Form990
Click to see attachment
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2011
Open to Public Inspection
A For the calendar year, or tax year beginning 01-01-2011 and ending 12-31-2011
BCheck if applicable:
CName of organization
IHC HEALTH SERVICES INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
36 SOUTH STATE SUITE 2200
 
Room/suite
City or town, state or country, and ZIP + 4
SALT LAKE CITY, UT84111
D Employer identification number

94-2854057
E Telephone number

G Gross receipts $ 10,826,438,987
F Name and address of principal officer:
Charles W Sorenson JR MD
36 South State Suite 2200
Salt Lake City,UT84111
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
www.intermountainhealthcare.org
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet  
K Form of organization:
 
L Year of formation: 1982
M State of legal domicile: UT
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: Excellence in the provision of healthcare services to communities in the intermountain region. See Schedule O.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a)..... 3 19
4 Number of independent voting members of the governing body (Part VI, line 1b) .... 4 15
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ... 5 36,230
6 Total number of volunteers (estimate if necessary) .... 6 4,612
7a Total unrelated business revenue from Part VIII, column (C), line 12 .. 7a 36,096,431
b Net unrelated business taxable income from Form 990-T, line 34 .. 7b -8,327,935
Revenues; Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 37,101,653 32,701,092
9 Program service revenue (Part VIII, line 2g) ......... 3,729,340,659 3,983,670,023
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 72,833,441 104,063,060
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 19,303,010 28,037,222
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 3,858,578,763 4,148,471,397
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 5,772,093 14,451,238
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 1,823,217,002 1,905,638,344
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet2,224,421    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24f).... 1,636,980,993 1,700,464,163
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 3,465,970,088 3,620,553,745
19 Revenue less expenses. Subtract line 18 from line 12....... 392,608,675 527,917,652
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 5,543,817,298 5,642,207,645
21 Total liabilities (Part X, line 26)............. 2,444,138,413 2,534,185,096
22 Net assets or fund balances. Subtract line 21 from line 20..... 3,099,678,885 3,108,022,549
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title.
Paid preparer use only
Print/type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name Right pointing arrowhead image

Firm's EIN Right pointing arrowhead image
Firm's address Right pointing arrowhead image



Phone no.
May the IRS discuss this return with the preparer shown above? See instructions .........bullet
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2011)
Form 990 (2011)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III .........
1
Briefly describe the organization’s mission: EXCELLENCE IN THE PROVISION OF HEALTHCARE SERVICES TO COMMUNITIES IN THE INTERMOUNTAIN REGION. SEE SCHEDULE O.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ....................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ..........................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations and section 4947(a)(1) trusts are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 3,603,188,569 including grants of $ 14,451,238 ) (Revenue $ 4,006,081,274 )
IHC HEALTH SERVICES, INC. ("HEALTH SERVICES") PROVIDED HIGH QUALITY HEALTH CARE THROUGH ITS SYSTEM OF 23 HOSPITALS (2,802 LICENSED BEDS) AND MORE THAN 275 CLINICS LOCATED IN UTAH AND IDAHO. IN ADDITION TO THE 136,000 INPATIENT ADMISSIONS, 464,000 EMERGENCY ROOM VISITS AND 2.56 MILLION CLINIC VISITS, HEALTH SERVICES PROVIDED MORE THAN $114.7 MILLION IN CHARITY CARE (AT COST) THROUGH 255,974 CASES. FOR A MORE DETAILED EXPLANATION OF THE ORGANIZATION'S PROGRAM SERVICE ACCOMPLISHMENTS IN 2011, SEE SCHEDULE O.
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet$ 3,603,188,569
Form 990 (2011)
Form 990 (2011)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment.....................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors? Click to see attachment........
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part IClick to see attachment..........
3
Yes
 
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities? If “Yes,” complete Schedule C,
Part IIClick to see attachment.........................
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C, Part IIIClick to see attachment........................
5
 
No
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part IClick to see attachment....................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas or historic structures? If “Yes,” complete Schedule D, Part IIClick to see attachment...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III Click to see attachment....................
8
 
No
9
Did the organization report an amount in Part X, line 21; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,”
complete Schedule D, Part IVClick to see attachment...................
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part VClick to see attachment
10
Yes
 
11
If the organization’s answer to any of the following questions is ‘Yes,’ then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable:
a
Did the organization report an amount for land, buildings, and equipment in Part X, line10? If “Yes,” complete Schedule D, Part VI.Click to see attachment
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VII.Click to see attachment
11b
 
No
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.Click to see attachment
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX.Click to see attachment
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part X.Click to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part X.Click to see attachment
11f
 
No
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI, XII, and XIII Click to see attachment
12a
Yes
 
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered ‘No’ to line 12a, then completing Schedule D, Parts XI, XII, and XIII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Part I......... Click to see attachment
14b
Yes
 
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the U.S.? If “Yes,” complete Schedule F, Part II.. Click to see attachment
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the U.S.? If “Yes,” complete Schedule F, Part III.. Click to see attachment
16
 
No
17
Did the organization report a total of more than $15,000, of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II..........
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospitals? If “Yes,” complete Schedule H..... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statement to this return? Note. All Form 990 filers that operated one or more hospitals must attach audited financial statements. Click to see list of attachments
20b
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II.. Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III..... Click to see attachment
22
 
No
23
Did the organization answer “Yes” to Part VII, Section A, questions 3, 4, or 5, about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J................ Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer questions 24b–24d and complete Schedule K. If “No,” go to line 25................ Click to see attachment
24a
Yes
 
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
No
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?......................
24c
 
No
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
No
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I...... Click to see attachment
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I................ Click to see attachment
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highly compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II......................... Click to see attachment
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III......... Click to see attachment
27
 
No
28
Was the organization a party to a business transaction with one of the following parties? (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ......................... Click to see attachment
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV................... Click to see attachment
28b
Yes
 
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or owner? If “Yes,” complete Schedule L, Part IV.. Click to see attachment
28c
Yes
 
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule MClick to see attachment
29
Yes
 
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M............ Click to see attachment
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II.......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Parts II, III, IV, and V, line 1..................... Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2........... Click to see attachment
36
Yes
 
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VIClick to see attachment
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11 and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2011)
Form 990 (2011)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V .........
Yes
No
1a
Enter the number reported in Box 3 of Form 1096. Enter -0- if not applicable. .......
1a
2,693
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable.
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and Tax Statements filed for the calendar year ending with or within the year covered by this return .....................
2a
36,230
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?

Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file. (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?.............................
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account or securities account)?.......................
4a
Yes
 
b
If "Yes," enter the name of the foreign country: MediumBulletBR , CJ , EG , GR , IN , ID , JA , SI , KS
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes” to line 5a or 5b, did the organization file Form 8886-T? ........
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible?..........
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?..........................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?...................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?...............
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?................
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?.........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them) ........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year.
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note. All 501(c)(29) organizations must list in Schedule O each state in which they are licensed to issue qualified health plans, the amount of reserves required by each state, and the amount of reserves the organization allocated to each state.
13a
 
 
b
Enter the aggregate amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans.
13b
 
c
Enter the aggregate amount of reserves on hand.
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
 
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2011)
Form 990 (2011)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI .........
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year
If the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
1a
19
b
Enter the number of voting members included in line 1a, above, who are independent .................
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
Yes
 
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed?
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? .................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ............
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ..........
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O .....
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal
Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
Yes
 
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes? ....
10b
Yes
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form?
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review the Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done ....................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
Yes
 
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
Yes
 
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes," to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
Yes
 
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization: MediumBullet
GREGORY M JOHNSON
36 SOUTH STATE SUITE 2200
SLC,UT84111
(801) 442-3491
Form 990 (2011)
Form 990 (2011)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII .........
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation, and current key employees. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organizations compensated any current or former officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) BETH V COLE
TRUSTEE
 2.0 X           964 0 0
(2) BRUCE T REESE
TRUSTEE
 2.0 X           2,177 0 0
(3) CHARLES W SORENSON JR MD
TRUSTEE/PRESIDENT/CEO
 50.0 X   X       1,225,110 0 971,371
(4) DOUGLAS C BLACK
TRUSTEE/VICE CHAIR/SECRETARY
 5.0 X           1,617 0 0
(5) F ANN MILLNER
TRUSTEE
 2.0 X           624 0 0
(6) JANE CARLILE
TRUSTEE
 2.0 X           1,429 0 0
(7) KAREN W FAIRBANKS
TRUSTEE
 2.0 X           1,710 0 0
(8) KEM C GARDNER
TRUSTEE/CHAIR
 5.0 X           1,066 569 0
(9) M ELIZABETH HAMMOND MD
TRUSTEE
 2.0 X           388 0 0
(10) MERRILL GAPPMAYER
TRUSTEE
 2.0 X           1,284 0 0
(11) RANDY HORIUCHI
TRUSTEE
 2.0 X           388 0 0
(12) REBECCA CHAVEZ-HOUCK
TRUSTEE
 2.0 X           1,142 0 0
(13) SPENCER F ECCLES
TRUSTEE
 2.0 X           0 0 0
(14) TERESA BECK
TRUSTEE
 5.0 X           388 0 0
(15) THOMAS B MORGAN
TRUSTEE
 2.0 X           1,080 2,392 0
(16) A SCOTT ANDERSON
TRUSTEE
 2.0 X           0 0 0
(17) ARNOLD MILSTEIN MD MPH
TRUSTEE
 2.0 X           0 0 0
Form 990 (2011)
Form 990 (2011)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title 		(B)
Average hours per week (describe hours for related organizations in Schedule O) 		(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee) 		(D)
Reportable compensation from the organization (W- 2/1099-MISC) 		(E)
Reportable compensation from related organizations (W- 2/1099-MISC) 		(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) KAREN HALE
TRUSTEE
 2.0 X           732 0 0
(19) S NEAL BERUBE
TRUSTEE
 2.0 X           338 0 0
(20) ALBERT R ZIMMERLI
SENIOR VP/CFO/TREASURER
 50.0     X       946,720 0 831,425
(21) BRENT C JAMES MD
VICE PRESIDENT
 50.0     X       422,173 0 325,808
(22) BRENT E WALLACE MD
VICE PRESIDENT/MEDICAL DIR
 50.0     X       565,190 0 516,280
(23) BRENT T JOHNSON
VICE PRESIDENT
 50.0     X       346,695 0 251,561
(24) BRUCE H JENSEN
VICE PRESIDENT
 50.0     X       413,793 0 315,299
(25) CAVELL ALEXANDER
VICE PRESIDENT
 50.0     X       264,272 0 101,728
(26) CHRIS M COONS
VICE PRESIDENT
 50.0     X       608,670 0 386,656
(27) D R GARDNER
VICE PRESIDENT
 50.0     X       334,222 0 203,629
(28) DANIEL L ZUHLKE
VICE PRESIDENT
 50.0     X       460,289 0 320,575
(29) DAVID CLARK
VICE PRESIDENT
 50.0     X       474,276 0 314,148
(30) DOUGLAS J HAMMER
VP/GENERAL COUNSEL
 50.0     X       486,311 0 260,297
(31) GREGORY M JOHNSON
VICE PRESIDENT
 50.0     X       366,910 0 183,611
(32) GREGORY P POULSEN
SENIOR VICE PRESIDENT
 50.0     X       592,497 0 473,116
(33) JACQUE MILLARD
VICE PRESIDENT
 50.0     X       308,485 0 151,423
(34) JOHN C PINGREE JR
VICE PRESIDENT
 50.0     X       152,343 0 13,010
(35) JOSEPH R HORTON
SENIOR VICE PRESIDENT/SEC
 50.0     X       3,342,825 0 408,059
(36) LARRY D HANCOCK
VICE PRESIDENT
 50.0     X       651,518 0 433,044
(37) MARC PROBST
VICE PRESIDENT/CIO
 50.0     X       540,029 0 361,096
(38) NANCY A NOWAK
VICE PRESIDENT
 50.0     X       1,042,262 0 207,465
(39) ROBERT W ALLEN
VICE PRESIDENT
 50.0     X       349,719 0 179,413
(40) SUZANNE DRAPER
VICE PRESIDENT
 50.0     X       254,926 0 117,551
(41) TIMOTHY T PEHRSON
VICE PRESIDENT
 50.0     X       517,785 0 277,719
(42) TODD CRAGHEAD
VICE PRESIDENT
 50.0     X       248,197 0 89,938
(43) LINDA C LECKMAN MD
VICE PRESIDENT
 50.0     X       593,226 0 471,658
(44) GEORGE HAMILTON
VICE PRESIDENT
 50.0     X       312,797 0 107,866
(45) KIMBERLY HENRICHSEN
VICE PRESIDENT
 50.0     X       306,438 0 121,127
(46) MIKELLE MOORE
VICE PRESIDENT
 50.0     X       325,560 0 124,049
(47) HOWARD RICHTER MD
MD-SURGERY/OTHOPEDIC
 50.0         X   1,261,987 0 124,027
(48) ERIC HOOLEY MD
MD-SURGERY/ORTHOPEDIC
 50.0         X   1,243,503 0 139,026
(49) WAYNE MORTENSEN MD
MD-SURGERY/ORTHOPEDIC
 50.0         X   1,210,016 0 151,931
(50) STEVEN CARABINE MD
MD-SURGERY/GENERAL
 50.0         X   1,188,796 0 139,783
(51) JEFFREY HARRISON MD
MD-SURGERY/ORTHOPEDIC
 50.0         X   1,170,371 0 134,823
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 22,543,238 2,961 9,208,512
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet2,334
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual .............
3
 
No
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person .....
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address 		(B)
Description of services 		(C)
Compensation
UTAH EMERGENCY PHYSICIANS PC
PO BOX 571117
MURRAY,UT84157 		MEDICAL 33,436,721
ASSOCIATED REGIONAL AND UNIVERSITY
500 CHIPETA WAY
SALT LAKE CITY,UT84108 		MEDICAL 15,998,346
SOUTHWEST EMERGENCY PHYSICIANS LC
PO BOX 910053
ST GEORGE,UT84791 		MEDICAL 8,373,634
MICROSOFT LICENSING GP
PO BOX 844510
DALLAS,TX75284 		COMPUTER SUPPORT 6,462,618
NEUROSURGICAL ASSOCIATES LLC
5171 S COTTONWOOD ST STE 950
MURRAY,UT84107 		MEDICAL 3,978,994
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet229
Form 990 (2011)
Form 990 (2011)
Page 9
Part VIII
Statement of Revenue
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,338,000
e Government grants (contributions)1e 7,725,367
f All other contributions, gifts, grants, and
similar amounts not included above1f 		23,637,725
g Noncash contributions included in lines 1a-1f:$ 25,183
h Total. Add lines 1a-1f.......MediumBullet 32,701,092
Program Service Revenue Business Code
2a PATIENT SERVICE REVENUE 621,110 3,403,771,888 3,403,771,888    
b PHARMACY SALES 446,110 71,468,066 43,639,883 27,828,183  
c LABORATORY REVENUE 621,500 485,875,047 475,915,355 9,959,692  
d RENTAL REVENUE (RELATED) 531,120 9,395,312 9,395,312    
e LAUNDRY 812,300 6,970,601 5,208,333 1,762,268  
f All other program service revenue . 6,189,109 5,618,563 570,546  
g Total. Add lines 2a–2f........MediumBullet 3,983,670,023
Other Revenue 3 Investment income (including dividends, interest
and other similar amounts).....MediumBullet 50,408,769   -3,440,113 53,848,882
4 Income from investment of tax-exempt bond proceeds..MediumBullet 131,883     131,883
5 Royalties............MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 6,491,762  
b Less: rental expenses 5,814,512  
c Rental income or (loss) 677,250  
d Net rental income or (loss).......MediumBullet 677,250   -580,390 1,257,640
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 6,722,134,782 3,540,704
b Less: cost or other basis and sales expenses 6,666,859,671 5,293,407
c Gain or (loss) 55,275,111 -1,752,703
d Net gain or (loss)..........MediumBullet 53,522,408   -3,755 53,526,163
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a CAFETERIA 722,210 15,397,249 15,397,249    
b GIFT SHOP / RETAIL 453,220 4,948,721     4,948,721
c OTHER RELATED REVENUE 624,100 7,014,002 7,014,002    
d All other revenue ....        
e Total. Add lines 11a–11d ......MediumBullet 27,359,972
12 Total revenue. See Instructions....MediumBullet 4,148,471,397 3,965,960,585 36,096,431 113,713,289
Form 990 (2011)
Form 990 (2011)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A) but are not required to complete columns (B), (C), and (D).
Check if Schedule O contains a response to any question in this Part IX. .........
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII. 		(A)
Total expenses 		(B)
Program service expenses 		(C)
Management and general expenses 		(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 14,449,738 14,449,738
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 1,500 1,500
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 24,975,412   24,975,412  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 1,562,827,323 1,523,483,741 38,161,212 1,182,370
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 67,188,893 67,188,893    
9 Other employee benefits ....... 144,650,998 137,589,277 7,061,329 392
10 Payroll taxes ........... 105,995,718 102,440,093 3,465,076 90,549
11 Fees for services (non-employees):        
a Management ...... 0      
b Legal ......... 12,026,245 5,375,569 6,650,676  
c Accounting ........... 699,947 82,288 617,659  
d Lobbying ........... 20,156   20,156  
e Professional fundraising. See Part IV, line 17.. 0  
f Investment management fees ...... 8,413,467 8,413,467    
g Other .......... 254,692,298 243,637,247 10,990,783 64,268
12 Advertising and promotion .... 11,557,351 4,735,140 6,821,148 1,063
13 Office expenses ....... 20,699,445 20,343,308 310,267 45,870
14 Information technology ...... 0      
15 Royalties .. 0      
16 Occupancy ........... 111,921,589 106,419,843 5,462,747 38,999
17 Travel ............ 3,168,122 2,978,542 186,990 2,590
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 9,957,483 8,570,274 1,364,126 23,083
20 Interest ........... 48,749,647 48,749,647    
21 Payments to affiliates ....... 0      
22 Depreciation, depletion, and amortization ..... 213,469,772 211,028,874 2,426,079 14,819
23 Insurance .............. 9,898,774 9,898,774    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24f. If line 24f amount exceeds 10% of line 25, column (A) amount, list line 24f expenses on Schedule O.)
a MEDICAL SUPPLIES 659,582,968 659,476,142 105,888 938
b BAD DEBT 193,024,287 192,991,849 32,438  
c NON-MEDICAL SUPPLIES 100,355,400 96,913,128 2,900,313 541,959
d ALLOCATION-INDIRECT EXPENSES   103,217,413 -103,217,413  
e
f All other expenses 42,227,212 35,203,822 6,805,869 217,521
25 Total functional expenses. Add lines 1 through 24f 3,620,553,745 3,603,188,569 15,140,755 2,224,421
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720).        
Form 990 (2011)
Form 990 (2011)
Page 11
Part X Balance Sheet
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash—non-interest-bearing .......... 178,885 1 172,206
2 Savings and temporary cash investments ....... 270,072,802 2 185,411,781
3 Pledges and grants receivable, net ......... 2,985,200 3 3,808,420
4 Accounts receivable, net ......... 437,853,162 4 490,360,411
5 Receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L .......... 0 5 0
6 Receivables from other disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B). Complete Part II of
Schedule L .......... 0 6 0
7 Notes and loans receivable, net ............. 2,018,010 7 1,919,654
8 Inventories for sale or use .............. 89,719,892 8 92,094,752
9 Prepaid expenses and deferred charges ............ 20,607,661 9 23,056,234
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 3,613,870,659
b Less: accumulated depreciation. ..... 10b 1,616,724,011 2,030,535,947 10c 1,997,146,648
11 Investments—publicly traded securities .......... 2,451,874,107 11 2,528,532,754
12 Investments—other securities. See Part IV, line 11 ...... 81,275,841 12 167,889,394
13 Investments—program-related. See Part IV, line 11 .. 13,887,771 13 19,896,422
14 Intangible assets ......... 404,073 14 273,742
15 Other assets. See Part IV, line 11 ........... 142,403,947 15 131,645,227
16 Total assets. Add lines 1 through 15 (must equal line 34)... 5,543,817,298 16 5,642,207,645
Liabilities 17 Accounts payable and accrued expenses . 381,090,766 17 433,141,770
18 Grants payable .......... 0 18 0
19 Deferred revenue .......... 1,841,529 19 2,631,194
20 Tax-exempt bond liabilities .......... 1,319,593,936 20 1,306,533,753
21 Escrow or custodial account liability. Complete Part IV of Schedule D.. 0 21 0
22 Payables to current and former officers, directors, trustees, key
employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L.......... 0 22 0
23 Secured mortgages and notes payable to unrelated third parties .. 26,516,693 23 23,682,512
24 Unsecured notes and loans payable to unrelated third parties .... 0 24 0
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D..... 715,095,489 25 768,195,867
26 Total liabilities. Add lines 17 through 25..... 2,444,138,413 26 2,534,185,096
Net Assets or Fund Balance Organizations that follow SFAS 117, check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets ..... 3,097,842,915 27 3,105,008,029
28 Temporarily restricted net assets ..... 1,835,970 28 3,014,520
29 Permanently restricted net assets ..... 0 29 0
Organizations that do not follow SFAS 117, check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds .....   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ..... 3,099,678,885 33 3,108,022,549
34 Total liabilities and net assets/fund balances ..... 5,543,817,298 34 5,642,207,645
Form 990 (2011)
Form 990 (2011)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI .........
1
Total revenue (must equal Part VIII, column (A), line 12) ...
1
4,148,471,397
2
Total expenses (must equal Part IX, column (A), line 25) ....
2
3,620,553,745
3
Revenue less expenses. Subtract line 2 from line 1 ...
3
527,917,652
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
3,099,678,885
5
Other changes in net assets or fund balances (explain in Schedule O) ...
5
-519,573,988
6
Net assets or fund balances at end of year. Combine lines 3, 4, and 5 (must equal Part X, line 33, column (B)) ....
6
3,108,022,549
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII .........
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?....
2a
 
No
b
Were the organization’s financial statements audited by an independent accountant?........
2b
Yes
 
c
If “Yes,” to 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant? If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O. ...........................
2c
Yes
 
d
If “Yes” to line 2a or 2b, check a box below to indicate whether the financial statements for the year were issued on a separate basis, consolidated basis, or both:
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133? ................
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits. ..
3b
Yes
 
Form 990 (2011)
Additional Data


Software ID:  
Software Version:  
Form 990, Special Condition Description:
Special Condition Description
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) a person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the the supported organization? ................
11g(i)
 
 
(ii) a family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) a 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
(i)
Name of supported organization 		(ii)
EIN 		(iii)
Type of organization (described on lines 1- 9 above or IRC section (see instructions)) 		(iv)
Is the organization in col. (i) listed in your governing document? 		(v)
Did you notify the organization in col. (i) of your support? 		(vi)
Is the organization in col. (i) organized in the U.S.? 		(vii)
Amount of support?
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 2
Part II
Support Schedule for Organizations Described in IRC 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3..            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public Support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. (Explain in Part IV.) Do not include gain or loss from the sale of capital assets..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 3
Part III
Support Schedule for Organizations Described in IRC 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year(or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public Support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) (a) 2007 (b) 2008 (c) 2009 (d) 2010 (e) 2011 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)            
13 Total support (Add lines 9, 10c, 11 and 12.).            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2011
Schedule A (Form 990 or 990-EZ) 2011
Page 4
Part IV
Supplemental Information. Supplemental Information. Complete this part to provide the explanation required by Part II, line 10; Part II, line 17a or 17b; or Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2011
Name of organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An Organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2, of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2, of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 2
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
IHC HEALTH SERVICES INC
  		Employer identification number

94-2854057
Part I
Contributors (see Instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
(a)
No.		 (b)
Name, address, and ZIP + 4		 (c)
Total contributions		 (d)
Type of contribution
 
 
 

     
 
   

$  




(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 3
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
IHC HEALTH SERVICES INC
  		Employer identification number

94-2854057
Part II
Noncash Property (see Instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
(a) No.
from
Part I		 (b)
Description of noncash property given		 (c)
FMV (or estimate)
(see instructions). 		(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Page 4
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)
Name of organization
IHC HEALTH SERVICES INC
  		Employer identification number

94-2854057
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet $  
Use duplicate copies of Part III if additional space is needed
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I		 (b)
Purpose of gift		 (c)
Use of gift		 (d)
Description of how gift is held
 
(e)
Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2011)

Additional Data


Software ID:  
Software Version:  
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.
SchCMd Bullet Attach to Form 990 or Form 990-EZ. SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)) Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$ 5,975
3
Volunteer hours ........................................
0

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$ 0
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$ 0
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c) except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Privacy Act and Paperwork Reduction Act Notice, see the instructions for Form 990.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2011

Schedule C (Form 990 or 990-EZ) 2011
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check expenses, and share of excess lobbying expenditures).
B Check
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.) 		(a) Filing
organization's
totals 		(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) ....... 20,156 20,156
c Total lobbying expenditures (add lines 1a and 1b) ................... 20,156 20,156
d Other exempt purpose expenditures ........................ 3,620,533,589 4,818,173,702
e Total exempt purpose expenditures (add lines 1c and 1d) ............... 3,620,553,745 4,818,193,858
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		 1,000,000 1,000,000
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) ................. 250,000 250,000
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in) 		(a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) Total
             
2a Lobbying non-taxable amount 1,000,000 1,000,000 1,000,000 1,000,000 4,000,000
             
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		        6,000,000
             
c Total lobbying expenditures 168,050 34,278 18,844 20,156 241,328
             
d Grassroots nontaxable amount 250,000 250,000 250,000 250,000 1,000,000
             
e Grassroots ceiling amount
(150% of line 2d, column (e))		         1,500,000
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2011


Schedule C (Form 990 or 990-EZ) 2011
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
Yes
No
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
 
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
 
c
Media advertisements? ....................................
 
 
 
d
Mailings to members, legislators, or the public? .........................
 
 
 
e
Publications, or published or broadcast statements? .......................
 
 
 
f
Grants to other organizations for lobbying purposes? .......................
 
 
 
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
 
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
 
 
i
Other activities? ..........................
 
 
 
j
Total. Add lines 1c through 1i ...............................
 
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
 
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2 are answered “No” OR (b) Part III-A, line 3 is answered “Yes”.
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ...........................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, Part II-A; line 5; and Part ll-B, line 1.
Also, complete this part for any additional information.
Identifier Return Reference Explanation
AFFILIATED GROUP MEMBERS FORM 990, SCHEDULE C, PART II-A THE FOLLOWING ORGANIZATIONS WERE PART OF THE AFFILIATED GROUP AS DEFINED IN THE INSTRUCTIONS FOR PURPOSES OF COMPLETING SCHEDULE C: IHC HEALTH SERVICES, INC 36 SOUTH STATE, SUITE 2200 SALT LAKE CITY, UTAH 84111 EIN: 94-2854057 EXEMPT PURPOSE EXPENDITURES: $3,620,553,745 501(H) ELECTION: YES INTERMOUNTAIN HEALTH CARE, INC 36 SOUTH STATE, SUITE 2200 SALT LAKE CITY, UTAH 84111 EIN: 87-0269232 EXEMPT PURPOSE EXPENDITURES: $1,312,064 501(H) ELECTION: NO IHC MANAGEMENT, INC 36 SOUTH STATE, SUITE 2200 SALT LAKE CITY, UTAH 84111 EIN: 94-2860622 EXEMPT PURPOSE EXPENDITURES: NONE 501(H) ELECTION: NO IHC PROFESSIONAL SERVICES, INC. 36 SOUTH STATE, SUITE 2200 SALT LAKE CITY, UTAH 84111 EIN: 94-2886596 EXEMPT PURPOSE EXPENDITURES: NONE 501(H) ELECTION: NO INTERMOUNTAIN HEALTHCARE FOUNDATION, INC 36 SOUTH STATE, SUITE 2200 SALT LAKE CITY, UTAH 84111 EIN: 94-2853320 EXEMPT PURPOSE EXPENDITURES: $4,496,858 501(H) ELECTION: NO SELECTHEALTH, INC. 5381 GREEN STREET MURRAY, UTAH 84123 EIN: 87-0409820 EXEMPT PURPOSE EXPENDITURES: $1,183,673,696 501(H) ELECTION: NO INTERMOUNTAIN HEALTH CARE,INC. RETIREE WELFARE BENEFIT TRUST 36 SOUTH STATE, SUITE 2200 SALT LAKE CITY, UTAH 84111 EIN: 74-2675605 EXEMPT PURPOSE EXPENDITURES: $8,157,495 501(H) ELECTION: NO
POLITICAL CAMPAIGN ACTIVITIES FORM 990, SCHEDULE C, PART I-A, LINE 2 DURING 2011, THE FILING ORGANIZATION INADVERTENTLY REIMBURSED PHYSICIANS FOR CONTRIBUTIONS TO A POLITICAL ACTION COMMITTEE THAT WERE INCLUDED IN THE PHYSICIANS' ANNUAL DUES TO THE UTAH MEDICAL ASSOCIATION.
POLITICAL ACTIVITY CORRECTION FORM 990, SCHEDULE C, PART I-B, LINE 4B BY POLICY, HEALTH SERVICES' EMPLOYEES ARE EXPECTED TO REFRAIN FROM ENGAGING IN ACTIVITY THAT MAY JEOPARDIZE THE TAX-EXEMPT STATUS OF THE ORGANIZATION, INCLUDING POLITICAL ACTIVITIES. UPON DISCOVERY OF THE POLITICAL ACTION COMMITTEE PAYMENTS, EDUCATIONAL MATERIAL WAS FORWARDED TO APPROPRIATE PERSONNEL RE-EMPHASIZING THAT SUCH CONTRIBUTIONS ARE PROHIBITED. THE REIMBURSEMENT OF PHYSICIAN DUES HAS ALSO BEEN CENTRALIZED UNDER ACCOUNTS PAYABLE TO PREVENT REOCCURRENCES.
Schedule C (Form 990 or 990EZ) 2011

Additional Data


Software ID:  
Software Version:  

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .......    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) ...    
4 Aggregate value at end of year .......    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting and enforcing conservation easements during the year SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section
170(h)(4)(B)(i) and 170(h)(4)(B)(ii)? ....................................
9
In Part XIV, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of
art, historical treasures, or other similar assets held for public exhibition, education or research in furtherance of public service,
provide, in Part XIV, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art,
historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service,
provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958), relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 52283D
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s accession and other records, check any of the following that are a significant use of its collection
items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIV.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIV and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIV.
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current Year (b)Prior Year (c)Two Years Back (d)Three Years Back (e)Four Years Back
1a Beginning of year balance .... 101,250,728 52,342,113 59,160,431 66,273,867
b Contributions ........ 9,298,218 62,579,130 10,677,665 24,863,264
c Net investment earnings, gains, and losses ... 757,340 1,441,018 10,327,590 -3,603,820
d Grants or scholarships ..... 28,378 1,302,467    
e Other expenditures for facilities
and programs ........ 		14,095,897 13,809,066 27,823,573 28,372,880
f Administrative expenses .... 4,502      
g End of year balance ...... 97,177,509 101,250,728 52,342,113 59,160,431
2
Provide the estimated percentage of the year end balance (line 1g) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet22.488 %
c
Temporarily restricted endowment SchDMd Bullet77.512 %
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
Yes
 
(ii) related organizations ........................
3a(ii)
Yes
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
Yes
 
4
Describe in Part XIV the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land ................. 35,292,419 229,644,391 264,936,810
b Buildings ................ 38,599,249 1,478,094,739 586,022,720 930,671,268
c Leasehold improvements ............ 1,524,035 53,635,467 22,560,089 32,599,413
d Equipment ................ 444,026 1,642,002,558 1,008,141,203 634,305,381
e Other ................. 493,970 134,139,806   134,633,776
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 1,997,146,648
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)		 (b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives    
(2)Closely-held equity interests    
Other








Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet  
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of Liability (b) Book value
Federal Income Taxes 0
PAYABLE TO THIRD PARTY PAYORS 83,092,524
MINORITY INT IN JT VENTURES 2,909,968
ACCRUED PENSION OBLIGATION 324,070,340
457 PLAN LIABILITY 31,724,287
ASSET RETIREMENT OBLIGATION 4,263,263
INTEREST RATE SWAP LIABILITIES 69,496,761
OTHER LONG TERM LIABILITIES 198,264,634
INVESTMENT PAYABLE 54,374,090

Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 768,195,867
2. Fin 48 (ASC 740) Footnote. In Part XIV, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC740).
Schedule D (Form 990) 2011

Schedule D (Form 990) 2011
Page 4
Part XI Reconciliation of Change in Net Assets from Form 990 to Financial Statements
1 Total revenue (Form 990, Part VIII, column (A), line 12) .................... 1 4,148,471,397
2 Total expenses (Form 990, Part IX, column (A), line 25) ..................... 2 3,620,553,745
3 Excess or (deficit) for the year. Subtract line 2 from line 1 ............. 3 527,917,652
4 Net unrealized gains (losses) on investments .......................... 4 -261,051,667
5 Donated services and use of facilities ............................. 5  
6 Investment expenses ................................... 6  
7 Prior period adjustments .................................. 7  
8 Other (Describe in Part XIV.) ................................. 8 -260,392,850
9 Total adjustments (net). Add lines 4 through 8 ......................... 9 -521,444,517
10 Excess or (deficit) for the year per financial statements. Combine lines 3 and 9 ......... 10 6,473,135
Part XII Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1 4,040,414,988
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a -105,926,322
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIV.) ............ 2d -1,025,248
e Add lines 2a through 2d ..................... 2e -106,951,570
3 Subtract line 2e from line 1..................... 3 4,147,366,558
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIV.) ........... 4b 1,104,839
c Add lines 4a and 4b....................... 4c 1,104,839
5 Total Revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5 4,148,471,397
Part XIII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ............. 1 3,626,980,333
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIV.) ............ 2d 7,571,172
e Add lines 2a through 2d...................... 2e 7,571,172
3 Subtract line 2e from line 1..................... 3 3,619,409,161
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIV.) ............ 4b 1,144,584
c Add lines 4a and 4b....................... 4c 1,144,584
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5 3,620,553,745
Part XIV
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X; Part XI, line 8; Part XII, lines 2d and 4b; and Part XIII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
FIXED ASSET DETAIL FORM 990, SCHEDULE D, PART VI, LINE 1E AMOUNTS REFLECTED ON LINE 1E REPRESENT CONSTRUCTION IN PROGRESS.
RECONCILIATION OF THE CHANGE IN NET ASSETS Form 990, Schedule D, Part XI, Line 8 ($258,769,070) - Unrecognized change in funded status of postretirement benefit plans ($1,870,528) - Change in interest in affiliated foundations $515,658 - Change in other temporarily restricted net assets ($268,910) - BOOK/TAX DIFFERENCE ON THE SALE OF LLC INTEREST
Reconciliation of Revenue to the Audited Financial Statements Form 990, Schedule D, Part XII, Lines 2d & 4b Line 2d: ($8,413,467) - Investment expenses netted against investment income on audited financial statements. $7,388,219 Medical supplies rebates recorded as income on audited financial statements. Line 4b: ($1,752,703) - Loss on sale of fixed assets reported on financial statements as an expense. $7,149,101 - Net book/tax difference in reporting of contributions. ($3,957) - Reclassification of contributions. $1,258,000 - Contribution reported ON books as an intercompany transfer. ($5,814,512) - Rental expenses reported net of revenues on PART VIII, LINE 6 OF THE FORM 990. $268,910 - BOOK/TAX DIFFERENCE ON THE SALE OF LLC INTEREST.
Reconciliation of Expenses to the Audited Financial Statements Form 990, Schedule D, Part XIII, Line 2d & 4b Line 2d: $3,957 - Reclassification of contributions. $1,752,703 - Loss on sale of fixed assets REPORTED ON FINANCIAL STATEMENTS AS AN EXPENSE. $5,814,512 - Rental expenses reported net of revenues on PART VIII, LINE 6 OF THE FORM 990. Line 4B: $8,413,467 - Investment expenses netted against investment income on audited financial statements. ($7,388,219) Medical supplies rebates reported as revenue on audited financial statements. $119,336 - Reclassification of Grants.
Intended Use of Endowment Funds Form 990, Schedule D, Part V The reported funds are held by both supporting and publicly supported organizations for the benefit of Health Services. The intended uses of these funds include research, charity care, patient care and other similar purposes.
FASB ACCOUNTING STANDARDS CODIFICATION TOPIC 740 (FIN 48) FORM 990, SCHEDULE D, PART X, LINE 2 HEALTH SERVICES DID NOT REPORT A LIABILITY IN THE FOOTNOTES OF THE AUDITED FINANCIAL STATEMENTS FOR UNCERTAIN TAX POSITIONS UNDER ASC TOPIC 740 (FIN 48).
Schedule D (Form 990) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE F(Form 990)
Department of the Treasury
Internal Revenue Service
Statement of Activities Outside the United States
Right pointing arrow large image Complete if the organization answered "Yes" to Form 990,Part IV, line 14b, 15, or 16.Right pointing arrow large image Attach to Form 990. Right pointing arrow large image See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I
General Information on Activities Outside the United States. Complete if the organization answered
“Yes” to Form 990, Part IV, line 14b.
1
For grantmakers. Does the organization maintain records to substantiate the amount of its grants
and other assistance, the grantees' eligibility for the grants or assistance, and the selection criteria used
to award the grants or assistance? ..............................
2
For grantmakers. Describe in Part V the organization’s procedures for monitoring the use of its grants and other
assistance outside the United States.
3
Activites per Region. (Use Part V if additional space is needed.)
(a) Region (b) Number of offices in the region (c) Number of employees or agents in region or independent contractors (d) Activities conducted in region (by type) (e.g., fundraising, program services, investments, grants to recipients located in the region) (e) If activity listed in (d) is a program service, describe specific type of
service(s) in region		 (f) Total
expenditures for region/investments
in region
Central America and the Caribbean     Investments   332,522,530
East Asia and the Pacific     Investments   41,006,669
Europe (Including Iceland and Greenland)     Investments   149,226,694
Middle East and North Africa     Investments   7,587,390
North America     Investments   21,359,263
Russia and the Newly Independent States     Investments   4,684,771
South America     Investments   2,214,716
Sub-Saharan Africa     Investments   2,654,073
           
           
           
           
           
           
           
           
           
3a Sub-total .....     561,256,106
b Total from continuation sheets to Part I ...      
c Totals (add lines 3a and 3b)     561,256,106
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.Cat. No. 50082W Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 2
Part II
Grants and Other Assistance to Organizations or Entities Outside the United States. Complete if the organization answered "Yes" to Form 990,
Part IV, line 15, for any recipient who received more than $5,000. Check this box if no one recipient received more than $5,000 ........ MediumBullet
Use Part V if additional space is needed.
1 (a) Name of organization (b) IRS code section
and EIN (if applicable)		 (c) Region (d) Purpose of
grant 		(e) Amount of
cash grant 		(f) Manner of
cash
disbursement 		(g) Amount of
of non-cash
assistance 		(h) Description
of non-cash
assistance 		(i) Method of
valuation
(book, FMV,
appraisal, other)
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
             
2
Enter total number of recipient organizations listed above that are recognized as charities by the foreign country, recognized as tax-exempt by the IRS, or for which the grantee or counsel has provided a section 501(c)(3) equivalency letter .....MediumBullet
 
3
Enter total number of other organizations or entities ........................MediumBullet
 
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011Page 3
Part III
Grants and Other Assistance to Individuals Outside the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 16.
Use Part V if additional space is needed.
(a) Type of grant or assistance (b) Region (c) Number of recipients (d) Amount of
cash grant 		(e) Manner of cash
disbursement 		(f) Amount of
non-cash
assistance 		(g) Description
of non-cash
assistance 		(h) Method of
valuation
(book, FMV,
appraisal, other)
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
               
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 4
Part IV
Foreign Forms
1 Was the organization a U.S. transferor of property to a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 926 (see instructions for Form 926).................
2 Did the organization have an interest in a foreign trust during the tax year? If " Yes," the organization may be required to file Form 3520 and/or Form 3520-A. (see instructions for Forms 3520 and 3520-A)..........
3 Did the organization have an ownership interest in a foreign corporation during the tax year? If "Yes," the organization may be required to file Form 5471, Information Return of U.S. Persons with respect to Certain Foreign Corporations. (see instructions for Form 5471)..............................
4 Was the organization a direct or indirect shareholder of a passive foreign investment company or a qualified electing fund during the tax year? If "Yes," the organization may be required to file Form 8621, Return by a Shareholder of a Passive Foreign Investment Company or Qualified Electing Fund. (see instructions for Form 8621)
5 Did the organization have an ownership interest in a foreign partnership during the tax year? If "Yes," the organization may be required to file Form 8865, Return of U.S. Persons with respect to Certain Foreign Partnerships. (see instructions for Form 8865)....................................
6 Did the organization have any operations in or related to any boycotting countries during the tax year? If "Yes," the organization may be required to file Form 5713, International Boycott Report (see instructions for Form 5713)................................................
Schedule F (Form 990) 2011
Schedule F (Form 990) 2011
Page 5
Part V
Supplemental Information
Complete this part to provide the information required by Part I, line 2 (monitoring of funds); Part I, line 3, column (f) (accounting method; amounts of investments vs. expenditures per region); Part II, line 1 (accounting method); Part III (accounting method); and Part III, column (c) (estimated number of recipients), as applicable. Also complete this part to provide any additional information (see instructions).
Identifier ReturnReference Explanation
International Investments Form 990, Schedule F, Part I, Line 3 AS PART OF A FULLY DIVERSIFIED PORTFOLIO, HEALTH SERVICES INVESTS IN CERTAIN ALTERNATIVE INVESTMENTS THAT ARE HELD BY ADMINISTRATORS IN FOREIGN JURISDICTIONS. WHILE MOST OF THE INVESTMENTS ARE DOMESTIC, THE STRUCTURE OF THE INVESTMENT AND LOCATION OF THE ADMINISTRATOR REQUIRE DISCLOSURE ON SCHEDULE F. THESE ALTERNATIVE INVESTMENTS ACCOUNT FOR APPROXIMATELY 65% OF THE TOTAL INTERNATIONAL INVESTMENT VALUES (BY MARKET VALUE). THE REMAINING 35% REPRESENTS INTERNATIONAL INVESTMENTS IN EQUITIES AND BONDS IN SEPARATELY MANAGED ACCOUNTS. HEALTH SERVICES USES THESE INTERNATIONAL INVESTMENTS AS AN ADDITIONAL DIVERSIFICATION TOOL. THE INVESTMENTS ARE HELD IN SAFEKEEPING IN THE UNITED STATES BUT ARE REQUIRED TO BE REPORTED BASED UPON THE COUNTRY OF ISSUANCE.
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
     
Schedule F (Form 990) 2011
Additional Data


Software ID:  
Software Version:  



SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I
Charity Care and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a....
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) to determine eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
Yes
 
b
Did the organization use FPG to determine eligibility for providing discounted care? If "Yes," indicate which of the
following was the family income limit for eligibility for discounted care: ............
3b
Yes
 
c
If the organization did not use FPG to determine eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, to determine eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount?......
5b
Yes
 
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care?...............
5c
 
No
6a
Did the organization prepare a community benefit report during the tax year?...........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ...............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance
and Means-Tested Government Programs		 (a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) .. 		    114,749,660   114,749,660 3.350 %
b Medicaid (from Worksheet 3, column a) .....     464,274,664 467,055,387 -2,780,723  
c Costs of other means-tested government programs (from Worksheet 3, column b) .            
dTotal Financial Assistance and
Means-Tested Government Programs ..... 		    579,024,324 467,055,387 111,968,937 3.350 %
Other Benefits
e Community health improvement
services and community
benefit operations (from
(Worksheet 4) .... 		    1,647,146 11,950 1,635,196 0.050 %
f Health professions education
(from Worksheet 5) .. 		    26,794,824   26,794,824 0.780 %
g Subsidized health services
(from Worksheet 6) .. 		           
h Research (from Worksheet 7)     11,668,372   11,668,372 0.340 %
i Cash and in-kind contributions for community benefit (from Worksheet 8) ....     14,724,204   14,724,204 0.430 %
jTotal Other Benefits ...     54,834,546 11,950 54,822,596 1.600 %
kTotal. Add lines 7d and 7j. ..     633,858,870 467,067,337 166,791,533 4.950 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue 		(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing            
2 Economic development            
3 Community support            
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building     43,287   43,287  
7 Community health improvement advocacy            
8 Workforce development     8,088   8,088  
9 Other            
10 Total     51,375   51,375  
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense........
2
193,024,287
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy .....
3
96,512,143
4
Provide in Part VI the text of the footnote to the organization's financial statements that describes bad debt expense. In addition, describe the costing methodology used in determining the amounts reported on lines 2 and 3, and rationale for including a portion of bad debt amounts as community benefit.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
448,417,203
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
448,080,918
7
Subtract line 6 from line 5. This is the surplus or (shortfall)........
7
336,285
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
 
No
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

 

 
Part IV
Management Companies and Joint Ventures
(see instructions)
(a) Name of entity (b) Description of primary
activity of entity 		(c) Organization's
profit % or stock
ownership % 		(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership% 		(e) Physicians'
profit % or stock
ownership %
1McKay Dee Surgical
  		Outpatient Surgery 80.300 %   19.700 %
2
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest)
How many hospital facilities did the organization operate during the tax year?22
Name and address 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe)
1 INTERMOUNTAIN MEDICAL CENTER
5121 SOUTH COTTONWOOD STREET
MURRAY,UT84157 		X X   X   X X    
2 PRIMARY CHILDREN'S MEDICAL CENTER
100 NORTH MARIO CAPECCHI DRIVE
SALT LAKE CITY,UT84113 		X X X X   X X    
3 UTAH VALLEY REGIONAL MEDICAL CENTER
1034 NORTH 500 WEST
PROVO,UT84604 		X X   X   X X    
4 MCKAY-DEE HOSPITAL CENTER
4401 HARRISON BOULEVARD
OGDEN,UT84403 		X X   X   X X    
5 DIXIE REGIONAL MEDICAL CENTER
1380 EAST MEDICAL CENTER DRIVE
ST GEORGE,UT84790 		X X       X X    
6 LDS HOSPITAL
8TH AVENUE AND C STREET
SALT LAKE CITY,UT84143 		X X   X   X X    
7 LOGAN REGIONAL HOSPITAL
500 EAST 1400 NORTH
LOGAN,UT84341 		X X         X    
8 AMERICAN FORK HOSPITAL
170 NORTH 1100 EAST
AMERICAN FORK,UT84003 		X X         X    
9 ALTA VIEW HOSPITAL
9660 SOUTH 1300 EAST
SANDY,UT84094 		X X         X    
10 RIVERTON HOSPITAL
3741 WEST 12600 SOUTH
RIVERTON,UT84065 		X X       X X    
11 THE ORTHOPEDIC SPECIALTY HOSPITAL
5848 SOUTH FASHION BOULEVARD
MURRAY,UT84107 		X                
12 VALLEY VIEW MEDICAL CENTER
1303 NORTH MAIN STREET
CEDAR CITY,UT84720 		X X         X    
13 PARK CITY MEDICAL CENTER
900 ROUND VALLEY DRIVE
PARK CITY,UT84060 		X X         X    
14 CASSIA REGIONAL MEDICAL CENTER
1501 HILAND AVENUE
BURLEY,ID83318 		X X     X   X    
15 OREM COMMUNITY HOSPITAL
331 NORTH 400 WEST
OREM,UT84057 		X X         X    
16 SEVIER VALLEY MEDICAL CENTER
100 NORTH MAIN
RICHFIELD,UT84701 		X X         X    
17 HEBER VALLEY MEDICAL CENTER
1485 SOUTH HIGHWAY 40
HEBER CITY,UT84032 		X X     X   X    
18 BEAR RIVER VALLEY HOSPITAL
440 WEST 600 NORTH
TREMONTON,UT84337 		X X         X    
19 SANPETE VALLEY HOSPITAL
1100 SOUTH MEDICAL DRIVE
MOUNT PLEASANT,UT84647 		X X     X   X    
20 GARFIELD MEMORIAL HOSPITAL
200 NORTH 400 EAST
PANGUITCH,UT84759 		X X         X    
21 DELTA COMMUNITY MEDICAL CENTER
126 WHITE SAGE AVENUE
DELTA,UT84624 		X X     X   X    
22 FILLMORE COMMUNITY MEDICAL CENTER
674 SOUTH HIGHWAY 99
FILLMORE,UT84631 		X X     X   X    
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
INTERMOUNTAIN MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):1

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
PRIMARY CHILDREN'S MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):2

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
UTAH VALLEY REGIONAL MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):3

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
MCKAY-DEE HOSPITAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):4

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
DIXIE REGIONAL MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):5

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
LDS HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):6

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
LOGAN REGIONAL HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):7

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
AMERICAN FORK HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):8

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
ALTA VIEW HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):9

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
RIVERTON HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):10

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
THE ORTHOPEDIC SPECIALTY HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):11

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
VALLEY VIEW MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):12

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
PARK CITY MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):13

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
CASSIA REGIONAL MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):14

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
OREM COMMUNITY HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):15

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
SEVIER VALLEY MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):16

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
HEBER VALLEY MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):17

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
BEAR RIVER VALLEY HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):18

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
SANPETE VALLEY HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):19

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
GARFIELD MEMORIAL HOSPITAL
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):20

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
DELTA COMMUNITY MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):21

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices.

(Complete a separate Section B for each of the hospital facilities listed in Part V, Section A)
FILLMORE COMMUNITY MEDICAL CENTER
Name of Hospital Facility:  
Line Number of Hospital Facility (from Schedule H, Part V, Section A):22

Yes No
Community Health Needs Assessment (Lines 1 through 7 are optional for 2011)
1 During the tax year or any prior tax year, did the hospital facility conduct a community health needs assessment (“Needs Assessment”)? If “No,” skip to question 8. ..................... 1    
If “Yes,” indicate what the Needs Assessment describes (check all that apply):
a A definition of the community served by the hospital facility
b Demographics of the community
c Existing health care facilities and resources within the community that are available to respond to the health needs of the community
d How data was obtained
e The health needs of the community
f Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups
g The process for identifying and prioritizing community health needs and services to meet the community health needs
h The process for consulting with persons representing the community’s interests
i Information gaps that limit the hospital facility’s ability to assess the community’s health needs
j Other (describe in Part VI)
2 Indicate the tax year the hospital facility last conducted a Needs Assessment: 20  
3 In conducting its most recent Needs Assessment, did the hospital facility take into account input from persons who represent the community served by the hospital facility? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted. 3    
4 Was the hospital facility’s Needs Assessment conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI............................ 4    
5 Did the hospital facility make its Needs Assessment widely available to the public? ........... 5    
If “Yes,” indicate how the Needs Assessment was made widely available (check all that apply):
a Hospital facility’s website
b Available upon request from the hospital facility
c Other (describe in Part VI)
6 If the hospital facility addressed needs identified in its most recently conducted Needs Assessment, indicate how (check all that apply):
a Adoption of an implementation strategy to address the health needs of the hospital facility’s community
b Execution of the implementation strategy
c Participation in the development of a community-wide community benefit plan
d Participation in the execution of a community-wide community benefit plan
e Inclusion of a community benefit section in operational plans
f Adoption of a budget for provision of services that address the needs identified in the Needs Assessment
g Prioritization of health needs in the community
h Prioritization of services that the hospital facility will undertake to meet health needs in its community
i Other (describe in Part VI)
7 Did the hospital facility address all of the needs identified in its most recently conducted Needs Assessment? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs. .... 7    
Financial Assistance Policy
Did the hospital facility have in place during the tax year a written financial assistance policy that:
8 Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 8 Yes  
9 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 9 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 150.%
If "No," explain in Part VI the criteria the hospital facility used.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Yes No
10 Used FPG to determine eligibility for providing discounted care?................. 10 Yes  
If “Yes,” indicate the FPG family income limit for eligibility for discounted care: 500.%
If "No," explain in Part VI the criteria the hospital facility used.
11 Explained the basis for calculating amounts charged to patients?................. 11 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a Income level
b Asset level
c Medical indigency
d Insurance status
e Uninsured discount
f Medicaid/Medicare
g State regulation
h Other (describe in Part VI)
12 Explained the method for applying for financial assistance?................... 12 Yes  
13 Included measures to publicize the policy within the community served by the hospital facility?....... 13 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a The policy was posted on the hospital facility’s web site
b The policy was attached to all billing invoices
c The policy was posted in the hospital facility’s emergency rooms or waiting rooms
d The policy was posted in the hospital facility’s admissions offices
e The policy was provided, in writing, to patients upon admission to the hospital facility
f The policy was available upon request
g Other (describe in Part VI)
Billing and Collections
14 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 14   No
15 Check all of the following collection actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
16 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 16   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a Reporting to credit agency
b Lawsuits
c Liens on residences
d Body attachments
e Other similar actions (describe in Part VI)
17 Indicate which efforts the hospital facility made before initiating any of the actions checked in line 16 (check all that apply):
a Notified patients of the financial assistance policy upon admission
b Notified patients of the financial assistance policy prior to discharge
c Notified patients of the financial assistance policy in communications with the patients regarding the patients’ bills
d Documented its determination of whether patients were eligible for financial assistance under the hospital facility’s financial assistance policy
e Other (describe in Part VI)
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Policy Relating to Emergency Medical Care
Yes No
18 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 18 Yes  
If “No,” indicate why:
a The hospital facility did not provide care for any emergency medical conditions
b The hospital facility’s policy was not in writing
c The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Part VI)
d Other (describe in Part VI)
Individuals Eligible for Financial Assistance
19 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a The hospital facility used its lowest negotiated commercial insurance rate when calculating the maximum amounts that can be charged
b The hospital facility used the average of it's three lowest negotiated commercial insurance rates when calculating the maximum amounts that can be charged
c The hospital facility used the Medicare rates when calculating the maximum amounts that can be charged
d Other (describe in Part VI)
20 Did the hospital facility charge any of its patients who were eligible for assistance under the hospital facility’s financial assistance policy, and to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care?......... 20   No
If “Yes,” explain in Part VI.
21 Did the hospital facility charge any of its FAP-eligible patients an amount equal to the gross charge for any services provided to that patient?............................... 21   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?288
Name and address Type of Facility (describe)
1 SALT LAKE CLINIC
333 S 900 E
SALT LAKE CITY,UT84102 		CLINIC
2 MEMORIAL CLINIC
2000 S 900 E
SALT LAKE CITY,UT84105 		CLINIC
3 BOUNTIFUL CLINIC
390 N MAIN STREET
BOUNTIFUL,UT84010 		CLINIC
4 MCKAY DEE RHEUMATOLOGY CLINIC
4403 HARRISON BLVD STE 3650
OGDEN,UT84403 		CLINIC
5 AVENUES SPECIALTY CLINIC
324 10TH AVE STE 100
SALT LAKE CITY,UT84103 		CLINIC
6 ORTHOPEDIC SPECIALTY GROUP-TOSH
5848 S 300 E STE 120
MURRAY,UT84107 		CLINIC
7 UTAH HEART
5169 S COTTONWOOD STREET 520
MURRAY,UT84107 		CLINIC
8 CANYON VIEW ORTHOPEDICS & ASSOCIATES
1300 N 500 E STE 130
LOGAN,UT84341 		CLINIC
9 LAYTON CLINIC
2075 UNIVERSITY PARK BLVD
LAYTON,UT84041 		CLINIC
10 HEART RHYTHM SPECIALISTS
5169 COTTONWOOD ST STE 510
MURRAY,UT84107 		CLINIC
11 BUDGE CLINIC INTERNAL MEDICINE
1350 N 500 E
LOGAN,UT84341 		CLINIC
12 CALTONHARRISON ORTHOPEDIC CLINIC
4403 HARRISON BLVD STE 2400
OGDEN,UT84403 		CLINIC
13 ALTA VIEW SPECIALTY CLINIC
9450 S 1300 E
SANDY,UT84094 		CLINIC
14 SALT LAKE CLINIC RADIOLOGY
333 S 900 E
SALT LAKE CITY,UT84102 		CLINIC
15 SOUTHWEST CARDIOLOGY-ST GEORGE
1380 E MEDICAL CENTER DR STE 1500
ST GEORGE,UT84790 		CLINIC
16 BUDGE CLINIC SURGICAL SPECIALISTS
1350 N 500 E
LOGAN,UT84341 		CLINIC
17 TAYLORSVILLE CLINIC
3845 W 4700 S
TAYLORSVILLE,UT84129 		CLINIC
18 NORTH OGDEN CLINIC
2400 N WASHINGTON BLVD
NORTH OGDEN,UT84414 		CLINIC
19 BUDGE CLINIC OBSTETRICS & GYNECOLOGY
1400 N 500 E
LOGAN,UT84341 		CLINIC
20 SALT LAKE CLINIC LABORATORY
333 S 900 E
SALT LAKE CITY,UT84102 		CLINIC
21 UTAH VALLEY NEONATOLOGY
1034 N 500 W
PROVO,UT84604 		CLINIC
22 CENTRAL OREM CLINIC
505 W 400 N
OREM,UT84057 		CLINIC
23 INTERMOUTAIN OB & GYN SPECIALISTS
5063 S COTTONWOOD ST 120
MURRAY,UT84107 		CLINIC
24 BUDGE CLINIC PEDIATRICS
1350 N 500 E
LOGAN,UT84341 		CLINIC
25 SANDY CLINIC
9500 S 1300 E
SANDY,UT84094 		CLINIC
26 NORTHERN UTAH SURGEONS
4403 HARRISON BLVD STE 1635
OGDEN,UT84403 		CLINIC
27 BRYNER CLINIC
525 E 100 S STE 500
SALT LAKE CITY,UT84102 		CLINIC
28 MCKAY DEE CARDIOLOGY CLINIC
4403 HARRISON BLVD STE 3490
OGDEN,UT84403 		CLINIC
29 CARDIOVASCULAR & THORACIC SURGERY
1380 E MEDICAL CENTER DR STE 2600
ST GEORGE,UT84790 		CLINIC
30 LEGACY OBGYN
1159 E 200 N STE 250
AMERICAN FORK,UT84003 		CLINIC
31 TAYLORSVILLE INSTACARE
3845 W 4700 S
TAYLORSVILLE,UT84129 		CLINIC
32 INTERMOUNTAIN HEART & LUNG SURGICAL ASOC
5169 COTTONWOOD ST STE 600
MURRAY,UT84107 		CLINIC
33 RIM ROCK ORTHOPAEDICS
652 S MEDICAL CENTER DR STE 120
ST GEORGE,UT84790 		CLINIC
34 CEDAR CITY CLINIC
1303 N MAIN ST STE 3C
CEDAR CITY,UT84720 		CLINIC
35 INTERMOUNTAIN SURGICAL SPECIALISTS
5169 COTTONWOOD ST STE 410
MURRAY,UT84107 		CLINIC
36 SOUTHRIDGE CLINIC
3723 W 12600 S 270
RIVERTON,UT84065 		CLINIC
37 LOGAN INSTACARE
412 N 200 E
LOGAN,UT84321 		CLINIC
38 REDROCK PEDIATRICS
1380 E MEDICAL CENTER DR STE 3100
ST GEORGE,UT84790 		CLINIC
39 ORTHOPEDIC SPECIALTY GROUP-LDS CAMPUS
324 10TH AVE STE 100
SALT LAKE CITY,UT84103 		CLINIC
40 INTERMOUNTAIN UROLOGICAL INSTITUTE
5169 COTTONWOOD ST STE 420
MURRAY,UT84107 		CLINIC
41 UTAH VALLEY ORTHOPAEDICS - PROVO
1157 N 300 W STE 201
PROVO,UT84604 		CLINIC
42 SOUTHRIDGE PEDIATRICS
3723 W 12600 S STE 450
RIVERTON,UT84065 		CLINIC
43 SANDY INSTACARE
9493 S 700 E
SANDY,UT84070 		CLINIC
44 MEMORIAL INSTACARE
2000 S 900 E
SALT LAKE CITY,UT84105 		CLINIC
45 NORTH OGDEN INSTACARE
2400 N WASHINGTON BLVD
NORTH OGDEN,UT84414 		CLINIC
46 SOUTH OGDEN CLINIC
975 CHAMBERS ST
SOUTH OGDEN,UT84403 		CLINIC
47 HOLLADAY PEDIATRICS
2180 E 4500 S STE 210
SALT LAKE CITY,UT84117 		CLINIC
48 RIVER ROAD FAMILY PRACTICE
577 S RIVER RD
ST GEORGE,UT84790 		CLINIC
49 AM FORK INTERNAL MEDICINE & DERMATOLOGY
1159 E 200 N STE 150
AMERICAN FORK,UT84003 		CLINIC
50 HEREFORDSHIRE CLINIC
1915 W 5950 S
ROY,UT84067 		CLINIC
51 REDROCK SPINE & NEUROSURGERY CLINIC
652 S MEDICAL CENTER DR STE 115
ST GEORGE,UT84790 		CLINIC
52 MOUNTAIN VIEW PEDIATRICS
9720 S 1300 E STE 100
SANDY,UT84094 		CLINIC
53 MCKAY DEE NEONATOLOGY
4401 HARRISON BLVD
OGDEN,UT84403 		CLINIC
54 OGDEN CARDIOVASCULAR ASSOCIATES
4403 HARRISON BLVD STE 3835
OGDEN,UT84403 		CLINIC
55 MEDICIAL CENTER HOSPITALISTS
5121 COTTONWOOD STREET
MURRAY,UT84107 		CLINIC
56 MEDICAL CENTER RADIATION ONCOLOGY
5131 COTTONWOOD STREET
MURRAY,UT84107 		CLINIC
57 NORTHERN UTAH PEDIATRICS
4403 HARRISON BLVD STE 4875
OGDEN,UT84403 		CLINIC
58 WEST JORDAN INSTACARE
2655 W 9000 S
WEST JORDAN,UT84088 		CLINIC
59 WEST JORDAN CLINIC
2655 W 900 S
WEST JORDAN,UT84088 		CLINIC
60 NORTH OREM INSTACARE
1975 N STATE STREET
OREM,UT84057 		CLINIC
61 HOLLADAY CLINIC
6272 HIGHLAND DR
MURRAY,UT84121 		CLINIC
62 NORTH CANYON FAMILY PRACTICE
3200 N CANYON RD STE D
PROVO,UT84604 		CLINIC
63 UTAH VALLEY HEART & LUNG SURGICAL ASSOC
1134 N 500 W STE 100
PROVO,UT84604 		CLINIC
64 ZION ORTHOPAEDICS & SPORTS MEDICINE
652 S MEDICAL CENTER DR STE 400
ST GEORGE,UT84790 		CLINIC
65 BOUNTIFUL INSTACARE
390 N MAIN STREET
BOUNTIFUL,UT84010 		CLINIC
66 SOUTHRIDGE INSTACARE
3723 W 12600 S STE 150
RIVERTON,UT84065 		CLINIC
67 PARK CITY SPECIALTY
900 ROUND VALLEY DR STE 200
PARK CITY,UT84060 		CLINIC
68 UTAH VALLEY WOMENS CENTER
1034 N 500 W
PROVO,UT84604 		CLINIC
69 MCKAY DEE INTERNAL MEDICINE CLINIC
4403 HARRISON BLVD STE 3875
OGDEN,UT84403 		CLINIC
70 AMERICAN FORK SURGICAL ASSOCIATES
1159 E 200 N STE 350
AMERICAN FORK,UT84003 		CLINIC
71 RIVER ROAD INTERNAL MEDICINE
577 S RIVER ROAD
ST GEORGE,UT84790 		CLINIC
72 SOUTH SANDY CLINIC
955 E 11400 S
SANDY,UT84094 		CLINIC
73 MCKAY DEE HEART SERVICES CLINIC
4403 HARRISON BLVD STE 3450
OGDEN,UT84403 		CLINIC
74 MCKAY DEE HOSPITALISTS
4401 HARRISON BLVD
OGDEN,UT84403 		CLINIC
75 HILLCREST PEDIATRICS
5063 COTTONWOOD ST STE 160
MURRAY,UT84107 		CLINIC
76 HEREFORDSHIRE INSTACARE
1915 W 5950 S
ROY,UT84067 		CLINIC
77 WASATCH OBGYN
4403 HARRISON BLVD STE 4815
OGDEN,UT84403 		CLINIC
78 HEART OF UTAH
4403 HARRISON BLVD STE 3400
OGDEN,UT84403 		CLINIC
79 HOLLADAY INSTACARE
6272 HIGHLAND DR
MURRAY,UT84121 		CLINIC
80 INTERNAL MEDICINE ASSOCIATES
9844 S 1300 E STE 200
SANDY,UT84094 		CLINIC
81 MCKAY DEE ENT CLINIC
4403 HARRISON BLVD STE 2645
OGDEN,UT84403 		CLINIC
82 SOUTH JORDAN CLINIC
11444 S REDWOOD RD
SOUTH JORDAN,UT84095 		CLINIC
83 ORTHOPEDIC SPECIALTY GROUP - MEDICAL CTR
5169 COTTONWOOD ST STE 430
MURRAY,UT84107 		CLINIC
84 LOGAN CINIC
412 N 200 E
LOGAN,UT84321 		CLINIC
85 UTAH VALLEY PULMONARY CLINIC
1055 N 300 W STE 500
PROVO,UT84604 		CLINIC
86 MT PLEASANT CLINIC
1100 S MEDICAL DT
MT PLEASANT,UT84647 		CLINIC
87 LAYTON ORTHOPEDICS
2075 UNIVERSITY PARK BLVD
LAYTON,UT84041 		CLINIC
88 BEAR RIVER FAMILY MEDICINE
935 N 1000 W
TREMONTON,UT84337 		CLINIC
89 DIXIE HOSPITALISTS
1380 E MEDICAL CENTER DR
ST GEORGE,UT84790 		CLINIC
90 SANDY OBGYN
9600 S 1300 E STE 308
SANDY,UT84094 		CLINIC
91 MURRAY INSTACARE
196 E WINCHESTER ST
MURRAY,UT84107 		CLINIC
92 LAYTON INSTACARE
2075 UNIVERSITY PARK BLVD
LAYTON,UT84041 		CLINIC
93 ORTHOPEDIC SPECIALTY GROUP ALTA VIEW
9450 S 1300 E STE 120
SANDY,UT84094 		CLINIC
94 INTERMOUNTAIN WOMENS HEALTH SPECIALISTS
346 E 600 S
ST GEORGE,UT84770 		CLINIC
95 BUDGE CLINIC GI
1300 N 500 E STE 340
LOGAN,UT84341 		CLINIC
96 RIVER ROAD INSTACARE
577 S RIVER RD
ST GEORGE,UT84790 		CLINIC
97 DIXIE NEONATOLOGY
544 S 400 E
ST GEORGE,UT84770 		CLINIC
98 SOUTH CACHE VALLEY CLINIC
190 S HIGHWAY 165
PROVIDENCE,UT84332 		CLINIC
99 COTTONWOOD INTERNAL MEDICINE
5770 S 250 E STE 335
MURRAY,UT84107 		CLINIC
100 SOUTH OGDEN INSTACARE
975 CHAMBERS ST
SOUTH OGDEN,UT84403 		CLINIC
101 SEVIER VALLEY CLINIC
70 E 1000 N
RICHFIELD,UT84701 		CLINIC
102 SOUTHRIDGE OBGYN
3723 W 12600 S STE 360
RIVERTON,UT84065 		CLINIC
103 ORTHOPEDIC SPECIALTY GROUP RIVERTON
3723 W 12600 S STE 460
RIVERTON,UT84065 		CLINIC
104 MEDICAL TOWER FAMILY PRACTICE
5770 S 250 E STE 170
MURRAY,UT84107 		CLINIC
105 HURRICANE VALLEY CLINIC
75 N 2260 W
HURRICANE,UT84737 		CLINIC
106 COTTONWOOD FAMILY PRACTICE
5872 S 900 E STE 100
MURRAY,UT84121 		CLINIC
107 MCKAY DEE DERMATOLOGY & PLASTIC SURGERY
4403 HARRISON BLVD STE 4835
OGDEN,UT84403 		CLINIC
108 UTAH VALLEY HOSPITALISTS
1034 N 500 W
PROVO,UT84604 		CLINIC
109 UTAH VALLEY SPORTS MEDICINE
1157 N 300 W STE 201
PROVO,UT84604 		CLINIC
110 SUNSET FAMILY PRACTICE
1739 W SUNSET BLVD
ST GEORGE,UT84770 		CLINIC
111 PROVO INSTACARE
1134 N 500 W STE 102
PROVO,UT84604 		CLINIC
112 SARATOGA SPRINGS INSTACARE
354 W STATE RD 73
SARATOGA SPRINGS,UT84043 		CLINIC
113 NOYES SURGICAL ONCOLOGY
5169 COTTONWOOD ST STE 440
MURRAY,UT84107 		CLINIC
114 CACHE VALLEY HEART CLINIC
1300 N 500 E STE 320
LOGAN,UT84341 		CLINIC
115 SPRINGVILLE INSTACARE
762 W 400 S
SPRINGVILLE,UT84663 		CLINIC
116 UTAH HEART - LDSH
8TH AVE AND C STREET
SALT LAKE CITY,UT84143 		CLINIC
117 MCKAY DEE FOOT & ANKLE CLINIC
4403 HARRISON BLVD STE 2835
OGDEN,UT84403 		CLINIC
118 MCKAY DEE CRITICAL CARE
4401 HARRISON BLVD
OGDEN,UT84403 		CLINIC
119 TAYLORSVILLE KIDSCARE
3845 W 4700 S
TAYLORSVILLE,UT84129 		CLINIC
120 UTAH VALLEY PULMONARY - CRITICAL CARE
1055 N 300 W STE 500
PROVO,UT84604 		CLINIC
121 SARATOGA SPRINGS FAMILY PRACTICE
354 W STATE RD 73
SARATOGA SPRINGS,UT84043 		CLINIC
122 LDS HOSPITAL RADIATION ONCOLOGY
8TH AVE AND C STREET
SALT LAKE CITY,UT84143 		CLINIC
123 NORTH OREM CLINIC
1975 N STATE ST
OREM,UT84057 		CLINIC
124 SOUTHRIDGE KIDSCARE
3723 W 12600 S STE 150
RIVERTON,UT84065 		CLINIC
125 COTTONWOOD ENDOCRINE & DIABETES CENTER
5770 S 250 E STE 310
MURRAY,UT84107 		CLINIC
126 NORTH VALLEY PEDIATRICS
212 S 1100 E
AMERICAN FORK,UT84003 		CLINIC
127 SPRINGVILLE CLINIC
762 W 400 S
SPRINGVILLE,UT84663 		CLINIC
128 RICHFIELD FAMILY PRATICE
460 N MAIN ST
RICHFIELD,UT84701 		CLINIC
129 MCKAY DEE ENDOCRINE & DIABETES CLINIC
4403 HARRISON BLVD STE 3630
OGDEN,UT84403 		CLINIC
130 HIGHLAND CLINIC
10968 N ALPINE HWY
HIGHLAND,UT84003 		CLINIC
131 LDS HOSPITAL HOSPITALISTS
8TH AVE AND C STREET
SALT LAKE CITY,UT84143 		CLINIC
132 EPHRAIM CLINIC
525 N MAIN STREET
EPHRAIM,UT84627 		CLINIC
133 SPORTS MEDICINE SPECIALISTS BOUNTIFUL
280 N MAIN ST
BOUNTIFUL,UT84010 		CLINIC
134 CEDAR CITY INSTACARE
962 SAGE DR
CEDAR CITY,UT84720 		CLINIC
135 SUMMIT CLINIC
502 S MAIN ST
SMITHFIELD,UT84335 		CLINIC
136 INTERMOUNTAIN PLASTIC SURGERY CENTER
5169 COTONWOOD ST STE 410
MURRAY,UT84107 		CLINIC
137 SUNSET INSTACARE
1739 W SUNSET BLVD
ST GEORGE,UT84770 		CLINIC
138 FILLMORE CLINIC
700 S HIGHWAY 99 STE 3
FILLMORE,UT84631 		CLINIC
139 SOUTHWEST NEUROLOGY ASSOCIATES
652 S MEDICAL CENTER DR STE 320
ST GEORGE,UT84790 		CLINIC
140 BOUNTIFUL KIDSCARE
390 N MAIN ST
BOUNTIFUL,UT84010 		CLINIC
141 UTAH VALLEY EAR NOSE & THROAT N VALLEY
872 N 2000 W STE A
PLEASANT GROVE,UT84062 		CLINIC
142 CALTON-HARRISON CLINIC TRAUMA
4403 HARRISON BLVD STE 2400
OGDEN,UT84403 		CLINIC
143 AMERICAN FORK HOSPITALISTS
170 N 1100 E
AMERICAN FORK,UT84003 		CLINIC
144 HEBER VALLEY CLINIC
1473 S HWY 40 E
HEBER CITY,UT84032 		CLINIC
145 MCKAY DEE RADIATION ONCOLOGY
4401 HARRISON BLVD
OGDEN,UT84403 		CLINIC
146 INT MFM SPECIALISTS DIAGNOSTIC
5121 COTTONWOOD ST STE 100
MURRAY,UT84107 		CLINIC
147 SOUTHWEST REGIONAL CANCER CLINIC
544 S 400 E
ST GEORGE,UT84770 		CLINIC
148 MEMORIAL KIDSCARE
2000 S 900 E
SALT LAKE CITY,UT84105 		CLINIC
149 PARK CITY SPECIALTY EAST
750 ROUND VALLEY DR STE 101
PARK CITY,UT84060 		CLINIC
150 INTERMOUNTAIN NURSE MIDWIVES
5063 COTTONWOOD ST STE 130
MURRAY,UT84107 		CLINIC
151 WEST JORDAN KIDSCARE
2655 W 9000 S
WEST JORDAN,UT84088 		CLINIC
152 HIGHLAND INSTACARE
10968 N ALPINE HWY
HIGHLAND,UT84003 		CLINIC
153 HURRICANE VALLEY INSTACARE
75 N 2260 W
HURRICANE,UT84737 		CLINIC
154 MANTI FAMILY CLINIC
159 N MAIN ST
MANTI,UT84642 		CLINIC
155 SOUTHERN UTAH SURGICAL ASSOCIATES
166 W 1325 N STE 350
CEDAR CITY,UT84720 		CLINIC
156 ISOM PLASTIC SURGERY
1350 N 500 E STE 310
LOGAN,UT84341 		CLINIC
157 DRMC RADIATION ONCOLOGY
544 S 400 E
ST GEORGE,UT84770 		CLINIC
158 SYRACUSE CLINIC
745 S 2000 W
SYRACUSE,UT84075 		CLINIC
159 DIXIE PLASTIC & RECONSTRUCTIVE SURGERY
652 S MEDICAL CENTER DR STE 300
ST GEORGE,UT84790 		CLINIC
160 UTAH HEART - AVH
9690 S 1300 E STE 200
SANDY,UT84094 		CLINIC
161 PHYSICAL MEDICINE & REHAB CLINIC
1055 N 300 W STE 410
PROVO,UT84604 		CLINIC
162 VALLEY VIEW HEART CLINIC
1303 N MAIN ST STE H
CEDAR CITY,UT84720 		CLINIC
163 MOUNTAIN VIEW PEDIATRICS KIDSCARE
9720 S 1300 E STE 100
SANDY,UT84094 		CLINIC
164 ORTHOPEDIC SPECIALTY GROUP TRAUMA
5169 COTTONWOOD ST STE 430
MURRAY,UT84107 		CLINIC
165 PROVO RADIATION ONCOLOGY
1034 N 500 W
PROVO,UT84604 		CLINIC
166 HOLLADAY PEDIATRICS NORTH
2160 E 4500 S
SALT LAKE CITY,UT84117 		CLINIC
167 LOGAN HOSPITALISTS
1400 N 500 E
LOGAN,UT84341 		CLINIC
168 WASATCH OBGYN LAYTON
2075 UNIVERSITY PARK BLVD
LAYTON,UT84041 		CLINIC
169 LAYTON CLINIC PHARMACY
2075 UNIVERSITY PARK BLVD
LAYTON,UT84041 		CLINIC
170 TOOELE INSTACARE
777 N MAIN ST
TOOELE,UT84074 		CLINIC
171 REDROCK DIGESTIVE HEALTH
652 S MEDICAL CENTER DR STE 330
ST GEORGE,UT84790 		CLINIC
172 BEAR RIVER SPECIALISTS
935 N 1000 W
TREMONTON,UT84337 		CLINIC
173 UTAH HEART RIVERTON
3741 W 12600 S
RIVERTON,UT84065 		CLINIC
174 UTAH VALLEY ORTHOPAEDICS NORTH VALLEY
10968 N ALPINE HWY
HIGHLAND,UT84003 		CLINIC
175 SOUTHWEST UROLOGY
1380 E MEDICAL CENTER DR STE 2100
ST GEORGE,UT84790 		CLINIC
176 MCKAY DEE WOUND & HYPERBARIC CENTER
4401 HARRISON BLVD STE 1885
OGDEN,UT84403 		CLINIC
177 NORTH SEVIER MEDICAL CLINIC
530 N 250 W
SALINA,UT84654 		CLINIC
178 ROCK CANYON PEDIATRIC SPECIALISTS
1055 N 300 W STE 110
PROVO,UT84604 		CLINIC
179 SYRACUSE INSTACARE
745 S 2000 W
SYRACUSE,UT84075 		CLINIC
180 REDROCK SPINE & NEUROSURGERY CLINIC
1303 N MAIN ST
CEDAR CITY,UT84720 		CLINIC
181 LOGAN RADIATION ONCOLOGY
500 E 1400 N
LOGAN,UT84341 		CLINIC
182 OREM MIDWIFERY
527 W 400 N STE 4
OREM,UT84057 		CLINIC
183 MATERNAL FETAL MEDICINE SPECIALISTS
5121 COTTONWOOD ST STE 100
MURRAY,UT84107 		CLINIC
184 WASATCH OBGYN NORTH OGDEN
2400 N WASHINGTON BLVD
NORTH OGDEN,UT84414 		CLINIC
185 RIVERTON HOSPITALISTS
3723 W 12600 S
RIVERTON,UT84065 		CLINIC
186 NORTHERN UTAH KIDSCARE
4403 HARRISON BLVD STE 4875
OGDEN,UT84403 		CLINIC
187 LAYTON KIDSCARE
2075 UNIVERSITY PARK BLVD
LAYTON,UT84041 		CLINIC
188 BLOOD & MARROW TRANSPLANTLEUKEMIA PROG
8TH AVE AND C STREET
SALT LAKE CITY,UT84143 		CLINIC
189 AMERICAN FORK RADIATION ONCOLOGY
170 N 1100 E
AMERCIAN FORK,UT84003 		CLINIC
190 UTAH VALLEY MATERNAL FETAL MEDICINE
1034 N 500 W
PROVO,UT84604 		CLINIC
191 INTERMOUNTAIN PULMONOLOGY CLINIC
5169 COTTONWOOD ST STE 640
MURRAY,UT84107 		CLINIC
192 AMERICAN FORK PULMONARY CLINIC
170 N 1100 E
AMERICAN FORK,UT84003 		CLINIC
193 PROVO NEUROLOGICAL CLINIC NW PLAZA
1134 N 500 W STE 101
PROVO,UT84604 		CLINIC
194 IM FLASH
1550 E 3400 N
LEHI,UT84043 		CLINIC
195 GORANG FAMILY PRACTICE
9720 S 1300 E STE E230
SANDY,UT84094 		CLINIC
196 UTAH VALLEY HYPERBARIC AND WOUND CARE
1034 N 500 W
PROVO,UT84604 		CLINIC
197 CW ENDOCRINE & DIABETES - MC
5169 COTTONWOOD ST STE 640
MURRAY,UT84107 		CLINIC
198 VALLEY VIEW RADIATION ONCOLOGY
1303 N MAIN ST
CEDAR CITY,UT84721 		CLINIC
199 SUMMIT ORTHOPEDICS
4403 HARRISON BLVD STE 2600
OGDEN,UT84403 		CLINIC
200 UTAH VALLEY INTERNAL MEDICINE
1134 N 500 W STE 101
PROVO,UT84604 		CLINIC
201 MORONI CLINIC
51 E MAIN ST
MORONI,UT84646 		CLINIC
202 MCKAY DEE MATERNAL FETAL MEDICINE
4401 HARRISON BLVD STE 4600
OGDEN,UT84403 		CLINIC
203 SOUTHERN UTAH BEHAVIROAL HEALTH
1054 E RIVERSIDE DR STE 202
ST GEORGE,UT84790 		CLINIC
204 CENTRAL ENT HEAD-NECK SURGERY
5169 COTTONWOOD ST STE 640
MURRAY,UT84107 		CLINIC
205 FRIEDEN PAIN MANAGEMENT
70 E 1000 N
RICHFIELD,UT84701 		CLINIC
206 MCKAY DEE URO-GYNECOLOGY CLINIC
4403 HARRISON BLVD STE 4400
OGDEN,UT84403 		CLINIC
207 LDS MATERNAL FETAL MEDICINE
8TH AVE AND C STREET
SALT LAKE CITY,UT84143 		CLINIC
208 ST GEORGE PULMONARY CLINIC
1380 E MEDICAL CENTER DR STE 2200
ST GEORGE,UT84790 		CLINIC
209 AMERICAN FORK PULMONARY CRITICAL CARE
170 N 1100 E
AMERICAN FORK,UT84003 		CLINIC
210 UTAH VALLEY SPORTS MEDICINE NORTH VALLEY
1159 E 200 N STE 100
AMERICAN FORK,WY84003 		CLINIC
211 CANYON VIEW FAMILY PRACTICE
15 E 400 N
PAROWAN,UT84761 		CLINIC
212 ALTA VIEW HOSPITALISTS
9660 S 1300 E
SANDY,UT84094 		CLINIC
213 UTAH VALLEY PEDIATRIC HOSPITALISTS
1034 N 500 W
PROVO,UT84604 		CLINIC
214 UTAH VALLEY PEDIATRIC SPECIALTY-UVRMC
1035 N 500 W
PROVO,UT84604 		CLINIC
215 PARK CITY HOSPITALISTS
900 ROUND VALLEY DR
PARK CITY,UT84060 		CLINIC
216 LDS CAMPUS SLEEP PROGRAM
325 8TH AVE
SALT LAKE CITY,UT84143 		CLINIC
217 INTERMOUNTAIN SLEEP PROGRAM TOSH
5770 S 250 E STE 340
MURRAY,UT84107 		CLINIC
218 SOUTHWEST RHEUMATOLOGY ASSOCIATES
577 S RIVER RD
ST GEORGE,UT84790 		CLINIC
219 SEVIER VALLEY FP SVMC
1000 N MAIN ST
RICHFIELD,UT84701 		CLINIC
220 DIXIE HIGH RISK OB
544 S 400 E
ST GEORGE,UT84770 		CLINIC
221 DRAPER EXPRESS CARE
212 E 12300 S
DRAPER,UT84020 		CLINIC
222 UTAH VALLEY ORTHO-NVSARATOGA
250 E STATE RD 73
SARATOGA SPRINGS,UT84043 		CLINIC
223 EAST MILLCREEK EXPRESS CARE
3215 S VALLEY ST
SALT LAKE CITY,UT84109 		CLINIC
224 AVENUES NEUROSURGERY
370 9TH AVE STE 111
SALT LAKE CITY,UT84103 		CLINIC
225 LAYTON ORTHOPEDICS-NORTH OGDEN
2400 N WASHINGTON BLVD
NORTH OGDEN,UT84414 		CLINIC
226 DIXIE MATERNAL FETAL MEDICINE
544 S 400 E
ST GEORGE,UT84770 		CLINIC
227 SNOWBIRD CLINIC
HIGHWAY 210 LITTLE COTTONWOOD CANY
SNOWBIRD,UT84092 		CLINIC
228 DIXIE SLEEP DISORDERS CENTER
652 S MEDICAL CENTER DR STE 310
ST GEORGE,UT84790 		CLINIC
229 BUDGE CLINIC RADIOLOGY
1350 N 500 E
LOGAN,UT84341 		CLINIC
230 SANDY SLEEP DISORDERS
9600 S 1300 E
SANDY,UT84094 		CLINIC
231 KEARNS CLINIC
4946 W 6200 S
KEARNS,UT84118 		CLINIC
232 PHYSICIAL MED AND REHAB AM FORK
1159 E 200 N STE 100
AMERICAN FORK,UT84003 		CLINIC
233 LDS CAMPUS SLEEP ST JOSEPH'S VILLA
451 BISHOP FEDERAL LN
SALT LAKE CITY,UT84115 		CLINIC
234 AMERICAN FORK MATERNAL FETAL MEDICINE
170 N 1100 E
AMERCIAN FORK,UT84003 		CLINIC
235 INTERMOUNTAIN NURSE MIDWIVES ROSE PARK
1105 W 1000 N
SALT LAKE CITY,UT84116 		CLINIC
236 INTERMOUNTAIN NURSE MIDWIVES SORENSON
855 CALIFORNIA AVE
SALT LAKE CITY,UT84104 		CLINIC
237 HEALTH AND FITNESS PROGRAM
400 D STREET STE 206
SALT LAKE CITY,UT84103 		CLINIC
238 BRYNER CLINIC INDEPENDENT LAB
525 E 100 S STE 500
SALT LAKE CITY,UT84102 		CLINIC
239 UTAH VALLEY SPORTS MED-UVSC
800 W UNIVERSITY PKWY
OREM,UT84058 		CLINIC
240 PROVO NEUROLOGICAL CLINIC-UVRMC
1034 N 500 W
PROVO,UT84604 		CLINIC
241 HEART RHYTHM SPECIALISTS CASPER
1233 E 2ND ST
CASPER,WY82601 		CLINIC
242 FARMINGTON EXPRESS CARE
1316 N HIGHWAY 89
FARMINGTON,UT84025 		CLINIC
243 SOUTHWEST CARDIOLOGY CEDAR CITY
110 W 1325 N STE 100
CEDAR CITY,UT84721 		CLINIC
244 UTAH HEART PARK CITY
900 ROUND VALLEY DR
PARK CITY,UT84060 		CLINIC
245 LOGAN MATERNAL FETAL MEDICINE
1400 N 500 E
LOGAN,UT84341 		CLINIC
246 MCKAY DEE PEDS CS SEDATION
4401 HARRISON BLVD
OGDEN,UT84403 		CLINIC
247 IMED CAMPUS SLEEP PROGRAM
5121 COTTONWOOD ST
MURRAY,UT84107 		CLINIC
248 SOUTHWEST CARDIOLOGY-EP
1380 E MEDICAL CENTER DR STE 4100
ST GEORGE,UT84790 		CLINIC
249 INTERMOUNTAIN SENIOR CLINIC
5770 S 250 E STE 210
MURRAY,UT84107 		CLINIC
250 HEART RHYTHM SPECIALISTS LOGAN
1300 N 500 E STE 320
LOGAN,UT84341 		CLINIC
251 HEART RHYTHM SPECIALISTS IDAHO FALLS
3100 CHANNING WAY
IDAHO FALLS,ID83404 		CLINIC
252 RIVERTON CAMPUS SLEEP PROGRAM
3723 W 12600 S STE 480
RIVERTON,UT84065 		CLINIC
253 SOUTHERN UTAH SURGICAL DELTA
126 WHITE SAGE AVE
DELTA,UT84624 		CLINIC
254 OREM WORKMED IMFT
1550 E 3400 N
LEHI,UT84043 		CLINIC
255 UTAH HEART SANPETE
1100 S MEDICAL DR
MT PLEASANT,UT84647 		CLINIC
256 RIM ROCK ORTHOPAEDICS HURRICANE
75 N 2260 W
HURRICANE,UT84737 		CLINIC
257 HEART RHYTHM SPECIALISTS POCATELLO
777 HOSPTIAL WAY STE 101
POCATELLO,ID83201 		CLINIC
258 SNOWBASIN CLINIC
3925 E SNOWBASIN DR
HUNTSVILLE,UT84317 		CLINIC
259 ALTA VIEW SENIOR CLINIC
9720 S 1300 E STE E240
SANDY,UT84094 		CLINIC
260 UTAH HEART MONTICELLO
380 W 100 N
MONTICELLO,UT84535 		CLINIC
261 UTAH HEART PANGUITCH
200 N 400 E
PANGUITCH,UT84759 		CLINIC
262 PULMONARY ST GEORGE CEDAR CITY
110 W 1325 N STE 100
CEDAR CITY,UT84721 		CLINIC
263 UTAH HEART KEMMERER
702 ONYX ST
KEMMERER,WY83101 		CLINIC
264 UTAH HEART AFTON
110 HOSPITAL LN
AFTON,WY83110 		CLINIC
265 UTAH VALLEY HEART & LUNG VEIN
1134 N 500 W STE 100
PROVO,UT84604 		CLINIC
266 UTAH VALLEY ORTHO-NV MT PLEASANT
1100 S MEDICAL DR
MT PLEASANT,UT84647 		CLINIC
267 HEART RHYTHM SPECIALISTS ROCK SPRINGS
2751 COMMERICAL WAY
ROCK SPRINGS,WY82091 		CLINIC
268 MCKAY DEE CARDIOLOGY HEART OF UTAH
4403 HARRISON BLVD STE 3400
OGDEN,UT84403 		CLINIC
269 CMT DEXA
5770 S 250 E STE 170
MURRAY,UT84107 		CLINIC
270 HEART RHYTHM SPECIALISTS MURRAY
5292 S COLLEGE DR STE 200
MURRAY,UT84123 		CLINIC
271 SOUTHWEST CARDIOLOGY MESQUITE
1301 BERTHA HOWE AVE STE 9
MESQUITE,NV89027 		CLINIC
272 MCKAY DEE CARDIO ID HEART INST
2985 CORTEZ AVE
IDAHO FALLS,ID83404 		CLINIC
273 SOUTHERN UTAH SURGICAL FILLMORE
700 S HIGHWAY 99
FILLMORE,UT84631 		CLINIC
274 HEART RHYTHM SPECIALISTS PANGUITCH
200 N 400 E
PANGUITCH,UT84759 		CLINIC
275 DIXIE NEONATOLOGY GRADUATE
544 S 400 E
ST GEORGE,UT84770 		CLINIC
276 HEART RHYTHM SPECIALISTS TOOELE
196 E 2000 N
TOOELE,UT84074 		CLINIC
277 UTAH HEART BLANDING
799 S 200 W
BLANDING,UT84511 		CLINIC
278 MCKAY DEE CARDIO EASTERN IDAHO
2001 S WOODRUFF AVE STE 12
IDAHO FALLS,ID83404 		CLINIC
279 HEART RHYTHM SPECIALISTS GREEN RIVER
1400 UNITA DR
GREEN RIVER,WY82935 		CLINIC
280 VALLEY VEIW HEART GARFIELD
200 N 400 E
PANGUITCH,UT84759 		CLINIC
281 DIXIE HIGH RISK FERTILITY
544 S 400 E
ST GEORGE,UT84770 		CLINIC
282 ALTA VIEW MATERNAL FETAL MEDICINE
9660 S 1300 E
SANDY,UT84094 		CLINIC
283 ALTA VIEW SLEEP PROGRAM
9660 S 1300 E
SANDY,UT84094 		CLINIC
284 MURRAY KIDSCARE
196 E WINCHESTER ST
MURRAY,UT84107 		CLINIC
285 PRIMARY CHILDRENS RADIATION ONCOLOGY
100 N MEDICAL DR
SALT LAKE CITY,UT84113 		CLINIC
286 UTAH HEART PC UTE
1612 UTE BLVD STE 112
PARK CITY,UT84098 		CLINIC
287 MT PLEASANT DELTA
126 WHITE SAGE AVE
DELTA,UT84624 		CLINIC
288 MCKAY DEE SURGICAL CENTER LLC
3903 HARRISON BLVD SUITE 100
OGDEN,UT84403 		OUTPATIENT SURGERY
Schedule H (Form 990) 2011
Schedule H (Form 990) 2011
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 9, 10, 11h, 13g, 15e, 16e, 17e, 18d, 19d, 20, and 21.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
Identifier ReturnReference Explanation
FINANCIAL ASSISTANCE ELIGIBILITY FORM 990, SCHEDULE H, PART I, LINE 3 MAXIMUM FINANCIAL ASSISTANCE IS PROVIDED TO INDIVIDUALS AT OR BELOW 150% OF THE FEDERAL POVERTY GUIDELINES ("FPG"). APPLICANTS EQUAL TO OR BELOW THIS THRESHOLD ARE RESPONSIBLE FOR ONLY A MINIMUM CO-PAY. EVIDENCE HAS SHOWN THAT PATIENTS WHO PAY SOMETHING, EVEN VERY SMALL AMOUNTS, ARE MORE LIKELY TO FOLLOW THE MEDICAL RECOMMENDATIONS GIVEN TO THEM BY PROVIDERS. PATIENTS WHO ARE NOT ABLE TO CONTRIBUTE ANYTHING WILL NOT BE REQUIRED TO CONTRIBUTE AND WILL STILL RECEIVE CARE. A SLIDING SCALE IS USED FOR PATIENTS BETWEEN 150% AND 500% OF FPG.
BAD DEBT EXPENSE FORM 990, SCHEDULE H, PART I, LINE 7, COLUMN (F) AMOUNT OF BAD DEBT EXPENSE INCLUDED ON THE FORM 990, PART IX, LINE 25: $193,024,287.
COMMUNITY BENEFITS AT COST FORM 990, SCHEDULE H, PART I, LINE 7 The financial assistance at cost (line 7a) was calculated using the cost to charge ratio derived from Worksheet 2 of the Schedule H instructions. The unreimbursed Medicaid (line 7b) was principally calculated using the filing organization's internal cost accounting system. The expenses reported for community health improvement (line 7e), health professions education (line 7f), and the cash and in-kind contributions include only the direct expenses associated with each activity. The indirect expenses associated with these activities were not reported. The expenses associated with research (Line 7h) were calculated using the same methodology used for grant progress reporting to the Federal government.
COMMUNITY BUILDING ACTIVITES FORM 990, SCHEDULE H, PART II HEALTH SERVICES REPORTED COALITION BUILDING AND WORKFORCE DEVELOPMENT DETAILS ON SCHEDULE H, PART II, COMMUNITY BUILDING ACTIVITIES. COALITION BUILDING PROMOTES THE HEALTH OF THE COMMUNITIES IT SERVES BY NETWORKING WITH OTHER COMMUNITY AGENCIES TO ADDRESS THE HEALTH AND SAFETY ISSUES OF THE COMMUNITY. HEALTH SERVICES PARTICIPATES IN STATEWIDE SAFEKIDS COALITIONS TO PROMOTE AWARENESS AND USE OF CHILD SEAT BELTS, TRAFFIC AND BICYCLE SAFETY AND DIABETES-RELATED COALITIONS TO HELP REDUCE THE INCIDENCE OF DIABETES IN CHILDREN AND ADULTS. HEALTH SERVICES EMPLOYEES UTILIZE THEIR CLINICAL EXPERTISE TO COLLABORATE WITH OTHER COMMUNITY AGENCIES AND COUNTY AND STATE HEALTH DEPARTMENTS TO PROVIDE EDUCATION AND OTHER INITIATIVES THAT BENEFIT THE HEALTH OF PEOPLE IN COMMUNITIES. HEALTH SERVICES ALSO RECRUITED PHYSICIANS TO MEDICALLY UNDERSERVED AREAS IN RURAL SETTINGS TO MEET THE HEALTHCARE NEEDS OF RESIDENTS IN RURAL SETTINGS, THEREBY HELPING REDUCE BARRIERS TO ACCESSING CARE. WORKFORCE DEVELOPMENT ACTIVITIES INCLUDE CURRICULUM DEVELOPMENT ACTIVITIES FOR HIGH SCHOOL STUDENTS FOR WHICH THEY RECEIVE SCHOOL CREDIT FOR HEALTH CAREERS TRAINING THAT LEADS TO COLLEGE-LEVEL EDUCATION.
BAD DEBT EXPENSE FORM 990, SCHEDULE H, PART III, LINE 4 The allowance for Bad debts on the filing organization's financial statements is estimated using a balance sheet approach based on both the payor mix and the age of the receivables. The underlying accounts receivables used in the analysis are recorded at the expected payment rates (established rates for the services provided net of discounts and negotiated contractual adjustments). When a patient or responsible party is uninsured or under-insured and expresses either concern about their ability to pay or interest in applying for financial assistance, Health Services' staff are educated to give the patient an application for financial assistance, instructions for completing and returning the application, and to code the patient's account Pending Financial Assistance. In situations where the patient fails to return the application and the account progresses through the collections cycle to bad debts, the account will be written off as bad debt. Accounts in bad debts with the code described above may have qualified for financial assistance had the patient or responsible party followed through and applied for assistance. The charity care amounts included in the financial statements are separate and distinct from bad debt expense, which generally represents patient services revenues that are not collectible due to either an unwillingness to pay by those responsible for payment, or an inability by Health Services to obtain documentation from those responsible for payment that would substantiate the patient's qualification for charity consideration. Bad debt expense is reflected in the consolidated statements of operations and changes in net assets and was $193.0 million and $199.4 million for the years ended December 31, 2011 and 2010, respectively.
MEDICARE SHORTFALL FORM 990, SCHEDULE H, PART III, LINES 5-7 The Medicare allowable costs on Part III, line 6 are based on the Medicare Cost Reports, which are significantly different from total financial statement expenses. Medicare's "allowable costs" exclude commonly incurred business expenses such as interest, research, public relations, etc. In addition, the amounts do not fully reflect the filing organization's participation in Medicare programs. For example, the following is a partial list of activities that are not currently included in the Schedule H calculation: - Physician Services Billed by the Filing Organization - Medicare Parts C and D (Medicare Advantage and Prescription Drug Coverage) - Reimbursed Services (e.g., Outpatient Clinical Laboratory and Therapy Services, etc.) - Durable Medical Equipment and Home IV Therapy Services Inclusion of all expenses associated with Medicare activities would make a significant difference in the filing organization's calculation. If the additional activities were reportable on Schedule H, it is estimated that the filing organization's Medicare shortfall would total approximately $163.1 million, a difference of $163.4 million from the amount disclosed on Part III of the Schedule H.
MEDICARE COSTING METHODOLOGY FOR 990, SCHEDULE H, PART III, LINE 8 Total direct and overhead costs for each cost center are divided by the corresponding total patient revenue to determine cost/charge ratios. The cost/charge ratios are multiplied by the applicable Medicare charges to determine Medicare costs. Allowable costs for routine areas are calculated based on per diem costs (i.e., (total costs / total days) x Medicare days). The methodology described in the instructions to Schedule H, part III, section b, line 6 does not take into account all of the associated costs incurred by Health Services' hospitals for the services provided and does not represent the total community benefit conferred in this area. The Medicare surplus reflected on schedule H, part iii, section b is determined using information from the Organization's Medicare cost reports (using the Medicare cost report step-down methodology). Medicare shortfalls should be treated and reported on Schedule H as a Community benefit for the following reasons: (1)absent the Medicare program, it is likely many of the individuals would qualify for charity care or other needs-based government Programs; (2) by accepting payment below cost to treat these individuals, the Burdens of government are relieved; (3) a significant possibility exists that continued reduction in Medicare reimbursement may actually create difficulties in access for These individuals; and (4) the amount spent to cover the reported Medicare shortfall is money not available to cover charity care and other community benefit needs.
BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS FORM 990, SCHEDULE H, PART V, LINE 11 CATASTROPHIC ASSISTANCE. HEALTH SERVICES ATTEMPTS TO LIMIT AN INDIVIDUAL'S FINANCIAL RESPONSIBILITY WHEN AN OUTSTANDING MEDICAL DEBT EXCEEDS 35% OF THE INDIVIDUAL'S GROSS HOUSEHOLD ANNUAL INCOME. EXTENUATING CIRCUMSTANCES. SINCE EACH INDIVIDUAL'S PERSONAL CIRCUMSTANCES VARY, HEALTH SERVICES ALLOWS FOR EXTENUATING CIRCUSTANCES NOT DIRECTLY ADDRESSED IN THE FINANCIAL ASSISTANCE POLICIES AND PROCEDURES TO BE CONSIDERED WHEN DETERMINING ELIGIBILTY FOR FINANCIAL ASSISTANCE.
PUBLICATION OF THE FINANCIAL ASSISTANCE POLICY FORM 990, SCHEDULE H, PART V, LINE 13 SPECIFIC INFORMATION REGARDING THE FINANCIAL ASSISTANCE PROGRAM CAN BE FOUND ON HEALTH SERVICES' WEBSITE IN BOTH ENGLISH AND SPANISH. DETAILS INCLUDE AN EXPLANATION OF THE PROGRAM, FREQUENTLY ASKED QUESTIONS, AN "800" NUMBER, AND A LINK TO THE APPLICATION. BROCHURES, IN ENGLISH AND SPANISH, ARE ALSO AVAILABLE THROUGHOUT THE PUBLIC RECEPTION AND REGISTRATION AREAS OF THE HOSPITALS AND THE CLINICS. THE BROCHURES DESCRIBE THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY. ELIGIBILITY COUNSELORS ASSSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION BEFORE, DURING, OR AFTER THE TIME OF SERVICE. THE PROCESS OFTEN BEGINS WITH THE PATIENT'S PRE-REGISTRATION PRIOR TO SERVICE. HEALTH SERVICES ALSO CONTRIBUTES TO THE SALARIES OF UTAH STATE BUREAU OF ELIGIBILITY STAFF WHO WORK ONSITE IN SEVERAL HOSPITALS TO ASSIST PATIENTS IN APPLYING FOR MEDICAID, CHIP, OR OTHER GOVERNMENT ASSISTANCE PROGRAMS. SIGNS ARE POSTED AT PUBLIC REGISTRATION AREAS, IN PRIVATE REGISTRATION ROOMS AND IN PATIENT CARE AREAS IN BOTH ENGLISH AND SPANISH, WHICH STATE THE FOLLOWING: "WE BELIEVE MEDICALLY NECESSARY HEALTHCARE SERVICES SHOULD BE ACCESSIBLE TO RESIDENTS IN THE COMMUNITIES WE SERVE REGARDLESS OF ABILITY TO PAY. IF YOU DO NOT HAVE INSURANCE OR IF YOU NEED HELP IN PAYING FOR CARE, ASK TO SPEAK WITH ONE OF OUR ELIGIBILITY COUNSELORS ABOUT IHC HEALTH SERVICES' FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE IS AVAILABLE FOR QUALIFYING PATIENTS." BILLING ENVELOPES ALSO INCLUDE A STATEMENT ON THE BACK THAT STATES IN ENGLISH AND SPANISH: "NEED HELP IN PAYING YOUR BILL? CONTACT THIS FACILITY, OR FOR GENERAL QUESTIONS, CALL OUR FINANCIAL ASSISTANCE HOTLINE." A TOLL-FREE NUMBER IS INCLUDED.
INDIVIDUALS ELIGIBLE FOR FINANCIAL ASSISTANCE FORM 990, SCHEDULE H, PART V, LINE 19 Health Services provides an automatic discount of 25% to uninsured patients who qualify under the financial assistance program. This discount approximates the average negotiated rates charged to commercial insurance companies. An additional 15% discount is available to patients who qualify for financial assistance if payment is made in full at the time of service. This combined discount of 40% is in excess of the best negotiated rates for insured patients. Rates charged to under-insured patients who qualify for financial assistance are consistent with the commercially negotiated rate of that individual's insurance carrier. Final amounts billed to patients who qualify for financial assistance are based on the patients' ability to pay as determined under Health Services' financial assistance policy.
NEEDS ASSESSMENT FORM 990, SCHEDULE H, PART VI, LINE 2 HEALTH SERVICES COMPLETED A COMPREHENSIVE, SYSTEM-WIDE COMMUNITY HEALTH NEEDS ASSESSMENT IN FALL 2009 THAT IDENTIFIED THE NEEDS WITHIN ITS SERVICE AREA. RESULTS OF THE SURVEY WERE USED TO DEVELOP COMMUNITY BENEFIT INITIATIVES FOR 2011 AND TO SUPPORT ADDITIONAL PLANNING FOR PROGRAMS AND SERVICES TO ADDRESS THE HEALTHCARE NEEDS OF LOW-INCOME, UNINSURED, AND VULNERABLE POPULATIONS. OBJECTIVE OF THE ASSESSMENT: - TO USE THE RESULTS OF THE ASSESSMENT TO GUIDE THE PRIORITIZATION, DESIGN AND IMPLEMENTATION OF EFFECTIVE HEALTH PROGRAMS FOR LOW-INCOME INDIVIDUALS. PRIMARY QUESTIONS: - WHAT HEALTH (MEDICAL, ORAL, MENTAL) NEEDS EXIST? - WHAT RESOURCES ARE AVAILABLE TO MEET THESE HEALTH NEEDS? - WHAT ARE THE GAPS IN MEETING THESE HEALTH NEEDS? DATA SOURCES: HEALTH SERVICES' STAFF UTILIZED EXISTING HEALTH SURVEYS FROM NATIONAL, STATE, AND COUNTY AGENCIES. THEY ALSO REVIEWED THE TOP 30 DIAGNOSES FOR HEALTH SERVICES' EMERGENCY DEPARTMENT AND INPATIENT AND OUTPATIENT SERVICES FOR THE PREVIOUS CALENDAR YEAR. DIAGNOSIS CODES WERE THEN BROKEN INTO SUBGROUPS BY GEOGRAPHY AND VARIOUS DEMOGRAPHIC MEASURES (E.G., GENDER, AGE, RACE) TO IDENTIFY SPECIFIC AREAS OF IMPORTANCE FOR DIFFERENT POPULATION GROUPS. HEALTH SERVICES FOCUSED ON SPECIFIC PREVENTABLE DISEASES IN WHICH EDUCATION, PREVENTION, EARLY DIAGNOSIS, AND TREATMENT AND COLLABORATIONS WITH COMMUNITY PARTNERS HAD SIGNIFICANT IMPACT. HEALTH INDICATORS WERE REPORTED FOR 61 SMALL GEOGRAPHIC AREAS IDENTIFIED BY THE UTAH DEPARTMENT OF HEALTH ACROSS THE STATE OF UTAH. HEALTH SERVICES' STAFF IDENTIFIED HEALTH PRIORITIES FOR EACH GEOGRAPHIC AREA SERVED BY ITS HOSPITALS AND DEVELOPED SPECIFIC PROGRAMS AND ACTIVITIES WHERE THERE WAS GREATEST NEED FOR SUCH INTERVENTIONS. FROM THE DATA GATHERED, AND IN CONSULTATION WITH NON-PROFIT AND GOVERNMENT PARTNERS, AS WELL AS INTERNAL MEDICAL STAFF, PRIORITIES WERE ESTABLISHED AND ARE ARTICULATED BELOW. THESE HEALTH PRIORITIES ALIGN WITH U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES' HEALTHY PEOPLE 2020 GOALS AND SUPPORT HEALTH SERVICES' CLINICAL GOALS. COMMUNITY BENEFIT INITIATIVES WERE DEVELOPED IN TEN GEOGRAPHIC AREAS TO ADDRESS DOCUMENTED HEALTHCARE NEEDS IN THE AREAS SERVED BY HEALTH SERVICES' HOSPITALS AND CLINICS. THESE COMMUNITY HEALTH INITIATIVES INCLUDE HEALTH ASSESSMENTS, EDUCATION PROGRAMS, AND EVALUATION TO HELP IMPROVE HEALTHCARE FOR LOW-INCOME POPULATIONS AND REDUCE THE COST OF HEALTHCARE FOR THE COMMUNITY. THREE HEALTH PRIORITIES WERE DEFINED FOR 2011 COMMUNITY BENEFIT PROGRAM FOCUS: 1. IMPROVE THE PREVENTION, DETECTION, AND TREATMENT OF CHRONIC DISEASES ASSOCIATED WITH UNHEALTHY WEIGHT AND BEHAVIORS. 2. IMPROVE ACCESS TO COMPREHENSIVE, HIGH-QUALITY HEALTHCARE SERVICES. 3. IMPROVE ACCESS TO APPROPRIATE BEHAVIORAL HEALTH SERVICES. HEALTH SURVEY DATA SOURCES: - NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION, CENTER FOR DISEASE CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2009. - NATIONAL CENTER FOR CHRONIC DISEASE PREVENTION AND HEALTH PROMOTION, CENTER FOR DISEASE CONTROL AND PREVENTION, U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, 2008. - BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM, OFFICE OF PUBLIC HEALTH ASSESSMENT, UTAH DEPARTMENT OF HEALTH, 2007. - BEHAVIORAL RISK FACTOR SURVEILLANCE SURVEY, UTAH, 2007. - UTAH HEALTHCARE ACCESS SURVEY, OFFICE OF PUBLIC HEALTH ASSESSMENT, UTAH DEPARTMENT OF HEALTH, 2008. - URBAN INSTITUTE AND KAISER COMMISSION ON MEDICAID AND THE UNINSURED ESTIMATES BASED ON THE CENSUS BUREAU'S MARCH 2008 AND 2009 CURRENT POPULATION SURVEY (CPS: ANNUAL SOCIAL AND ECONOMIC SUPPLEMENTS). - UTAH HEALTH STATUS UPDATE, TEEN AND ADULT SUICIDE, UTAH DEPARTMENT OF HEALTH, JULY 2008. - INTERNAL CASE MIX DATA, INTERMOUNTAIN HEALTHCARE, 2008.
PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE FORM 990, SCHEDULE H, PART VI, LINE 3 BY POLICY, HEALTH SERVICES PROVIDES HEALTHCARE SERVICES TO RESIDENTS IN THE COMMUNITY ON THE BASIS OF MEDICAL NEED WITHOUT REGARD TO RACE, RELIGION, GENDER, AGE, OR ABILITY TO PAY. AN UNINSURED, LOW-INCOME PERSON WILL RECEIVE THOSE SERVICES GENERALLY AVAILABLE FOR NO CHARGE OR A REDUCED CHARGE BASED UPON SUCH PERSON'S ABILITY TO PAY, IF IN THE JUDGMENT OF THE ADMITTING PHYSICIAN THE SERVICES ARE MEDICALLY NECESSARY AND GENERALLY AVAILABLE AT THE HOSPITALS AND CLINICS AND THE PERSON REQUIRES THAT SERVICE. SPECIFIC INFORMATION REGARDING THE FINANCIAL ASSISTANCE PROGRAM CAN BE FOUND ON HEALTH SERVICES' WEBSITE IN BOTH ENGLISH AND SPANISH. DETAILS INCLUDE AN EXPLANATION OF THE PROGRAM, FREQUENTLY ASKED QUESTIONS, AN "800" NUMBER, AND A LINK TO THE APPLICATION. BROCHURES, IN ENGLISH AND SPANISH, ARE ALSO AVAILABLE THROUGHOUT THE PUBLIC RECEPTION AND REGISTRATION AREAS OF THE HOSPITALS AND THE CLINICS. THE BROCHURES DESCRIBE THE AVAILABILITY OF FINANCIAL ASSISTANCE, WHO QUALIFIES, AND HOW TO APPLY. ELIGIBILITY COUNSELORS ASSIST PATIENTS IN COMPLETING THE FINANCIAL ASSISTANCE APPLICATION BEFORE, DURING, OR AFTER THE TIME OF SERVICE. THE PROCESS OFTEN BEGINS WITH THE PATIENTS' PRE-REGISTRATION PRIOR TO SERVICE. HEALTH SERVICES ALSO CONTRIBUTES TO THE SALARIES OF UTAH STATE BUREAU OF ELIGIBILITY STAFF WHO WORK ONSITE IN SEVERAL HOSPITALS TO ASSIST PATIENTS IN APPLYING FOR MEDICAID, CHIP, OR OTHER GOVERNMENT ASSISTANCE PROGRAMS. SIGNS ARE POSTED AT PUBLIC REGISTRATION AREAS, IN PRIVATE REGISTRATION ROOMS AND IN PATIENT CARE AREAS IN BOTH ENGLISH AND SPANISH, WHICH STATE THE FOLLOWING: "WE BELIEVE MEDICALLY NECESSARY HEALTHCARE SERVICES SHOULD BE ACCESSIBLE TO RESIDENTS IN THE COMMUNITIES WE SERVE REGARDLESS OF ABILITY TO PAY. IF YOU DON'T HAVE INSURANCE OR IF YOU NEED HELP IN PAYING FOR CARE, ASK TO SPEAK WITH ONE OF OUR ELIGIBILITY COUNSELORS ABOUT [HEALTH SERVICES'] FINANCIAL ASSISTANCE PROGRAM. FINANCIAL ASSISTANCE IS AVAILABLE FOR QUALIFYING PATIENTS." BILLING ENVELOPES ALSO INCLUDE A STATEMENT ON THE BACK THAT STATES IN BOTH ENGLISH AND SPANISH: "NEED HELP IN PAYING YOUR BILL? CONTACT THIS FACILITY, OR FOR GENERAL QUESTIONS, CALL OUR FINANCIAL ASSISTANCE HOTLINE." A TOLL-FREE NUMBER IS INCLUDED.
COMMUNITY INFORMATION FORM 990, SCHEDULE H, PART VI, LINE 4 HEALTH SERVICES OPERATES 23 HOSPITALS (22 OWNED AND ONE - GARFIELD MEMORIAL - MANAGED BY HEALTH SERVICES) AND MORE THAN 275 CLINICS THROUGHOUT UTAH AND SOUTHERN IDAHO. THE HOSPITALS AND CLINICS VARY IN SIZE AND SERVICES BASED ON THE INDIVIDUAL NEEDS OF EACH COMMUNITY. FACILITY LOCATIONS RANGE FROM URBAN SETTINGS TO RURAL AREAS SCATTERED ACROSS UTAH'S LESS POPULATED REGIONS. AN ADDITIONAL 25 HOSPITALS ALSO PROVIDE SERVICES WITHIN THESE COMMUNITIES. BASED ON 2011 ESTIMATES, HEALTH SERVICES SERVES A POPULATION OF APPROXIMATELY 2.8 MILLION INDIVIDUALS, 2.1 MILLION OF WHICH LIVE ALONG THE WASATCH FRONT, ENCOMPASSING THE OGDEN TO PROVO METROPOLITAN AREA. THE AREA REPRESENTS A RELATIVELY YOUNGER POPULATION THAN THE NATIONAL AVERAGE (31.5% OF THE POPULATION is UNDER 18 YEARS OLD WHILE ONLY 9% is 65 YEARS AND OLDER). EDUCATION LEVELS ARE SLIGHTLY HIGHER THAN THE NATIONAL AVERAGE - 90.6% OF THE POPULATION ARE HIGH SCHOOL GRADUATES AND 29.4% HAVE A BACHELOR'S DEGREE OR HIGHER. THOSE WITH DISABILITIES NUMBER ALMOST 300,000. THE 2010 MEDIAN HOUSEHOLD INCOME FOR THE AREA WAS APPROXIMATELY $56,330. A LITTLE MORE THAN 10% OF THE POPULATION LIVED AT OR BELOW POVERTY LEVELS. A TOTAL OF 9% OF THE POPULATION WAS ENROLLED IN MEDICAID (OVER HALF OF WHICH WERE CHILDREN); 10% was ENROLLED IN MEDICARE; AND 61% Was ENROLLED IN EMPLOYER-SPONSORED HEALTH INSURANCE. A LITTLE MORE THAN 15% OF THE POPULATION DID NOT HAVE HEALTH INSURANCE. AS OF SEPTEMBER 2011, FOUR OF UTAH'S COUNTIES WERE DESIGNATED AS FULL COUNTY MEDICALLY UNDERSERVED POPULATIONS. NINE OF THE COUNTIES WERE DESIGNATED AS FULL COUNTY MEDICALLY UNDERSERVED AREAS. AN ADDITIONAL SIX COUNTIES WERE LISTED AS PARTIAL COUNTY MEDICALLY UNDERSERVED AREAS OR POPULATIONS. NINE OF THE COUNTIES WERE DESIGNATED AS FULL OR PARTIAL COUNTY HEALTH PROFESSIONAL SHORTAGE AREAS. THERE ARE 44 HOSPITALS IN THE SERVICE AREA.
PROMOTION OF COMMUNITY HEALTH FORM 990, SCHEDULE H, PART VI, LINE 5 THE MAJORITY OF HEALTH SERVICES' GOVERNING BODY IS COMPRISED OF PEOPLE WHO RESIDE IN ITS SERVICE AREA, REPRESENTING BROAD COMMUNITY PERSPECTIVES. GOVERNING BOARD MEMBERS ARE NOT EMPLOYEES OR CONTRACTORS OF THE ORGANIZATION. SEE FORM 990, PART VI, LINES 1 & 2 AND FORM 990, SCHEDULE L. HEALTH SERVICES EXTENDS MEDICAL STAFF PRIVILEGES TO QUALIFIED PHYSICIANS IN THE COMMUNITIES SERVED. AS AN ORGANIZATION EXEMPT UNDER IRC SEC 501(C)(3), SURPLUS FUNDS OF HEALTH SERVICES ARE REINVESTED BACK INTO THE COMMUNITY TO IMPROVE PATIENT CARE BY UPGRADING FACILITIES AND EQUIPMENT AND BY PROVIDING CHARITY CARE AND SIMILAR COMMUNITY BENEFIT ACTIVITIES THAT IMPROVE THE HEALTH OF THE COMMUNITIES.
Affiliated health care system FORM 990, SCHEDULE H, Part VI line 6 The parent organization, Intermountain Health Care, Inc., is a 501(c)(3) ORGANIZATION that promotes community healthcare through coordinating the activities of and providing support to Health Services and its other affiliated subsidiaries. Medical services for the communities served are provided through the hospitals and clinics of IHC Health Services. Its mission is "Excellence in the provision of healthcare services to communities in the intermountain region." A more detailed account of Health Services' activities is available on Form 990, Part III and Schedule O. The Intermountain Healthcare Foundation makes grants to local nonprofit agencies that provide direct medical, dental, and mental health services for low-income, uninsured or medically-underserved populations. Health Services has partnered with qualified physicians to form the McKay Dee Surgical Center, LLC, an organization that provides surgical services on an outpatient basis in the Ogden Utah area. SelectHealth, Inc. has as its purpose the development and operation of alternative healthcare delivery plans and financing systems to provide cost-effective and high quality care to participating employer groups and individuals as well as the conducting of research and educational demonstration projects. The Healthcare Captive Insurance Company is engaged in underwriting the liabilities of Intermountain Health Care, Inc. and certain affiliates in excess of their self-insured limits. The two remaining entities, IHC Professional Services, Inc. and IHC Management Co. are either inactive or have a de minimis level of activity.
COMMUNITY BENEFIT REPORT FORM 990, SCHEDULE H, PART VI, LINE 7 HEALTH SERVICES FILES COMMUNITY BENEFIT REPORTS (OR "CHARITY PLANS") WITH EACH COUNTY IN UTAH WHERE HOSPITALS ARE LOCATED AS REQUIRED BY THE UTAH NONPROFIT HOSPITAL AND NURSING HOME PROPERTY TAX EXEMPTION STANDARDS. HEALTH SERVICES HAS ONE HOSPITAL IN IDAHO, CASSIA REGIONAL MEDICAL CENTER. IDAHO DOES NOT HAVE STATE NONPROFIT HOSPITAL REPORTING REQUIREMENTS.
COLLECTION PRACTICES FORM 990, SCHEDULE H, PART III, LINE 9A & PART V, LINE 14 A WRITTEN DEBT COLLECTIONS POLICY WAS APPROVED BY THE HEALTH SERVICES DURING 2012 PRIOR TO THE FILING OF THIS RETURN.
Schedule H (Form 990) 2011
Additional Data


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Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number
94-2854057
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21 for any recipient that received more than $5,000. Check this box if no one recipient received more than $5,000. Use
Part IV and Schedule I-1 (Form 990) if additional space is needed ......................... lBullet
(a) Name and address of organization
or government		 (b) EIN (c) IRC Code section
if applicable		 (d) Amount of cash grant (e) Amount of non-cash
assistance		 (f) Method of valuation
(book, FMV, appraisal,
other)		 (g) Description of
non-cash assistance		 (h) Purpose of grant
or assistance
(1) HUNTSMAN CANCER FOUNDATION500 HUNTSMAN WAY
SLC,UT84108 		87-0541293 501(C)(3) 12,000,000       CANCER RESEARCH
(2) THE FOUNDATION OF DIXIE REG MED CENTER1380 E MEDICAL CENTER DR
ST GEORGE,UT84790 		94-2638220 501(C)(3) 6,200       COMMUNITY HELATH
(3) THE HEART & LUNG RESEARCH FOUNDATION5121 S COTTONWOOD DR
MURRAY,UT84107 		87-0617606 501(c)(3) 35,000       SUPPORT MEDICAL RESEARCH
(4) UNITED WAY OF SALT LAKE175 S WEST TEMPLE STE 30
SLC,UT84111 		87-0227091 501(C)(3) 175,109       SUPPORT COMM PROGRAMS
(5) WESTMINSTER COLLEGE1840 S 1300 E
SLC,UT84105 		87-0212470 501(C)(3) 11,500       HEALTHCARE EDUCATION
(6) COMMUNITY HEALTH CONNECT591 S STATE STREET
PROVO,UT84606 		65-1260998 501(C)(3) 32,635       SUPPORT ADULT DENTAL PROGRAMS
(7) COMMUNITY HEALTH SERVICES220 W 7200 S SUITE A
MIDVALE,UT84047 		74-2412898 501(c)(3) 100,000       SUPPORT UNINSURED POPULATION
(8) FAMILY COUNSELING CENTER5250 S COMMERCE DR
SLC,UT84107 		87-0212455 501(C)(3) 20,000       SUPPORT COMMUNITY CARE PROGRAMS
(9) INTERMOUNTAIN RESEARCH AND MEDICAL FND5121 S COTTONWOOD
MURRAY,UT84107 		23-7062016 501(C)(3) 514,400       SUPPORT FOUNDATION
(10) ROCKY MOUNTAIN CENTER FOR OCCUP & ENV HLTH391 CHIPETA WAY SUITE C
SLC,UT84108 		87-1269232 501(C)(3) 6,190       SUPPORT OCCUPATIONAL SAFETY
(11) RONALD MCDONALD HOUSE CHARITIES1135 E SOUTH TEMPLE
SLC,UT84102 		74-2386043 501(C)(3) 12,500       SUPPORT PATIENT FAMILIES
(12) SEALANTS FOR SMILES5373 S GREEN STREET SUITE 400
SLC,UT84123 		20-8857514 501(C)(3) 7,635       ORAL HEALTH EDUCATION
(13) UTAH FAMILIES FOUNDATION9160 SOUTH 300 WEST 21
SANDY,UT84070 		87-0509416 501(C)(3) 20,000       CHILDREN'S HEALTHCARE
(14) VOLUNTEERS OF AMERICA UTAH718 SOUTH 600 EAST
SLC,UT84102 		94-3008720 501(C)(3) 10,000       SUPPORT COMM PROGRAMS
(15) WASATCH COMMUNITY FOUNDATION101 EAST 200 NORTH
HEBER CITY,UT84032 		87-0650772 501(C)(3) 5,400       SCHOLARSHIPS
(16) WEBER STATE UNIVERSITY1001 UNIVERSITY CIRCLE
OGDEN,UT84408 		87-6000535   1,000,000       HEALTHCARE EDUCATION
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image
15
3
Enter total number of other organizations listed in the line 1 table ......................... . Bullet Image
1
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2011

Schedule I (Form 990) 2011
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Use Schedule I-1 (Form 990) if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients		 (c)Amount of
cash grant		 (d)Amount of
non-cash assistance		 (e)Method of valuation (book,
FMV, appraisal, other)		 (f)Description of non-cash assistance













Part IV
Supplemental Information. Complete this part to provide the information required in Part I, line 2, and any other additional information.
Identifier Return Reference Explanation
Monitoring Grant Funds in the United States Form 990, Schedule I, Part I, Line 2 BY POLICY, GRANTS ARE GENERALLY LIMITED TO PUBLIC CHARITIES EXEMPT FROM INCOME TAX UNDER IRS SECTION 501(C)(3). GRANTS TO ANY OTHER TYPE OF ENTITY REQUIRE WRITTEN APPROVAL FROM BOTH THE CEO AND CFO. THE CEO AND THE EXECUTIVE COMMITTEE OF THE BOARD MUST APPROVE INDIVIDUAL GRANTS EQUAL TO OR EXCEEDING $10,000. OVERSITE OF THE GRANTS ARE THE RESPONSIBILTY OF THE EXECUTIVE COMMITTEE OF THE BOARD.
Schedule I (Form 990) 2011


Additional Data


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Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all the expenses described above? If "No," complete Part III to explain....
1b
Yes
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
officers, directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? ....
2
Yes
 
3
Indicate which, if any, of the following the organization uses to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ...............
4a
 
No
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? ........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? ........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
Yes
 
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
 
No
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Privacy Act and Paperwork Reduction Act Notice, see the Intructions for Form 990
Cat. No. 50053T
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.

Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and column (E) for that individual.
(A) Name (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits		 (E) Total of columns
(B)(i)-(D) 		(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1) ALBERT R ZIMMERLI (i)
(ii)		 664,026
0 		238,567
0 		44,127
0 		810,302
0 		21,123
0 		1,778,145
0 		238,567
 
(2) BRENT C JAMES MD (i)
(ii)		 320,296
0 		76,132
0 		25,745
0 		310,295
0 		15,513
0 		747,981
0 		76,132
 
(3) BRENT E WALLACE MD (i)
(ii)		 420,733
0 		122,317
0 		22,140
0 		502,158
0 		14,122
0 		1,081,470
0 		122,317
 
(4) BRENT T JOHNSON (i)
(ii)		 257,094
0 		78,966
0 		10,635
0 		238,279
0 		13,282
0 		598,256
0 		78,966
 
(5) BRUCE H JENSEN (i)
(ii)		 295,881
0 		95,134
0 		22,778
0 		300,972
0 		14,327
0 		729,092
0 		95,134
 
(6) CAVELL ALEXANDER (i)
(ii)		 178,995
0 		59,691
0 		25,586
0 		89,490
0 		12,238
0 		366,000
0 		59,691
 
(7) CHARLES W SORENSON JR MD (i)
(ii)		 877,940
0 		311,153
0 		36,017
0 		954,672
0 		16,699
0 		2,196,481
0 		311,153
 
(8) CHRIS M COONS (i)
(ii)		 397,076
0 		125,718
0 		85,876
0 		367,985
0 		18,671
0 		995,326
0 		125,718
 
(9) D R GARDNER (i)
(ii)		 233,780
0 		76,571
0 		23,871
0 		186,347
0 		17,282
0 		537,851
0 		76,571
 
(10) DANIEL L ZUHLKE (i)
(ii)		 330,797
0 		104,649
0 		24,843
0 		306,382
0 		14,193
0 		780,864
0 		104,649
 
(11) DAVID CLARK (i)
(ii)		 357,755
0 		109,269
0 		7,252
0 		298,396
0 		15,752
0 		788,424
0 		109,269
 
(12) DOUGLAS J HAMMER (i)
(ii)		 356,456
0 		101,242
0 		28,613
0 		244,746
0 		15,551
0 		746,608
0 		101,242
 
(13) GREGORY M JOHNSON (i)
(ii)		 257,172
0 		79,071
0 		30,667
0 		166,553
0 		17,058
0 		550,521
0 		79,071
 
(14) GREGORY P POULSEN (i)
(ii)		 405,638
0 		147,125
0 		39,734
0 		457,565
0 		15,551
0 		1,065,613
0 		147,125
 
(15) JACQUE MILLARD (i)
(ii)		 215,117
0 		67,162
0 		26,206
0 		133,224
0 		18,199
0 		459,908
0 		67,162
 
(16) JOHN C PINGREE JR (i)
(ii)		 84,002
0 		50,660
0 		17,681
0 		5,297
0 		7,713
0 		165,353
0 		50,660
 
(17) JOSEPH R HORTON (i)
(ii)		 518,579
0 		187,688
0 		2,636,558
0 		393,782
0 		14,277
0 		3,750,884
0 		2,777,344
 
(18) LARRY D HANCOCK (i)
(ii)		 500,885
0 		145,862
0 		4,771
0 		415,837
0 		17,207
0 		1,084,562
0 		145,862
 
(19) MARC PROBST (i)
(ii)		 390,294
0 		122,561
0 		27,174
0 		341,191
0 		19,905
0 		901,125
0 		122,561
 
(20) NANCY A NOWAK (i)
(ii)		 303,516
0 		95,204
0 		643,542
0 		195,233
0 		12,232
0 		1,249,727
0 		396,952
 
(21) ROBERT W ALLEN (i)
(ii)		 251,463
0 		77,656
0 		20,600
0 		163,808
0 		15,605
0 		529,132
0 		77,656
 
(22) SUZANNE DRAPER (i)
(ii)		 194,438
0 		58,593
0 		1,895
0 		97,638
0 		19,913
0 		372,477
0 		58,593
 
(23) TIMOTHY T PEHRSON (i)
(ii)		 382,380
0 		117,412
0 		17,993
0 		257,898
0 		19,821
0 		795,504
0 		117,412
 
(24) TODD CRAGHEAD (i)
(ii)		 189,277
0 		57,101
0 		1,819
0 		76,170
0 		13,768
0 		338,135
0 		57,101
 
(25) LINDA C LECKMAN MD (i)
(ii)		 436,189
0 		134,793
0 		22,244
0 		460,359
0 		11,299
0 		1,064,884
0 		134,793
 
(26) GEORGE HAMILTON (i)
(ii)		 302,152
0 		0
0 		10,645
0 		89,385
0 		18,481
0 		420,663
0 		0
 
(27) KIMBERLY HENRICHSEN (i)
(ii)		 212,980
0 		68,077
0 		25,381
0 		105,292
0 		15,835
0 		427,565
0 		68,077
 
(28) MIKELLE MOORE (i)
(ii)		 229,980
0 		77,175
0 		18,405
0 		104,346
0 		19,703
0 		449,609
0 		77,175
 
(29) HOWARD RICHTER MD (i)
(ii)		 1,177,489
0 		83,169
0 		1,329
0 		108,594
0 		15,433
0 		1,386,014
0 		82,719
 
(30) ERIC HOOLEY MD (i)
(ii)		 1,124,464
0 		101,013
0 		18,026
0 		123,297
0 		15,729
0 		1,382,529
0 		100,563
 
(31) WAYNE MORTENSEN MD (i)
(ii)		 1,090,159
0 		118,528
0 		1,329
0 		136,328
0 		15,603
0 		1,361,947
0 		118,078
 
(32) STEVEN CARABINE MD (i)
(ii)		 1,094,934
0 		92,533
0 		1,329
0 		124,279
0 		15,504
0 		1,328,579
0 		92,083
 
(33) JEFFREY HARRISON MD (i)
(ii)		 1,039,903
0 		102,413
0 		28,055
0 		119,319
0 		15,504
0 		1,305,194
0 		101,963
 
Schedule J (Form 990) 2011

Schedule J (Form 990) 2011
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4c, 5a, 5b, 6a, 6b, 7, and 8. Also complete this part for any additional information.
Identifier Return Reference Explanation
Supplemental Compensation Information Form 990, Schedule J Health Services is nationally recognized for providing quality medical care that ranks among the highest in the nation with charges that are among the lowest in the nation. Health Services' policy is to compensate its employees, including senior management, at or around the 50th percentile of the healthcare labor markets for similar positions and organizations (i.e., similar size and nonprofit status). The Compensation Committee of the Board retains outside consultants to provide objective data on compensation levels and practices. The Committee annually analyzes this data and makes compensation decisions, which are reviewed by the full Board of Trustees. The Board places a high priority on the need to recruit and retain a strong leadership team and to create a highly motivated and engaged workforce to drive superior organizational performance to achieve a top-tier integrated healthcare delivery system. Compensation levels follow IRS guidelines and are subject to IRS audit. A portion of the compensation reported on this form reflects deferred amounts that are not vested, are subject to a substantial risk of forfeiture, and may or may not be paid in the future. THE REPORTABLE COMPENSATION ON SCHEDULE J INCLUDES CERTAIN AMOUNTS THAT HAVE BEEN OR WILL BE REPORTED TWICE, BOTH IN THE YEAR ACCRUED AND AGAIN IN THE YEAR PAID.
Questions Regarding Compensation Form 990, Schedule J, Part I, Line 1 TRAVEL FOR COMPANIONS - PURSUANT TO COMPANY POLICY, COMPANION TRAVEL EXPENSES WILL NOT BE REIMBURSED BY THE ORGANIZATION UNLESS APPROVED BY SENIOR MANAGEMENT. IF APPROVED, THE REIMBURSED EXPENSES ARE REPORTED AS TAXABLE TO THE INDIVIDUAL ON A FORM W-2 OR 1099. TAX GROSS-UP PAYMENTS - PURSUANT TO COMPANY POLICY, A LIMITED NUMBER OF BENEFITS AND PERQUISITES TO THE GOVERNING BODY ARE GROSSED UP FOR TAX PURPOSES.
Supplemental Nonqualified Retirement Plan Form 990, Schedule J, Part I, Line 4b THE FOLLOWING INDIVIDUALS RECEIVED SUPPLEMENTAL EMPLOYER RETIREMENT PAYMENTS IN 2011: - JOSEPH R. HORTON $2,589,656 - NANCY A. NOWAK $633,055 THE FILING ORGANIZATION OFFERS A SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TO MEMBERS OF ITS CENTRAL OPERATING GROUP. THE AMOUNTS IN THE PLAN ARE NOT VESTED, ARE SUBJECT TO A SUBSTANTIAL RISK OF FORFEITURE, AND MAY OR MAY NOT BE PAID IN THE FUTURE. AMOUNTS DEFERRED FOR THESE INDIVIDUALS DURING 2011 ARE INCLUDED IN THE SCHEDULE J, PART II, COLUMN (C) TOTAL. PHYSICIANS AND CERTAIN MANAGEMENT LEVEL EMPLOYEES WHOSE COMPENSATION EXCEEDS A MINIMUM THRESHOLD MAY ALSO PARTICIPATE IN THE FILING ORGANIZATION'S 457(F) PLAN.
ACCRUED COMPENSATION BASED ON REVENUES SCH J PART I LINE 5a CERTAIN PHYSICIAN CONTRACTS PROVIDE FOR ANY EXCESS OF COLLECTED REVENUE OVER ANNUAL EXPENSES TO BE PAID TO THE PHYSICIAN ON A PHYSICIAN PRACTICE BASIS.
Schedule J (Form 990) 2011

Additional Data


Software ID:  
Software Version:  
Schedule K
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Information on Tax Exempt Bonds
SchKMediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, line 24a. Provide descriptions,
explanations, and any additional information in Part VI.
SchKMediumBullet Attach to Form 990. SchKMediumBullet See separate instructions.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number
94-2854057
Part I
Bond Issues
(a) Issuer Name (b) Issuer EIN (c) CUSIP # (d) Date Issued (e) Issue Price (f) Description of Purpose (g) Defeased (h) On
Behalf of
Issuer 		(i) Pool
financing
Yes No Yes No Yes No
A MURRAY CITY UT
  		87-6000254 626853CE3 11-19-2003 308,000,000 BLDG CONSTRUCTION & EQUIPMENT   X   X   X
B MURRAY CITY UT
  		87-6000254 626853CJ2 10-04-2005 262,000,000 BLDG CONSTRUCTION & EQUIPMENT   X   X   X
C CITY OF RIVERTON UTAH
  		87-0344045 769369AA7 04-10-2007 199,028,000 BLDG CONSTRUCTION & EQUIPMENT   X   X   X
D CITY OF RIVERTON UTAH
  		87-0344045 769369AL3 11-05-2009 252,199,400 BLDG CONSTRUCTION & EQUIPMENT   X   X   X
Part II
Proceeds
A B C D
1 Amount of bonds retired . . . . . . . . . . . . . 0 20,000,000 0 0
2 Amount of bonds legally defeased . . . . . . . . . . 0 0 0 0
3 Total proceeds of issue . . . . . . . . . . . . . 314,823,712 273,598,644 207,213,358 253,283,187
4 Gross proceeds in reserve funds . . . . . . . . 0 0 0 0
5 Capitalized interest from proceeds . . . . . . . . . . 0 0 0 1,083,787
6 Proceeds in refunding escrows . . . . . . . . . . . 0 0 0 0
7 Issuance costs from proceeds . . . . . . . . . . . 1,561,803 1,339,946 1,133,925 0
8 Credit enhancement from proceeds . . . . . . . . . . 0 0 0 0
9 Working capital expenditures from proceeds . . . . . . . 0 0 0 0
10 Capital expenditures from proceeds . . . . . . . . . . 313,261,909 272,258,698 206,079,433 191,316,629
11 Other spent proceeds . . . . . . . . . . . 0 0 0 0
12 Other unspent proceeds . . . . . . . . . . . 0 0 0 60,375,451
13 Year of substantial completion . . . . . . . . . . . 2007 2007 2009
Yes No Yes No Yes No Yes No
14 Were the bonds issued as part of a current refunding issue? . . . .   X   X   X   X
15 Were the bonds issued as part of an advance refunding issue? . . . .   X   X   X   X
16 Has the final allocation of proceeds been made? . . . . . . X   X   X     X
17 Does the organization maintain adequate books and records to support the final allocation of proceeds? . . . . . . . . . . . . . X   X   X   X  
Part III
Private Business Use
A B C D
Yes No Yes No Yes No Yes No
1 Was the organization a partner in a partnership, or a member of an LLC, which owned property financed by tax-exempt bonds? . . . . . . .   X   X   X   X
2 Are there any lease arrangements that may result in private business use of bond-financed property? . . . . . . . . . X   X   X   X  
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50193E
Schedule K (Form 990) 2011
Schedule K (Form 990) 2011
Page 2
Part III
Private Business Use (Continued)
A B C D
Yes No Yes No Yes No Yes No
3a Are there any management or service contracts that may result in private business use of bond-financed property? . . . . . . . . .   X   X   X   X
b If ‘Yes’ to line 3a, does the organization routinely engage bond counsel or other outside counsel to review any management or service contracts relating to the financed property? . . . . .                
c Are there any research agreements that may result in private business use of bond-financed property? . . . . . . .   X   X   X   X
d If ‘Yes’ to line 3c, does the organization routinely engage bond counsel or other outside counsel to review any research agreements relating to the financed property? .                
4 Enter the percentage of financed property used in a private business use by entities other than a section 501(c)(3) organization or a state or local government . . SchKMediumBullet 0% 0% 0% 0%
5 Enter the percentage of financed property used in a private business use as a result of unrelated trade or business activity carried on by your organization, another section 501(c)(3) organization, or a state or local government . . . . . . . SchKMediumBullet   %   %   %   %
6 Total of lines 4 and 5 . . .. . . . . . . . . 0% 0% 0%   %
7 Does the bond issue meet the private security or payment test? . . . X   X   X   X  
8 Has the organization established written procedures to ensure that all nonqualified bonds of the issue are remediated in accordance with the requirements under
Regulations sections 1.141-12 and 1.145-2?
X   X   X   X  
Part IV
Arbitrage
A B C D
Yes No Yes No Yes No Yes No
1 Has a Form 8038-T, Arbitrage Rebate, Yield Reduction and Penalty in Lieu of Arbitrage Rebate, been filed with respect to the bond issue? . . . X   X   X     X
2 Is the bond issue a variable rate issue? X   X     X   X
3a Has the organization or the governmental issuer entered into a qualified hedge with respect to the bond issue? X   X     X   X
b Name of provider . . . . . . . . JP MORGAN
  		JP MORGAN
  		0
  		 
 
c Term of hedge . . . . . . . . 29.2 31.7    
d Was the hedge superintegrated? . . . . X   X          
e Was a hedge terminated? . . . . .   X   X        
4a Were gross proceeds invested in a guaranteed investment contract (GIC)? . . . . . .   X   X   X   X
b Name of provider . . . . . . 0
  		0
  		0
  		0
 
c Term of GIC . . . . . . .        
d Was the regulatory safe harbor for establishing the fair market value of the GIC satisfied? . . . . . .                
5 Were any gross proceeds invested beyond an available temporary period? . . . . . .   X   X   X   X
6 Did the bond issue qualify for an exception to rebate? .   X X   X     X
7 Has the organization established written procedures to monitor the requirements of section 148? . . .   X X   X     X
Schedule K (Form 990) 2011

Schedule K (Form 990) 2011
Page 3
Part V
Procedures To Undertake Corrective Action
Has the organization established written procedures to ensure that violations of federal tax requirements are timely identified and corrected through the voluntary closing agreement program if self-remediation is not available under applicable regulations? . . . . . . . . . . . . . .
Part VI
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule K (see instructions).
Identifier Return Reference Explanation
THE 2011 BONDS REFUNDED THE SERIES 2001B BONDS. THE 2001B BONDS WERE 0  
CALLED ON MAY 15, 2011. ALL PROCEEDS LESS ISSUANCE COSTS WERE USED TO 0  
REFUND THE 2001B BONDS. PART II LINES 13-17 REFER TO THE REFUNDED 2001B 0  
BONDS. 0  
Schedule K (Form 990) 2011

Additional Data


Software ID:  
Software Version:  

Schedule L
(Form 990 or 990-EZ)
Department of the Treasury
Internal Revenue Service
Transactions with Interested Persons
MediumBullet Complete if the organization answered
"Yes" on Form 990, Part IV, lines 25a, 25b, 26, 27, 28a, 28b, or 28c,
or Form 990-EZ, Part V lines 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBulletSee separate instructions.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I
Excess Benefit Transactions (section 501(c)(3) and section 501 (c)(4) organizations only).
Complete if the organization answered "Yes" on Form 990, Part IV, line 25a or 25b, or Form 990-EZ, Part V, line 40b.
1(a) Name of disqualified person (b) Description of transaction (c) Corrected?
Yes No





2
Enter the amount of tax imposed on the organization managers or disqualified persons during the year under section 4958. ......................... Bullet Image$
 
3
Enter the amount of tax, if any, on line 2, above, reimbursed by the organization ....... Bullet Image$
 

Part II
Loans to and/or From Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 26, or Form 990-EZ, Part V, line 38a.
(a) Name of interested person and purpose (b) Loan to or from the organization? (c)Original principal amount (d)Balance due (e) In default? (f) Approved by board or committee? (g)Written agreement?
To From Yes No Yes No Yes No
Total ...............Small Bullet $  
Part III
Grants or Assistance Benefitting Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 27.
(a) Name of interested person (b)Relationship between interested person and the organization (c)Amount of grant or type of assistance
For Privacy Act and Paperwork Reduction Act Notice, see the
Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2011
Schedule L (Form 990 or 990-EZ) 2011
Page 2
Part IV
Business Transactions Involving Interested Persons.
Complete if the organization answered "Yes" on Form 990, Part IV, line 28a, 28b, or 28c.
(a) Name of interested person (b) Relationship between interested person and the organization (c) Amount of transaction (d) Description of transaction (e) Sharing of organization's revenues?
Yes No
(1) ZIONS BANK A SCOTT ANDERSON 119,833 BANKING TRANSACTIONS   No
(2) QUESTAR GAS TERESA BECK 2,727,962 PURCHASE OF NATURAL GAS   No
(3) BOYER KEM GARDNER 424,562 RENTAL OF REAL PROPERTY   No
(4) JEFFERY T CRAGHEAD FAMILY MEMBER OF OFFICER 62,251 EMPLOYEE COMPENSATION   No
(5) MERIT MEDICAL SYSTEMS A SCOTT ANDERSON 1,626,797 PURCHASE OF MEDICAL SUPPLIES   No
(6) DOROTHY HENDERSON CLARK FAMILY MEMBER OF OFFICER 16,785 EMPLOYEE COMPENSATION   No
(7) COLBY L HANCOCK FAMILY MEMBER OF OFFICER 12,934 EMPLOYEE COMPENSATION   No
(8) JEFFREY L ANDERSON FAMILY MEMBER OF TRUSTEE 311,354 EMPLOYEE COMPENSATION   No
(9) SCOTT PINGREE FAMILY MEMBER OF OFFICER 172,250 EMPLOYEE COMPENSATION   No
(10) KELSIE N SANCHEZ FAMILY MEMBER OF OFFICER 20,736 EMPLOYEE COMPENSATION   No
(11) WILLIAM B CHOPLIN FAMILY MEMBER OF OFFICER 54,870 EMPLOYEE COMPENSATION   No
(12) NICHOLAS PAGE FAMILY MEMBER OF OFFICER 35,572 EMPLOYEE COMPENSATION   No
(13) KCI MEDICAL BRENT C JAMES MD 1,920,969 PURCHASE MEDICAL SUPPLIES   No
Part V
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule L (see instructions).
Identifier Return Reference Explanation
ZIONS BANK PART IV   A SCOTT ANDERSON, A TRUSTEE, IS ALSO AN OFFICER OF ZIONS BANK.
QUESTAR GAS PART IV   TERESA BECK, A TRUSTEE, IS ALSO A DIRECTOR OF QUESTAR GAS.
BOYER PART IV   KEM GARDNER, A TRUSTEE, IS ALSO A PARTNER IN TWO PARTNERSHIPS LEASING PROPERTY TO THE FILING ORGANIZATION.
MERIT MEDICAL SYSTEMS PART IV   A SCOTT ANDERSON, A TRUSTEE, IS ALSO A DIRECTOR OF MERIT MEDICAL.
KCI MEDICAL PART IV   BRENT C JAMES MD, AN OFFICER, HAS A FAMILY MEMBER WHO IS A DIRECTOR AT KCI MEDICAL.
Schedule L (Form 990 or 990-EZ) 2011

Additional Data


Software ID:  
Software Version:  




SCHEDULE M
(Form 990)

Department of the Treasury
Internal Revenue Service
NonCash Contributions
Right pointing arrow large imageComplete if the organization answered "Yes" on Form 990, Part IV, lines 29 or 30.
Right pointing arrow large image Attach to Form 990.
OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I
Types of Property
(a)
Check if applicable 		(b)
Number of Contributions or items contributed 		(c)
Noncash contribution amounts reported on
Form 990, Part VIII, line 1g 		(d)
Method of determining
noncash contribution amounts
1 Art—Works of art ....        
2 Art—Historical treasures .        
3 Art—Fractional interests ..        
4 Books and publications ..      
5 Clothing and household
goods ....... 		     
6 Cars and other vehicles ..        
7 Boats and planes ....        
8 Intellectual property ...        
9 Securities—Publicly traded .        
10 Securities—Closely held stock .        
11 Securities—Partnership, LLC,
or trust interests .... 		       
12 Securities—Miscellaneous ..        
13 Qualified conservation
contribution—Historic
structures ..... 		       
14 Qualified conservation
contribution—Other ... 		       
15 Real estate—Residential .        
16 Real estate—Commercial ..        
17 Real estate—Other ...        
18 Collectibles .....        
19 Food inventory ...        
20 Drugs and medical supplies .        
21 Taxidermy ......        
22 Historical artifacts ....        
23 Scientific specimens ..        
24 Archeological artifacts ...        
25 Other Right pointing arrow large image ( TRAVEL BAGS ) X 1,800 10,800 FMV
26 Other Right pointing arrow large image ( TRICYCLE, WALKER, CARSEAT ) X 3 2,800 FMV
27 Other Right pointing arrow large image ( SIGN ) X 1 11,583 FMV
28 Other Right pointing arrow large image ( )
29
Number of Forms 8283 received by the organization during the tax year for contributions
for which the organization completed Form 8283, Part IV, Donee Acknowledgement ...
29
0
Yes
No
30a
During the year, did the organization receive by contribution any property reported in Part I, lines 1-28 that it
must hold for at least three years from the date of the initial contribution, and which is not required to be used
for exempt purposes for the entire holding period? ..................
30a
 
No
b
If "Yes," describe the arrangement in Part II.
31
Does the organization have a gift acceptance policy that requires the review of any non-standard contributions?
31
Yes
 
32a
Does the organization hire or use third parties or related organizations to solicit, process, or sell noncash
contributions? ............................
32a
 
No
b
If "Yes," describe in Part II.
33
If the organization did not report revenues in column (c) for a type of property for which column (a) is checked,
describe in Part II.
For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 51227J
Schedule M (Form 990) 2011
Schedule M (Form 990) 2011
Page 2
Part II
Supplemental Information. Complete this part to provide the information required by Part I, lines 30b,
32b, and 33 and whether the organization is reporting in Part I, column (b) the number of contributions, the number of items received, or a combination of both. Also complete this part for any additional information.
Identifier Return Reference Explanation
Schedule M (Form 990) 2011
Additional Data


Software ID:  
Software Version:  
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2011
Open to Public
Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Identifier Return Reference Explanation
ORGANIZATION'S MISSION FORM 990, PART I, LINE 1 AND PART III, LINE 1 MISSION: EXCELLENCE IN THE PROVISION OF HEALTHCARE SERVICES TO COMMUNITIES IN THE INTERMOUNTAIN REGION. - EXCELLENT SERVICE TO OUR PATIENTS, CUSTOMERS, AND PHYSICIANS IS OUR MOST IMPORTANT CONSIDERATION. - WE WILL PROVIDE OUR SERVICES WITH INTEGRITY. OUR ACTIONS WILL ENHANCE OUR REPUTATION AND REFLECT THE TRUST PLACED IN US BY THOSE WE SERVE. - OUR EMPLOYEES ARE OUR MOST IMPORTANT RESOURCE. WE WILL ATTRACT EXCEPTIONAL INDIVIDUALS AT ALL LEVELS OF THE ORGANIZATION AND PROVIDE FAIR COMPENSATION AND OPPORTUNITIES FOR PERSONAL AND PROFESSIONAL GROWTH. WE WILL RECOGNIZE AND REWARD EMPLOYEES WHO ACHIEVE EXCELLENCE IN THEIR WORK. - WE ARE COMMITTED TO SERVING DIVERSE NEEDS OF THE YOUNG AND OLD, THE RICH AND POOR, AND THOSE LIVING IN URBAN AND RURAL COMMUNITIES, WITH SENSITIVITY TO CULTURAL DIFFERENCES. - WE WILL REFLECT THE CARING AND NOBLE NATURE OF OUR MISSION IN ALL THAT WE DO. OUR SERVICES MUST BE HIGH QUALITY, COST-EFFECTIVE, AND ACCESSIBLE, ACHIEVING A BALANCE BETWEEN COMMUNITY NEEDS AND AVAILABLE RESOURCES. - IT IS OUR INTENT TO BE A MODEL HEALTHCARE SYSTEM. WE WILL STRIVE TO BE A LEARNING ORGANIZATION AND NATIONAL LEADER IN NONPROFIT HEALTHCARE DELIVERY. - WE WILL MAINTAIN THE FINANCIAL STRENGTH NECESSARY TO FULFILL OUR MISSION. VISION: WE WILL SUPPORT OUR CORE ASPIRATION TO DELIVER "EXTRAORDINARY CARE IN ALL ITS DIMENSIONS" WITH OUR VISION, WHICH IS TO PROVIDE: - THE BEST CLINICAL PRACTICE DELIVERED IN A CONSISTENT AND INTEGRATED WAY. - LOWEST APPROPRIATE COST TO THE POPULATION WE SERVE. - A SERVICE EXPERIENCE, SUPPORTED BY SYSTEMS AND PROCESSES, THAT FOCUSES ON PATIENTS, ENROLLEES, FAMILIES, AND ONE ANOTHER. - A GENUINE CARING AND CONCERN IN OUR INTERACTIONS WITH PATIENTS, FAMILIES, AND ONE ANOTHER. CORE VALUES: - MUTUAL RESPECT. "WE TREAT OTHERS THE WAY WE WANT TO BE TREATED." - ACCOUNTABILITY. "WE ACCEPT RESPONSIBILITY FOR OUR ACTIONS, ATTITUDES AND MISTAKES." - TRUST. "WE CAN COUNT ON EACH OTHER." - EXCELLENCE. "WE DO OUR BEST AT ALL TIMES AND LOOK FOR WAYS TO DO IT EVEN BETTER."
PROGRAM SERVICE ACCOMPLISHMENTS FORM 990, PART III, LINE 4A INTERMOUNTAIN HEALTH CARE, INC. (INTERMOUNTAIN) WAS ORGANIZED IN 1975 TO OWN AND OPERATE THE 15 HOSPITALS FORMERLY OWNED BY THE CHURCH OF JESUS CHRIST OF LATTER-DAY SAINTS. IN 1982, INTERMOUNTAIN FORMED IHC HEALTH SERVICES, INC. (UNDER ITS FORMER NAME IHC HOSPITALS, INC.) AS A UTAH NONPROFIT SUBSIDIARY AND TRANSFERRED TO HEALTH SERVICES ITS HEALTHCARE FACILITIES. HEALTH SERVICES CURRENTLY CONSISTS OF THE HOSPITAL DIVISION, COMPRISED OF 23 HOSPITALS (22 OWNED AND ONE - GARFIELD MEMORIAL - MANAGED BY HEALTH SERVICES) WITH 2,802 LICENSED BEDS IN UTAH AND SOUTHEAST IDAHO, AND THE INTERMOUNTAIN MEDICAL GROUP, WHICH EMPLOYS MORE THAN 880 PRIMARY AND SECONDARY CARE PHYSICIANS IN HOSPITALS AND MORE THAN 275 CLINIC SITES. TWENTY OF HEALTH SERVICES' HOSPITALS ARE GENERAL ACUTE CARE FACILITIES WHICH PROVIDE INPATIENT AND OUTPATIENT MEDICAL SERVICES BASED ON SPECIFIC NEEDS IN EACH COMMUNITY. THE REMAINING THREE HOSPITALS PROVIDE SPECIALTY CARE IN THE FOLLOWING AREAS: - PRIMARY CHILDREN'S MEDICAL CENTER - PEDIATRIC CARE - MCKAY-DEE INSTITUTE FOR BEHAVIORAL MEDICINE - PSYCHIATRIC AND BEHAVIORAL HEALTH - THE ORTHOPEDIC SPECIALTY HOSPITAL - ORTHOPEDIC CARE HEALTH SERVICES' CLINICAL STATISTICS FOR 2011: - ACUTE ADMISSIONS - 135,953 - ACUTE PATIENT DAYS - 519,688 - BIRTHS - 30,973 - INPATIENT SURGERIES - 40,650 - AMBULATORY SURGERIES - 108,149 - EMERGENCY ROOM VISITS - 463,872 - PHYSICIAN CLINIC VISITS - 2,563,492 - HOMECARE PATIENTS SERVED - 70,082 HEALTH SERVICES' CORE BUSINESS IS MANAGING COMMON CLINICAL PROCESSES OF CARE TO ACHIEVE THE HIGHEST CLINICAL QUALITY, SERVICE QUALITY, AND COST OUTCOMES. EACH YEAR, HEALTH SERVICES SETS GOALS FOR CLINICAL QUALITY IMPROVEMENT IN EIGHT CLINICAL PROGRAMS AND OTHER AREAS. PHYSICIANS, NURSES, AND OTHER CLINICAL PROFESSIONALS MEASURE THEIR PROGRESS TOWARD THESE GOALS AND EVALUATE RESULTS. THIS LEADS TO THE SYSTEMATIC IMPLEMENTATION OF BEST PRACTICES - A PROCESS THAT YIELDS BETTER CARE FOR PATIENTS. HEALTH SERVICES AND ITS AFFILIATES (COLLECTIVELY RECOGNIZED AS INTERMOUNTAIN HEALTHCARE) IS RECOGNIZED WORLDWIDE AS AN ORGANIZATION FOCUSED ON PROVIDING CARE BASED ON PROVEN RESULTS. THE FOLLOWING EIGHT CLINICAL PROGRAMS ARE ORGANIZED AND OPERATED BY HEALTH SERVICES TO DEVELOP AND IMPLEMENT EVIDENCED BASED BEST PRACTICES IN OUR HOSPITAL AND COMMUNITY BASED SETTINGS: - THE CARDIOVASCULAR CLINICAL PROGRAM INCLUDES THE SPECIALTIES OF CARDIOLOGY, CARDIAC SURGERY, VASCULAR SURGERY, AND THORACIC SURGERY. TEAMS REVIEW AND ESTABLISH BEST PRACTICES FOR PATIENTS WITH HEART DISEASE IN HOSPITALS, EMERGENCY DEPARTMENTS, AND PRIMARY CARE AND SPECIALIST OFFICES. CARE PROCESS MODELS HAVE BEEN DEVELOPED FOR HYPERTENSION, ACUTE CORONARY SYNDROME, HEART FAILURE, AND STROKE PREVENTION. CARDIOVASCULAR SERVICES WORKED CLOSELY WITH THE IMAGING CLINICAL SERVICES TO ESTABLISH GUIDELINES FOR REDUCING RADIATION EXPOSURE TO PATIENTS UNDERGOING CARDIOVASCULAR IMAGING PROCEDURES. - THE WOMEN AND NEWBORNS CLINICAL PROGRAM FOCUSES ATTENTION ON PREGNANCY (INCLUDING HIGH-RISK PREGNANCY), CHILDBIRTH, AND THE NEONATAL PERIOD. GUIDELINES ADOPTED FROM NATIONAL SPECIALTY SOCIETIES AND PEER REVIEW STUDIES HAVE BEEN USED TO ESTABLISH BEST PRACTICE MODELS AND DRIVE CONSISTENCY IN ANTEPARTUM, INTRAPARTUM, POSTPARTUM, AND NEONATAL PROCESSES. - THE PRIMARY CARE CLINICAL PROGRAM ADDRESSES THE NEEDS OF AMBULATORY PATIENTS CARED FOR BY FAMILY PRACTITIONERS, INTERNISTS AND PEDIATRICIANS. MAJOR EFFORTS HAVE BEEN DIRECTED AT SMOKING CESSATION, CHILDHOOD VACCINATION, TREATMENT OF COMMUNITY-ACQUIRED PNEUMONIA, AND STANDARDIZING THE CARE OF PATIENTS WITH DIABETES AND ASTHMA. - THE ONCOLOGY CLINICAL PROGRAM INCLUDES A NETWORK OF CANCER SURGEONS, RADIATION ONCOLOGISTS, MEDICAL ONCOLOGISTS, PHARMACISTS, NURSES, PATHOLOGISTS AND RADIOLOGISTS, ALONG WITH CANCER REGISTRY AND CLINICAL TRIALS DEPARTMENTS THAT PROVIDE AND SUPPORT CANCER SERVICES THROUGHOUT HEALTH SERVICES. EFFORTS HAVE BEEN MADE TO STANDARDIZE SURGICAL ONCOLOGY, PATHOLOGY, MAMMOGRAPHY, MEDICAL ONCOLOGY, AND RADIATION ONCOLOGY DATA COLLECTION TO IMPROVE THE PROCESS OF CANCER DIAGNOSIS AND TREATMENT. THE PROGRAM ADDITIONALLY SUPPORTS A COLLABORATIVE EFFORT BETWEEN HEALTH SERVICES AND HUNTSMAN CANCER INSTITUTE TO STRENGTHEN CANCER OUTCOMES, RESEARCH, QUALITY IMPROVEMENT, CLINICAL TRIALS RESEARCH, AND PATIENT EDUCATION. - THE PEDIATRIC SPECIALTIES CLINICAL PROGRAM WORKS TO IMPROVE HOSPITAL CARE FOR CHILDREN, INCLUDING CARE BY PEDIATRIC SUBSPECIALTY PROVIDERS. BEST PRACTICE GUIDELINES HAVE BEEN DEVELOPED FOR TREATMENT OF BRONCHIOLITIS, THE FEBRILE INFANT, TYPE I DIABETES, AND TORTICOLLIS. PEDIATRIC TEAMS HAVE ALSO TAKEN STEPS TO PREVENT PEDIATRIC MEDICATION ERRORS, IMPROVE EDUCATION FOR ASTHMA PATIENTS, AND IMPROVE EARLY RECOGNITION OF SHOCK IN CHILDREN. - THE SURGICAL SERVICES CLINICAL PROGRAM IS COMPRISED OF TEAMS OF PHYSICIANS, NURSES, ADMINISTRATORS, AND OTHER CARE PROVIDERS IN THE AREAS OF OPERATING ROOMS, SAME DAY SURGERY, POST ANESTHESIA CARE UNIT, ANESTHESIA, CENTRAL PROCESSING, SEDATION SERVICES, AND PAIN MANAGEMENT. EACH TEAM IDENTIFIES AND IMPLEMENTS VERY FOCUSED GOALS OF EVIDENCE-BASED BEST PRACTICES, WHICH HAVE THE POTENTIAL OF GREATLY AFFECTING PATIENT OUTCOMES. SEVERAL INITIATIVES ARE CURRENTLY IN PROCESS, INCLUDING OUR CARE PROCESS FOR COLON RESECTION PATIENTS, BLOOD UTILIZATION PILOT PROJECT FOR PACKED RED BLOOD CELLS, AND DEVELOPMENT OF OUR PAIN MANAGEMENT DATA MART. - THE INTENSIVE MEDICINE CLINICAL PROGRAM IS COMPRISED OF TEAMS OF PHYSICIANS, NURSES, RESPIRATORY THERAPISTS, ADMINISTRATORS, AND OTHER CARE PROVIDERS IN THE AREAS OF EMERGENCY CARE, CRITICAL CARE, TRAUMA CARE, TRANSPORT (AIR AND GROUND AMBULANCE), HOSPITALISTS, HYPERBARIC MEDICINE, STROKE CARE, AND TELEMEDICINE / TELESTROKE. EACH TEAM IDENTIFIES AND IMPLEMENTS VERY FOCUSED GOALS OF EVIDENCED-BASED BEST PRACTICE, WHICH HAVE THE POTENTIAL OF GREATLY IMPACTING PATIENT OUTCOMES. CARE PROCESS MODELS IN PLACE INCLUDE ACUTE STROKE CARE, TRAUMATIC BRAIN INJURY, AND FEVER IN CHILDREN. THE TEAM HAS WORKED TO REDUCE VENTILATOR ASSOCIATED PNEUMONIA, CONTROL GLUCOSE LEVELS IN THE CRITICAL CARE POPULATION, IMPLEMENT RAPID RESPONSE TEAMS IN EACH HOSPITAL, IMPLEMENT THE SEPSIS, VENTILATOR, AND CENTRAL LINE BUNDLES, AS WELL AS TO DEVELOP AND IMPLEMENT A NEW ELECTRONIC MEDICAL RECORD IN THE EMERGENCY DEPARTMENTS AND CRITICAL CARE UNITS IN PARTNERSHIP WITH GE HEALTHCARE. FUTURE INITIATIVES INCLUDE A SYSTEM-WIDE BOARD GOAL IN ACUTE STROKE CARE IN 2012, CONTINUED WORK IN THE DEVELOPMENT AND IMPLEMENTATION OF THE ELECTRONIC MEDICAL RECORD, AND ADVANCING TELEMEDICINE. - THE BEHAVIORAL HEALTH CLINICAL PROGRAM IS COMPRISED OF TEAMS OF PHYSICIANS, NURSES, BEHAVIORAL THERAPISTS, ADMINISTRATORS, AND OTHER CARE PROVIDERS. THE TEAM HAS WORKED TO IMPROVE THERAPEUTIC ALLIANCE SCORES FOR THEIR PATIENTS AND ITS CORRELATION TO CLINICAL OUTCOME MEASUREMENTS. IN ADDITION, SCREENING FOR COMMON MEDICAL CONDITIONS IN BEHAVIORAL HEALTH PATIENTS IN BEHAVIORAL HEALTH TREATMENT SETTINGS IS MEASURED. CURRENTLY, THE TEAM IS WORKING TO REDUCE WEIGHT GAIN AND IMPROVE GENERAL HEALTH TO PATIENTS PRESENTING WITH MENTAL HEALTH ILLNESS REQUIRING MEDICATION MANAGEMENT. THE MISSION OF HEALTH SERVICES IS EXCELLENCE IN THE PROVISION OF HEALTHCARE SERVICES TO COMMUNITIES IN THE INTERMOUNTAIN REGION. PROVIDING THE HIGHEST QUALITY HEALTHCARE AT THE LOWEST POSSIBLE COST TO OUR PATIENTS AND CUSTOMERS IS ONE OF OUR MOST IMPORTANT CONSIDERATIONS. HEALTH SERVICES PROVIDES SERVICES ON THE BASIS OF MEDICAL NEED, WITHOUT REGARD OF ABILITY TO PAY. AN UNINSURED, LOW-INCOME PERSON WILL RECEIVE THOSE SERVICES GENERALLY AVAILABLE AT ITS HOSPITALS AND CLINICS FOR NO CHARGE OR A REDUCED CHARGE BASED UPON SUCH PERSON'S ABILITY TO PAY, IF IN THE JUDGMENT OF THE ADMITTING PHYSICIAN THE SERVICES ARE AVAILABLE AT THE HOSPITAL AND CLINICS AND THE PERSON REQUIRES THAT SERVICE. THE AVAILABILITY OF FINANCIAL ASSISTANCE FOR PATIENTS WILL CONTINUE TO BE COMMUNICATED THROUGH ALL REASONABLE MEANS. HEALTH SERVICES HAS ESTABLISHED A FINANCIAL ASSISTANCE POLICY FOR THE UNINSURED AND THE UNDERINSURED, WHICH OFFERS DISCOUNTS UP TO 100 PERCENT OF CHARGES ON A SLIDING SCALE. FINANCIAL ASSISTANCE IS BASED ON BOTH INCOME AS A PERCENTAGE OF THE FEDERAL POVERTY LEVEL GUIDELINES AND THE CHARGES FOR SERVICES RENDERED. HEALTH SERVICES' FINANCIAL ASSISTANCE GUIDELINES INCLUDE PROVISIONS THAT ARE RESPONSIVE TO THOSE PATIENTS SUBJECT TO CATASTROPHIC HEALTHCARE EXPENSES.
PROGRAM SERVICE ACCOMPLISHMENTS - CONTINUED FORM 990, PART III, LINE 4A DURING 2011, THROUGH MORE THAN 255,000 CASES, HEALTH SERVICES' FACILITIES AND PHYSICIANS PROVIDED MORE THAN $114.6 MILLION IN FINANCIAL ASSISTANCE (AT COST) TO PEOPLE UNABLE TO PAY. THIS AMOUNT DOES NOT INCLUDE BAD DEBTS. BAD DEBTS REFER TO THE CIRCUMSTANCE WHERE A PERSON HAS THE ABILITY TO PAY BUT DOES NOT PAY FOR THE SERVICES RECEIVED AND THE AMOUNT IS NOT OTHERWISE COLLECTED. IF AN ACCOUNT HAS BEEN INITIALLY IDENTIFIED AS A BAD DEBT BUT THE PATIENT LATER APPLIES FOR AND IS DETERMINED TO HAVE BEEN ELIGIBLE FOR FINANCIAL ASSISTANCE AT THE TIME OF TREATMENT, THEN THE BILL IS NO LONGER CONSIDERED A BAD DEBT AND IS CHARGED TO CHARITY CARE. HOWEVER, IF IT IS DETERMINED THAT THE PATIENT HAD THE ABILITY TO PAY AT THE TIME OF SERVICE BUT THE ACCOUNT CANNOT BE COLLECTED LATER, OR THE PATIENT DID NOT COMMUNICATE AN INABILITY TO PAY, IT IS CONSIDERED TO BE A BAD DEBT, WHICH IS NOT COLLECTIBLE. HEALTH SERVICES GENERALLY INCURS SHORTFALLS BETWEEN ITS ESTABLISHED RATES AND AMOUNTS PAID BY MEDICARE (PRINCIPALLY RELATED TO ELDERLY PATIENTS). HEALTH SERVICES PROVIDES A SIGNIFICANT ARRAY OF ADDITIONAL COMMUNITY SERVICES INCLUDING OWNING AND OPERATING SIX COMMUNITY AND SCHOOL-BASED CLINICS TO HELP MEET THE NEEDS OF UNINSURED AND LOW-INCOME PEOPLE IN NEIGHBORHOODS THAT WOULD OTHERWISE LACK CONVENIENT ACCESS TO HEALTHCARE. IN 2011, THESE CLINICS HAD MORE THAN 26,700 PATIENT VISITS. MOST PATIENTS PAY ON A SLIDING FEE SCALE ACCORDING TO THEIR HOUSEHOLD INCOMES, AND MANY QUALIFY FOR HEALTH SERVICES' FINANCIAL ASSISTANCE. AFFILIATED FOUNDATIONS SUPPORTED BY HEALTH SERVICES AWARD GRANTS AND OTHER CASH CONTRIBUTIONS TO 12 INDEPENDENTLY OWNED CLINICS THAT PROVIDE PRIMARY HEALTHCARE SERVICES TO UNINSURED, LOW-INCOME, AND HOMELESS POPULATIONS. THESE CLINICS, LOCATED THROUGHOUT UTAH, HAD MORE THAN 185,000 PATIENT VISITS IN 2011. HEALTH SERVICES PROVIDES COMMUNITY BENEFIT ACTIVITIES INCLUDING: HEALTH EDUCATION, HEALTH IMPROVEMENT SERVICES, HEALTH PROFESSIONS EDUCATION, INTERN AND RESIDENT TRAINING, AND MEDICAL RESEARCH. DURING 2011, THESE COMMUNITY SERVICES AND CONTRIBUTIONS TOTALED MORE THAN $54.8 MILLION. SEE SCHEDULE H.
BUSINESS AND/OR FAMILY RELATIONSHIPS FORM 990, PART VI, SECTION A, LINE 2 Charles W. Sorenson Jr. M.D. / Gregory P. Poulsen - Family Relationship Albert R. Zimmerli / Douglas C. Black / Chris M. Coons / Brent T. Johnson - Business Relationship (Board members of a corporate investment that is 50% owned by the filing organization) A. SCOTT ANDERSON / DOUGLAS J. HAMMER - BUSINESS RELATIONSHIP (Trustee/employee relationship in an unrelated tax exempt organization) SPENCER F. ECCLES / DOUGLAS J. HAMMER - BUSINESS RELATIONSHIP (TRUSTEE/EMPLOYEE RELATIONSHIP IN AN UNRELATED TAX EXEMPT ORGANIZAION) A. Scott Anderson / Thomas B. Morgan - Business Relationship (Employer/employee relationship in an unrelated taxable corporation) ALBERT R. ZIMMERLI / BRUCE T. REESE / CHARLES W. SORENSON JR MD / DOUGLAS C. BLACK / F. ANN MILLNER / KEM C. GARDNER / MERRILL GAPPMAYER / TERESA BECK - BUSINESS RELATIONSHIP (BOARD MEMBERS AND/OR OFFICERS OF THE HEALTHCARE CAPTIVE INSURANCE COMPANY, A TAXABLE ORGANIZATION THAT IS WHOLLY-OWNED BY THE FILING ORGANIZATION'S PARENT) ALBERT R. ZIMMERLI / CHARLES W. SORENSON JR. MD / THOMAS B. MORGAN - BUSINESS RELATIONSHIP (BOARD MEMBERS OF SELECTHEALTH BENEFIT ASSURANCE COMPANY, A TAXABLE CORPORATION THAT IS WHOLLY-OWNED BY AN AFFILIATE OF THE FILING ORGANIZATION) ALBERT R. ZIMMERLI / BRUCE T. REESE / CHARLES W. SORENSON JR MD / A. SCOTT ANDERSON / DOUGLAS C. BLACK / F. ANN MILLNER /GREGORY M. JOHNSON / KEM C. GARDNER / MERRILL GAPPMAYER / TERESA BECK - BUSINESS RELATIONSHIP (BOARD MEMBERS AND/OR OFFICERS OF IHC AFFILIATED SERVICES, INC., A TAXABLE CORPORATION WITH MINIMAL ACTIVITY THAT IS WHOLLY-OWNED BY AN AFFILIATE OF THE FILING ORGANIZATION)
ORGANIZATION MEMBER FORM 990, PART VI, SECTION A, LINES 6-7 The sole member of Health Services is Intermountain Health Care, Inc., a Utah nonprofit corporation. Pursuant to the approved bylaws, the member exercises all property, voting, and other rights, interests and powers conferred under local statute, including the election of Health Services' trustees.
FORM 990 REVIEW BY BOARD MEMBERS FORM 990, PART VI, SECTION B, LINE 11 HEALTH SERVICES' BOARD OF TRUSTEES DELEGATED THE INITIAL DETAILED REVIEW OF THE FORM 990 TO THE AUDIT AND COMPLIANCE COMMITTEE. DRAFT COPIES OF THE RETURN WERE MAILED TO COMMITTEE MEMBERS IN ADVANCE AND DISCUSSED IN DEPTH DURING AN AUDIT COMMITTEE MEETING. PRIOR TO FILING WITH THE IRS, COPIES OF THE FINAL RETURN WERE PROVIDED TO BOARD MEMBERS FOR REVIEW AND WERE DISCUSSED AS PART OF A REGULARLY SCHEDULED BOARD MEETING.
MONITORING AND ENFORCEMENT OF THE CONFLICT OF INTEREST POLICY FORM 990, PART VI, SECTION B, LINE 12 EACH OFFICER, DIRECTOR, TRUSTEE, AND KEY EMPLOYEE IS REQUIRED TO COMPLETE A CONFLICT OF INTEREST QUESTIONNAIRE AT LEAST ANNUALLY. THESE INDIVIDUALS HAVE ALSO 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. THE QUESTIONNAIRES ARE COLLECTED AND REVIEWED, PER POLICY, BY THE VICE PRESIDENT OF BUSINESS ETHICS AND COMPLIANCE. 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, HEALTH SERVICES DETERMINES IF 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 OR REQUIRING A CHOICE BETWEEN THE INDIVIDUAL'S ROLE WITH HEALTH SERVICES OR THE OUTSIDE ENTITY). FINDINGS ARE REPORTED TO THE FULL AUDIT AND COMPLIANCE COMMITTEE. THE MINUTES FROM THAT REPORT ARE SUBMITTED TO THE BOARD OF TRUSTEES.
DETERMINATION OF EXECUTIVE COMPENSATION FORM 990, PART VI, SECTION B, LINE 15 THE EXECUTIVE COMPENSATION COMMITTEE ("COMMITTEE"), A SUBSET OF HEALTH SERVICES' BOARD MEMBERS, IS RESPONSIBLE FOR THE PROCESS OF ANNUALLY DETERMINING THE TOTAL COMPENSATION PACKAGES (INCLUDING CASH AND NON-CASH BENEFITS) FOR THE FOLLOWING OFFICERS: - PRESIDENT / CHIEF EXECUTIVE OFFICER - SENIOR VICE PRESIDENT / CHIEF FINANCIAL OFFICER / TREASURER - SENIOR VICE PRESIDENT / SECRETARY - SENIOR VICE PRESIDENTS - CORPORATE VICE PRESIDENTS - REGIONAL VICE PRESIDENTS PURSUANT TO HEALTH SERVICES' WRITTEN "COMPENSATION PHILOSOPHY," THE COMMITTEE ANUALLY RETAINS AN INDEPENDENT, EXTERNAL CONSULTING FIRM TO PROVIDE AN ANALYSIS OF COMPARABLE MARKET DATA. THE CONSULTANTS REVIEW THE VARIOUS TYPES OF DIRECT COMPENSATION, INCLUDING BASE SALARY, TOTAL CASH, AND ANNUAL AND LONG-TERM INCENTIVES. INFORMATION FROM A SELECTED GROUP OF COMPARABLE NOT-FOR-PROFIT ORGANIZATIONS IS USED TO SUPPLEMENT PUBLISHED SURVEY DATA. THE CONSULTANTS ALSO CONDUCT AN IN-DEPTH ANALYSIS OF THE ASSOCIATED BENEFITS AND PERQUISITES. INFORMATION PROVIDED BY THE EXTERNAL CONSULTANTS IS REVIEWED BY THE COMMITTEE ALONG WITH THE PERFORMANCE DATA FOR EACH INDIVIDUAL LISTED ABOVE. DECISIONS BY THE COMMITTEE ARE CONTEMPORANEOUSLY DOCUMENTED. THE COMMITTEE PRESENTS ALL OF THE COLLECTED INFORMATION AND THE ASSOCIATED COMPENSATION DECISIONS TO THE ENTIRE BOARD OF TRUSTEES. HEALTH SERVICES' PHILOSOPHY IS TO PAY COMPENSATION AT OR AROUND THE 50TH PERCENTILE OF COMPARABLE HEALTHCARE ORGANIZATIONS. THE DETERMINATION OF EXECUTIVE COMPENSATION IS ALSO DESIGNED TO MEET THE "REBUTTABLE PRESUMPTION OF REASONABLENESS" STANDARD AS OUTLINED IN THE TREASURY REGULATIONS.
PUBLIC INSPECTION OF GOVERNING DOCUMENTS, POLICIES, AND FINANCIAL STMTS. FORM 990, PART VI, SECTION C, LINE 19 HEALTH SERVICES DOES NOT CURRENTLY ALLOW PUBLIC INSPECTION OF ITS GOVERNING DOCUMENTS OR CONFLICT OF INTEREST POLICY. THE FINANCIAL STATEMENTS ARE AVAILABLE TO THE PUBLIC ON THE ELECTRONIC MUNICIPAL MARKET ACCESS (EMMA) WEBSITE, A SERVICE PROVIDED BY THE MUNICIPAL SECURITIES RULEMAKING BOARD.
RECONCILIATION OF NET ASSETS FORM 990, PART XI, LINE 5 ($261,051,666) - Unrealized LOSSES On investments ($258,769,070) - Unrecognized change in funded status of postretirement benefit plans $515,658 - Change in other temporarily restricted net assets ($268,910) - BOOK/TAX DIFFERENCE ON THE SALE OF AN LLC INTEREST
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BETH V COLE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRUCE T REESE TITLE:TRUSTEE HOURS:11
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:CHARLES W SORENSON JR MD TITLE:TRUSTEE/PRESIDENT/CEO HOURS:29
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DOUGLAS C BLACK TITLE:TRUSTEE/VICE CHAIR/SECRETARY HOURS:15
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:F ANN MILLNER TITLE:TRUSTEE HOURS:10
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JANE CARLILE TITLE:TRUSTEE HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KAREN W FAIRBANKS TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KEM C GARDNER TITLE:TRUSTEE/CHAIR HOURS:15
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:M ELIZABETH HAMMOND MD TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MERRILL GAPPMAYER TITLE:TRUSTEE HOURS:12
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:RANDY HORIUCHI TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:REBECCA CHAVEZ-HOUCK TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:SPENCER F ECCLES TITLE:TRUSTEE HOURS:5
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TERESA BECK TITLE:TRUSTEE HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:THOMAS B MORGAN TITLE:TRUSTEE HOURS:10
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:A SCOTT ANDERSON TITLE:TRUSTEE HOURS:4
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ARNOLD MILSTEIN, MD MPH TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:KAREN HALE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:S NEAL BERUBE TITLE:TRUSTEE HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ALBERT R ZIMMERLI TITLE:SENIOR VP/CFO/TREASURER HOURS:30
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:BRUCE H JENSEN TITLE:VICE PRESIDENT HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DANIEL L ZUHLKE TITLE:VICE PRESIDENT HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DAVID CLARK TITLE:VICE PRESIDENT HOURS:1
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:DOUGLAS J HAMMER TITLE:VP/GENERAL COUNSEL HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GREGORY M JOHNSON TITLE:VICE PRESIDENT HOURS:11
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:GREGORY P POULSEN TITLE:SENIOR VICE PRESIDENT HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOHN C PINGREE JR TITLE:VICE PRESIDENT HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:JOSEPH R HORTON TITLE:SENIOR VICE PRESIDENT/SEC HOURS:7
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LARRY D HANCOCK TITLE:VICE PRESIDENT HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:ROBERT W ALLEN TITLE:VICE PRESIDENT HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:TIMOTHY T PEHRSON TITLE:VICE PRESIDENT HOURS:3
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:LINDA C LECKMAN MD TITLE:VICE PRESIDENT HOURS:2
HOURS DEVOTED FOR RELATED ORGANIZATION FORM 990 PART VII NAME:MIKELLE MOORE TITLE:VICE PRESIDENT HOURS:4
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2011

Additional Data


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Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2011
Open to Public Inspection
Name of the organization
IHC HEALTH SERVICES INC
 
Employer identification number

94-2854057
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" on Form 990, Part IV, line 33.)
(a)
Name, address, and EIN of disregarded entity


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Total income
(e)
End-of-year assets


 		(f)
Direct controlling
entity







(1) Lost Creek-Murray LLC
36 South State Suite 2200
Salt Lake City,UT84111
87-0622176 		Apt Rentals UT 2,169,104 9,266,843 IHC HTH SVS
 
(2) IHC Utah Valley LLC
36 South State Suite 2200
Salt Lake City,UT84111
94-2854057 		MED OFFICES UT 295,886 2,777,587 IHC HTH SVS
 
(3) Intermountain Invention Management LLC
36 South State Suite 2200
Salt Lake City,UT84111
94-2854057 		Health Tech UT 91,751 0 IHC HTH SVS
 
(4) 5300 South Center LLC
36 South State Suite 2200
Salt Lake City,UT84111
20-5881911 		Office Rental UT 2,726,205 17,995,580 IHC HTH SVS
 
(5) 5245 College LLC
36 South State Suite 2200
Salt Lake City,UT84111
26-0806138 		Office Rental UT 1,377,853 18,853,421 IHC HTH SVS
 
(6) Pediatric Specialty Services LLC
36 South State Suite 2200
Salt Lake City,UT84111
94-2854057 		Pediatric Ser UT 0 0 IHC HTH SVS
 
Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


 		(c)
Legal domicile (state
or foreign country)

 		(d)
Exempt Code section
(e)
Public charity status
(if section 501(c)(3))

 		(f)
Direct controlling
entity

 		(g)
Section 512(b)(13) controlled organization
Yes No
(1) Intermountain Health care Inc

36 South State Suite 2200

Salt Lake City,UT84111
87-0269232 		Holding Co UT 501(C)(3) 11a TYPE I NA
 
 
No
(2) IHC Management Inc

36 South State Suite 2200

Salt Lake City,UT84111
94-2860622 		Comm Health UT 501(C)(3) 11b TYPE II INT HTH CARE
 
 
No
(3) IHC Professional Services Inc

36 South State Suite 2200

Salt Lake City,UT84111
94-2886596 		Comm Health UT 501(C)(3) 11a TYPE I INT HTH CARE
 
 
No
(4) Intermountain Healthcare Foundation inc

36 South State Suite 2200

Salt Lake City,UT84111
94-2853320 		Comm Health UT 501(C)(3) 11a TYPE I INT HTH CARE
 
 
No
(5) SelectHealth Inc

5381 GREEN STREET

MURRAY,UT84123
87-0409820 		Comm Health UT 501(C)(4) N/A INT HTH CARE
 
 
No
(6) Intermountain Health Care Retiree VEBA

36 South State Suite 2200

Salt Lake City,UT84111
74-2675605 		Retiree Ben UT 501(C)(9) N/A INT HTH CARE
 
 
No


For Privacy Act and Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



 		(b)
Primary activity




 		(c)
Legal
domicile
(state or foreign
country)


 		(d)
Direct controlling
entity



 		(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




 		(g)
Share of end-of-year
assets



 		(h)
Disproprtionate allocations?




 		(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
 		(j)
General or
managing
partner?



 		(k)
Percentage
ownership
Yes No Yes No
(1) McKay Dee Surgical Center LLC

3903 Harrison Blvd Suite 100
Ogden,UT84403
26-0286308 		Outpt Surgery UT IHC HTH SVS
  		RELATED 3,862,717 3,088,350   No 0 Yes   80.300 %












Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" on Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of related organization



 		(b)
Primary activity



 		(c)
Legal domicile
(state or
foreign
country)
 		(d)
Direct controlling
entity


 		(e)
Type of entity
(C corp, S corp,
or trust)

 		(f)
Share of total income



 		(g)
Share of
end-of-year
assets

 		(h)
Percentage
ownership
(1) SelectHealth Benefit Assurance Company
5381 GREEN STREET
MURRAY,UT84123
87-0497549 		Insurance UT NA
  		C      
(2) IHC Affiliated Services INc
36 South State Suite 2300
Salt Lake City,UT84111
87-0405996 		INACTIVE UT NA
  		C      
(3) Healthcare Captive Insurance Company
36 South State Suite 2200
Salt Lake City,UT84111
20-1937561 		Insurance AZ NA
  		C      








Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35, 35A, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III or IV.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
 
No
f Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
Yes
 
j Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
 
No
k Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1k
Yes
 
l Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
 
No
p Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
 
No
r Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization 		(b)
Transaction
type(a-r) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) MCKAY DEE SURGICAL CENTER LLC

 A / I 359,022 FMV
(2) MCKAY DEE SURGICAL CENTER LLC

 K 756,719 CONTRACT
(3) MCKAY DEE SURGICAL CENTER LLC

 P 3,084,935 COST
(4) SELECTHEALTH INC

 K / I 559,710,546 COST
(5) SELECTHEALTH INC

 L 11,805,050 COST
(6) SELECTHEALTH INC

 P 62,250,021 COST
Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" on Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity 		(b)
Primary activity 		(c)
Legal domicile
(state or foreign
country) 		(d)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(e)
Are all
partners
section
501(c)(3)
organizations? 		(f)
Share of total income




 		(g)
Share of
end-of-year
assets 		(h)
Disproprtionate allocations? 		(i)
Code V—UBI
amount in box
20 of Schedule K-1
(Form 1065) 		(j)
General or
managing
partner? 		(k)
Percentage
ownership
Yes No Yes No Yes No






























Schedule R (Form 990) 2011
Schedule R (Form 990) 2011
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation
Additional Data


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