2024-11-07T09:57:11-06:00 2023-12-31 990 2023-01-01 810231785 ST JAMES HEALTHCARE STJA 4067232500 400 SOUTH CLARK STREET BUTTE MT 59701 PAM PALAGI VP FINANCE & CFO 4067232500 2024-11-06 0 2023 2024-10-15 13:58:12Z KAREN COSTELLO 400 SOUTH CLARK STREET BUTTE MT 59701 142338596 0 0928 X SEE SCHEDULE O X 1976 MT 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. 16 14 649 6 1429631 630951 1284754 1601677 149865562 137870334 1335299 1203515 1311010 1509349 153796625 142184875 3992423 4749916 0 0 44208136 47799296 0 0 0 104676289 99041771 152876848 151590983 919777 -9406108 156566506 143832551 12824303 11557408 143742203 132275143 X 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. 0 0 131053379 4749916 138488781 ST. JAMES HEALTHCARE HAS PLAYED AN IMPORTANT ROLE IN THE HISTORY OF BUTTE, MONTANA. FOUNDED IN 1881 BY THE SISTERS OF CHARITY OF LEAVENWORTH, ST. JAMES HAS BEEN KNOWN FOR GENERATIONS FOR ITS MISSION OF COMPASSIONATE CARE AND SERVICE TO THE POOR. TODAY, THAT COMMITMENT IS ACCOMPANIED BY ST. JAMES' REPUTATION AS A TECHNOLOGICAL LEADER IN MONTANA'S HEALTHCARE INDUSTRY AND THE LARGEST ACUTE-CARE HOSPITAL IN SOUTHWEST MONTANA.ST. JAMES HEALTHCARE IS RELATED TO SCL HEALTH MEDICAL GROUP-BUTTE, LLC, A SINGLE MEMBER LIMITED LIABILITY COMPANY OWNED BY A RELATED ORGANIZATION, SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. SCL HEALTH MEDICAL GROUP-BUTTE, LLC IS A GROUP OF PHYSICIAN CLINICS THAT PROVIDE PROFESSIONAL SERVICES TO THE ST. JAMES HEALTHCARE COMMUNITY AND SUPPORTS THE MISSION OF ST. JAMES HEALTHCARE. ALTHOUGH SCL HEALTH MEDICAL GROUP-BUTTE, LLC IS NOT OWNED DIRECTLY BY ST. JAMES HEALTHCARE, ST. JAMES HEALTHCARE IS REQUIRED TO FUND ALL OPERATING LOSSES OF SCL HEALTH MEDICAL GROUP-BUTTE, LLC. IN 2023, THE HOSPITAL PROVIDED $7,144,013 IN SUPPORT OF THE LOSSES OF THE PHYSICIAN CLINICS.ON APRIL 1, 2022, INTERMOUNTAIN HEALTH CARE, INC. AND SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. AFFILIATED, 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 MORE THAN 66,000 CAREGIVERS, OPERATES 33 HOSPITALS (INCLUDING ONE VIRTUAL HOSPITAL), AND RUNS HUNDREDS OF CLINICS, WHILE PROVIDING HEALTH INSURANCE TO OVER ONE MILLION PEOPLE IN UTAH, IDAHO AND NEVADA.AS PART OF INTERMOUNTAIN HEALTH (INTEGRATED HEALTH SYSTEM), ST. JAMES HEALTHCARE HAS DIRECT ACCESS TO BEST PRACTICES, RESOURCES, TECHNOLOGY, TALENT AND STRATEGIC CAPITAL. ST. JAMES HEALTHCARE CONTINUES TO BE A PROUD RECIPIENT OF THE PRESS GANEY GUARDIAN OF EXCELLENCE AWARD.ST. JAMES HEALTHCARE HAS A VARIETY OF PROGRAMS AND SERVICES TO SERVE THE COMMUNITY INCLUDING BUT NOT LIMITED TO:- CANCER CARE- CARDIAC SERVICES- EMERGENCY AND TRAUMA SERVICES (LEVEL III TRAUMA CENTER)- HOSPICE AND PALLIATIVE CARE- IMAGING- JOINT SURGERY AND REPLACEMENT CENTER- LABOR AND DELIVERY- ORTHOPEDICS- SPORTS MEDICINE- SURGERY CENTER- THERAPY AND REHAB SERVICES- WOMEN'S HEALTH SERVICESDURING 2023, ST. JAMES HEALTHCARE HAD THE FOLLOWING RESULTS:ADMISSIONS - 2,687OUTPATIENT VISITS - 82,820EMERGENCY DEPARTMENT VISITS - 16,721BIRTHS - 255SURGERIES - 1,902LABORATORY TESTS - 309,445MISSION: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.VISION:INSPIRED BY OUR FAITH, WE WILL PARTNER WITH OUR PATIENTS AND COMMUNITIES TO EXCEED THEIR EXPECTATIONS FOR HEALTH.VALUES:CARING SPIRIT - WE HONOR THE SACRED DIGNITY OF EACH PERSON.EXCELLENCE - WE SET AND SURPASS HIGH STANDARDS.GOOD HUMOR - WE CREATE JOYFUL AND WELCOMING ENVIRONMENTS.INTEGRITY - WE DO THE RIGHT THING WITH OPENNESS AND PRIDE.SAFETY - WE DELIVER CARE THAT SEEKS TO ELIMINATE ALL HARM FOR PATIENTS AND ASSOCIATES.STEWARDSHIP - WE ARE ACCOUNTABLE FOR THE RESOURCES ENTRUSTED TO US. 131053379 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 649 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 16 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 0 X COLIN QUINCY 8014423491 36 SOUTH STATE STREET SALT LAKE CITY UT 84111 BRYAN JOHNSON INTERIM PRESIDENT, MONTANA REGION (PARTIAL) 6.00 49.00 X X 0 684612 282612 JENNIFER ALDERFER PRESIDENT, MONTANA REGION - PART YEAR (PARTIAL) 9.00 44.00 X X 0 756683 42121 JAMES DOYLE PRESIDENT SJB 50.00 0.00 X 453264 0 176214 JAMES RITCHEY FORMER KEY EMPLOYEE 0.00 50.00 X 0 434421 181079 MARWAN MASSOUH MD FORMER HIGHEST COMPENSATED 0.00 50.00 X 0 554246 36817 JENNIFER DAVENPORT MD VP CMO SJB/ASSOCIATE CMO MT (PARTIAL) 50.00 1.00 X 399681 0 182178 MOHAN NANDALUR MD FORMER HIGHEST COMPENSATED 0.00 50.00 X 0 521725 23523 PAMELA PALAGI VP FINANCE REGION MT 9.00 41.00 X 0 386020 148363 KATIE ROEDOCKER VP COO/CNO SJB 50.00 0.00 X 362780 0 127960 ADAM SCHAFER VP NETWORK DEVELOPMENT REGION MT 9.00 41.00 X 0 273752 122709 SUSAN PETERSEN MD DIRECTOR 1.00 52.00 X 0 330406 15404 TRACY NEARY VP MISSION INTEGRATION REGION MT 9.00 41.00 X 0 227988 111563 JOEL DYE MD FORMER HIGHEST COMPENSATED 0.00 50.00 X 0 293643 44249 LUC HIBBS MD FORMER HIGHEST COMPENSATED 0.00 50.00 X 0 296303 38595 DAVID SILK MD FORMER HIGHEST COMPENSATED 0.00 50.00 X 0 290364 44011 ALAN MAYER MD FORMER HIGHEST COMPENSATED 0.00 50.00 X 0 296689 37618 JAMES BARRY OSER MD FORMER HIGHEST COMPENSATED 0.00 50.00 X 0 315555 17590 TRISHA PALMER DIRECTOR OF HUMAN RESOURCES 50.00 0.00 X 208164 0 68207 DANAE APLAS ANESTHESIOLOGIST 50.00 0.00 X 234497 0 25293 RISIK RASK DIRECTOR PHARMACY 50.00 0.00 X 182016 0 46094 TONYA GRIM DIRECTOR HEALTH INFORMATICS NURSING_SJB 50.00 0.00 X 168062 0 57107 JEFFREY NEIL PHARMACIST 50.00 0.00 X 180559 0 39327 CHRISTOPHER EDWARDS VICE CHAIR 1.00 2.00 X X 0 0 0 KAREN FAGG DIRECTOR 1.00 4.00 X 0 0 0 DANETTE GLEASON CHAIR 1.00 2.00 X X 0 0 0 SISTER EILEEN HURLEY DIRECTOR 1.00 2.00 X 0 0 0 SISTER JUDITH JACKSON DIRECTOR 1.00 2.00 X 0 0 0 MJ JANSSEN DIRECTOR 1.00 2.00 X 0 0 0 BERNARD MCCARTHY DIRECTOR 1.00 2.00 X 0 0 0 CHARLES NOTBOHM SECRETARY 1.00 2.00 X X 0 0 0 COLLEEN O'LEARY DIRECTOR 1.00 2.00 X 0 0 0 NGUYEN-VU PHAM DIRECTOR 1.00 4.00 X 0 0 0 BECKY RENO DIRECTOR 1.00 2.00 X 0 0 0 MAJEL RUSSELL DIRECTOR 1.00 2.00 X 0 0 0 CINDY SORICH DIRECTOR 1.00 2.00 X 0 0 0 MISTY STEADMAN DIRECTOR 1.00 2.00 X 0 0 0 2189023 5662407 1868634 89 1 1 0 0 701677 900000 1601677 PATIENT CARE 620000 137870334 137369100 501234 137870334 1198626 1198626 65361 388 64973 64973 64973 34993 30104 4889 4889 4889 20761 123229 -102468 -102468 SUMMIT SURGERY CTR 620000 874474 874474 CAFETERIA REVENUE 720000 657689 618447 39242 LAUNDRY SERVICES 810000 14681 14681 1546844 142184875 137987547 1429631 1166020 X 4749916 4749916 2294427 2252321 42106 36151439 35488003 663436 1957744 1921725 36019 4548622 4495854 52768 2847064 2799200 47864 13749 13749 13428 13428 27777222 27591703 185519 105584 105003 581 227784 225787 1997 7360112 28973 7331139 2125135 1851203 273932 234978 217433 17545 44775 38545 6230 880041 880041 6839671 6839671 1147775 1147775 MEDICAL SUPPLIES 27627360 27627360 SHARED SERVICES-OTHER 5221828 5221828 MAINTENANCE & OTHER SER 5061536 5060037 1499 BILLING & COLLECTION 4373735 4373735 9987058 7732829 2254229 151590983 131053379 20537604 0 1776 1125 16445432 13088022 71898 0 2972017 2741233 473239 618847 98632089 11379736 86849612 87252353 6048665 6250918 43703867 33880053 156566506 143832551 11519400 10197905 1229414 312892 75489 1046611 12824303 11557408 X 143742203 132275143 143742203 132275143 156566506 143832551 X -9406108 -30079 -2030873 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 13428 13428 0 PART II-B, LINE 1: ST. JAMES HEALTHCARE PAID MEMBERSHIP DUES TO THE MONTANA HOSPITAL ASSOCIATION OF WHICH $579 IS ATTRIBUTED TO LOBBYING. LOBBYING EXPENSES OF $12,849 WERE DERIVED FROM FEES FOR ADVOCACY SERVICES RELATED TO MONTANA LEGISLATIVE ACTIVITIES. 1734169 878858 30621 813556 1830092 1499543 714391 -30367 449398 1734169 4368820 472377 10491 25874 3326271 1499543 4773804 1819711 14882 2239577 4368820 4194521 729022 9111 158850 4773804 0.00000 0.26800 0.73200 0 1 1 1245204 1245204 70811612 4497441 66314171 1260850 220648 1040202 24461665 6661647 17800018 852758 852758 87252353 INTERCOMPANY RECEIVABLE 20564849 3RD PARTY SETTLEMENTS 12870944 LEASED ASSETS 235222 RENT RECEIVABLE 73203 OTHER ASSETS 135835 33880053 OPERATING LEASE 236780 FINANCING LEASE 9831 ENVIRONMENTAL REMEDITION LIABILITY 800000 1046611 PART V, LINE 4: ST. JAMES HEALTHCARE FOUNDATION'S TEMPORARY ENDOWMENT FUNDS AND EARNINGS FROM THE PERMANENT ENDOWMENT FUNDS SUPPORT ST. JAMES HEALTHCARE IN AREAS INCLUDING ASSOCIATE EDUCATION, CARDIOVASCULAR, CHARITY CARE, COMMUNITY HEALTH & WELLNESS, GREATEST NEED, MOM/BABY & PEDIATRICS, NEUROSCIENCES, ONCOLOGY, SPIRITUAL CARE, WOMEN'S SERVICES, AND OTHER SERVICES AND PROGRAMS. 1 1 X 1 X 250.000000000000 1 X 500.000000000000 1 1 1 0 1 1 2012972 2012972 0.01340 22727637 21802566 925071 0.00620 1075050 955129 119921 0.00080 25815659 22757695 3057964 0.02040 1080554 329996 750558 0.00500 319932 319932 0.00210 8029266 4971693 3057573 0.02040 4634520 4634520 0.03090 14064272 5301689 8762583 0.05840 39879931 28059384 11820547 0.07880 10331 10331 0.00010 10331 10331 0.00010 1 1577119 45974591 59028503 -13053912 X 1 1 1 SUMMIT SURGERY CENTER OUTPATIENT SURGERY CENTER 0.89860 0.10140 1 1 ST JAMES HEALTHCARE 400 SOUTH CLARK ST BUTTE MT 59701 WEBSITE: SEE PART VI 13287 X X X ST JAMES HEALTHCARE 1 0 0 1 X X X X X X X X X 23 1 0 1 1 X SEE PART V, SECTION C X X 1 23 1 SEE PART V, SECTION C 0 1 X 250.000000000000 500.000000000000 X X 1 1 X X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 ST. JAMES HEALTHCARE PART V, SECTION B, LINE 5: THE 2023 CHNA WAS CONDUCTED BY PROFESSIONAL RESEARCH CONSULTANTS (PRC) ON BEHALF OF ST. JAMES HEALTHCARE (REFERRED TO HEREAFTER AS ST. JAMES) AND THE BUTTE-SILVER BOW HEALTH DEPARTMENT. THE 2023 CHNA WAS A FOLLOW-UP TO SIMILAR STUDIES CONDUCTED IN 2020, 2017, 2014, AND 2011. AN ADVISORY GROUP INCLUDING REPRESENTATIVES FROM ST. JAMES, BUTTE SILVER-BOW PUBLIC HEALTH DEPARTMENT, AND SOUTHWEST MONTANA COMMUNITY HEALTH CENTER PROVIDED INPUT THROUGHOUT THE CHNA PROCESS INCLUDING SURVEY QUESTION SELECTION AND IDENTIFYING KEY INFORMANTS. THE CHNA INCORPORATED: 1) PRIMARY QUALITATIVE DATA (A 400 HOUSEHOLD TELEPHONE COMMUNITY HEALTH SURVEY), 2) SECONDARY QUANTITATIVE DATA (EXISTING PUBLIC HEALTH DATA) AND 3) PRIMARY QUALITATIVE DATA (KEY INFORMANT ONLINE SURVEYS). THE COMMUNITY HEALTH NEEDS ASSESSMENT INCORPORATED PRIMARY RESEARCH THROUGH A COMMUNITY HEALTH SURVEY WHICH RANDOMLY SAMPLED 400 INDIVIDUALS AGED 18 AND OLDER IN THE PRIMARY SERVICE AREA. THE SAMPLE DESIGN AND QUALITY CONTROL PROCEDURES USED IN THE DATA COLLECTION ENSURE THAT THE SAMPLE IS REPRESENTATIVE OF THE COMMUNITY. THE 2023 CHNA WAS A FOLLOW-UP TO SIMILAR SURVEYS CONDUCTED IN 2020, 2017, AND 2014 WHICH ALLOWED FOR TRENDING OVER TIME. IN ADDITION, AN ONLINE KEY INFORMANT SURVEY WAS CONDUCTED TO SOLICIT INPUT FROM KEY INFORMANTS WHO WERE SELECTED BECAUSE OF THEIR ABILITY TO IDENTIFY PRIMARY CONCERNS OF THE POPULATIONS WITH WHOM THEY WORK AND THE CONCERNS OF THE COMMUNITY OVERALL. IN ALL, 117 COMMUNITY STAKEHOLDERS TOOK PART IN THE ONLINE KEY INFORMANT SURVEY, INCLUDING REPRESENTATIVES FROM HEALTHCARE, PUBLIC HEALTH, EDUCATION, SOCIAL SERVICES, GOVERNMENT, LAW ENFORCEMENT, AND THE FAITH COMMUNITY. ON NOVEMBER 17, 2022, ST. JAMES AND THE BUTTE-SILVER BOW HEALTH DEPARTMENT HOSTED A COMMUNITY FORUM WITH COMMUNITY STAKEHOLDERS REPRESENTING A CROSS-SECTION OF COMMUNITY-BASED ORGANIZATIONS TO EVALUATE, DISCUSS AND PRIORITIZE HEALTH ISSUES FOR THE COMMUNITY, BASED ON FINDINGS OF THE 2023 CHNA. ST. JAMES HEALTHCARE PART V, SECTION B, LINE 6B: THE 2023 CHNA WAS CONDUCTED WITH THE BUTTE-SILVER BOW HEALTH DEPARTMENT AND INCLUDED INPUT FROM SOUTHWEST MONTANA COMMUNITY HEALTH CENTER. IN ADDITION, 117 REPRESENTATIVES FROM VARIOUS COMMUNITY ORGANIZATIONS PROVIDED INPUT IN THE KEY INFORMANT SURVEY. ST. JAMES HEALTHCARE:PART V, SECTION B, LINE 7A: HTTPS://INTERMOUNTAINHEALTHCARE.ORG/ABOUT/WHO-WE-ARE/CHNA-REPORTS ST. JAMES HEALTHCARE PART V, SECTION B, LINE 7D: A PRESS CONFERENCE WAS HELD ON MARCH 23, 2023, BY ST. JAMES AND THE BUTTE-SILVER BOW HEALTH DEPARTMENT TO PUBLICIZE THE CHNA AND PROVIDE A SUMMARY OF KEY FINDINGS.ST. JAMES HEALTHCARE:PART V, SECTION B, LINE 10A: HTTPS://INTERMOUNTAINHEALTHCARE.ORG/ABOUT/WHO-WE-ARE/CHNA-REPORTS ST. JAMES HEALTHCARE PART V, SECTION B, LINE 11: THE 2023 CHNA IDENTIFIED 14 AREAS OF OPPORTUNITY AFTER CONSIDERATION OF VARIOUS CRITERIA INCLUDING: STANDING IN COMPARISON TO BENCHMARK DATA (PARTICULARLY NATIONAL DATA); IDENTIFIED TRENDS; THE PREPONDERANCE OF SIGNIFICANT FINDINGS WITHIN TOPIC AREAS; THE MAGNITUDE OF THE ISSUE IN TERMS OF PERSONS AFFECTED; AND THE POTENTIAL HEALTH IMPACT OF A GIVEN ISSUE. IN ALPHABETICAL ORDER, THEY ARE:1. ACCESS TO HEALTHCARE SERVICES2. CANCER3. DIABETES4. ENVIRONMENTAL HEALTH5. HEART DISEASE AND STROKE6. INFANT HEALTH AND FAMILY PLANNING7. INJURY AND VIOLENCE8. MENTAL HEALTH9. NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT10. POTENTIALLY DISABLING CONDITIONS11. RESPIRATORY DISEASE12. SEXUAL HEALTH13. SUBSTANCE ABUSE14. TOBACCO USEA GROUP OF COMMUNITY STAKEHOLDERS, REPRESENTING A CROSS-SECTION OF COMMUNITY-BASED AGENCIES AND ORGANIZATIONS, WAS CONVENED TO EVALUATE, DISCUSS, AND PRIORITIZE HEALTH ISSUES FOR THE COMMUNITY. PARTICIPANTS EVALUATED EACH OF THE 14 IDENTIFIED AREAS OF OPPORTUNITY ALONG TWO CRITERIA: SCOPE AND SEVERITY, AND ABILITY TO IMPACT. THIS PROCESS YIELDED A PRIORITIZED LIST OF COMMUNITY NEEDS WITH THE TOP FOUR IDENTIFIED NEEDS AS: 1. SUBSTANCE USE2. MENTAL HEALTH3. NUTRITION, PHYSICAL ACTIVITY/WEIGHT4. HEART DISEASE AND STROKEFOLLOWING THE COMMUNITY'S PRIOIRITIZATION, ST. JAMES'S COMMUNITY BENEFIT COMMITTEE OF THE MONTANA MARKET BOARD OF DIRECTORS AND ST. JAMES'S LEADERSHIP TEAM REVIEWED THE DATA AND PRIORITIZED BASED ON THE FOLLOWING CRITERIA: ABILITY TO IMPACT, SCOPE AND SEVERITY OF THE ISSUE, COMMUNITY PRIORITIZATION OF ISSUES, POTENTIAL COMMUNITY PARTNERS, AND ALIGNMENT WITH CURRENT EFFORTS AND STRATEGIES. FROM THIS PROCESS, FOUR PRIORITY NEEDS WERE IDENTIFIED:1. ACCESS TO HEALTHCARE SERVICES2. BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE USE)3. HEART DISEASE AND STROKE4. SOCIAL DETERMINANTS OF HEALTHACCESS TO HEALTHCARE SERVICES:ST. JAMES IS LOCATED IN A HEALTHCARE PROVIDER SHORTAGE AREA. A THIRD OF BUTTE-SILVER BOW RESIDENTS (32.2%) REPORTED DIFFICULTY OR DELAY IN OBTAINING HEALTHCARE SERVICES IN THE PAST YEAR. 74.6% OF RESIDENTS REPORTED A ROUTINE CHECK-UP IN THE PAST YEAR. BUTTE-SILVER BOW HAS A HIGHER RATE OF LOW BIRTHWEIGHT BIRTHS COMPARED TO THE STATE OF MONTANA. IN 2023, ST. JAMES EXPANDED ACCESS TO HEALTHCARE SERVICES BY PROVIDING OUTREACH CLINICS FOR FOUR COMMUNITIES IN PEDIATRIC CARDIOLOGY, UROLOGY, AND OB/GYN. VIRTUAL HEALTH IS ALSO A KEY STRATEGY TO OVERCOME BARRIERS TO ACCESS. IN 2023, 1,636 VIRTUAL HEALTH VISITS WERE CONDUCTED. A MOBILE MAMMOGRAPHY COACH WAS LAUNCHED TO INCREASE ACCESS TO PREVENTIVE SCREENINGS FOR 270 PATIENTS IN OVER 20 LOCATIONS ACROSS SOUTHWESTERN MONTANA. IN 2023, ST. JAMES RECRUITED 28 PROVIDERS IN 11 SPECIALTIES INCLUDING ANESTHESIA, EAR/NOSE/THROAT, EMERGENCY MEDICINE, INTERNAL MEDICINE, INTERVENTIONAL CARDIOLOGY, NEUROLOGY, OBGYN, ORTHOPEDICS, PRIMARY CARE, RADIOLOGY, AND SPORTS MEDICINE TO SERVE THIS HEALTHCARE PROFESSIONAL SHORTAGE AREA. CAPACITY FOR HEALTHCARE WAS ALSO INCREASED THROUGH THE TRAINING OF STUDENTS IN THE MEDICAL FIELD INCLUDING 145 NURSING STUDENTS, 4 DIETARY STUDENTS, 3 PHARMACY STUDENTS, 3 PHYSICAL THERAPY STUDENTS, 1 LABORATORY TECHNICIAN STUDENT, 3 RESPIRATORY THERAPY STUDENTS, AND 9 RADIOLOGY STUDENTS. BEHAVIORAL HEALTH (MENTAL HEALTH AND SUBSTANCE USE):MOST BUTTE-SILVER BOW RESIDENTS RATE THEIR OVERALL MENTAL HEALTH FAVORABLY, BUT 15.2% OF ADULTS BELIEVE THEIR MENTAL HEALTH IS FAIR OR POOR. 30% OF ADULTS HAVE BEEN DIAGNOSED AS HAVING A DEPRESSIVE DISORDER, HIGHER THAN THE U.S. PREVALENCE (20.6%). NEARLY 40% OF RESPONDENTS REPORTED SYMPTOMS OF CHRONIC DEPRESSION. DISPARITIES WERE NOTED BY LOW-INCOME RESIDENTS WITH 49% OF LOW-INCOME RESIDENTS REPORTING SYMPTOMS OF CHRONIC DEPRESSION. SUICIDE RATES IN BUTTE-SILVER BOW WERE CONSIDERABLY HIGHER THAN THE STATE RATE AND NEARLY THREE TIMES THS U.S. RATE WITH 31 SUICIDES PER 100,000 POPULATION. 19.4% OF OVERALL SURVEY RESPONDENTS REPORTED HAVING CONSIDERED SUICIDE. A THIRD OF RESIDENTS UNDER THE AGE OF 40 REPORTED SUICIDAL IDEATION. 45.1% OF BUTTE-SILVER BOW COUNTY RESIDENTS REPORTED THEIR LIVES HAD BEEN NEGATIVELY IMPACTED BY SUBSTANCE USE EITHER BY THEMSELVES OR SOMEONE ELSE.TO ADDRESS THESE HIGH RATES OF SUICIDAL IDEATION AND CHRONIC DEPRESSION, ST. JAMES PROVIDED 4 EVIDENCE-BASED QPR SUICIDE PREVENTION GATEKEEPER TRAININGS TO THE MONTANA CHEMICAL DEPENDENCY CENTER. MENTAL HEALTH AND SUBSTANCE USE SCREENINGS WERE PROVIDED TO EXPECTANT MOTHERS DURING PRENATAL VISITS. THE FIRST 1,000 DAYS MEADOWLARK INITIATIVE PROVIDED PRENATAL SCREENING FOR SUBSTANCE USE AND MENTAL HEALTH NEEDS TO 89% OF EXPECTANT MOTHERS. IN ADDITION, INTEGRATED BEHAVIORAL HEALTH SPECIALISTS ARE EMBEDDED IN PRIMARY CARE CLINICS TO PROVIDE INCREASED ACCESS TO MENTAL HEALTH TREATMENTS AND REDUCE BARRIERS RELATED TO STIGMA. ST. JAMES COLLABORATED WITH COMMUNITY PARTNERS TO ADDRESS BEHAVIORAL HEALTH NEEDS IN THE COMMUNITY PROVIDING IN-KIND AND/OR FINANCIAL SUPPORT TO FOUR COMMUNITY ORGANIZATIONS. ST. JAMES LED COMMUNITY EFFORTS TO ADDRESS SUBSTANCE USE AND THE OPIOID CRISIS, PARTICULARLY FOR RESIDENTS OF CHILDBEARING AND CHILDREARING AGES, THROUGH THE HRSA GRANT-FUNDED RURAL COMMUNITIES OPIOID RESPONSE PROGRAM PROJECT. IN ADDITION, ST. JAMES PROMOTED MT211 AS A TOOL FOR COMMUNITY MEMBERS SEEKING RESOURCES. IN 2023, 1,116 INDIVIDUALS WERE CONNECTED TO MENTAL HEALTH AND OTHER RESOURCES THROUGH MT211. HEART DISEASE AND STROKE: WHILE NOT A PRIORITY FOCUS AREA FOR COMMUNITY HEALTH IMPROVEMENT UNTIL 2024, ST. JAMES ADDRESSES HEART DISEASE AND STROKE THROUGH STRATEGIES UNDER ACCESS TO HEALTHCARE INCLUDING SPECIALTY PROVIDER RECRUITMENT AND VIRTUAL HEALTH. IN ADDITION, ST. JAMES OFFERS A DIABETES AND HEART DISEASE PREVENTION PROGRAM. IN 2023, EDUCATIONAL MESSAGING FOR HEART ATTACK AWARENESS WAS PROVIDED ON SNOW SHOVELS AT LOCAL BUSINESSES. HANDS ONLY CPR EDUCATION WAS PROVIDED TO COMMUNITY ORGANIZATIONS, SCHOOLS, AND CHURCHES. SCREENING EVENTS WERE HELD TO SCREEN FOR HIGH BLOOD PRESSURE AND CARDIOVASCULAR RISK WITH REFERRALS TO PROVIDERS FOR RESIDENTS DETERMINED TO BE AT-RISK. SOCIAL DETERMINANTS OF HEALTH: HOUSING INSECURITY WAS REPORTED BY 42.5% OF LOW-INCOME RESIDENTS IN SILVER BOW COUNTY. 16.3% OF THE BUTTE-SILVER BOW POPULATION IS LIVING BELOW THE FEDERAL POVERTY LEVEL, HIGHER THAN THE MONTANA AND U.S. PERCENTAGES. LOW-INCOME RESIDENTS HAVE POORER HEALTH OUTCOMES ON A NUMBER OF MEASURES INCLUDING MULTIPLE CHRONIC HEALTH CONDITIONS, SYMPTOMS OF CHRONIC DEPRESSION, SUICIDAL IDEATION, USE OF THE EMERGENCY ROOM, UNSAFE HOUSING, TOBACCO USE, FOOD INSECURITY, AND SELF-REPORTED FAIR/POOR OVERALL HEALTH. ST. JAMES COLLABORATED WITH COMMUNITY PARTNERS TO PROVIDE SUPPORTIVE HOUSING TO 6 HIGH NEED RESIDENTS THROUGH THE FUSE INITIATIVE. SUPPORT FOR HOMELESS RESIDENTS WAS ALSO PROVIDED THROUGH 65,794 DONATED MEALS FOR THE BUTTE RESCUE MISSION. HOMELESSNESS WAS ALSO ADDRESSED WITH IN-KIND SUPPORT OF THE LOCAL CONTINUUM OF CARE COALITION. IN ADDITION, ST. JAMES SUPPORTED COMMUNITY EFFORTS TO IMPROVE ECONOMIC DEVELOPMENT FOR BUTTE-SILVER BOW, INCLUDING IN-KIND SUPPORT TO LOCAL ECONOMIC DEVELOPMENT ORGANIZATIONS. OTHER SIGNIFICANT NEEDS NOT PRIORITIZED: ST. JAMES RECOGNIZES OTHER HEALTH NEEDS AND INDICATORS IDENTIFIED IN THE CHNA PROCESS ARE IMPORTANT FOR THE HOSPITAL AND COMMUNITIES IT SERVES. NUMEROUS OTHER ORGANIZATIONS ARE CONCURRENTLY ADDRESSING THE OTHER NEEDS THAT WERE NOT PRIORITIZED BY ST. JAMES. DUE TO LIMITED EXPERTISE AND RESOURCES, ST. JAMES NARROWED ITS PRIORITY HEALTH NEEDS TO THE FOUR HEALTH NEEDS DISCUSSED. ST. JAMES CONTINUES TO COLLABORATE WITH COMMUNITY ORGANIZATIONS TO ENSURE THESE HEALTH NEEDS ARE ADDRESSED. PART V, SECTION, B, LINE 16A, 16B, 16C: HTTPS://INTERMOUNTAINHEALTHCARE.ORG/FOR-PATIENTS/FINANCIAL-ASSISTANCE 1 1 - SUMMIT SURGERY CENTER LLC 434 S CLARK STREET BUTTE MT 59701 OUTPATIENT SURGERY CENTER PART I, LINE 3C: MAXIMUM FINANCIAL ASSISTANCE IS PROVIDED TO PATIENTS AT OR BELOW 250% OF THE FEDERAL POVERTY GUIDELINES ("FPG"). APPLICANTS EQUAL TO OR BELOW THIS THRESHOLD RECEIVE A 100% WAIVER OF PATIENT FINANCIAL OBLIGATION.A SLIDING SCALE IS USED FOR PATIENTS BETWEEN 250% AND 500% OF FPG.TO DETERMINE ELIGIBILITY FOR PROVIDING FREE OR DISCOUNTED CARE, A VARIETY OF FACTORS IS USED, INCLUDING INCOME, MEDICAL INDIGENCE, INSURANCE STATUS, SOCIAL-ECONOMIC, GEOGRPAHICAL LOCATION, AND MEDICAID ELIGIBILITY.TOTAL CHARGES ARE LIMITED IN RELATION TO THE GROSS HOUSEHOLD INCOME. CHARGES ARE DISCOUNTED TO NOT EXCEED 25% OF GROSS ANNUAL HOUSEHOLD INCOME.SINCE EACH PATIENT'S CIRCUMSTANCES VARY, ALLOWANCE IS MADE FOR EXTENUATING CIRCUMSTANCES NOT DIRECTLY ADDRESSED IN THE FINANCIAL ASSISTANCE POLICIES TO BE CONSIDERED WHEN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. PART I, LINE 6A: THIS ORGANIZATION IS PART OF THE INTERMOUNTAIN HEALTH CARE, INC. SYSTEM WHICH PREPARES AN ANNUAL REPORT TO THE COMMUNITY ON A CONSOLIDATED BASIS. THE REPORT IS PREPARED BY THE PARENT COMPANY, INTERMOUNTAIN HEALTH CARE, INC. PART I, LINE 7: THE AMOUNTS REPORTED ON FORM 990, SCHEDULE H, PART I, LINE 7A, 7B AND 7C WERE DETERMINED USING THE COST TO CHARGE RATIO DERIVED FROM WORKSHEET 2, IN THE SCHEDULE H, FORM 990 INSTRUCTIONS. FORM 990, SCHEDULE H, PART I, LINES 7E, 7F, 7G, 7H AND 7I ARE REPORTED AT COST AS REPORTED IN THE ORGANIZATION'S FINANCIAL STATEMENTS.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 ON SCHEDULE H, PART I, LINE 7 COLUMN (F) IS $1,577,119. PART II, COMMUNITY BUILDING ACTIVITIES: ST. JAMES RECOGNIZES THE NEED TO ADDRESS UNDERLYING FACTORS WHICH INFLUENCE HEALTH IN OUR COMMUNITY SUCH AS EDUCATION, HOUSING, EARLY CHILDHOOD DEVELOPMENT AND ECONOMIC SECURITY. WE COLLABORATE WITH COMMUNITY BASED ORGANIZATIONS TO ADDRESS THESE ISSUES. IN 2023, ST. JAMES DONATED 65,794 MEALS TO THE BUTTE RESCUE MISSION TO FEED INDIVIDUALS AND FAMILIES EXPERIENCING HOMELESSNESS.PART III, LINE 1: THE ORGANIZATION REPORTS BAD DEBT IN ACCORDANCE WITH HEALTHCARE FINANCIAL MANAGEMENT ASSOCIATION (HFMA) STATEMENT NO. 15 TO THE EXTENT THAT HFMA STATEMENT NO. 15 FOLLOWS GENERALLY ACCEPTED ACCOUNTING PRINCIPLES (GAAP) FOR REPORTING BAD DEBT. PART III, LINE 2: THE BAD DEBT EXPENSE REPORTED ON PART III, LINE 2 IS AT CHARGES AS RECORDED IN THE ORGANIZATION'S FINANCIAL STATEMENTS. THE ALLOWANCE FOR BAD DEBT IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING THE BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS.THE BAD DEBT ALLOWANCE IS CALCULATED AS A PERCENTAGE OF PATIENT RECEIVABLES AFTER DEDUCTIONS FOR ESTIMATED PROVISIONS FOR CONTRACTUAL ADJUSTMENTS (DISCOUNTS) ON SERVICES PROVIDED TO ENROLLEES OF MEDICARE, MEDICAID, THIRD-PARTY PAYOR PROGRAMS, CHARITY CARE, UNINSURED DISCOUNTS, AND OTHER ADMINISTRATIVE ADJUSTMENTS. PART III, LINE 4: THE ALLOWANCE FOR BAD DEBT IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING THE BUSINESS AND GENERAL ECONOMIC CONDITIONS IN ITS SERVICE AREA, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS.THE BAD DEBT ALLOWANCE IS CALCULATED AS A PERCENTAGE OF PATIENT RECEIVABLES AFTER DEDUCTIONS FOR ESTIMATED PROVISIONS FOR CONTRACTUAL ADJUSTMENTS (DISCOUNTS) ON SERVICES PROVIDED TO ENROLLEES OF MEDICARE, MEDICAID, THIRD-PARTY PAYOR PROGRAMS, CHARITY CARE, UNINSURED DISCOUNTS, AND OTHER ADMINISTRATIVE ADJUSTMENTS.THE ORGANIZATION HAS A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES PATIENTS OPPORTUNITIES TO APPLY FOR FREE OR DISCOUNTED CARE AND/OR TO BE ENROLLED IN A GOVERNMENT SPONSORED MEDICAL CARE PROGRAM. THE PROCESS INCLUDES IDENTIFYING PATIENTS WITH A FINANCIAL CONCERN AND PROVIDING FINANCIAL COUNSELING AND ASSISTANCE IN APPLYING FOR THE ORGANIZATION'S CHARITY CARE AND OTHER FINANCIAL ASSISTANCE PROGRAMS.CERTAIN PATIENT ACCOUNTS ARE WRITTEN OFF TO BAD DEBT BECAUSE THE ORGANIZATION DOES NOT HAVE SUFFICIENT INFORMATION TO DETERMINE IF THE PATIENT WOULD QUALIFY FOR FREE CARE OR FINANCIAL AID. THEREFORE, IT IS POSSIBLE THAT SOME BAD DEBT IS ACTUALLY CHARITY CARE. HOWEVER, IF A PATIENT ACCOUNT IS WRITTEN OFF TO BAD DEBT AND THE COLLECTION AGENCY LATER DETERMINES THAT THE PATIENT WOULD HAVE QUALIFIED FOR FREE CARE OR FINANCIAL AID, THEN THE BAD DEBT EXPENSE IS RECLASSIFIED TO CHARITY CARE. THE PATIENT SERVICE REVENUE FOOTNOTE WHICH DESCRIBES BAD DEBT EXPENSE AND ALLOWANCE FOR UNCOLLECTIBLE ACCOUNTS IS ON PAGES 12 AND 13 OF THE AUDITED CONSOLIDATED FINANCIAL STATEMENTS. PART III, LINE 8: THE ORGANIZATION BELIEVES THAT AT LEAST SOME PORTION OF THE COSTS WE INCUR IN EXCESS OF PAYMENTS RECEIVED FROM THE FEDERAL GOVERNMENT FOR PROVIDING MEDICAL SERVICES TO MEDICARE ENROLLEES AND BENEFICIARIES UNDER THE FEDERAL MEDICARE PROGRAM (SHORTFALL OR MEDICARE SHORTFALL) CONSTITUTES A COMMUNITY BENEFIT. PROVIDING THESE SERVICES CLEARLY LESSENS THE BURDENS OF THE GOVERNMENT BY ALLEVIATING THE FEDERAL GOVERNMENT FROM HAVING TO DIRECTLY PROVIDE THESE MEDICAL SERVICES. AS DEMONSTRATED AND CALCULATED ON FORM 990, SCHEDULE H, PART III, LINES 5, 6 AND 7, OUR MEDICARE "ALLOWABLE COSTS" CLEARLY EXCEED THE PAYMENTS WE RECEIVE FOR PROVIDING THESE MEDICAL SERVICES UNDER THE MEDICARE PROGRAM. BY ABSORBING THE MEDICARE SHORTFALL COSTS, WE ARE PROVIDING A COMMUNITY BENEFIT AS WELL AS EASING THE BURDEN OF THE FEDERAL GOVERNMENT HAVING TO COVER THESE COSTS. ABSENT THE MEDICARE PROGRAM, IT IS LIKELY MANY OF THE INDIVIDUALS WOULD QUALIFY FOR CHARITY CARE OR OTHER NEEDS-BASED GOVERNMENT PROGRAMS. BY ACCEPTING PAYMENT BELOW COST TO TREAT THESE INDIVIDUALS, BURDENS BORNE BY GOVERNMENTS ARE RELIEVED. TO ARRIVE AT THE FORM 990, SCHEDULE H, PART III, LINE 6 AMOUNT, WE USED ACTUAL MEDICARE CHARGES FROM INTERNAL RECORDS AND APPLIED AN ESTIMATED COST TO CHARGE RATIO TO DETERMINE THE MEDICARE ALLOWABLE COSTS. THE ESTIMATED MEDICARE COST TO CHARGE RATIO IS THE PRIOR PERIOD MEDICARE COST REPORT COST TO CHARGE RATIO. 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 ENSURE THAT WE MANAGE OUR RESOURCES SOWE CAN CONTINUE TO BE HERE WHEN PEOPLE NEED US MOST. THE ORGANIZATION NOTIFIES PATIENTS OF FINANCIAL ASSISTANCE POLICY UPON ADMISSION AND DISCHARGE. IN ADDITION, THE PATIENTS RECEIVE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY WITH THEIR 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. PART V, SECTION A, WEBSITE WEBSITE: HTTPS://INTERMOUNTAINHEALTHCARE.ORG/LOCATIONS/INTERMOUNTAIN-HEALTH-ST-JAMES-HOSPITAL PART VI, LINE 2: ST. JAMES CONTINUOUSLY ASSESSES THE NEEDS OF THE COMMUNITY THROUGH CLOSE WORKING RELATIONSHIPS AND PARTNERSHIPS WITH SERVICE AGENCIES IN THE COMMUNITY. ST. JAMES'S LEADERSHIP SERVES ON VARIOUS COMMUNITY BOARDS TO UNDERSTAND THE SPECIFIC NEEDS OF THEIR COMMUNITY.IN ADDITION TO THE CHNA DATA FOCUSED ON BUTTE-SILVER BOW COUNTY, ST. JAMES UTILIZES DATA FROM COMMUNITY BASED ORGANIZATIONS THAT CONDUCT PERIODIC SURVEYS RELATED TO HEALTH. SECONDARY DATA SUCH AS COUNTY HEALTH RANKINGS AND THE BEHAVIOR RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) IS REVIEWED TO DETERMINE HEALTH NEEDS FOR NEIGHBORING COUNTIES. ADDITIONAL OUTREACH AND RELATIONSHIPS WITH OTHER CRITICAL ACCESS HOSPITALS, HEALTH CENTERS, AND CLINICS IN SURROUNDING RURAL COMMUNITIES ENABLE ST. JAMES TO BETTER ASSESS THE HEALTH NEEDS OF THESE COMMUNITIES. PART VI, LINE 3: THE ORGANIZATION NOTIFIES PATIENTS ABOUT THE FINANCIAL ASSISTANCE POLICY UPON ADMISSION AND PRIOR TO DISCHARGE. NOTICES ABOUT THE FINANCIAL ASSISTANCE POLICY ARE DISPLAYED THROUGHOUT THE HOSPITAL. IN ADDITION, PATIENTS RECEIVE INFORMATION ABOUT THE FINANCIAL ASSISTANCE POLICY WITH THEIR PATIENT BILLS AND THROUGH THE PATIENT PORTAL, MYCHART. THE FINANCIAL ASSISTANCE POLICY AND APPLICATION ARE POSTED ON THE HOSPITAL'S WEBSITE. THE POLICY AND APPLICATION ARE ALSO AVAILABLE UPON REQUEST. THE ORGANIZATION HAS A FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES PATIENTS OPPORTUNITIES TO APPLY FOR FREE OR DISCOUNTED CARE AND/OR TO BE ENROLLED IN A GOVERNMENT SPONSORED MEDICAL CARE PROGRAM. THE PROCESS INCLUDES IDENTIFYING PATIENTS WITH A FINANCIAL CONCERN, PROVIDING FINANCIAL COUNSELING AND ASSISTANCE IN APPLYING FOR THE ORGANIZATION'S CHARITY CARE AND OTHER FINANCIAL ASSISTANCE PROGRAMS. PART VI, LINE 4: GEOGRAPHY AND POPULATION: SILVER BOW COUNTY, THE 2023 CHNA-DEFINED COMMUNITY, IS LOCATED IN SOUTHWEST MONTANA AND SPANS 716 SQUARE MILES. BUTTE-SILVER BOW IS PREDOMINANTLY URBAN, WITH 88.6% OF THE POPULATION LIVING IN AREAS DESIGNATED AS URBAN. THE ESTIMATED POPULATION OF SILVER BOW COUNTY IS 34,895 REPRESENTING A 2.7% INCREASE FROM 2010.HOSPITALS IN THE SERVICE AREA: THERE ARE NO OTHER ACUTE HOSPITALS SERVING BUTTE AND SILVER BOW COUNTY.AGE: IN BUTTE-SILVER BOW 20.4% OF THE POPULATION ARE CHILDREN AGED 0-17; 60.7% ARE AGES 18 TO 64; AND 18.9% ARE 65 AND OVER. THE MEDIAN AGE IS 40.1. RACIAL AND ETHNICITY: THE MAJORITY OF BUTTE-SILVER BOW RESIDENTS ARE WHITE (93.5%), 2.3% ARE NATIVE AMERICAN, AND 2.9% OF RESIDENTS ARE MULTIPLE RACES. TOTAL OF 4.7% OF BUTTE-SILVER BOW RESIDENTS ARE HISPANIC OR LATINO, HIGHER THAN THE MONTANA PERCENTAGE.ECONOMICS: THE PERCENTAGE OF INDIVIDUALS LIVING IN POVERTY IN SILVER BOW COUNTY IS 16.3%, INCLUDING AN ESTIMATED 1,279 CHILDREN IN POVERTY. A HIGHER PERCENTAGE OF BUTTE-SILVER BOW RESIDENTS LIVE BELOW THE POVERTY LINE THAN STATE OR NATIONAL PERCENTAGES. AMONG THE BUTTE-SILVER BOW POPULATION AGE 25 AND OLDER, AN ESTIMATED 6.5% DO NOT HAVE A HIGH SCHOOL DIPLOMA. HEALTH STATUS: MOST BUTTE-SILVER BOW RESIDENTS RATE THEIR OVERALL HEALTH FAVORABLY WITH 81.9% REPORTING EXCELLENT, VERY GOOD, OR GOOD OVERALL HEALTH. 18.1% OF BUTTE-SILVER BOW ADULTS BELIEVE THEIR HEALTH IS FAIR OR POOR. DISPARITIES IN HEALTH STATUS ARE NOTABLE AMONG LOW-INCOME ADULTS WITH 28.5% OF LOW-INCOME ADULTS REPORTING FAIR OR POOR HEALTH.UNINSURED RATE: 9.2% OF PEOPLE IN SILVER BOW COUNTY ARE UNINSURED, WHICH IS SLIGHTLY LOWER THAN THE U.S. AVERAGE OF 9.3%. PART VI, LINE 5: ST. JAMES ADHERES TO COMMUNITY BENEFIT GUIDELINES OUTLINED IN THE CATHOLIC HEALTH ASSOCIATION'S PUBLICATION, "A GUIDE TO PLANNING AND REPORTING COMMUNITY BENEFIT". ST. JAMES'S COMMUNITY BENEFIT WORK IS DRIVEN BY IDENTIFIED COMMUNITY HEALTH NEEDS AND DIRECTED IN COLLABORATION WITH OTHER HEALTHCARE ORGANIZATIONS AND THE BROADER COMMUNITY. A COMMUNITY BENEFIT REPORT TO THE COMMUNITY IS PUBLISHED ANNUALLY AND CAN BE FOUND AT: HTTPS://INTERMOUNTAINHEALTHCARE.ORG/-/MEDIA/FILES/INTERMOUNTAIN-HEALTH/CHNA-REPORTS---PEAKS/ST-JAMES-CHNA-2023.ASHXCOMMUNITY BENEFIT STRATEGIES ARE INTEGRATED IN THE ORGANIZATIONAL STRATEGIC PLAN. PROGRAMS ARE LOCATED THROUGHOUT THE ORGANIZATION AND STAFF AND BOARD EDUCATION IS CONDUCTED. ST. JAMES HAS DEDICATED STAFF COMMITTED TO COMMUNITY BENEFIT EFFORTS. HOSPITAL LEADERS, MANAGERS, AND SUPERVISORS ARE ENCOURAGED TO PARTICIPATE ANNUALLY IN COMMUNITY BENEFIT SERVICE EVENTS WITH NON-PROFIT ORGANIZATIONS TO IMPROVE THE HEALTH OF THE COMMUNITIES WE SERVE. MONTANA MARKET'S BOARD OF DIRECTORS IS A VOLUNTEER GOVERNING BODY WHICH INCLUDE INDEPENDENT PERSONS THAT REPRESENT THE COMMUNITY. WITHIN THE BOARD OF DIRECTORS, THERE IS A SPECIFIC COMMUNITY BENEFIT BOARD LEVEL COMMITTEE. THIS COMMITTEE IS DEEPLY INVOLVED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS AND PROVIDES DIRECTION TOWARDS THE DEVELOPMENT OF THE ORGANIZATION'S IMPROVEMENT PLAN IN RESPONSE TO RESULTS OF COMMUNITY HEALTH NEEDS ASSESSMENT. THE HOSPITAL'S COMMUNITY BENEFIT BOARD COMMITTEE MONITORS IMPLEMENTATION OF COMMUNITY BENEFIT PROGRAMS AND PROVIDES REPORTS BACK TO THE FULL MARKET BOARD. AS THE ONLY ACUTE CARE FACILITY IN SOUTHWEST MONTANA, ST. JAMES SERVES ITS COMMUNITY BY PROVIDING COMPREHENSIVE MEDICAL SERVICES INCLUDING CARDIOLOGY, ONCOLOGY, ORTHOPEDIC, OB/GYN FOR WOMEN, UROLOGY, EMERGENCY AND TRAUMA, NEONATAL INTENSIVE CARE, NEUROLOGY, GENERAL SURGICAL, PRIMARY CARE, PEDIATRIC CARE, FAMILY AND INTERNAL MEDICINE. ST. JAMES OPERATES AN EMERGENCY DEPARTMENT THAT IS OPEN TO ALL PERSONS REGARDLESS OF ABILITY TO PAY. ST. JAMES ENGAGES IN THE TRAINING AND EDUCATION OF HEALTHCARE PROFESSIONALS AND PARTICIPATES IN MEDICAID, MEDICARE, AND OTHER GOVERNMENT-SPONSORED HEALTH PROGRAMS. ST. JAMES EMPLOYS THE STAFF OF THE ST. JAMES HOSPITAL FOUNDATION, A NON-PROFIT ORGANIZATION THAT PROVIDES FUNDRAISING FOR ST. JAMES FACILITIES AND PROGRAMS THAT REACH BOTH THE POOR AND THE BROADER COMMUNITY. OPERATIONS OF THE FOUNDATION ARE GOVERNED BY A SEPARATE FOUNDATION BOARD WITH VOLUNTARY MEMBERSHIPS FROM THE LOCAL COMMUNITY. WHEN ST. JAMES HAS EXCESS REVENUE OVER OPERATING EXPENSES, THOSE FUNDS ARE USED TO OBTAIN CURRENT HEALTH CARE TECHNOLOGIES AND EQUIPMENT, IMPROVE PATIENT CARE, PROVIDE MEDICAL TRAINING EDUCATION, AND WORK TO EXPAND ACCESS TO CARE. THESE INVESTMENTS ENSURE ST. JAMES WILL CONTINUE TO PROVIDE CARE FOR FUTURE GENERATIONS. PART VI, LINE 6: THE FILING ORGANIZATION IS AN AFFILIATE OF INTERMOUNTAIN HEALTH CARE, INC. (INTERMOUNTAIN), AN INTEGRATED HEALTH SYSTEM WHOSE VISION IS TO "BE A MODEL HEALTH SYSTEM BY PROVIDING EXTRAORDINARY CARE AND SUPERIOR SERVICES AT AN AFFORDABLE COST". INTERMOUNTAIN STRIVES TO FULFILL THAT MISSION THROUGH ACCOMPLISHING ITS STATED MISSION OF "HELPING PEOPLE LIVE THE HEALTHIEST LIVES POSSIBLE". INTERMOUNTAIN, IS A NONPROFIT CORPORATION EXEMPT UNDER INTERNAL REVENUE CODE 501(C)(3). AFFILIATES WITHIN THE HEALTH SYSTEM NETWORK INCLUDE NONPROFIT CORPORATIONS EXEMPT UNDER IRS 501(C)(3) AND 501(C)(4), TAXABLE CORPORATIONS, PARTNERSHIPS WITH PHYSICIANS, STRATEGIC INVESTMENTS, AND JOINT VENTURES.HEADQUARTERED IN UTAH WITH LOCATIONS IN SEVEN STATES AND ADDITIONAL OPERATIONS ACROSS THE WESTERN U.S., INTERMOUNTAIN HEALTH IS A NONPROFIT SYSTEM OF MORE THAN 66,000 CAREGIVERS, 33 HOSPITALS, 385 CLINICS, MEDICAL GROUP, A HEALTH PLAN DIVISION CALLED SELECT HEALTH WITH MORE THAN ONE MILLION MEMBERS, AND OTHER HEALTH SERVICES. HELPING PEOPLE LIVE THE HEALTHIEST LIVES POSSIBLE, INTERMOUNTAIN IS COMMITTED TO IMPROVING COMMUNITY HEALTH AND IS WIDELY RECOGNIZED AS A LEADER IN TRANSFORMING HEALTHCARE BY USING EVIDENCE-BASED BEST PRACTICES TO CONSISTENTLY DELIVER HIGH-QUALITY OUTCOMES AT SUSTAINABLE COSTS. INTERMOUNTAIN IS WORKING TO IMPROVE THE HEALTH AND WELL-BEING BY IMPROVING MENTAL WELL-BEING, PREVENTING AVOIDABLE DISEASE, IMPROVING AIR QUALITY, ADDRESSING SOCIAL DETERMINANTS OF HEALTH, AND OTHER COMMUNITY HEALTH INITIATIVES.THROUGH MULTIPLE CHARITABLE FOUNDATIONS, INTERMOUNTAIN ALSO DEVELOPS FINANCIAL AND CHARITABLE SUPPORT FOR ITS PATIENTS WHILE ALSO SUPPORTING OTHER NONPROFIT ORGANIZATIONS THAT PROVIDE DIRECT MEDICAL, DENTAL, AND MENTAL SERVICES FOR LOW-INCOME, UNINSURED, OR MEDICALLY UNDERSERVED POPULATIONS. 1 SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM INC 500 ELDORADO BLVD SUITE 4300 BROOMFIELD CO 80021 237379161 501(C)(3) 4349664 0 SUPPORT MONTANA CLINCIS ST JAMES HEALTHCARE FOUNDATION 400 SOUTH CLARK ST BUTTE MT 59701 651202190 501(C)(3) 388667 0 SUPPORT FOR MISSION 2 0 PART I, LINE 2: PROCESS FOR MONITORING GRANTS AND AWARDS THE ORGANIZATION KEEPS RECORDS TO SUPPORT THE AMOUNTS PROVIDED OR REASON FOR SUCH SUPPORT. ELIGIBILITY FOR FUNDING IS DETERMINED ON AN INDIVIDUAL BASIS, CONSIDERING THE USE OF THE FUNDS AND HOW THE USE RELATES TO THE ORGANIZATION'S MISSION. X 0 1 0 1 0 0 0 0 0 0 0 BRYAN JOHNSON INTERIM PRESIDENT, MONTANA REGION (P 0 502548 0 109425 0 72639 0 255252 0 27360 0 967224 0 162823 JENNIFER ALDERFER PRESIDENT, MONTANA REGION - PART YEA 0 549575 0 130931 0 76177 0 14518 0 27603 0 798804 0 203684 JAMES DOYLE PRESIDENT SJB 329299 0 80718 0 43247 0 155408 0 20806 0 629478 0 75553 0 JAMES RITCHEY FORMER KEY EMPLOYEE 0 327797 0 62403 0 44221 0 150869 0 30210 0 615500 0 73082 MARWAN MASSOUH MD FORMER HIGHEST COMPENSATED 0 534089 0 12000 0 8157 0 14436 0 22381 0 591063 0 0 JENNIFER DAVENPORT MD VP CMO SJB/ASSOCIATE CMO MT (PARTIAL 347301 0 50533 0 1847 0 160737 0 21441 0 581859 0 50004 0 MOHAN NANDALUR MD FORMER HIGHEST COMPENSATED 0 521725 0 0 0 0 0 14380 0 9143 0 545248 0 0 PAMELA PALAGI VP FINANCE REGION MT 0 309390 0 47018 0 29612 0 137628 0 10735 0 534383 0 74294 KATIE ROEDOCKER VP COO/CNO SJB 201779 0 31345 0 129656 0 100320 0 27640 0 490740 0 31345 0 ADAM SCHAFER VP NETWORK DEVELOPMENT REGION MT 0 261298 0 10565 0 1889 0 112625 0 10084 0 396461 0 10565 SUSAN PETERSEN MD DIRECTOR 0 222183 0 106353 0 1870 0 12912 0 2492 0 345810 0 0 TRACY NEARY VP MISSION INTEGRATION REGION MT 0 183426 0 28674 0 15888 0 85749 0 25814 0 339551 0 42913 JOEL DYE MD FORMER HIGHEST COMPENSATED 0 286882 0 0 0 6761 0 13167 0 31082 0 337892 0 0 LUC HIBBS MD FORMER HIGHEST COMPENSATED 0 294985 0 0 0 1318 0 13432 0 25163 0 334898 0 0 DAVID SILK MD FORMER HIGHEST COMPENSATED 0 285907 0 0 0 4457 0 12929 0 31082 0 334375 0 0 ALAN MAYER MD FORMER HIGHEST COMPENSATED 0 289887 0 0 0 6802 0 13220 0 24398 0 334307 0 0 JAMES BARRY OSER MD FORMER HIGHEST COMPENSATED 0 309053 0 0 0 6502 0 13860 0 3730 0 333145 0 0 TRISHA PALMER DIRECTOR OF HUMAN RESOURCES 184389 0 18063 0 5712 0 54343 0 13864 0 276371 0 14340 0 DANAE APLAS ANESTHESIOLOGIST 193740 0 0 0 40757 0 11354 0 13939 0 259790 0 0 0 RISIK RASK DIRECTOR PHARMACY 168552 0 12936 0 528 0 27884 0 18210 0 228110 0 12936 0 TONYA GRIM DIRECTOR HEALTH INFORMATICS NURSING_ 152292 0 12308 0 3462 0 26333 0 30774 0 225169 0 12308 0 JEFFREY NEIL PHARMACIST 179111 0 450 0 998 0 8327 0 31000 0 219886 0 0 0 PART I, LINE 1A THE FILING ORGANIZATION AND RELATED ORGANIZATIONS ALLOW FOR CERTAIN TAX INDEMNIFICATION AND GROSS-UP PAYMENTS IN THE INSTANCES OF RELOCATION. THESE AMOUNTS ARE TREATED AS TAXABLE COMPENSATION. THE INDIVIDUALS THAT RECEIVED TAX GROSS-UP PAYMENTS IN 2023 WERE: KATIE ROEDOCKER - $33,193 PART I, LINE 1B THE FILING ORGANIZATION DOES NOT HAVE A FORMAL WRITTEN POLICY FOR TAX INDEMNIFICATION AND GROSS-UP PAYMENTS. HOWEVER, BEFORE ANY TAX INDEMNIFICATION AND GROSS-UP PAYMENTS ARE MADE; PROPER APPROVAL FROM THE EMPLOYEE'S MANAGER IS REQUIRED. IN ADDITION, APPROVAL IS ALSO REQUIRED FROM HUMAN RESOURCES. 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, SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS). COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS MANAGED BY THE INTERMOUNTAIN HEALTH CARE, INC. BOARD COMPENSATION COMMITTEE (COMMITTEE) ON BEHALF OF SCLHS 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. 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. THE BOARD PLACES A HIGH PRIORITY ON THE NEED TO RECURIT AND RETAIN A STRONG LEADERSHIP TEAM AND TO CREATE A HIGHLY MOTIVATED AND ENGAGED WORKFORCE. COMPENSATION LEVELS FOLLOW IRS GUIDELINES AND ARE SUBJECT TO IRS OVERSIGHT. 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) COMPENSATION SURVEYS AND STUDIES 5) 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 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 COSTS 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 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. CERTAIN PARTICIPANTS ARE VESTED OR BECAME VESTED IN THE PLAN DURING 2023. VESTED AMOUNTS ARE PAYABLE TO THE RECIPIENT UPON THE END OF EMPLOYMENT. 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 2023 WERE: JENNIFER ALDERFER - $72,753; BRYAN JOHNSON - $53,398; JAMES DOYLE - $32,949; PAMELA PALAGI - $27,276; TRACY NEARY - $14,239; JAMES RITCHEY - $25,482. ADDITIONAL OFFICER AND BOARD DISCLOSURES 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. FORM 990, LINE J WEBSITE: HTTPS://INTERMOUNTAINHEALTHCARE.ORG/LOCATIONS/INTERMOUNTAIN-HEALTH-ST-JA MES-HOSPITAL 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 VI, SECTION A, LINE 2 PAM PALAGI / TRACY NEARY - BUSINESS RELATIONSHIP (EMPLOYER/EMPLOYEE RELATIONSHIP IN SCL HEALTH - MONTANA, A RELATED TAX-EXEMPT ORGANIZATION). JEN ALDERFER / ADAM SCHAFER / SUSAN PETERSEN - BUSINESS RELATIONSHIP (EMPLOYER/EMPLOYEE RELATIONSHIP IN SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC., A RELATED TAX-EXEMPT ORGANIZATION). FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) IS THE SOLE MEMBER OF ST. JAMES HEALTHCARE. FORM 990, PART VI, SECTION A, LINE 7A POWER TO ELECT OR APPOINT MEMBERS SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC., THE SOLE MEMBER OF ST. JAMES HEALTHCARE, HAS THE POWER TO APPOINT MEMBERS OF THE ST. JAMES HEALTHCARE BOARD OF DIRECTORS, SUBJECT TO THE RATIFICATION BY THE BOARD OF INTERMOUNTAIN HEALTH CARE, INC. FORM 990, PART VI, SECTION A, LINE 7B DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS WHILE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS) IS THE SOLE MEMBER OF ST. JAMES HEALTHCARE, RESERVED POWERS ARE PRIMARILY HELD BY INTERMOUNTAIN HEALTH CARE, INC. (INTERMOUNTAIN), WHO AS A RESULT OF AFFILIATION, IS A MEMBER OF SCLHS. SCLHS, HAS THE POWER TO APPOINT TRUSTEES TO THE BOARD OF DIRECTORS, WHICH ARE SUBJECT TO RATIFICATION BY INTERMOUNTAIN. RESERVED POWERS HELD BY INTERMOUNTAIN INCLUDE: - ESTABLISH THE MISSION, VISION, AND VALUES FOR THE CORPORATION; - DEVELOP, ADOPT, AND OVERSEE STRATEGY, GOALS, OBJECTIVES, POLICIES, STANDARDS, AND GUIDELINES FOR THE CORPORATION; - ADOPT, AMEND, OR REPEAL THE GOVERNING DOCUMENTS OF THE CORPORATION; - FIX THE NUMBER OF TRUSTEES OF THE BOARD AND APPOINT AND REMOVE TRUSTEES TO AND FROM THE BOARD; - APPOINT AND REMOVE THE TRUSTEES, DIRECTORS, MANAGERS, OR BOARD OFFICERS OF THE CORPORATION; - PROVIDE FOR THE OVERALL MANAGEMENT OF THE CORPORATION, INCLUDING APPOINTING, OVERSEEING, AND REMOVING THE PRESIDENT AND CHIEF EXECUTIVE OFFICER OF THE CORPORATION; - OVERSEE AUDIT AND COMPLIANCE, CLINICAL EXCELLENCE, COMPENSATION, FINANCE, INVESTMENT, NOMINATING AND GOVERNANCE, AND ANY OTHER NEEDED FUNCTIONS FOR THE PROPER OPERATION OF THE CORPORATION; - OVERSEE THE MEDICAL GROUPS OF THE SYSTEM IN A MANNER TO ENCOURAGE THE DELIVERY OF COST-EFFECTIVE PROFESSIONAL SERVICES TO PATIENTS SERVED AND, IN ACCORDANCE WITH APPLICABLE STATE LAW, OVERSEE CLINICAL PRACTICE AND EVIDENCED-BASED MEDICINE; - APPROVE THE ACQUISITION OF ASSETS, INCURRENCE OF INDEBTEDNESS, SALE, LEASE, TRANSFER, ASSIGNMENT, OR ENCUMBRANCE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CORPORATION; - APPROVE ANY MERGER, CHANGE OF CONTROL, DISSOLUTION, OR CORPORATE RESTRUCTURING OF THE CORPORATION; - OVERSEE THE ACQUISITION OR FORMATION OF ANY NEW SUBSIDIARY OF THE CORPORATION; AND - DIRECT FINANCES AND INVESTMENTS OF THE CORPORATION, INCLUDING CONTROLS, OPERATING AND CAPITAL BUDGETS, INTERCOMPANY TRANSFERS OR LOANS, AND SELECTION AND REMOVAL OF EXTERNAL AUDITORS. THE OTHER MEMBER OF SCLHS IS LEAVEN MINISTRIES, WHO WAS GRANTED THE FOLLOWING RESERVED POWERS: - TO APPROVE THE ADOPTION, AMENDMENT OR REPEAL OF THE CIVIL ARTICLES OF INCORPORATION OR BYLAWS OF SCLHS, OF ANY CIVIL CORPORATION OF WHICH SCLHS IS THE CONTROLLING MEMBER, AND OF ANY SUBSIDIARY CORPORATION OF SCLHS; - TO FIX THE NUMBER AND APPOINT THE MEMBERS OF THE BOARD OF TRUSTEES OF SCLHS; - TO REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF TRUSTEES OF SCLHS; - TO APPROVE FOR SCLHS, ANY CORPORATION OF WHICH SCLHS IS THE CONTROLLING MEMBER, OR ANY SUBSIDIARY CORPORATION OF SCLHS, THE INCURRENCE OF INDEBTEDNESS OR THE SALE, TRANSFER, ASSIGNMENT, OR ENCUMBERING OF THE ASSETS, PURSUANT TO POLICIES ESTABLISHED FROM TIME TO TIME BY THE MEMBERS OF LEAVEN MINISTRIES; - TO APPROVE ANY OTHER ACTION WHICH, IN ACCORDANCE WITH THE CIVIL CORPORATE DOCUMENTS GOVERNING SCLHS IS RESERVED TO THE MEMBERS OF LEAVEN MINISTRIES; - TO APPROVE ANY ALIENATION, SALE, GIFT OR OTHER TRANSFER OF THE REAL PROPERTY HELD BY ANY SCLHS CATHOLIC ENTITY THAT CONSTITUTES ECCLESIASTICAL GOODS; - TO APPROVE ANY DISSOLUTION, FILING OF A BANKRUPTCY PETITION, MERGER, CONSOLIDATION OR CHANGE OF MAJORITY CONTROL OF ANY SCLHS CATHOLIC ENTITY; - TO APPROVE ANY MORTGAGE OR OTHER SECURITY INSTRUMENT THAT DIRECTLY ENCUMBERS THE REAL PROPERTY OF ANY SCLHS CATHOLIC ENTITY THAT CONSTITUTES ECCLESIASTICAL GOODS; - TO MONITOR, OVERSEE AND ENFORCE THE CATHOLIC PROTECTIONS INCLUDING THOSE ON-GOING OBLIGATIONS OF THE CONSOLIDATED SYSTEM PARENT SET FORTH IN THE MERGER AGREEMENT THAT ARE FOR THE BENEFIT OF LEAVEN MINISTRIES; AND - TO APPROVE ANY ALTERATION, REVOCATION, SUSPENSION, OR OTHER TERMINATION OR MODIFICATION OF THE RESERVED POWERS SET FORTH HEREIN. IN THE EVENT ANY CONFLICTS ARISE BETWEEN THE RESERVED POWERS GRANTED TO LEAVEN MINISTRIES AND THOSE OF INTERMOUNTAIN, THE LEAVEN RESERVED POWERS WILL CONTROL. FORM 990, PART VI, SECTION B, LINE 11B THE FORM 990 IS PREPARED BY THE TAX DEPARTMENT OF INTERMOUNTAIN HEALTH CARE, INC. AND SUBSIDIARIES. THE DRAFT FORM 990 IS REVIEWED BY CERTAIN MEMBERS OF SENIOR MANAGEMENT. A COPY OF THE FINAL FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS PRIOR TO THE FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C EACH OFFICER, DIRECTOR, TRUSTEE AND KEY EMPLOYEE IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AT LEAST ANNUALLY. THESE INDIVIDUALS HAVE BEEN INSTRUCTED TO UPDATE THEIR QUESTIONNAIRE INFORMATION IF THEY BECOME AWARE OF A NEW POTENTIAL CONFLICT, OR IF ANY OF THE PREVIOUSLY REPORTED INFORMATION CHANGES. ADDITIONALLY, BOARD MEMBERS ARE ASKED AT THE BEGINNING OF EACH BOARD OR COMMITTEE MEETING IF THEY ARE AWARE OF ANY CONFLICTS. ACCORDING TO POLICY, THE QUESTIONNAIRES ARE COLLECTED AND REVIEWED BY INTERMOUNTAIN'S CHIEF COMPLIANCE OFFICER. POTENTIAL CONFLICTS OF INTEREST ARE REVIEWED WITH APPROPRIATE PERSONNEL, WHICH MAY INCLUDE (BUT IS NOT LIMITED TO) THE AUDIT AND COMPLIANCE COMMITTEE CHAIR, SENIOR MANAGEMENT AND THE LEGAL DEPARTMENT. IF AN INDIVIDUAL DISCLOSES A SITUATION THAT POSES A CONFLICT OF INTEREST, A DETERMINATION IS MADE WHETHER THE SITUATION CAN BE MANAGED (SUCH AS BY RECUSAL IN DECISION-MAKING SETTINGS) OR MUST BE ELIMINATED (SUCH AS THROUGH DIVESTITURE OF THE OUTSIDE INTEREST). FINDINGS ARE REPORTED TO THE AUDIT AND COMPLIANCE COMMITTEE OF INTERMOUNTAIN HEALTH CARE, INC. FORM 990, PART VI, SECTION B, LINE 15 THE ORGANIZATION'S OFFICERS AND SENIOR MANAGEMENT ARE PAID BY A RELATED ORGANIZATION, SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS). COMPENSATION FOR THE OFFICERS AND SENIOR MANAGEMENT IS MANAGED BY THE INTERMOUNTAIN HEALTH CARE, INC. BOARD COMPENSATION COMMITTEE (COMMITTEE) ON BEHALF OF SCLHS 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) COMPENSATION SURVEYS AND STUDIES 5) 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 IX, LINE 11G PHYSICIAN SERVICES: PROGRAM SERVICE EXPENSES 13,023,295. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,023,295. MEDICAL STAFFING: PROGRAM SERVICE EXPENSES 4,650,782. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,650,782. CONSULTING: PROGRAM SERVICE EXPENSES 0. MANAGEMENT AND GENERAL EXPENSES 185,519. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 185,519. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 9,110,798. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 9,110,798. LAB SERVICES: PROGRAM SERVICE EXPENSES 806,828. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 806,828. FORM 990, PART XI, LINE 9: BOOK VS TAX ADJUSTMENT FOR JOINT VENTURE INCOME -92,670. ENVIRONMENTAL REMEDITION LIABILITY ADJUSTMENT -800,000. THIRD PARTY MEDICARE ADJUSTMENT -426,113. FAIR VALUE ACQUISITION ADJUSTMENT -712,090. 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