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.
Attach to Form 990 or Form 990-EZ. See separate instructions.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
STORMONT-VAIL HEALTHCARE INC
Employer identification number
48-0543789
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
By checking this box, I certify that the organization is not controlled directly or indirectly by one or more disqualified persons other than foundation managers and other than one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2).
f
If the organization received a written determination from the IRS that it is a Type I, Type II or Type III supporting organization, check this box
..................................................
g
Since August 17, 2006, has the organization accepted any gift or contribution from any of the following persons?
(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
Provide the following information about the supported organization(s).
(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) 2010
Schedule A (Form 990 or 990-EZ) 2010
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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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
Gross receipts from related activities, etc. (See instructions.)
..................
12
13
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here..........................................
Section C. Computation of Public Support Percentage
14
Public Support Percentage for 2010 (line 6 column (f) divided by line 11 column (f))
.........
14
15
Public Support Percentage for 2009 Schedule A, Part II, line 14
...............
15
16a
33 1/3% support test—2010.
If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization
......................
b
33 1/3% support test—2009.
If the organization did not check the box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization
.....................
17a
10%-facts-and-circumstances test—2010.
If the organization did not check a box on line 13, 16a, or 16b and line 14
is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here. Explain
in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported
organization
..................................................
b
10%-facts-and-circumstances test—2009.
If the organization did not check a box on line 13, 16a, 16b, or 17a and line
15 is 10% or more, and if the organization meets the "facts and circumstances" test, check this box and stop here.
Explain in Part IV how the organization meets the "facts and circumstances" test. The organization qualifies as a publicly supported organization
..............................................
18
Private Foundation
If the organization did not check a box on line 13, 16a, 16b, 17a or 17b, check this box and see
instructions
...................................................
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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) 2006
(b) 2007
(c) 2008
(d) 2009
(e) 2010
(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
First Five Years
If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization,
check this box and stop here.............................................
Section C. Computation of Public Support Percentage
15
Public Support Percentage for 2010 (line 8 column (f) divided by line 13 column (f))
.........
15
16
Public support percentage from 2009 Schedule A, Part III, line 15
...............
16
Section D. Computation of Investment Income Percentage
17
Investment income percentage for 2010 (line 10c column (f) divided by line 13 column (f))
......
17
18
Investment income percentage from 2009 Schedule A, Part III, line 17
.............
18
19a
33 1/3% support tests—2010.
If the organization did not check the box on line 14, and line 15 is more than 33 1/3% and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
..........
b
33 1/3% support tests—2009.
If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization
....
20
Private Foundation
If the organization did not check a box on line 14, 19a or 19b, check this box and see instructions
.....
Schedule A (Form 990 or 990-EZ) 2010
Schedule A (Form 990 or 990-EZ) 2010
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) 2010
Additional Data
Software ID:
Software Version:
-
TIN:
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.
Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2010
Open to Public Inspection
Name of the organization
STORMONT-VAIL HEALTHCARE INC
Employer identification number
48-0543789
Identifier
Return Reference
Explanation
FORM 990, PART VI, SECTION B, LINE 11
A DRAFT OF THE RETURN IS PROVIDED TO THE FINANCE COMMITTEE FOR REVIEW. ANY CHANGES ARE COMMUNICATED TO THE PAID PREPARER. A COPY OF THE RETURN IS PROVIDED TO THE ENTIRE BOARD OF DIRECTORS FOR DISCUSSION AND APPROVAL. WITH THE BOARD'S APPROVAL, THE PAID PREPARER THEN FILES THE RETURN ELECTRONICALLY.
FORM 990, PART VI, SECTION B, LINE 12C
THE OFFICERS, DIRECTORS AND KEY EMPLOYEES SUBMIT CONFLICT OF INTEREST STATEMENTS TO THE CHAIRMAN OF THE AUDIT COMMITTEE OF STORMONT-VAIL HEALTHCARE EACH YEAR. THE CHAIRMAN REVIEWS THE RESPONSES AND REPORTS TO THE AUDIT COMMITTEE FOR THEIR REVIEW, ANY APPROPRIATE ACTION IF REQUIRED AND APPROVAL. THE CHAIRMAN ALSO THEN REPORTS THE RESULTS TO THE FULL BOARD OF DIRECTORS.
FORM 990, PART VI, SECTION B, LINE 15
THE PERFORMANCE COMMITTEE OF THE STORMONT-VAIL HEALTHCARE BOARD OF DIRECTORS ENGAGED INTEGRATED HEALTHCARE STRATEGIES, AN EXECUTIVE COMPENSATION CONSULTING FIRM, TO PROVIDE RECOMMENDATIONS REGARDING ALL ASPECTS OF COMPENSATION OF THE ORGANIZATION'S SENIOR LEADERSHIP GROUP, INCLUDING THE PRESIDENT & CEO. THAT ENGAGEMENT INCLUDED THE FOLLOWING COMPONENTS: -REVIEW OF BACKGROUND DATA, INCLUDING INFORMATION ON CURRENT PROGRAM; -COMPILATION OF DATA ON COMPENSATION AND BENEFIT PRACTICES OF COMPARABLE ORGANIZATIONS; -COMPARISON OF BASE SALARIES AT SVHC TO BASE SALARY LEVELS IN THE MARKET; -COMPARISON OF ANNUAL AND LONG-TERM INCENTIVES AT SVHC TO INCENTIVE LEVELS IN THE MARKET; -ANALYSIS OF BENEFITS ON BOTH A QUANTITATIVE AND QUALITATIVE BASIS; -COMPARISON OF SVHC TOTAL COMPENSATION (BASE, INCENTIVE, BENEFITS) TO PEER GROUP TOTAL COMPENSATION; -PREPARATION OF REPORT TO FACILITATE SVHC BOARD DISCUSSION OF THE TOTAL COMPENSATION; AND -RECOMMENDATIONS REGARDING ESTABLISHMENT OF SALARY RANGES FOR SENIOR LEADERSHIP POSITIONS. THE DELIBERATIONS AND DECISIONS OF THE PERFORMANCE COMMITTEE AND THE BOARD OF DIRECTORS ARE DOCUMENTED IN MEETING MINUTES MAINTAINED BY SVHC.
FORM 990, PART VI, SECTION C, LINE 19
STORMONT-VAIL HEALTHCARE, INC. MAKES THEIR FINANCIAL STATEMENTS AVAILABLE FOR PUBLIC INSPECTION AS PART OF THE 990 INFORMATION RETURN. ANY CHANGES TO THE GOVERNING DOCUMENTS ARE INCLUDED WITH THE 990 RETURN. AT THIS TIME, THE HEALTH CENTER DOES NOT MAKE THEIR CONFLICT OF INTEREST POLICY AVAILABLE TO THE PUBLIC.
CHANGES IN NET ASSETS OR FUND BALANCES:
FORM 990, PART XI, LINE 5:
NET UNREALIZED LOSSES ON INVESTMENTS: -5,962,075. EQUITY IN NET INCOME OF CONSOLIDATED AFFILIATES 1,725,640. CHANGE IN ADDITIONAL MINIMUM LIABILITY FOR RETIREMENT BENEFITS -40,015,373. NET GAINS/(LOSS) OF UNCONSOLIDATED AFFILIATES -188,114. TAX AMORTIZATION GREATER THAN BOOK 337,511. INTEREST RATE SWAP 706,418. LOSS ON EXTINGUISHMENT OF DEBT -911,138. TOTAL TO FORM 990, PART XI, LINE 5: -44,307,131.
PART XII, LINE 2C
NO CHANGE FROM PRIOR YEAR
FORM 990, PART III, LINE 4B, PROGRAM SERVICE ACCOMPLISHMENTS:
IN ADDITION TO THESE COMMUNITY CONTRIBUTIONS, STORMONT-VAIL PROVIDED SUPERVISED CLINICAL EXPERIENCE FOR OVER 998 STUDENTS AND 144,910 HOURS TO THE FOLLOWING ENTITIES: NAME/LOCATION TYPE OF STUDENTS DEPT/DIVISION UNIVERSITY OF ARKANSAS GENETICS COTTON O'NEIL CANCER CENTER BAKER UNIVERSITY NURSING MULTIPLE BARTON CO COMMUNITY COLLEGE PARAMEDIC MULTIPLE CLARKSON COLLEGE PA PEDIATRICCARE COFFEY COUNTY HOSPITAL NURSING MULTIPLE COLBY COMMUNITY COLLEGE PT REHAB SERVICES COMMUNITY HEALTH SYSTEM-ONAGA NURSING MULTIPLE COMMUNITY HEALTH SYSTEMS-ST. MARYS NURSING MULTIPLE CREIGHTON UNIVERSITY PHARMACY PHARMACY EMPORIA STATE UNIVERSITYNURSING MEDICAL ARTS CLINIC-EMPORIA FORT HAYS NURSING NURSING MULTIPLE HOLTON COMMUNITY HOSPITAL NURSING PATIENT CARE SERVICES INSTITUTE OF MIDWIFERY MIDWIFERY STUDENTS BIRTHPLACE KANSAS CITY KS COMM COLLEGE PT/OT REHAB SERVICES KANSAS STATE UNIVERSITY KINESIOLOGY HEART CENTER KANSAS STATE UNIVERSITY SPEECH THERAPY REHAB SERVICES UNIVERSITY OF KANSAS EXERCISE SCIENCE HEART CENTER UNIVERSITY OF KANSAS NURSING PATIENT CARE SERVICES UNIVERSITY OF KANSAS OT PATIENT CARE SERVICES UNIVERSITY OF KANSAS PHARMACY PHARMACY UNIVERSITY OF KANSAS PT ASSISTANTS REHAB SERVICES UNIVERSITY OF KANSAS SOCIAL WORK BEHAVIORAL HEALTH MIDLAND LUTHERAN COLLEGE NURSING PATIENT CARE SERVICES UNIVERSITY OF MISSOURI-KC NURSING COTTON-O'NEIL CLINICS MORRIS COUNTY EMS EMTS EMERGENCY DEPT MORRIS COUNTY EMS NURSING PATIENT CARE SERVICES MORRIS COUNTY EMS PHARMACY PHARMACY NEBRASKA MEDICAL CENTER MEDICAL TECHNOLOGY LABORATORY NEWMAN UNIVERSITY OTA REHAB SERVICES PRONERVE SURGERY ROCKHURST UNIVERSITY PT/OT REHABILITATION SERVICES ST. LOUIS UNIVERSITY PA COTTON-O'NEIL CLINICS ST. LOUIS UNIVERSITY NURSING PATIENT CARE SERVICES UNIVERSITY OF SOUTHERN INDIANA NURSING PATIENT CARE SERVICES TEXAS WESLEYAN UNIVERSITY CRNA SURGERY USD #501 HIGH SCHOOL MULTIPLE WASHBURN UNIVERSITY COMMUNICATIONS MARKETING/FOUNDATION WASHBURN UNIVERSITY KINESIOLOGY HEART CENTER WASHBURN UNIVERSITY HEALTH INFORMATION HEALTH INFORMATION MGMT. WASHBURN UNIVERSITY NURSING MULTIPLE WASHBURN UNIVERSITY OT REHABILITATION SERVICES WASHBURN UNIVERSITY PT ASSISTANTS REHABILITATION SERVICES WASHBURN UNIVERSITY IMAGING SCIENCES MEDICAL IMAGING WASHBURN UNIVERSITY RADIATION THERAPY CANCER CENTER WASHBURN UNIVERSITY RESP THERAPY PULMONARY CARE WASHBURN UNIVERSITY SOCIAL WORK SV BEHAVIORAL HEALTH WASHBURN UNIVERSITY ULTRASOUND-CARDIO RADIOLOGY/ULTRASOUND WASHBURN UNIVERSITY ULTRASOUND-GEN RADIOLOGY ULTRASOUND WASHBURN INSTITUTE OF TECHNOLOGY LPNS MULTIPLE WASHBURN INSTITUTE OF TECHNOLOGY SURG TECHS SURGICAL SERVICES/TSDS WASHBURN INSTITUTE OF TECHNOLOGY EMT PATIENT CARE SERVICES WICHITA STATE UNIVERSITY NURSING MULTIPLE WICHITA STATE UNIVERSITY PA MULTIPLE WICHITA STATE UNIVERSITY PT ASSISTANTS REHABILITATION SERVICE
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.