE TAKEN AT THAT TIME. FORM 990, PART VI, SECTION C, LINE 19 Public Availability of financials, governing documents, and COI policies SCLHS' GOVERNANCE MANUAL FOR BOARD MEMBERS AND ITS AFFILIATE BOARD MEMBERS IS AVAILABLE TO THE PUBLIC ON THE WEBSITE, WWW.GREATBOARDS.ORG. THE MANUAL SETS FORTH THE STANDARDS AND EXPECTATIONS OF EACH BOARD MEMBER INCLUDING THE FIDUCIARY DUTY OF LOYALTY WHICH REQUIRES THAT EACH MEMBER ABIDE BY SCLHS' CONFLICT OF INTEREST POLICY, DISCLOSE ANY ISSUES WHICH MAY PRESENT A CONFLICT, COMPLETE THE ANNUAL DISCLOSURE STATEMENT, REVIEW POLICIES AND PROCEDURES PERTAINING TO CONFLICTS OF INTEREST, AND PROVIDE OVERSIGHT OF SCLHS' RESPONSIBILITY PROGRAM. PROVIDENCE MEDICAL CENTER'S UNAUDITED FINANCIAL STATEMENTS ARE NOT AVAILABLE TO THE PUBLIC. PROVIDENCE MEDICAL CENTER IS A MEMBER OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM. THE AUDITED FINANCIAL STATEMENTS FOR THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM ARE AVAILABLE TO THE PUBLIC AT THEIR WEBSITE. FORM 990, PART XI, LINE 5 OTHER CHANGES IN NET ASSETS OR FUND BALANCES RECONCILING AMOUNTS INCLUDE EQUITY TRANSFERS AND CONTRIBUTIONS TO/FROM RELATED ORGANIZATIONS OF $1,566,714, UNREALIZED INTEREST INCOME OF $97,952, MISSION FUND EXPENDITURES OF $33,833, MEDICAL STAFF EQUITY ADJUSTMENTS OF $7,326, AND CONTRIBUTIONS TO LONG LIVED ASSETS OF 26,774. FORM 990, PART VI, SECTION B, LINE 11B THIS FORM 990 AND ITS ATTACHED SCHEDULES HAVE BEEN REVIEWED BY SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEMS (CONTROLLING ORGANIZATION) AND AN INDEPENDENT ACCOUNTING FIRM BEFORE FILING. HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MICHAEL A DORSEY TITLE:PRESIDENT/CEO/ASST SECRETARY HOURS:12 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MARY JO GREGORY TITLE:BOARD MEMBER HOURS:40 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOE JEANS TITLE:CHIEF FINANCIAL OFFICER HOURS:10 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JUANITA ROY TITLE:EXEC VP & CHIEF OPER OFFICER HOURS:10 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DR BARRY SOLOMON, MD TITLE:CHIEF MEDICAL OFFICER HOURS:10 HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JAMES PAQUETTE TITLE:FORMER CEO HOURS:40 KANSAS CITY RADIOSURGERY VENTURE INC 8929 PARALLEL PARKWAY KANSAS CITY KS 66112 201258438 EQUIP LEASING KS 212500 89293 NA SISTERS OF CHARITY LEAVENWORTH HLTH SYST 9801 RENNER BLVD STE 100 LENEXA KS 66219 237379161 SUPPORT MMBRS KS 501(C)(3) 11B-TYPE II NA CARITAS CLINICS INC 818 NORTH 7TH STREET LEAVENWORTH KS 66048 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