2023-10-31T11:34:37-05:00 2022-12-31 990 2022-01-01 237001007 ST MARY'S HOSPITAL FOUNDATION STMA 8018427851 2635 N 7TH STREET GRAND JUNCTION CO 81501 CARMEN SHIPLEY EXECUTIVE DIRECTOR 8018427851 2023-10-31 CARMEN SHIPLEY 999009999 0 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CARMEN SHIPLEY 2635 N 7TH STREET GRAND JUNCTION CO 81501 5744789 0 0928 X SEE SCHEDULE "O" FOR WEBSITE ADDRESS X 1967 CO WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.ST. MARY'S HOSPITAL FOUNDATION WEBSITE ADDRESS:HTTPS://WWW.SCLHEALTH.ORG/LOCATIONS/ST-MARYS-MEDICAL-CENTER-FOUNDATION/ 19 15 0 69 0 0 4736616 5363595 0 0 1361499 203275 -11034 -56049 6087081 5510821 3403694 4463998 0 0 526562 560121 0 0 149711 454835 430531 4385091 5454650 1701990 56171 23607311 20470965 2062522 1570330 21544789 18900635 X WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OFTHE PEOPLE AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POORAND VULNERABLE. 0 0 4996741 4463998 0 THE PROMISE OF HEALTHCARE PHILANTHROPY IS THE ABILITY TO CHANGE LIVES AND THE POWER TO SAVE LIVES. THE ST. MARY'S HOSPITAL FOUNDATION DEVELOPS THE RESOURCES THAT HELP KEEP AND EXPAND THIS PROMISE TO THE PEOPLE WHO TRUST ST. MARY'S HOSPITAL AND MEDICAL CENTER, INC., TO CARE FOR THEM. IT IS COMMITTED TO ADVANCING THE PROMISE OF LIFE THROUGH PHILANTHROPY. THE FOUNDATION'S FUNDRAISING EFFORTS ENSURE THAT THE HOSPITAL IS ABLE TO MEET THE COMMUNITY'S HEALTHCARE NEEDS. ST. MARY'S HOSPITAL FOUNDATION WAS PART OF THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM. ON APRIL 1, 2022, INTERMOUNTAIN HEALTH CARE, INC. AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. MERGED, CREATING A MODEL HEALTH SYSTEM THAT PROVIDES HIGH-QUALITY, ACCESSIBLE, AND AFFORDABLE HEALTHCARE TO COMMUNITIES IN UTAH, IDAHO, NEVADA, COLORADO, MONTANA, WYOMING, AND KANSAS. THE ORGANIZATION EMPLOYS NEARLY 60,000 CAREGIVERS, OPERATES 33 HOSPITALS (INCLUDING ONE VIRTUAL HOSPITAL), AND RUNS HUNDREDS OF CLINICS, WHILE PROVIDING HEALTH INSURANCE TO OVER ONE MILLION PEOPLE IN UTAH AND IDAHO.AS PART OF INTERMOUNTAIN HEALTH (INTEGRATED HEALTH SYSTEM), ST. MARY'S HAS DIRECT ACCESS TO BEST PRACTICES, RESOURCES, TECHNOLOGY, TALENT AND STRATEGIC CAPITAL.MAJOR AREAS OF SUPPORT DURING THE YEAR INCLUDED:ROSE HILL HOSPITALITY HOUSE ROSE HILL HOUSE REFLECTS THE COMPASSION AND GENEROSITY OF OUR COMMUNITY BY PROVIDING A FREE, COMFORTABLE, HOME-LIKE SETTING WHERE FAMILIES CAN HAVE A REST FROM THE OFTEN CRITICAL CONCERNS ASSOCIATED WITH THE HEALTH OF A LOVED ONE. PATIENTS COME TO ST. MARY'S FROM MANY DISTANT PLACES TO RECEIVE MEDICAL ASSISTANCE OFTEN NOT AVAILABLE OUTSIDE OF GRAND JUNCTION. ST. MARY'S HOSPITAL FOUNDATION RECOGNIZES THE IMPORTANCE OF MEETING THE NEEDS OF FAMILY AND FRIENDS SUPPORTING A LOVED ONE IN THE HEALING PROCESS. CANCER SURVIVORSHIP PROGRAM THE ST. MARY'S HOSPITAL FOUNDATION ALSO FINANCIALLY SUPPORTS ST. MARY'S CANCER SURVIVORSHIP PROGRAM. ST. MARY'S IS PROUD TO OFFER A COMPREHENSIVE CANCER SURVIVORSHIP PROGRAM FOR PATIENTS FROM DIAGNOSIS, THROUGH TREATMENT, AND BEYOND. AS HEALTHCARE CHANGES, WE HAVE IDENTIFIED THE NEED FOR NOT ONLY PREVENTATIVE MEDICINE, BUT TO PROVIDE HOLISTIC CARE TO OUR PATIENTS. THE CANCER SURVIVORSHIP PROGRAM EDUCATES, SUPPORTS, AND EMPOWERS THOSE AFFECTED BY CANCER TO TAKE CHARGE OF THEIR HEALTH SO THEY CAN TRULY THRIVE. SURVIVORSHIP EMBRACES THE PHYSICAL, EMOTIONAL, SOCIAL, SPIRITUAL, AND ECONOMIC ASPECTS OF LIFE THAT MAY BE INFLUENCED BY CANCER, PROVIDING A VARIETY OF SERVICES FOR CANCER PATIENTS AND THEIR FAMILY INCLUDING: ART EXPLORATION CLASSES, SUPPORT GROUPS, CANCER EDUCATION AND SCREENING EVENTS, A RESOURCE LIBRARY, EQUINE THERAPY, PATIENT ADVISORY TEAMS, REHABILITATION, THERAPEUTIC MASSAGE, AND NUTRITION AND EXERCISE RETREATS. SENIOR PROGRAMS ST. MARY'S HOSPITAL FOUNDATION IS PROUD TO SPONSOR THE FOSTER GRANDPARENT, SENIOR COMPANION, AND MEALS ON WHEELS PROGRAM (FORMERLY CALLED GRAY GOURMET). THE FOSTER GRANDPARENT PROGRAM (FGP) IS A SUCCESSFUL NATIONWIDE VOLUNTEER PROGRAM THAT HELPS ACTIVE SENIORS USE THEIR EXPERIENCE TO IMPROVE THE LIVES OF CHILDREN IN THE CLASSROOM. THROUGH A FEDERALLY FUNDED PROGRAM, THE FOSTER GRANDPARENT PROGRAM IS ABLE TO PAY SENIOR VOLUNTEERS AN HOURLY NON-TAXABLE STIPEND. SENIOR COMPANIONS PROVIDE SUPPORT AND FRIENDSHIP TO THOSE WHO NEED ASSISTANCE WITH GROCERY SHOPPING, ERRANDS, AND OTHER EVERYDAY TASKS NECESSARY TO MAINTAINING INDEPENDENCE. WITHOUT THIS HELP, MANY OLDER ADULTS WOULD BE FORCED TO LEAVE THEIR HOMES FOR ASSISTED LIVING FACILITIES OR NURSING HOMES. IN MESA COUNTY, SENIORS 60 YEARS AND OLDER CAN RECEIVE HELP AND FRIENDSHIP THROUGH ST. MARY'S SENIOR COMPANION PROGRAM. LASTLY, THE ST. MARY'S FOUNDATION RAISES FUNDS TO SUPPORT MEALS ON WHEELS MESA COUNTY, A HOSPITAL AND GOVERNMENT SPONSORED PROGRAM TO PROVIDE NOURISHING MEALS TO THE HOMEBOUND AND TO OTHERS THAT ARE IN NEED. PROGRAM REVENUE ASSOCIATED WITH THE PROGRAM REPRESENTS A VOLUNTARY CO-PAYMENT FOR THE MEALS AND IS NOT A REQUIREMENT FOR RECEIVING A MEAL.MICAH S. MONTAG PEDIATRIC FUNDST. MARY'S HOSPITAL FOUNDATION RECOGNIZES THE IMPORTANCE OF KEEPING CHILDREN IN THEIR OWN COMMUNITY WHEN HOSPITALIZATION IS REQUIRED. TOO OFTEN KIDS ARE TRANSFERRED TO THE FRONT RANGE FOR INPATIENT CARE THAT COULD BE ACCOMPLISHED IN THEIR OWN BACKYARD. THIS RESULTS IN MISSED SCHOOL AND WORK DAYS AND THE ADDITIONAL STRESS OF BEING ISOLATED, FAR FROM HOME, WITH NO SUPPORT SYSTEM. THROUGH THE MICAH MONTAG PEDIATRIC FUND THE FOUNDATION WILL PROVIDE THE FUNDING FOR IMMEDIATE NEEDS WHILE ALSO BUILDING FOR THE FUTURE. 4996741 1 1 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 1 0 0 0 0 0 0 1 1 0 1 1 1 0 0 0 0 0 0 0 0 1 0 0 0 0 1 0 0 0 1 X 0 0 0 0 0 0 0 0 1 1 0 0 0 0 0 0 X 19 15 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 X COLIN QUINCY 8014423491 36 SOUTH STATE STREET SUITE 1600 SALT LAKE CITY UT 84111 X BRYAN JOHNSON DIRECTOR/SMHMC CEO 1.00 56.00 X 0 635785 207161 TERRI CHINN DIRECTOR/SMHMC VP FINANCE 1.00 50.00 X 0 409204 105357 MARY BETH DEERING MD DIRECTOR 1/1-12/13/22 1.00 50.00 X 0 266718 15231 CARMEN SHIPLEY EXECUTIVE DIR FOUNDATION 50.00 0.00 X X 0 154075 47845 SANDRA HICKS DIRECTOR 1.00 50.00 X 0 43838 19336 KIM ALEXANDER DIRECTOR 1.00 0.00 X 0 0 0 JOEL BECHTEL MD DIRECTOR 1.00 0.00 X 0 0 0 MIKE BLACKBURN DIRECTOR 1.00 0.00 X 0 0 0 JOE BREMAN VICE CHAIR 3.00 0.00 X X 0 0 0 KEIRA BRESNAHAN DIRECTOR 1.00 0.00 X 0 0 0 CLARA BROWN SHAFFER SECRETARY 3.00 0.00 X X 0 0 0 FRANK DESANTIS DIRECTOR 1.00 0.00 X 0 0 0 CASEY FLEMING CHAIR 3.00 0.00 X X 0 0 0 DAVE HUERKAMP DIRECTOR 1.00 0.00 X 0 0 0 ADAM KINSEY DIRECTOR 1.00 0.00 X 0 0 0 LISA MULLEN DIRECTOR 1/1-4/30/22 1.00 0.00 X 0 0 0 MICHELLE REPLOGLE DIRECTOR 1.00 0.00 X 0 0 0 SETH ROSA DIRECTOR 1.00 0.00 X 0 0 0 JESSICA SHAFFER TREASURER 3.00 0.00 X X 0 0 0 JOSH SMITH DIRECTOR 1.00 0.00 X 0 0 0 ASHLIE ZIMMERMAN DIRECTOR 1.00 0.00 X 0 0 0 0 1509620 394930 0 0 1 0 0 11549 145244 1004354 2260529 1941919 33758 5363595 290985 290985 87710 -87710 -87710 -87710 66135 145244 137296 -71161 -71161 24074 8962 15112 15112 5510821 0 0 147226 4432771 4432771 31227 31227 190872 152641 13418 24813 297925 238259 20936 38730 25266 15960 3242 6064 13663 6456 2161 5046 32395 21860 3408 7127 5547 2413 2413 721 56086 48963 87 7036 20344 7025 5488 7831 4472 393 527 3552 850 850 SHARED SERVICES - ADMIN 215688 215688 BANK CHARGES 80848 16170 20212 44466 FOOD-MEALS ON WHEELS 18662 9969 6693 2000 SHARED SERVICES - HR 8268 8268 19766 11784 5657 2325 5454650 4996741 308198 149711 1121246 840685 1898760 1818520 20587305 17811760 23607311 20470965 43690 96581 2018832 1473749 2062522 1570330 X 3286509 2797099 18258280 16103536 21544789 18900635 23607311 20470965 X 56171 -2707522 7197 X 0 1 X 1 1 1 X X 1 ST MARY'S HOSPITAL & MEDICAL CENTER INC 840425720 3 1 4426880 0 1 4426880 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 18258279 3651938 -1788101 4018580 16103536 17128359 3258508 1437882 3566470 18258279 16284424 3108968 1375860 3640893 17128359 14686783 1994367 1646149 2042875 16284424 6322745 10716826 -388808 1963980 14686783 0.00000 0.60400 0.39600 0 0 0 GIFT ANNUITIES 994581 INTERCOMPANY PAYABLES 479168 1473749 PART V, LINE 4: THE FOUNDATION'S TEMPORARY ENDOWMENT FUNDS AND EARNINGS FROM THE PERMANENT ENDOWMENT FUNDS SUPPORT THE ST. MARY'S HOSPITAL IN AREAS INCLUDING ASSOCIATE EDUCATION, GREATEST NEED, MOM/BABY & PEDIATRICS, PATIENT EXPERIENCE, RESPIRATORY, AND OTHER SERVICES AND PROGRAMS. HIGHBALLS & HANDBAGS 23772 11252 12520 1088 2129 8412 29 14721 ST. MARY'S BALL 187607 133992 53615 8292 6150 33825 1133 61517 211379 145244 66135 9380 8279 42237 1162 76238 137296 -71161 24074 8376 586 1 1.00000 24074 8376 586 8962 15112 CO 1 0 1 0 0.00000 1.00000 KITTY DEXTER 2635 N 7TH ST GRAND JUNCTION CO 81501 0 DEANNA COLAIZZI 0 MAKE SURE WE FOLLOW THE RAFFLE PROCEDURES DESIGNATED BY THE STATE X 1 15112 1 ST MARY'S HOSPITAL & MEDICAL CENTER INC 2635 N 7TH STREET GRAND JUNCTION CO 81501 840425720 501(C)(3) 4426880 0 SUPPORT MISSION SCL HEALTH - FRONT RANGE INC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 841103606 501(C)(3) 5042 0 SUPPORT MISSION HUMANITARIAN GRANT 19 19227 SCHOLARSHIPS 10 12000 PART I, LINE 2: UPON APPROVAL OF THE TRANSFER OF FUNDS FROM THE ST. MARY'S HOSPITAL FOUNDATION TO ST. MARY'S HOSPITAL & MEDICAL CENTER, INC., THE ST. MARY'S HOSPITAL FINANCE DEPARTMENT RECORDS THE FUNDS TO THE PROPER DEPARTMENT WITHIN THE HOSPITAL FOR USE AS AN OFFSET TO THE EXPENSES THAT HAVE BEEN INCURRED, OR TO CAPITAL. THE TRANSFERS ARE RECONCILED BETWEEN THE HOSPITAL AND THE FOUNDATION QUARTERLY. THE RECONCILIATIONS ARE REVIEWED BY MANAGERS AT THE HOSPITAL AND SYSTEM OFFICE. 0 1 0 0 0 0 0 1 0 BRYAN JOHNSON DIRECTOR/SMHMC CEO 0 457894 0 141306 0 36585 0 181461 0 25700 0 842946 0 32319 TERRI CHINN DIRECTOR/SMHMC VP FINANCE 0 304090 0 66914 0 38200 0 95275 0 10082 0 514561 0 29421 MARY BETH DEERING MD DIRECTOR 1/1-12/13/22 0 257382 0 5060 0 4276 0 2652 0 12579 0 281949 0 0 CARMEN SHIPLEY EXECUTIVE DIR FOUNDATION 0 135248 0 18369 0 458 0 19621 0 28224 0 201920 0 0 PART I, LINE 3 COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR THE ORGANIZATION'S OFFICERS AND SENIOR MANAGEMENT ARE PAID BY A RELATED ORGANIZATION, ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS MANAGED BY THE INTERMOUNTAIN HEALTH CARE, INC. BOARD COMPENSATION COMMITTEE (COMMITTEE) ON BEHALF OF SCL HEALTH AND ALL OF ITS AFFILIATES. THE COMMITTEE REVIEWS AND APPROVES COMPENSATION ARRANGEMENTS OF THE OFFICERS AND SENIOR MANAGEMENT AND MAKES RECOMMENDATIONS TO INTERMOUNTAIN HEALTH CARE, INC.'S BOARD FOR APPROVAL OF ANY CHANGES TO COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT. THE COMMITTEE'S REVIEW IS CONDUCTED IN A MANNER THAT IS INTENDED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS RULES OF INTERNAL REVENUE CODE SECTION 4958. THE COMMITTEE CONDUCTS THE REVIEW WITH THE ASSISTANCE OF AN EXPERIENCED AND INDEPENDENT COMPENSATION CONSULTING FIRM THAT HAS DEEP NATIONAL EXPERTISE IN HEALTH SYSTEMS' EXECUTIVE COMPENSATION PROGRAMS AND LEVELS. THE COMMITTEE OBTAINS AND RELIES UPON CURRENT, COMPARABLE MARKET DATA FOR PEER ORGANIZATIONS PRIOR TO MAKING COMPENSATION RELATED DECISIONS. THE INFORMATION REVIEWED INCLUDES COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR FUNCTIONALLY COMPARABLE POSITIONS, THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA SERVED BY INTERMOUNTAIN HEALTH CARE, INC. AND CURRENT COMPENSATION SURVEYS COMPILED BY AN INDEPENDENT FIRM. CONSISTENT WITH THE PAY PHILOSOPHY SET BY INTERMOUNTAIN HEALTH CARE INC.'S BOARD, THE COMMITTEE EMPHASIZES THE IMPORTANCE OF ENSURING TOTAL REMUNERATION IS REASONABLE AND APPROPRIATE WHEN REVIEWING AND MAKING RECOMMENDATIONS WITH RESPECT TO COMPENSATION PACKAGES FOR THE OFFICERS AND SENIOR MANAGEMENT. AS PART OF THE REVIEW PROCESS, INTERMOUNTAIN HEALTH CARE, INC. USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF OFFICERS AND SENIOR MANAGEMENT. 1) COMPENSATION COMMITTEE 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYMENT CONTRACTS 5) COMPENSATION SURVEYS AND STUDIES 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ITEMS LISTED ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. PART I, LINE 4B SCHEDULE J, PART I, LINE 4B PAYMENTS FROM A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN A RELATED ORGANIZATION PROVIDES NONQUALIFIED DEFERRED COMPENSATION PLANS (NQDC) KNOWN AS SUPPLEMENTAL EXECUTIVE RETIREMENT PROGRAM (SERP) FOR EXECUTIVES (SENIOR MANAGEMENT) TO COMPENSATE FOR REGULATORY 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. IN 2014, IN AN EFFORT TO REDUCE LONG-TERM COST AND HAVE GREATER CONTROL OVER FINANCIAL RISK, THE SERP WAS CONVERTED FROM A DEFINED BENEFIT (DB) TO A DEFINED CONTRIBUTION (DC) DESIGN. CERTAIN MEMBERS OF SENIOR MANAGEMENT WHOSE BENEFITS WERE CONVERTED FROM DB TO DC WOULD HAVE BEEN DISPROPORTIONATELY AND NEGATIVELY AFFECTED BY THE CHANGE, SO THE COMMITTEE DETERMINED IT WOULD BE APPROPRIATE TO GRANT "TRANSITION CREDITS" IN ORDER TO MITIGATE THE NEGATIVE IMPACT OF THE CHANGE ON THEIR RETIREMENT BENEFITS. THIS IS A COMMON APPROACH EMPLOYED BY OTHER ORGANIZATIONS UNDERGOING A SIMILAR TRANSITION. THE TRANSITION CREDITS VEST IN ACCORDANCE WITH THE TERMS OF THE DC SERP (I.E., AFTER THREE YEARS) AND ARE PAID TO THE EXECUTIVE UPON VESTING. NQDC SERP PLANS PRIOR TO 2014 PRIOR TO 2014, THE RELATED ORGANIZATION'S NQDC SERP PLAN PROVIDED A BENEFIT TO ELIGIBLE PARTICIPANTS BASED ON A PERCENTAGE OF THEIR BASE COMPENSATION. THE VESTING PERIOD IS 5 YEARS OR WHEN THE PARTICIPANT IS AGE 65 OR OLDER. THERE WERE NO CONTRIBUTIONS TO THIS PLAN AFTER DECEMBER 31, 2013. FOR AMOUNTS CONTRIBUTED TO THE NQDC SERP PLAN PRIOR TO 2014, VESTED AMOUNTS ARE PAYABLE UPON THE END OF EMPLOYMENT. THE VESTED AMOUNTS WITHDRAWN INCLUDE AMOUNTS PREVIOUSLY TAXED TO THE RECIPIENT AND AMOUNTS TAXABLE TO THE RECIPIENT IN THE CURRENT YEAR. THE TAXABLE AMOUNTS ARE INCLUDED ON THE RECIPIENT'S W-2. ANY DISTRIBUTIONS FROM THIS PLAN ARE REPORTED BELOW. IN 2019, THE RELATED ORGANIZATION CONSOLIDATED FOUR NON QUALIFED DEFERRED COMPENSATION PLANS INTO ONE PLAN. AS PART OF THIS EFFORT, ALL VESTED BALANCES FROM THE SERP PLANS PRIOR TO 2014 WERE PAID TO THE PARTICIPANTS IN 2020. THERE ARE NO REMAINING PARTICIPANTS IN THE LEGACY PLANS. NQDC SERP PLANS STARTING IN 2014 STARTING IN 2014, THE RELATED ORGANIZATION'S NQDC SERP PLAN PROVIDED A BENEFIT TO ELIGIBLE PARTICIPANTS BASED ON A PERCENTAGE OF THEIR BASE COMPENSATION. THE VESTING PERIOD IS ROLLING 3 YEARS OR WHEN THE PARTICIPANT IS AGE 65 OR OLDER. THERE WERE NO CONTRIBUTIONS TO THIS PLAN BEFORE JANUARY 1, 2014. ANY DISTRIBUTIONS FROM THIS PLAN ARE REPORTED BELOW. STARTING IN 2014, FOR CONTRIBUTIONS TO THE NQDC SERP PLAN, CERTAIN PARTICIPANTS ARE VESTED OR BECAME VESTED IN THE PLAN DURING 2022. VESTED AMOUNTS ARE PAYABLE TO THE RECIPIENT. THE VESTED AMOUNTS ARE TAXABLE TO THE RECIPIENT IN THE CURRENT YEAR. THE TAXABLE AMOUNTS ARE INCLUDED ON THE RECIPIENT'S W-2. THE AMOUNTS WITHDRAWN FROM THE NQDC SERP PLANS IN 2022 WERE: TERRI CHINN - $29,421, BRYAN JOHNSON - $32,319 IN ACCORDANCE WITH THE REQUIREMENTS OF SCHEDULE J, DEFERRED COMPENSATION EARNED OVER THE VESTING PERIOD IS REPORTED IN COLUMN C AND ANY AMOUNTS VESTED/PAID FROM A DEFERRED COMPENSATION PLAN ARE REPORTED IN COLUMN B(III). THUS, THE SAME AMOUNT WOULD BE REPORTED TWICE (FIRST WHEN IT ACCRUED DURING THE VESTING PERIOD AND AGAIN WHEN IT IS VESTED/PAID). THIS RESULTS IN THE APPEARANCE OF CERTAIN EXECUTIVES RECEIVING MORE THAN THEY ARE ACTUALLY PAID FROM THE DEFERRED COMPENSATION PLANS. COLUMN F IS INTENDED TO RECONCILE THIS DUPLICATION (BY REPORTING AMOUNTS INCLUDED IN COLUMN B(III) THAT HAD BEEN REPORTED AS DEFERRED COMPENSATION ON A SCHEDULE J FOR A PREVIOUS YEAR). HOWEVER, THE SIGNIFICANCE OF THE AMOUNTS LISTED IN COLUMN F IS OFTEN OVERLOOKED AND GIVEN THE COMPLEXITY OF THE SCHEDULE J REPORTING REQUIREMENTS, THE AMOUNTS SHOWN ARE EASILY MISUNDERSTOOD. TO DETERMINE TOTAL AMOUNT EARNED (RATHER THAN THE AMOUNT VESTED/PAID OUT) DURING THE YEAR, SUBTRACT THE AMOUNT IN COLUMN F FROM COLUMN E. PART I, LINE 7 OTHER NON-FIXED PAYMENTS THE AT-RISK COMPENSATION (ARC) PLAN WAS ESTABLISHED TO ENABLE SCL HEALTH TO ATTRACT AND ENGAGE QUALIFIED LEADERS AND TO PROVIDE SUCH LEADERS WITH AN ADDITIONAL PERFORMANCE COMPENSATION OPPORTUNITY TO PROMOTE AND FURTHER ITS CHARITABLE MISSION AND STRATEGIC IMPERATIVES. THE PLAN OPERATES ON A CALENDAR-YEAR BASIS AND AWARD OPPORTUNITIES ARE A PERCENTAGE OF LEADERS' BASE PAY AS DETERMINED BY THEIR MANAGEMENT LEVEL AT SCL HEALTH. ACTUAL AWARDS WILL BE PAID OUT BASED ON ATTAINMENT OF SELECTED SCL HEALTH BOARD-APPROVED GOALS, INCLUDING EBIDA (EARNINGS BEFORE INTEREST, DEPRECIATION AND AMORTIZATION), STEWARDSHIP, QUALITY, PATIENT AND ASSOCIATE SAFETY, AND PATIENT EXPERIENCE AND FULFILLMENT OF OUR MISSION. AWARDS ARE BASED ON THE BOARD'S DETERMINATION ON HOW WELL THE HEALTH CARE SYSTEM PERFORMS RELATIVE TO THE PLAN'S STATED PERFORMANCE STANDARDS AND THE WEIGHT GIVEN TO EACH OF THE PERFORMANCE MEASURES AS DEFINED FOR THAT PLAN YEAR. THE AT RISK COMPENSATION PLAN SHALL BE INTERPRETED, APPLIED AND ADMINISTERED AT ALL TIMES IN ACCORDANCE WITH CODE SECTION 409A AND GUIDANCE ISSUED THEREUNDER. THE HEALTH CARE SYSTEM RESERVES THE RIGHT TO AMEND OR TERMINATE THIS PLAN AT ANY TIME FOR ANY REASON. ADDITIONAL OFFICER AND BOARD DISCLOSURES ON APRIL 1, 2022, INTERMOUNTAIN HEALTH CARE, INC. AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCL HEALTH) MERGED, CREATING A MODEL HEALTH SYSTEM THAT PROVIDES HIGH-QUALITY, ACCESSIBLE, AND AFFORDABLE HEALTHCARE TO COMMUNITIES IN UTAH, IDAHO, NEVADA, COLORADO, MONTANA, WYOMING, AND KANSAS. THE ORGANIZATION EMPLOYS NEARLY 60,000 CAREGIVERS, OPERATES 33 HOSPITALS (INCLUDING ONE VIRTUAL HOSPITAL), AND RUNS HUNDREDS OF CLINICS, WHILE PROVIDING HEALTH INSURANCE TO OVER ONE MILLION PEOPLE IN UTAH AND IDAHO. INTERMOUNTAIN HEALTH CARE, INC. AND RELATED TAX-EXEMPT ORGANIZATIONS ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING ACCOUNTABILITY. IN KEEPING WITH INTERMOUNTAIN HEALTH CARE, INC.'S CORE VALUE OF STEWARDSHIP, INTERMOUNTAIN HEALTH CARE, INC.'S BOARD COMPENSATION COMMITTEE (COMMITTEE) HAS RETAINED THE SERVICES OF AN INDEPENDENT COMPENSATION ADVISOR. THE COMPENSATION ADVISOR IS RESPONSIBLE FOR ADVISING THE COMMITTEE ON ALL MATTERS RELATING TO EXECUTIVE COMPENSATION INCLUDING SUPPORTING THE COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. THE SISTERS WHO SERVE AS OFFICERS AND/OR BOARD MEMBERS ARE MEMBERS OF THE SISTERS OF CHARITY OF LEAVENWORTH (A RELIGIOUS ORDER OF WOMEN). THE SISTERS HAVE TAKEN VOWS OF POVERTY AND RECEIVE NO COMPENSATION, EXPENSE ACCOUNT ALLOWANCE, OR CONTRIBUTIONS TO BENEFIT PLANS FOR THEIR SERVICES TO THE HEALTH CARE SYSTEM. HOWEVER, A PAYMENT IS MADE DIRECTLY TO THE SISTERS OF CHARITY OF LEAVENWORTH FOR THE SERVICES OF THOSE WHO PERFORM PROFESSIONAL, ADMINISTRATIVE, AND OTHER SUCH SERVICES. X EVENT ITEMS 143 33758 FMV 0 1 0 FORM 990, PART V, LINE 1A EXPLANATION FOR NUMBER REPORTED IN BOX 3 OF FORM 1096: THE ORGANIZATION'S EXPENSES ARE PAID BY A RELATED 501(C)(3) TAX-EXEMPT ORGANIZATION. THE RELATED ORGANIZATION FILES THE REQUIRED FORM 1096 AND RELATED 1099 TAX FORMS FOR ANY EXPENDITURE THAT REQUIRES A FORM 1099 TO BE FILED. FORM 990, PART V, LINE 2A EXPLANATION FOR NUMBER REPORTED ON FORM W-3: THE ORGANIZATION LEASES EMPLOYEES FROM A RELATED 501(C)(3) TAX-EXEMPT ORGANIZATION. THE RELATED ORGANIZATION FILES THE REQUIRED W-3 AND RELATED W-2 TAX FORMS FOR THESE INDIVIDUALS. ACCORDING TO THE FORM 990 INSTRUCTIONS FOR PART IX, WE REFLECT THE LEASED EMPLOYEE'S COMPENSATION ON THE FORM 990, PART IX AS IF THE ORGANIZATION COMPENSATES THESE INDIVIDUALS. FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS ST. MARY'S HOSPITAL & MEDICAL CENTER, INC., (SMHMC) IS THE SOLE MEMBER OF ST. MARY'S HOSPITAL FOUNDATION. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT OR APPOINT MEMBERS ST. MARY'S HOSPITAL & MEDICAL CENTER, INC., THE SOLE MEMBER OF ST. MARY'S HOSPITAL FOUNDATION, APPROVES MEMBERS OF ST. MARY'S HOSPITAL FOUNDATION BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS ST. MARY'S HOSPITAL & MEDICAL CENTER, INC., HAS CERTAIN RESERVE POWERS TO APPROVE CHANGES TO THE ARTICLES OF INCORPORATION AND THE BYLAWS INCLUDING THE APPOINTMENT OR REMOVAL OF BOARD MEMBERS AND THE PRESIDENT/CEO. SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. ALSO HAS CERTAIN RESERVE POWERS OVER ANY CHANGE IN OWNERSHIP OF THE CORPORATION, CHANGE IN MISSION, ACQUISITION OF ASSETS, DISPOSAL OF ASSETS, LEASING OF ASSETS, INCURRENCE OF DEBT, MERGER OR DISSOLUTION, APPROVAL OF STRATEGIC PLANS AND BUDGETS, APPOINTMENT OF AUDITORS AND OVERSIGHT AND APPROVAL OF COMPENSATION AND BENEFITS FOR DIRECTORS, OFFICERS, KEY EMPLOYEES AND PHYSICIANS. FORM 990, PART VI, SECTION B, LINE 11B PROCESS USED TO REVIEW THE FORM 990 THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF THE HEALTH CARE SYSTEM. THE FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGEMENT. A COPY OF THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE FILING OF THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. ANY QUESTIONS ARE ADDRESSED TO THE TAX DEPARTMENT PRIOR TO FILING THE FORM 990 WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C MONITORING AND ENFORCEMENT OF COMPLIANCE WITH CONFLICT OF INTEREST POLICY ST. MARY'S HOSPITAL FOUNDATION AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (COLLECTIVELY REFERRED TO AS SCL HEALTH), REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES ITS CONFLICT OF INTEREST POLICY BY PROVIDING EDUCATION AND TRAINING FOR ITS EMPLOYEES, OFFICERS AND DIRECTORS. PERSONS CONSIDERED TO BE IN AN INFLUENTIAL POSITION, SUCH AS BOARD MEMBERS, OFFICERS, PHYSICIANS, EXECUTIVES AND DIRECTOR LEVEL MANAGERS ARE ALL REQUIRED TO COMPLETE A CONFLICT OF INTEREST STATEMENT UPON HIRE/APPOINTMENT AND ON AN ANNUAL BASIS TO DISCLOSE ANY POTENTIAL CONFLICT ISSUES. THESE STATEMENTS ARE CAREFULLY REVIEWED BY THE SCL HEALTH INTEGRITY AND COMPLIANCE DEPARTMENT AND APPROPRIATE LEADERSHIP. THE BUSINESS AND AFFAIRS OF SCL HEALTH WILL AT ALL TIMES BE CONDUCTED IN A MANNER THAT IS SOLELY IN THE BEST INTERESTS OF SCL HEALTH AND NOT BE INFLUENCED BY CONFLICTING INTERESTS OF PERSONS RESPONSIBLE FOR ADMINISTERING THOSE AFFAIRS. THE EXISTENCE OF ANY CONFLICTS OF INTEREST WILL BE DISCLOSED AND THE PROCEDURES SET FORTH HEREIN WILL BE FOLLOWED. CERTAIN TRANSACTIONS DETERMINED TO CONSTITUTE A CONFLICT OF INTEREST ARE PROHIBITED. ANY PERSON IN A POSITION TO EXERCISE SUBSTANTIAL INFLUENCE OVER SCL HEALTH IS CONSIDERED AN INTERESTED PERSON. THIS TERM INCLUDES, BUT IS NOT LIMITED TO THE FOLLOWING: - BOARD MEMBERS, BOARD COMMITTEE MEMBERS, OFFICERS AND DIRECTORS; - SENIOR LEADERS AND EXECUTIVES (CEO, PRESIDENT, SVP, VP, EXECUTIVE DIRECTORS); - EMPLOYED PHYSICIANS AND PHYSICIANS IN MEDICAL STAFF LEADERSHIP ROLES (E.G., DEPARTMENT CHAIRS, MEMBERS OF MEDICAL STAFF COMMITTEES); - MEDICAL DIRECTORS OF CLINICAL PROGRAMS THAT ASSESS, REVIEW, RECOMMEND OR REQUEST PURCHASE OF ANY SPECIFIC PHARMACEUTICAL PRODUCTS, MEDICAL DEVICES, SUPPLIES AND/OR EQUIPMENT; - DEPARTMENT DIRECTORS; AND - OTHER SELECT INDIVIDUALS IDENTIFIED BY LEADERSHIP WHICH MAY INCLUDE, BUT IS NOT LIMITED TO, SUPPLY CHAIN AND FINANCE. UPON BECOMING AN INTERESTED PERSON AND ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO DISCLOSE ANY RELATIONSHIPS THAT CONSTITUTE OR MIGHT LEAD TO A CONFLICT OF INTEREST BY COMPLETING THE CURRENT CONFLICT OF INTEREST AND GIFT DISCLOSURE STATEMENT ("STATEMENT") AS APPROVED BY THE CHIEF INTEGRITY AND COMPLIANCE OFFICER. THE CHIEF INTEGRITY AND COMPLIANCE OFFICER WILL OVERSEE THE REVIEW OF THE STATEMENTS AND THE RESOLUTION OF ANY IDENTIFIED CONFLICTS OF INTEREST AND ALERT THE SUPERVISOR AND/OR BOARD CHAIR. WHEN AN INTERESTED PERSON BECOMES AWARE OF A CONFLICT OF INTEREST WHICH HAS NOT BEEN DISCLOSED ON A STATEMENT, HE OR SHE SHALL CONTACT THE LOCAL COMPLIANCE AND PRIVACY OFFICER OR THE CHIEF INTEGRITY AND COMPLIANCE OFFICER, COMPLETE A DISCLOSURE, AND RETURN IT TO THE SCL HEALTH INTEGRITY AND COMPLIANCE DEPARTMENT. WHENEVER AN INTERESTED PERSON BECOMES AWARE THAT AN ARRANGEMENT WITH RESPECT TO WHICH HE OR SHE HAS A CONFLICT OF INTEREST IS BEING CONSIDERED, THE INTERESTED PERSON MUST DISCLOSE ALL MATERIAL FACTS CONCERNING THE EXISTENCE AND NATURE OF THE CONFLICT OF INTEREST TO HIS OR HER SUPERVISOR OR TO THE APPLICABLE BOARD OR COMMITTEE CHAIR, EVEN IF THE CONFLICT OF INTEREST HAS BEEN PREVIOUSLY DISCLOSED. THE INTERESTED PERSON'S LOCAL COMPLIANCE AND PRIVACY OFFICER AND/OR SUPERVISOR/BOARD OR COMMITTEE CHAIR WILL DETERMINE WHETHER A CONFLICT OF INTEREST EXISTS. PERSON(S) RESPONSIBLE FOR THE DETERMINATION SHOULD OBTAIN FURTHER GUIDANCE FROM THE SCL HEALTH INTEGRITY AND COMPLIANCE OR LEGAL DEPARTMENTS. UPON MAKING HIS OR HER DISCLOSURE, THE INTERESTED PERSON WILL LEAVE THE MEETING OR OTHERWISE REMOVE HIM OR HERSELF FROM THE DELIBERATIONS OR OTHER DECISION-MAKING PROCESS UNTIL SUCH TIME AS A DETERMINATION IS REACHED. IF A DETERMINATION HAS BEEN MADE THAT NO CONFLICT OF INTEREST EXISTS, THE INTERESTED PERSON MAY BE PRESENT AND PARTICIPATE IN THE DELIBERATION REGARDING THE TRANSACTION OR ARRANGEMENT. HOWEVER, IF AN INTERESTED PERSON HAS BEEN DETERMINED TO HAVE A CONFLICT OF INTEREST, HE OR SHE MAY NOT PARTICIPATE IN THE DELIBERATION OR DECISION REGARDING THE TRANSACTION OR ARRANGEMENT; BE PRESENT DURING THE DELIBERATION OR DECISION-MAKING; OR BE ALLOWED TO MAKE A PRESENTATION PRIOR TO THE DELIBERATION AND DECISION-MAKING ACTIVITIES. WHEN AN INTERESTED PERSON HAS A CONFLICT OF INTEREST, THE DECISION-MAKER/DECISION-MAKING BODY CONSIDERING THE TRANSACTION OR ARRANGEMENT WILL TAKE REASONABLE MEASURES, PRIOR TO APPROVING OR ENTERING INTO THE TRANSACTION OR ARRANGEMENT, TO ENSURE THAT THE PROPOSAL IS IN SCL HEALTH'S BEST INTERESTS. THE PROPOSED TRANSACTION OR ARRANGEMENT MAY PROCEED IF THE DECISION-MAKER/DECISION-MAKING BODY, AFTER HAVING BEEN FULLY INFORMED OF THE MATERIAL FACTS ESTABLISHING THE CONFLICT OF INTEREST, DETERMINES THAT THE TRANSACTION OR ARRANGEMENT IS IN SCL HEALTH'S BEST INTERESTS AND IS FAIR AND REASONABLE. A MAJORITY VOTE OF THE DISINTERESTED DECISION-MAKERS IS REQUIRED WHEN A DETERMINATION IS MADE BY A BOARD, COMMITTEE OR OTHER DECISION-MAKING BODY. MANAGEMENT OF POTENTIAL CONFLICTS IS DONE BY THE CHIEF INTEGRITY AND COMPLIANCE OFFICER AND/OR CARE SITE COMPLIANCE AND PRIVACY OFFICERS AND REPORTED ANNUALLY TO THE CARE SITE LEADERSHIP COMMITTEES AND/OR AUDIT AND COMPLIANCE COMMITTEES. ANY REPORTED CONFLICTS OR POTENTIAL CONFLICTS WILL ALSO BE REPORTED TO AND REVIEWED BY THE HEALTH CARE SYSTEM'S TAX DEPARTMENT FOR COMPLIANCE WITH THE FORM 990 TAX RETURN. FORM 990, PART VI, SECTION B, LINE 15 FORM 990, PART VI, SECTION B (POLICIES) LINES 15(A) & 15(B) THE ORGANIZATION'S OFFICERS AND SENIOR MANAGEMENT ARE PAID BY A RELATED ORGANIZATION, ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS MANAGED BY THE INTERMOUNTAIN HEALTH CARE, INC. BOARD COMPENSATION COMMITTEE (COMMITTEE) ON BEHALF OF SCL HEALTH AND ALL OF ITS AFFILIATES. THE COMMITTEE REVIEWS AND APPROVES COMPENSATION ARRANGEMENTS OF THE OFFICERS AND SENIOR MANAGEMENT AND MAKES RECOMMENDATIONS TO INTERMOUNTAIN HEALTH CARE, INC.'S BOARD FOR APPROVAL OF ANY CHANGES TO COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT. THE COMMITTEE'S REVIEW IS CONDUCTED IN A MANNER THAT IS INTENDED TO QUALIFY FOR THE REBUTTABLE PRESUMPTION OF REASONABLENESS UNDER THE INTERMEDIATE SANCTIONS RULES OF INTERNAL REVENUE CODE SECTION 4958. THE COMMITTEE CONDUCTS THE REVIEW WITH THE ASSISTANCE OF AN EXPERIENCED AND INDEPENDENT COMPENSATION CONSULTING FIRM THAT HAS DEEP NATIONAL EXPERTISE IN HEALTH SYSTEMS' EXECUTIVE COMPENSATION PROGRAMS AND LEVELS. THE COMMITTEE OBTAINS AND RELIES UPON CURRENT, COMPARABLE MARKET DATA FOR PEER ORGANIZATIONS PRIOR TO MAKING COMPENSATION RELATED DECISIONS. THE INFORMATION REVIEWED INCLUDES COMPENSATION LEVELS PAID BY SIMILARLY SITUATED ORGANIZATIONS FOR FUNCTIONALLY COMPARABLE POSITIONS, THE AVAILABILITY OF SIMILAR SERVICES IN THE GEOGRAPHIC AREA SERVED BY INTERMOUNTAIN HEALTH CARE, INC. AND CURRENT COMPENSATION SURVEYS COMPILED BY AN INDEPENDENT FIRM. CONSISTENT WITH THE PAY PHILOSOPHY SET BY INTERMOUNTAIN HEALTH CARE, INC.'S BOARD, THE COMMITTEE EMPHASIZES THE IMPORTANCE OF ENSURING TOTAL REMUNERATION IS REASONABLE AND APPROPRIATE WHEN REVIEWING AND MAKING RECOMMENDATIONS WITH RESPECT TO COMPENSATION PACKAGES FOR THE OFFICERS AND SENIOR MANAGEMENT. AS PART OF THE REVIEW PROCESS, INTERMOUNTAIN HEALTH CARE, INC. USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF OFFICERS AND SENIOR MANAGEMENT. 1) COMPENSATION COMMITTEE 2) INDEPENDENT COMPENSATION CONSULTANT 3) FORM 990 OF OTHER ORGANIZATIONS 4) WRITTEN EMPLOYMENT CONTRACTS 5) COMPENSATION SURVEYS AND STUDIES 6) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ITEMS LISTED ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS OFFICERS AND SENIOR MANAGEMENT IS REASONABLE, APPROPRIATE AND CONSISTENT WITH THE PAY PHILOSOPHY SET BY THE BOARD. FORM 990, PART VI, SECTION C, LINE 19 AVAILABILITY OF GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC THE ORGANIZATION MAKES ITS CONFLICT OF INTEREST POLICY, FINANCIAL STATEMENTS, AND GOVERNING DOCUMENTS AVAILABLE UPON REQUEST. FORM 990, PART VII, SECTION B INDEPENDENT CONTRACTORS THE ORGANIZATION'S EXPENSES ARE PAID BY A RELATED 501(C)(3) TAX-EXEMPT ORGANIZATION. THE RELATED ORGANIZATION FILES THE REQUIRED FORM 1096 AND RELATED 1099 TAX FORMS FOR ANY EXPENDITURE THAT REQUIRES A FORM 1099 TO BE FILED. FORM 990, PART XI, LINE 9: DONATED SERVICE ITEMS TO AUCTION (GIK) 7,197. 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