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 private foundations)
MediumBullet Do not enter Social Security numbers on this form as it may be made public. By law, the IRS
generally cannot redact the information on the form.
MediumBullet Information about Form 990 and its instructions is at www.IRS.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
A For the 2013 calendar year, or tax year beginning 01-01-2013 , 2013, and ending 12-31-2013
BCheck if applicable:
CName of organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2635 N 7TH STREET
 
Room/suite
City or town, state or province, country, and ZIP or foreign postal code
GRAND JUNCTION, CO81502
D Employer identification number

84-0425720
E Telephone number

G Gross receipts $ 404,561,208
F Name and address of principal officer:
MICHAEL MCBRIDE
2635 N 7TH STREET
GRAND JUNCTION,CO81502
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.STMARYGJ.ORG
H(a)
Is this a group return for
subordinates?
H(b)
Are all subordinates
included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1975
M State of legal domicile: CO
Part I
Summary
Activities & Governance 1 Briefly describe the organization’s mission or most significant activities: WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 16
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 13
5 Total number of individuals employed in calendar year 2013 (Part V, line 2a) ...... 5 2,474
6 Total number of volunteers (estimate if necessary) ............. 6 674
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 4,269,637
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b 1,571,495
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,096,421 3,173,896
9 Program service revenue (Part VIII, line 2g) ......... 378,884,254 380,824,186
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 11,610,206 7,084,381
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 15,713,804 12,047,861
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 408,304,685 403,130,324
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 2,581,684 3,120,978
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) 151,576,900 143,552,960
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 219,523,733 225,367,318
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 373,682,317 372,041,256
19 Revenue less expenses. Subtract line 18 from line 12....... 34,622,368 31,089,068
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 538,052,222 562,368,160
21 Total liabilities (Part X, line 26)............. 62,519,123 55,745,993
22 Net assets or fund balances. Subtract line 21 from line 20..... 475,533,099 506,622,167
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 MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2013)
Form 990 (2013)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response or note to any line in this Part III ..............
1
Briefly describe the organization’s mission: WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND COMMUNITIES WE SERVE, ESPECIALLY THOSE WHO ARE POOR AND VULNERABLE.
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 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 $ 313,369,217 including grants of $ 3,120,978 ) (Revenue $ 381,784,892 )
ATTACHMENT 1
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 expensesMediumBullet313,369,217
Form 990 (2013)
Form 990 (2013)
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 (see instructions)? 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
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? 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 for escrow or custodial account liability; 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, line 10?
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 VIIClick 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 VIIIClick 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 IXClick to see attachment............
11d
Yes
 
e
Did the organization report an amount for other liabilities in Part X, line 25? If "Yes," complete Schedule D, Part XClick 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 XClick 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 and XII Click to see attachment.................
12a
 
No
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 and XII 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, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or other assistance to or for any foreign organization? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or other assistance to or for foreign individuals? If “Yes,” complete Schedule F, Parts III and IV...
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 (see instructions)....
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 hospital facilities? 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 statements to this return?
20b
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants or other assistance to any domestic organization or government 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 or 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
Yes
 
23
Did the organization answer "Yes" to Part VII, Section A, line 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 lines 24b through 24d and complete Schedule K. If “No,” go to line 25a................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
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
 
 
d
Did the organization act as an "on behalf of" issuer for bonds outstanding at any time during the year?...
24d
 
 
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
Did the organization report any amount on Part X, line 5, 6, or 22 for receivables from or payables to any current or former officers, directors, trustees, key employees, highest compensated employees, or disqualified persons? If so, 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
 
No
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 direct or indirect 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 M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If "Yes," complete Schedule M.............
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, Part II, III, or IV, and Part 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
 
No
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 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2013)
Form 990 (2013)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response or note to any line in this Part V ..............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
325
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
2,474
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” to line 3b, 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, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
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 as charitable contributions?...
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. See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the 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 amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If "No," provide an explanation in Schedule O..
14b
 
 
Form 990 (2013)
Form 990 (2013)
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 or note to any line 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 .....................
1a
16
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
13
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
 
No
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
 
No
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
 
 
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 this 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
 
No
b
Other officers or key employees of the organization ................
15b
 
No
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
 
No
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:
MediumBulletSHARON OWENS2480 W 26TH AVE SUITE 200-BDENVERCO80211 (303) 813-5190
Form 990 (2013)
Form 990 (2013)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response or note to any line 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. 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 organization compensated any current officer, director, or trustee.
(A)
Name and Title 		(B)
Average hours per week (list any hours for related organizations below dotted line) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(1) DOUGLAS ADEN........................................................................
VICE CHAIR
 1.00
.......................0.00 		X   X       0 0 0
(2) ROB BICKLEY........................................................................
TREASURER
 1.00
.......................0.00 		X   X       0 0 0
(3) SISTER CATRINA ANN BONES........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(4) JANET COMERFORD........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(5) DUANE HARTSHORN MD........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(6) DR MICHAEL HOLT........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(7) DAVID JAMES MD........................................................................
DIRECTOR
 41.00
.......................0.00 		X           427,545 0 23,395
(8) GREGG KAMPF........................................................................
CHAIR
 1.00
.......................0.00 		X   X       0 0 0
(9) MICHAEL MCBRIDE........................................................................
PRESIDENT/CEO
 41.00
.......................0.00 		X   X       0 470,538 90,767
(10) MIKE MURRAY MD........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(11) SISTER JEAN ANNE PANISKO........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(12) CHRISTINA REDDIN........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(13) KRISTINE REUSS........................................................................
SECRETARY
 1.00
.......................0.00 		X   X       0 0 0
(14) MONIQUE SERRA........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(15) SISTER PHYLLIS STOWELL........................................................................
DIRECTOR
 1.00
.......................0.00 		X           0 0 0
(16) CHRISTINE WOOLSEY........................................................................
SVP & CHIEF COMM-MKTG OFFICER
 1.00
.......................40.00 		X           0 312,389 59,911
(17) FOREST C BINDER........................................................................
CFO-THROUGH 07/2013
 40.00
.......................0.00 		    X       0 395,428 37,180
Form 990 (2013)
Form 990 (2013)
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 (list any hours for related organizations below dotted line) 		(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; OfficerInd; Key Employee; Highest compensated employee; FormerOfcrDirectorTrusteeInd;
(18) TERRI CHINN........................................................................
CFO-STARTED FALL 2013
 40.00
.......................0.00 		    X       0 69,817 7,305
(19) THAD RITTER........................................................................
INTERIM CFO
 40.00
.......................0.00 		    X       134,344 0 19,528
(20) JOHN BEESON MD........................................................................
VP & CMO
 40.00
.......................0.00 		      X     0 454,424 29,157
(21) REZA KALEEL........................................................................
EXECUTIVE VP & COO
 40.00
.......................0.00 		      X     0 315,439 58,300
(22) DORA PETERSON........................................................................
VP PATIENT SERVICES
 40.00
.......................0.00 		      X     0 253,974 49,085
(23) DANIEL PRINSTER........................................................................
VP BUSINESS DEVELOPMENT
 40.00
.......................0.00 		      X     0 242,694 37,602
(24) GEORGE SCOTT........................................................................
CHIEF MEDICAL INFO OFFICER
 40.00
.......................0.00 		      X     228,351 0 35,178
(25) JUDITH WHITE HOUSE........................................................................
VP HUMAN RESOURCES
 40.00
.......................0.00 		      X     0 220,578 42,796
(26) CHRISTOPHER STEEN........................................................................
VP MEDICAL GROUP
 40.00
.......................0.00 		      X     0 185,139 32,578
(27) BRIAN WITWER MD........................................................................
NEURO SURGEON
 40.00
.......................0.00 		        X   799,079 0 18,360
(28) JOHN LOPEZ MD........................................................................
NEURO SURGEON
 40.00
.......................0.00 		        X   788,079 0 10,710
(29) JAMES NARROD MD........................................................................
CARDIOVASCULAR SURGEON
 40.00
.......................0.00 		        X   712,197 0 18,360
(30) SUSAN HEMLEY MD........................................................................
NEURO SURGEON
 40.00
.......................0.00 		        X   590,495 0 18,360
(31) LEONARD LAPKIN MD........................................................................
CARDIOVASCULAR SURGEON
 40.00
.......................0.00 		        X   586,731 0 18,360
(32) BOB LADENBURGER........................................................................
FORMER CEO
 0.00
.......................40.00 		          X 0 1,957,445 156,351
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 4,266,821 4,877,865 763,283
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet8
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
Yes
 
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
ANESTHESIA CONSULTANTS OF WESTERN CO1120 WELLINGTON STREET SUITE 206GRAND JUNCTIONCO81501 ANESTHESIA SERVICES 3,970,437
GENERAL SURGEONS OF WESTERN CO1001 WELLINGTON AVENUEGRAND JUNCTIONCO81501 PHYSICIAN SERVICES 1,703,083
CHG COMPANIESPO BOX 972651DALLASTX753972651 PHYSICIAN SERVICES 1,638,099
ROCKY MOUNTAIN ORTHOPAEDIC ASSOCIATION627 25 1/2 ROADGRAND JUNCTIONCO81505 PHYSICIAN SERVICES 1,264,459
ASSOCIATED REGIONAL AND UNIVERSITY PATHO500 CHIPETA WAYSALT LAKE CITYUT84127 REFERENCE LAB 939,116
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet36
Form 990 (2013)
Form 990 (2013)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response or note to any line in this Part VIII .............
(A)
Total revenue 		(B)
Related or
exempt
function
revenue 		(C)
Unrelated
business
revenue 		(D)
Revenue
excluded from
tax under sections
512-514
Contributions, Gifts, GrantAmt and OtherAmt Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 1,531,417
e Government grants (contributions)1e 1,544,114
f All other contributions, gifts, grants, and
similar amounts not included above1f 		98,365
g Noncash contributions included in lines
1a-1f:$ 		 
h Total. Add lines 1a-1f.......MediumBullet 3,173,896
Program Service RevenueAmt Business Code
2a PATIENT SERVICE REVENUE 624100 368,690,201 368,690,201    
b IMAGING SERVICES 624100 10,697,211 10,697,211    
c HEALTHCARE MANAGEMENT SERVICES 624100 915,784 915,784    
d CANCER SERVICES 624100 578,890 578,890    
e SURGICAL SERVICES 624100 -57,900 -57,900    
f All other program service revenue .        
g Total. Add lines 2a–2f........MediumBullet 380,824,186
OtherAmt RevenueAmt 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 6,808,859     6,808,859
4 Income from investment of tax-exempt bond proceeds..MediumBullet        
5 Royalties...........MediumBullet        
(i) Real (ii) Personal
6a Gross rents 1,492,241 452,016
b Less: rental expenses 992,041 46,399
c Rental income or (loss) 500,200 405,617
d Net rental income or (loss).......MediumBullet 905,817   398,211 507,606
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 530,000  
b Less: cost or other basis and sales expenses 254,478  
c Gain or (loss) 275,522  
d Net gain or (loss)..........MediumBullet 275,522     275,522
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      
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        
10a Gross sales of inventory, less
returns and allowances .
a 171,170
b Less: cost of goods sold ..b 137,966
c Net income or (loss) from sales of inventory..MediumBullet 33,204     33,204
Miscellaneous Revenue Business Code
11a REIMBURSEMENTS FROM RELATED PARTI 624100 4,062,359     4,062,359
b REFERENCE LAB 624100 3,094,434   3,094,434  
c CAFETERIA 722514 1,474,523     1,474,523
d All other revenue .... 2,477,524 960,706 776,992 739,826
e Total. Add lines 11a–11d ...... MediumBullet 11,108,840
12 Total revenue. See Instructions......MediumBullet 403,130,324 381,784,892 4,269,637 13,901,899
Form 990 (2013)
Form 990 (2013)
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).Check if Schedule O contains a response or note to any line 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 3,058,812 3,058,812
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 62,166 62,166
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16    
4 Benefits paid to or for members    
5 Compensation of current officers, directors, trustees, and key employees .... 3,644,838 3,098,112 546,726  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) ....        
7 Other salaries and wages 112,807,810 96,020,678 16,787,132  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 5,044,904 4,288,264 756,640  
9 Other employee benefits ....... 14,020,554 11,934,939 2,085,615  
10 Payroll taxes ........... 8,034,854 7,905,213 129,641  
11 Fees for services (non-employees):        
a Management ...... 5,610,180 5,516,288 93,892  
b Legal ......... 163,272 163,272    
c Accounting ...........        
d Lobbying ........... 27,849   27,849  
e Professional fundraising services. See Part IV, line 17    
f Investment management fees ......        
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 28,915,687 28,396,965 518,722  
12 Advertising and promotion .... 359,937 359,692 245  
13 Office expenses ....... 920,500 820,434 100,066  
14 Information technology ......        
15 Royalties ..        
16 Occupancy ........... 5,159,974 4,796,411 363,563  
17 Travel ............ 541,775 538,180 3,595  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ......        
19 Conferences, conventions, and meetings .... 629,986 629,584 402  
20 Interest ........... 1,362,324 1,362,324    
21 Payments to affiliates .......        
22 Depreciation, depletion, and amortization ..... 32,034,923 28,485,516 3,549,407  
23 Insurance .............. 2,666,035 2,422,781 243,254  
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a MEDICAL SUPPLIES 64,279,467 64,279,467 0 0
b SYSTEM ALLOCATION 33,303,390 0 33,303,390 0
c BAD DEBT EXPENSE 25,729,529 25,729,529 0 0
d MEDICAID PROVIDER TAXES 20,006,148 20,006,148 0 0
e All other expenses 3,656,342 3,494,442 161,900  
25 Total functional expenses. Add lines 1 through 24e 372,041,256 313,369,217 58,672,039 0
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 (2013)
Form 990 (2013)
Page 11
Part X Balance Sheet Check if Schedule O contains a response or note to any line in this Part X ..............
(A)
Beginning of year 		(B)
End of year
Assets 1 Cash–non-interest-bearing ............. 9,275 1 9,275
2 Savings and temporary cash investments ......... 8,020,709 2 6,315,557
3 Pledges and grants receivable, net ........... 0 3 0
4 Accounts receivable, net ............. 58,353,861 4 55,032,341
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
0 5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
0 6 0
7 Notes and loans receivable, net ............. 2,063,154 7 2,038,203
8 Inventories for sale or use .............. 6,342,862 8 6,689,527
9 Prepaid expenses and deferred charges .......... 3,126,841 9 3,741,776
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 613,055,438
b Less: accumulated depreciation ..... 10b 319,270,186 314,836,249 10c 293,785,252
11 Investments—publicly traded securities .......... 137,823,467 11  
12 Investments—other securities. See Part IV, line 11 ..... 11,574,913 12 15,489,586
13 Investments—program-related. See Part IV, line 11 .....   13  
14 Intangible assets ...............   14  
15 Other assets. See Part IV, line 11 ........... -4,099,109 15 179,266,643
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 538,052,222 16 562,368,160
Liabilities 17 Accounts payable and accrued expenses ......... 31,040,465 17 30,531,492
18 Grants payable .................   18  
19 Deferred revenue ................   19  
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22  
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
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.................... 31,478,658 25 25,214,501
26 Total liabilities. Add lines 17 through 25......... 62,519,123 26 55,745,993
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 475,533,099 27 506,622,167
28 Temporarily restricted net assets ...........   28  
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), 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 ........... 475,533,099 33 506,622,167
34 Total liabilities and net assets/fund balances ........ 538,052,222 34 562,368,160
Form 990 (2013)
Form 990 (2013)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response or note to any line in this Part XI ..............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
403,130,324
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
372,041,256
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
31,089,068
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
475,533,099
5
Net unrealized gains (losses) on investments ...............
5
 
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
 
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
0
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
506,622,167
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response or note to any line 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
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If "Yes," to line 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?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
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 (2013)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID:  
Software Version:  
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.
right arrow Information about Schedule A (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
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 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 monetary support
Yes No Yes No Yes No
Total  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 2
Part II
Support Schedule for Organizations Described in Sections 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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).  
12
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.................................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
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 ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 3
Part III
Support Schedule for Organizations Described in Section 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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) right arrow (a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) 2013 (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) 2013
Schedule A (Form 990 or 990-EZ) 2013
Page 4
Part IV
Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and 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) 2013

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.
Arrow Bullet Information about Schedule B (Form 990, 990-EZ, or 990-PF) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
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 its Form 990PF, Part I, line 2, 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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 2
Name of organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
  		Employer identification number

84-0425720
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, RESTRICTEDRESTRICTED

$RESTRICTED


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


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

   
 
 

$  


(Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 3
Name of organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
  		Employer identification number

84-0425720
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) (2013)

Schedule B (Form 990, 990-EZ, or 990-PF) (2013)
Page 4
Name of organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
  		Employer identification number

84-0425720
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) (2013)

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.SchCMd Bullet Information about Schedule C (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
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, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
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
$  
3
Volunteer hours ........................................
 

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
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
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 Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2013

Schedule C (Form 990 or 990-EZ) 2013
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 SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
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) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.		    
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) .................    
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) 2010 (b) 2011 (c) 2012 (d) 2013 (e) Total
2a Lobbying nontaxable amount          
b Lobbying ceiling amount
(150% of line 2a, column(e)) 		 
c Total lobbying expenditures          
d Grassroots nontaxable amount          
e Grassroots ceiling amount
(150% of line 2d, column (e))		  
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2013


Schedule C (Form 990 or 990-EZ) 2013
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)
No
Yes
(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? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
 
No
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
15,660
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
 
No
 
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
 
No
 
i
Other activities? ..........................
Yes
 
12,189
j
Total. Add lines 1c through 1i ...............................
27,849
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
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
Provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Return Reference Explanation
FORM 990, SCH C, PART II-B, LINE 1F: $6,500 PAYMENT TO MCDERMOTT WILL & EMERY FOR PROMOTION OF RURAL HEALTH RELATED LEGISLATION. $8,910 PAID TO CAPSTONE GROUP FOR LOBBYING OF HEALTH RELATED ISSUES IN COLORADO. $250 PAYMENT TO CLUB 20 A LOBBYING GROUP FOR ISSUES CONCERNING WESTERN COLORADO.
FORM 990, SCH C, PART II-B, LINE 1I LOBBYING PORTION OF DUES REPORTED ON ASSOCIATION MEMBERSHIP INVOICES, $12,189. ST. MARY'S HOSPITAL HAS NO CONTROL OVER HOW THE FUNDS ARE SPENT OR DIRECTED.
Schedule C (Form 990 or 990EZ) 2013

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. SchDMd Bullet Information about Schedule D (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
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 section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, 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 XIII, 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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, 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 XIII.
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 XIII 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 XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance .... 7,949,114 6,419,628 6,462,683 5,949,382 4,225,092
b Contributions ........ 69,271 924,522 168,214 25,481 2,619
c Net investment earnings, gains, and losses 941,428 686,603 50,698 771,583 1,722,549
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........ 		327,461 81,639 261,967 283,763 878
f Administrative expenses ....          
g End of year balance ...... 8,632,352 7,949,114 6,419,628 6,462,683 5,949,382
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet96.000 %
b
Permanent endowment SchDMd Bullet4.000 %
c
Temporarily restricted endowment SchDMd Bullet  
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)
 
No
(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 XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11a. 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 .................   9,395,131 9,395,131
b Buildings ................   234,565,386 87,215,811 147,349,575
c Leasehold improvements ............   312,960 307,929 5,031
d Equipment ................   350,379,939 219,793,439 130,586,500
e Other .................   18,402,022 11,953,007 6,449,015
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 293,785,252
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 3
Part VII
Investments—Other Securities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11b. 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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11c. See Form 990, Part X, line 13.
(a) Description of investment (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. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11d. See Form 990, Part X, line 15.
(a) Description (b) Book value
(1) IC TRANSACTIONS 179,116,704
(2) DEPOSITS 149,939







Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet 179,266,643
Part X
Other Liabilities. Complete if the organization answered 'Yes' to Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes  
CAPITAL STRUCTURE 25,214,501








Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 25,214,501
2. Liability for uncertain tax positions In Part XIII, 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 (ASC 740). Check here if the text of the footnote has been provided in Part XIII ..................................................
Schedule D (Form 990) 2013

Schedule D (Form 990) 2013
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return. Complete if the organization answered 'Yes' to Form 990, Part IV, line 12a.
1 Total expenses and losses per audited financial statements ........... 1  
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 XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
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 XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
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, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Return Reference Explanation
PART V, LINE 4: INTENDED USE OF ENDOWMENT FUNDS BOARD ENDOWMENT - QUASI - ENDOWMENT USED FOR AREAS OF GREATEST NEED AS DETERMINED BY SENIOR LEADERSHIP OF ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. CUMMINGS FAMILY ENDOWMENT - QUASI-ENDOWMENT TO ASSIST LOW INCOME CANCER PATIENTS WITH NON-MEDICAL EXPENSES. SACCOMANNO RESEARCH INSTITUTE - QUASI-ENDOWMENT FUND DEDICATED TO RESEARCH. BRUCE E. DIXSON PULMONARY REHABILITATION ENDOWMENT - ASSIST LOW INCOME PULMONARY PATIENTS WITH NON-MEDICAL EXPENSES. WORLEY FAMILY INFECTION CONTROL ENDOWMENT - INFECTION CONTROL EDUCATION. DR. LYNN JAMES PULMONARY ENDOWMENT FUND - ASSIST LOW INCOME PULMONARY PATIENTS WITH NON-MEDICAL EXPENSES. ENDOWMENT FUNDS ARE HELD BY THE ST. MARY'S HOSPITAL FOUNDATION FOR THE BENEFIT OF ST. MARY'S HOSPITAL & MEDICAL CENTER, INC.
Schedule D (Form 990) 2013

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.
MediumBullet Information about Schedule H (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
Part I
Financial Assistance 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) as a factor in determining 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 as a factor in determining 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 used factors other than FPG in determining 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, as a factor in determining 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) .. 		    15,941,884   15,941,884 4.600 %
b Medicaid (from Worksheet 3,
column a) .... 		    63,940,024 40,303,393 23,636,631 6.830 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) . 		    10,590,493 1,008,897 9,581,596 2.770 %
d Total Financial Assistance
and Means-Tested
Government Programs . 		    90,472,401 41,312,290 49,160,111 14.200 %
Other Benefits
     2,960,982 1,637,260 1,323,722 0.380 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) .. 		    6,692,234 0 6,692,234 1.930 %
g Subsidized health services
(from Worksheet 6) .. 		    3,789,741 3,484,740 305,001 0.090 %
h Research (from Worksheet 7)     871,124   871,124 0.250 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8) 		    1,594,195   1,594,195 0.460 %
j Total. Other Benefits ..     15,908,276 5,122,000 10,786,276 3.110 %
k Total. Add lines 7d and 7j .     106,380,677 46,434,290 59,946,387 17.310 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
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     1,694,958   1,694,958 0.490 %
4 Environmental improvements            
5 Leadership development and training for community members            
6 Coalition building            
7 Community health improvement advocacy            
8 Workforce development            
9 Other            
10 Total     1,694,958   1,694,958 0.490 %
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. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
8,516,539
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
 
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
87,866,334
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
125,338,884
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-37,472,550
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
Yes
 
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

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—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 %
11 PAVILION IMAGING LLC
  		OUTPATIENT RADIOLOGY 75.000 % 0 % 25.000 %
22 GRAND VALLEY SURGERY CENTER LLC
  		OUTPATIENT SURGERY 37.330 % 0 % 62.670 %
33 SAN JUAN CANCER CENTER LLC
  		OUTPATIENT CANCER TREATMENT 33.000 % 0 % 33.000 %
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?1
Name, address, primary website address, and state license number 		Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital ResearchGrp Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 ST MARY'S HOSPITAL & MEDICAL CENTER IN
2635 N 7TH STREET
GRAND JUNCTION,CO81502
WWW.STMARYGJ.ORG
011160 		X X       X X      
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
ST MARY'S HOSPITAL & MEDICAL CENTER IN
Name of hospital facility or facility reporting group  
If reporting on Part V, Section B for a single hospital facility only: line number of
hospital facility (from Schedule H, Part V, Section A) 		1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If "Yes," indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? 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 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Part VI................................ 4 Yes  
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If "Yes," indicate how the CHNA report was made widely available (check all that apply):
a
b
c
d
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply as of the end of the tax year):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If "No," explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10 Yes  
If "Yes," indicate the FPG family income limit for eligibility for free care: 200.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11 Yes  
If "Yes," indicate the FPG family income limit for eligibility for discounted care: 400.000000000000%
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If "Yes," indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
i
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If "Yes," indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 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?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP:
a
b
c
d
e
17 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 individual’s eligibility under the facility’s FAP?.......... 17   No
If "Yes," check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 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?.......... 19 Yes  
If "No," indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 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
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individual 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? ............................ 21   No
If "Yes," explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If "Yes," explain in Part VI.
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part V
Facility Information (continued)
Section C. Supplemental Information for Part V, Section B.Provide descriptions required for Part V, Section B, lines 1j, 3, 4, 5d, 6i, 7, 10, 11, 12i, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22. If applicable, provide separate descriptions for each facility in a facility reporting group, designated by "Facility A," "Facility B," etc.
Form and Line Reference Explanation
ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 3: INPUT FROM COMMUNITY REPRESENTATIVESAS OUR MISSION STATES, WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND THE COMMUNITIES WE SERVE AND IN ORDER TO DO THIS WE HAVE REGULARLY PARTICIPATED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. CHNA'S WERE CONDUCTED IN 1998, 2005, 2009, AND 2012. IN 2012, THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY THE MESA COUNTY HEALTH DEPARTMENT.THE HEALTHY MESA COUNTY 2012 CHNA IS A SYSTEMATIC, DATA-DRIVEN APPROACH TO DETERMINING THE HEALTH STATUS, BEHAVIORS, PERCEPTIONS AND NEEDS OF RESIDENTS IN MESA COUNTY. SUBSEQUENTLY, THIS INFORMATION MAY BE USED TO FORMULATE STRATEGIES TO IMPROVE COMMUNITY HEALTH AND WELLNESS. MESA COUNTY HEALTH DEPARTMENT STARTED THE CHNA PROCESS AND DECIDED ON FOUR CRUCIAL STEPS TO ASSESS NEEDS, DETERMINE CAUSES, AND REACH CONSENSUS ON POSSIBLE INTERVENTIONS TO ACHIEVE DESIRED OUTCOMES. THOSE STEPS WERE: COMPILE EXISTING DATA, ENGAGE STAKEHOLDERS AND PRIORITIZE HEALTH PROBLEMS, GATHER PRIMARY DATA FROM COMMUNITY INPUT, AND DETERMINE HEALTH PRIORITIES.COMPILE EXISTING DATA-- IN FEBRUARY 2011, MESA COUNTY HEALTH DEPARTMENTREVIEWED A LIST OF 250 INDICATORS DEVELOPED BY THE PUBLIC HEALTHINDICATOR TASK FORCE AS A STARTING POINT FOR GATHERING LOCAL DATA. MESACOUNTY HEALTH DEPARTMENT STAFF RESEARCHED ALL AVAILABLE DATA FOR MESACOUNTY RELATED TO EACH OF THE 250 INDICATORS AND IDENTIFED WHETHER A STATE STANDARD OR A HEALTHY PEOPLE 2020 OBJECTIVE WAS AVAILABLE FOR COMPARISON. ENGAGE STAKEHOLDERS AND PRIORITIZE HEALTH PROBLEMS-- MESA COUNTY HEALTHDEPARTMENT ESTABLISHED THE MESA COUNTY COMMUNITY HEALTH STEERING COMMITTEE, COMPRISED OF SELECTED COMMUNITY REPRESENTATIVES TO PROVIDE GUIDANCE FOR THE HEALTH ASSESSMENT PROCESS. MEMBERS OF THE STEERING COMMITTEE WERE CHOSEN BASED ON THEIR ABILITIES TO PROVIDE SUBJECT MATTER EXPERTISE, PROVIDE INPUT, SEE THE BIG PICTURE OF COMMUNITY HEALTH, AND REVIEW THE HEALTH-INDICATOR DATA. COMMITTEE MEMBERS WERE ASKED TO COMMIT TO A KICKOFF MEETING, POTENTIALLY PARTICIPATE IN PRIORITY AREA FOCUS GROUPS, AND PROVIDE A REVIEW OF THE FINAL CHNA REPORT.THE FOLLOWING KEY COMMUNITY ORGANIZATIONS PARTICIPATED, REPRESENTINGDIVERSITY WITHIN THE PUBLIC HEALTH SYSTEM: CITY OF GRAND JUNCTION,COLORADO WEST REGIONAL MENTAL HEALTH, COMMUNITY HOSPITAL, FAMILY HEALTHWEST, HILLTOP, MARILLAC CLINIC, MESA COUNTY 211, MESA COUNTY DEPARTMENTOF HUMAN SERVICES, MESA COUNTY HEALTH DEPARTMENT, MESA COUNTY LOCAL EMERGENCY PLANNING COMMITTEE (LEPC), MESA COUNTY SCHOOL DISTRICT #51, ST. MARY'S HOSPITAL & REGIONAL MEDICAL CENTER, AND STRIDE.
ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 4: CHNA HOSPITAL FACILITIESCOMMUNITY HOSPITAL, GRAND JUNCTION, THE DEPARTMENT OF VETERAN AFFAIRS MEDICAL CENTER, GRAND JUNCTION, FAMILY HEALTH WEST, FRUITA, AND COLORADO WEST PSYCHIATRIC HOSPITAL, GRAND JUNCTION, COLORADO.
ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 7: NEEDS NOT ADDRESSEDCOMPLETING THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS LED TO THE IDENTIFICATION OF SEVERAL HEALTH OUTCOMES AND HEALTH BEHAVIORS WHERE MESACOUNTY IS DOING BETTER THAN COLORADO AND THE NATION. HOWEVER, THERE ARESEVERAL AREAS WHERE MESA COUNTY CAN IMPROVE. THE FOLLOWING FIVEPREDISPOSING, REINFORCING AND ENABLING FACTORS WERE IDENTIFIED AS HAVINGA POTENTIAL IMPACT ON HEALTH OUTCOMES IN MESA COUNTY AND WILL BECOME THEEMPHASIS OF FUTURE PUBLIC HEALTH IMPROVEMENT EFFORTS:- PARENTING- SOCIAL & EMOTIONAL WELLBEING- ACCESS TO HEALTHCARE- BUILT ENVIRONMENT- BUILDING A SENSE OF COMMUNITY.PRIORITY AREAS WERE SELECTED BY ANALYZING THE ROOT CAUSES OF MORBIDITIESAND MORTALITIES IN MESA COUNTY. THE MESA COUNTY HEALTH DEPARTMENT UNDERSTANDS THAT IN ORDER TO IMPACT HEALTH OUTCOMES, HEALTH OFFICIALS MUST LOOK BEYOND PROGRAMS, POLICIES, AND EVEN INDIVIDUAL BEHAVIORS AND FOCUS ON ADDRESSING THE CONTRIBUTING FACTORS AND DETERMINANTS OF POOR HEALTH. THE PRIORITY AREAS, RECOMMENDATIONS, AND STRATEGIES FOR IMPLEMENTATION RECOGNIZE THE INTERCONNECTEDNESS OF INDIVIDUAL BEHAVIORS AND THE SYSTEMS AND ENVIRONMENTS IN WHICH PEOPLE GROW AND LEARN. THE RESULTS IDENTIFED SIX HEALTH PRIORITIES THAT CLUSTERED TOGETHER AS MOST IMPORTANT AND ACTIONABLE:MATERNAL AND CHILD HEALTH,MENTAL HEALTH,TOBACCO USE,OBESITY,FAMILY ABUSE AND VIOLENCE,AND SCREENING/DETECTION.THE IMPLEMENTATION PLAN HAS BEEN DEVELOPED UNDER THE ASSUMPTION THAT SUSTAINABLE CHANGE AND POSITIVE HEALTH OUTCOMES ARE ONLY POSSIBLE IF PROGRAMS AND AGENCIES WITH SIMILAR MISSIONS JOIN FORCES AND DEDICATE THEIR RESOURCES TO ACHIEVING A COMMON GOAL. IT IS IMPORTANT TO MAXIMIZE PARTNERSHIPS AND IDENTIFY LEADERS WHO HAVE THE EXPERTISE AND THE ABILITY TO MOVE THE PROCESS FORWARD.
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
   
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VFacility Information (continued)

Section D. 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?2
Name and address Type of Facility (describe)
1 GRAND VALLEY SURGICAL CENTER LLC
710 WELLINGTON
GRAND JUNCTION,CO81501 		OUTPATIENT SURGERY
2 SAN JUAN CANCER CENTER LLC
600 SOUTH 5TH STREET
MONTROSE,CO81401 		OUTPATIENT CANCER TREATMENT
3
4
5
6
7
8
9
10
Schedule H (Form 990) 2013
Schedule H (Form 990) 2013
Page
Part VI
Supplemental Information
Provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.
Form and Line Reference Explanation
ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 3: INPUT FROM COMMUNITY REPRESENTATIVESAS OUR MISSION STATES, WE REVEAL AND FOSTER GOD'S HEALING LOVE BY IMPROVING THE HEALTH OF THE PEOPLE AND THE COMMUNITIES WE SERVE AND IN ORDER TO DO THIS WE HAVE REGULARLY PARTICIPATED IN OUR COMMUNITY HEALTH NEEDS ASSESSMENT SURVEYS TO IDENTIFY THE ONGOING AND CHANGING NEEDS OF THE COMMUNITY. CHNA'S WERE CONDUCTED IN 1998, 2005, 2009, AND 2012. IN 2012, THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WAS CONDUCTED BY THE MESA COUNTY HEALTH DEPARTMENT.THE HEALTHY MESA COUNTY 2012 CHNA IS A SYSTEMATIC, DATA-DRIVEN APPROACH TO DETERMINING THE HEALTH STATUS, BEHAVIORS, PERCEPTIONS AND NEEDS OF RESIDENTS IN MESA COUNTY. SUBSEQUENTLY, THIS INFORMATION MAY BE USED TO FORMULATE STRATEGIES TO IMPROVE COMMUNITY HEALTH AND WELLNESS. MESA COUNTY HEALTH DEPARTMENT STARTED THE CHNA PROCESS AND DECIDED ON FOUR CRUCIAL STEPS TO ASSESS NEEDS, DETERMINE CAUSES, AND REACH CONSENSUS ON POSSIBLE INTERVENTIONS TO ACHIEVE DESIRED OUTCOMES. THOSE STEPS WERE: COMPILE EXISTING DATA, ENGAGE STAKEHOLDERS AND PRIORITIZE HEALTH PROBLEMS, GATHER PRIMARY DATA FROM COMMUNITY INPUT, AND DETERMINE HEALTH PRIORITIES.COMPILE EXISTING DATA-- IN FEBRUARY 2011, MESA COUNTY HEALTH DEPARTMENTREVIEWED A LIST OF 250 INDICATORS DEVELOPED BY THE PUBLIC HEALTHINDICATOR TASK FORCE AS A STARTING POINT FOR GATHERING LOCAL DATA. MESACOUNTY HEALTH DEPARTMENT STAFF RESEARCHED ALL AVAILABLE DATA FOR MESACOUNTY RELATED TO EACH OF THE 250 INDICATORS AND IDENTIFED WHETHER A STATE STANDARD OR A HEALTHY PEOPLE 2020 OBJECTIVE WAS AVAILABLE FOR COMPARISON. ENGAGE STAKEHOLDERS AND PRIORITIZE HEALTH PROBLEMS-- MESA COUNTY HEALTHDEPARTMENT ESTABLISHED THE MESA COUNTY COMMUNITY HEALTH STEERING COMMITTEE, COMPRISED OF SELECTED COMMUNITY REPRESENTATIVES TO PROVIDE GUIDANCE FOR THE HEALTH ASSESSMENT PROCESS. MEMBERS OF THE STEERING COMMITTEE WERE CHOSEN BASED ON THEIR ABILITIES TO PROVIDE SUBJECT MATTER EXPERTISE, PROVIDE INPUT, SEE THE BIG PICTURE OF COMMUNITY HEALTH, AND REVIEW THE HEALTH-INDICATOR DATA. COMMITTEE MEMBERS WERE ASKED TO COMMIT TO A KICKOFF MEETING, POTENTIALLY PARTICIPATE IN PRIORITY AREA FOCUS GROUPS, AND PROVIDE A REVIEW OF THE FINAL CHNA REPORT.THE FOLLOWING KEY COMMUNITY ORGANIZATIONS PARTICIPATED, REPRESENTINGDIVERSITY WITHIN THE PUBLIC HEALTH SYSTEM: CITY OF GRAND JUNCTION,COLORADO WEST REGIONAL MENTAL HEALTH, COMMUNITY HOSPITAL, FAMILY HEALTHWEST, HILLTOP, MARILLAC CLINIC, MESA COUNTY 211, MESA COUNTY DEPARTMENTOF HUMAN SERVICES, MESA COUNTY HEALTH DEPARTMENT, MESA COUNTY LOCAL EMERGENCY PLANNING COMMITTEE (LEPC), MESA COUNTY SCHOOL DISTRICT #51, ST. MARY'S HOSPITAL & REGIONAL MEDICAL CENTER, AND STRIDE.
ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 4: CHNA HOSPITAL FACILITIESCOMMUNITY HOSPITAL, GRAND JUNCTION, THE DEPARTMENT OF VETERAN AFFAIRS MEDICAL CENTER, GRAND JUNCTION, FAMILY HEALTH WEST, FRUITA, AND COLORADO WEST PSYCHIATRIC HOSPITAL, GRAND JUNCTION, COLORADO.
ST. MARY'S HOSPITAL & MEDICAL CENTER, INC. PART V, SECTION B, LINE 7: NEEDS NOT ADDRESSEDCOMPLETING THE COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS LED TO THE IDENTIFICATION OF SEVERAL HEALTH OUTCOMES AND HEALTH BEHAVIORS WHERE MESACOUNTY IS DOING BETTER THAN COLORADO AND THE NATION. HOWEVER, THERE ARESEVERAL AREAS WHERE MESA COUNTY CAN IMPROVE. THE FOLLOWING FIVEPREDISPOSING, REINFORCING AND ENABLING FACTORS WERE IDENTIFIED AS HAVINGA POTENTIAL IMPACT ON HEALTH OUTCOMES IN MESA COUNTY AND WILL BECOME THEEMPHASIS OF FUTURE PUBLIC HEALTH IMPROVEMENT EFFORTS:- PARENTING- SOCIAL & EMOTIONAL WELLBEING- ACCESS TO HEALTHCARE- BUILT ENVIRONMENT- BUILDING A SENSE OF COMMUNITY.PRIORITY AREAS WERE SELECTED BY ANALYZING THE ROOT CAUSES OF MORBIDITIESAND MORTALITIES IN MESA COUNTY. THE MESA COUNTY HEALTH DEPARTMENT UNDERSTANDS THAT IN ORDER TO IMPACT HEALTH OUTCOMES, HEALTH OFFICIALS MUST LOOK BEYOND PROGRAMS, POLICIES, AND EVEN INDIVIDUAL BEHAVIORS AND FOCUS ON ADDRESSING THE CONTRIBUTING FACTORS AND DETERMINANTS OF POOR HEALTH. THE PRIORITY AREAS, RECOMMENDATIONS, AND STRATEGIES FOR IMPLEMENTATION RECOGNIZE THE INTERCONNECTEDNESS OF INDIVIDUAL BEHAVIORS AND THE SYSTEMS AND ENVIRONMENTS IN WHICH PEOPLE GROW AND LEARN. THE RESULTS IDENTIFED SIX HEALTH PRIORITIES THAT CLUSTERED TOGETHER AS MOST IMPORTANT AND ACTIONABLE:MATERNAL AND CHILD HEALTH,MENTAL HEALTH,TOBACCO USE,OBESITY,FAMILY ABUSE AND VIOLENCE,AND SCREENING/DETECTION.THE IMPLEMENTATION PLAN HAS BEEN DEVELOPED UNDER THE ASSUMPTION THAT SUSTAINABLE CHANGE AND POSITIVE HEALTH OUTCOMES ARE ONLY POSSIBLE IF PROGRAMS AND AGENCIES WITH SIMILAR MISSIONS JOIN FORCES AND DEDICATE THEIR RESOURCES TO ACHIEVING A COMMON GOAL. IT IS IMPORTANT TO MAXIMIZE PARTNERSHIPS AND IDENTIFY LEADERS WHO HAVE THE EXPERTISE AND THE ABILITY TO MOVE THE PROCESS FORWARD.
Schedule H (Form 990) 2013
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
lBullet Information about Schedule I (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number
84-0425720
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. Part II can be duplicated if additional space is needed.
(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) MIND SPRINGS HEALTH INC
858 GRAND AVENUE
GRAND JUNCTION,CO81501 		84-0625890 501(C)(3) 229,167       OPERATIONAL SUPPORT
(2) MARILLAC CLINIC
2333 N 6TH STREET
GRAND JUNCTION,CO81501 		84-1085822 501(C)(3)   481,309 BOOK SUPPLIES, SERVICES OPERATIONAL SUPPORT
(3) COLORADO MESA UNIVERSITY
1100 NORTH AVENUE
GRAND JUNCTION,CO81502 		84-6037667 501(C)(3) 88,600       NURSING SCHOLARSHIPS
(4) HILLTOP COMMUNITY RESOURCES
1331 HERMOSA
GRAND JUNCTION,CO81051 		74-2321009 501(C)(3) 50,000       PRENATAL EDUCATION
(5) MARCH OF DIMES COLORADO
634 MAIN STREET
GRAND JUNCTION,CO81501 		13-1846366 501(C)(3) 10,000       OPERATIONAL SUPPORT
(6) GRAND JUNCTION ECONOMIC PARTNERSHIP
717 WALKER FIELD
GRAND JUNCTION,CO81501 		84-0972492 501(C)(3) 20,450       COMMUNITY DEVELOPMENT
(7) AMERICAN CANCER SOCIETY
2754 COMPAS DRIVE
GRAND JUNCTION,CO81506 		84-1316555 501(C)(3) 10,000       CANCER PREVENTION
(8) COLORADO PHYSICIANS HEALTH
899 LOGAN STREET
DENVER,CO80210 		74-2428019 501(C)(3) 7,500       PHYSICIANS HEALTHCARE
(9) GRAND VALLEY CATHOLIC OUTREACH
2465 SOUTH DOWNING
DENVER,CO80210 		20-0064007 501(C)(3) 9,500       ASSIST NEEDY
(10) HOLY FAMILY CATHOLIC SCHOOL
786 26 1/2 ROAD
GRAND JUNCTION,CO81506 		86-0297730 501(C)(3) 17,000       OPERATIONAL SUPPORT
(11) GRAND JUNCTION COMMUNITY HOMELESS SHELTER
2853 NORTH AVENUE
GRAND JUNCTION,CO81502 		98-1621600 501(C)(3)   68,058 BOOK LAUNDRY SERVICES LINEN SERVICES FOR SHELTER
(12) QUALITY HEALTH NETWORK
2764 COMPAS DRIVE
GRAND JUNCTION,CO81506 		20-1632384 501(C)(3) 300,000       HEALTH RECORD NETWORK
(13) HOPEWEST
3090 B NORTH 12TH STREET
FRUITA,CO80506 		84-1316555 501(C)(3) 12,400       OPERATIONAL SUPPORT
(14) COUNSELING & EDUCATION CENTER
2708 PATTERSON ROAD
GRAND JUNCTION,CO81506 		74-2232416 501(C)(3) 10,000       OPERATIONAL SUPPORT
(15) HOMEWARD BOUND
2853 NORTH AVENUE
GRAND JUNCTION,CO81501 		26-0052916 501(C)(3) 25,000       OPERATIONAL SUPPORT
(16) RIVERSIDE EDUCATIONAL CENTER
PO BOX 4367
GRAND JUNCTION,CO81502 		20-5451495 501(C)(3) 5,500       OPERATIONAL SUPPORT
(17) STRIVE
950 GRAND AVENUE
GRAND JUNCTION,CO81501 		84-6044855 501(C)(3) 15,000       OPERATIONAL SUPPORT
(18) SUICIDE PREVENTION FUND
PO BOX 4329
GRAND JUNCTION,CO81502 		20-3972058 501(C)(3) 10,000       OPERATIONAL SUPPORT
(19) ST MARY'S HOSPITAL FOUNDATION
2635 N 7TH STREET
GRAND JUNCTION,CO81502 		23-7001007 501(C)(3) 1,277,910       SUPPORT HOSPITAL MISSION
(20) MARILLAC CLINIC
2333 N 6TH STREET
GRAND JUNCTION,CO81501 		84-1085822 501(C)(3) 405,000       OPERATIONAL SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
19
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2013

Schedule I (Form 990) 2013
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.
Part III can be duplicated 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
(1) TRANSPORTATION FOR INDIGENTS 1874 62,166      












Part IV
Supplemental Information. Provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Return Reference Explanation
SCHEDULE I, PART 1, LINE 2: PROCESS FOR MONITORING GRANTS AND AWARDS THE ORGANIZATION KEEPS RECORDS TO SUPPORT THE AMOUNTS PROVIDED OR REASON FOR SUCH SUPPORT. SUPPORT IS NOT CONSIDERED GRANTS, BUT RATHER MISCELLANEOUS DONATIONS AND SPONSORSHIPS. ELIGIBILITY FOR FUNDING IS DETERMINED ON AN INDIVIDUAL BASIS, CONSIDERING THE USE OF THE FUNDS AND HOW THE USE RELATES TO THE ORGANIZATIONS MISSION.
Schedule I (Form 990) 2013


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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, line 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
SchJMediumBullet Information about Schedule J (Form 990) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
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 of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked in line 1a? ..
2
 
 
3
Indicate which, if any, of the following the filing organization used 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
Yes
 
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
 
No
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
Yes
 
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 Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
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 (E) amounts for that individual.
(A) Name and Title (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)DAVID JAMES MDDIRECTOR (i)
(ii)		 423,013
0 		0
0 		4,532
0 		1,466
0 		21,929
0 		450,940
0 		0
0
(2)MICHAEL MCBRIDEPRESIDENT/CEO (i)
(ii)		 0
406,173 		0
50,360 		0
14,005 		0
69,237 		0
21,530 		0
561,305 		0
0
(3)CHRISTINE WOOLSEYSVP & CHIEF COMM-MKTG OFFICER (i)
(ii)		 0
259,748 		0
40,807 		0
11,834 		0
45,122 		0
14,789 		0
372,300 		0
0
(4)FOREST C BINDERCFO-THROUGH 07/2013 (i)
(ii)		 0
266,050 		0
27,545 		0
101,833 		0
18,360 		0
18,820 		0
432,608 		0
27,500
(5)THAD RITTERINTERIM CFO (i)
(ii)		 129,701
0 		2,541
0 		2,102
0 		4,008
0 		15,520
0 		153,872
0 		0
0
(6)JOHN BEESON MDVP & CMO (i)
(ii)		 0
214,988 		0
37,709 		0
201,727 		0
9,188 		0
19,969 		0
483,581 		0
46,633
(7)REZA KALEELEXECUTIVE VP & COO (i)
(ii)		 0
284,247 		0
30,046 		0
1,146 		0
43,931 		0
14,369 		0
373,739 		0
0
(8)DORA PETERSONVP PATIENT SERVICES (i)
(ii)		 0
225,663 		0
23,178 		0
5,133 		0
38,235 		0
10,850 		0
303,059 		0
0
(9)DANIEL PRINSTERVP BUSINESS DEVELOPMENT (i)
(ii)		 0
197,865 		0
21,115 		0
23,714 		0
15,683 		0
21,919 		0
280,296 		0
20,991
(10)GEORGE SCOTTCHIEF MEDICAL INFO OFFICER (i)
(ii)		 226,739
0 		0
0 		1,612
0 		16,020
0 		19,158
0 		263,529
0 		0
0
(11)JUDITH WHITE HOUSEVP HUMAN RESOURCES (i)
(ii)		 0
199,439 		0
11,160 		0
9,979 		0
26,147 		0
16,649 		0
263,374 		0
0
(12)CHRISTOPHER STEENVP MEDICAL GROUP (i)
(ii)		 0
174,823 		0
3,745 		0
6,571 		0
12,964 		0
19,614 		0
217,717 		0
0
(13)BRIAN WITWER MDNEURO SURGEON (i)
(ii)		 796,522
0 		0
0 		2,557
0 		18,360
0 		0
0 		817,439
0 		0
0
(14)JOHN LOPEZ MDNEURO SURGEON (i)
(ii)		 786,296
0 		0
0 		1,783
0 		10,710
0 		0
0 		798,789
0 		0
0
(15)JAMES NARROD MDCARDIOVASCULAR SURGEON (i)
(ii)		 704,015
0 		0
0 		8,182
0 		18,360
0 		0
0 		730,557
0 		0
0
(16)SUSAN HEMLEY MDNEURO SURGEON (i)
(ii)		 581,420
0 		0
0 		9,075
0 		18,360
0 		0
0 		608,855
0 		0
0
(17)LEONARD LAPKIN MDCARDIOVASCULAR SURGEON (i)
(ii)		 581,073
0 		0
0 		5,658
0 		18,360
0 		0
0 		605,091
0 		0
0
(18)BOB LADENBURGERFORMER CEO (i)
(ii)		 0
698,525 		0
583,719 		0
675,201 		0
139,611 		0
16,740 		0
2,113,796 		0
656,519
Schedule J (Form 990) 2013

Schedule J (Form 990) 2013
Page 3
Part III
Supplemental Information
Provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Return Reference Explanation
PART I, LINES 4A-B SEVERANCE PAYMENTS SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM PERIODICALLY INCURS SEVERANCE PAYMENTS RELATED TO FORMER EMPLOYEES. THE AMOUNTS PAID TO LISTED INDIVIDUALS FOR SEVERANCE IN 2013 WERE: JOHN BEESON, MD- $180,697. FORM 990, SCHEDULE J, PART I, LINE 4B PAYMENTS FROM SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN OTHER REPORTABLE COMPENSATION SHOWN IN SCHEDULE J PART II COLUMN (B) (III) CONTAINS AN ANNUAL REPORTING ADJUSTMENT FOR CERTAIN EMPLOYEES WHO PARTICIPATE IN THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS. SCLHS PROVIDES NONQUALIFIED RETIREMENT PLANS FOR EXECUTIVES TO COMPENSATE FOR REGULATORY IMPOSED LIMITATIONS IN QUALIFIED RETIREMENT PLANS AND TO PROVIDE A BENEFIT CONSISTENT WITH OTHER NOT FOR PROFIT HEALTH SYSTEMS. THESE PLANS ENABLE THE EXECUTIVE TO EARN BENEFITS DURING EACH YEAR THAT THEY PARTICIPATE. ON THE ADVICE OF COUNSEL, SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS) HAS DETERMINED THAT THESE BENEFITS SHOULD BE SUBJECT TO TAXATION AS THEY ARE EARNED AND VESTED RATHER THAN WHEN THEY ARE RECEIVED. AS A RESULT, THE TOTAL NONQUALIFIED RETIREMENT PLAN BENEFITS, WHICH WERE ACCRUED AND VESTED IN THE CURRENT YEAR, ARE NOW CONSIDERED TAXABLE AND THUS WERE TAXED TO THE PARTICIPANTS. AN AMOUNT EQUAL TO THE PARTICIPANT'S EXPECTED INCOME TAX LIABILITY WAS WITHDRAWN FROM THE PARTICIPANT'S ACCOUNT AND REMITTED TO THE IRS AS WITHHOLDING ON THE TAXABLE BENEFIT. THE AMOUNTS WITHDRAWN FROM THE PLAN FOR TAXES IN 2013 WERE: FOREST BINDER- $8,794; DAN PRINSTER- $6,713; BOB LADENBURGER- $209,955. IN ADDITON, VESTED AMOUNTS ARE PAYABLE UPDON END OF EMPLOYMENT. THE VESTED AMOUNTS WITHDRAWN INCLUDE AMOUNTS PREVIOUSLY TAXED TO THE RECIPIENT AND AMOUNTS TAXABLE TO THE RECIPIENT IN THE CURRENT YEAR. THE TAXABLE AMOUNTS ARE INCLUDED ON THE RECIPIENTS W-2. THE AMOUNTS WITHDRAWN FROM THE PLAN IN 2013 WERE: JOHN BEESON- $248,360
PART I, LINE 7 OTHER NON-FIXED PAYMENTS SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS) HAS MANAGEMENT INCENTIVE PLANS WHICH ARE BASED ON A COMBINATION OF MEASURES. MANAGEMENT AND SENIOR LEADERSHIP ARE ELIGIBLE FOR THE INCENTIVE COMPENSATION. PERFORMANCE CATEGORIES ARE MADE UP OF A COMBINATION OF CLINICAL QUALITY MEASURES AND OPERATING INCOME. THE OPERATING INCOME CATEGORY IS GENERALLY RELATED TO THE NET EARNINGS OF THE CARE SITE IN WHICH THE INDIVIDUAL WORKS, OR IN THE CASE OF SCLHS SENIOR MANAGEMENT, THE NET EARNINGS OF SCLHS.
FORM 990, SCHEDULE J, PART II THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS CONSISTS OF ELEVEN HOSPITALS AND FOUR CLINICS (AFFILIATES) IN FOUR STATES INCLUDING ST. MARY'S HOSPITAL AND MEDICAL CENTER (ST. MARY'S) IN GRAND JUNCTION, COLORADO. SCLHS AND ITS AFFILIATES ADHERE TO GOVERNANCE EXCELLENCE STANDARDS INCLUDING TRANSPARENCY AND ACCOUNTABILITY. THE COMPENSATION REFLECTED IN PART VII AND SCHEDULE J ARE FOR RESPONSIBILITIES TO RELATED ORGANIZATIONS AND NOT FOR PARTICIPAING ON THE BOARD. IN KEEPING WITH SCLHS CORE VALUE OF STEWARDSHIP, NO BOARD MEMBER SERVING ON SCLHS OR AFFILIATE BOARDS IS COMPENSATED FOR THAT SERVICE.
Schedule J (Form 990) 2013

Additional Data


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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, line 38a or 40b.
MediumBullet Attach to Form 990 or Form 990-EZ. MediumBullet See separate instructions.
MediumBulletInformation about Schedule L (Form 990 or 990-EZ) and its instructions is at www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
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) Relationship between disqualified person and organization (c) Description of transaction (d) Corrected?
Yes No





2
Enter the amount of tax incurred by 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-EZ, Part V, line 38a, or Form 990, Part IV, line 26; or if the organization reported an amount on Form 990, Part X, line 5, 6, or 22
(a) Name of interested person (b) Relationship with organization (c) Purpose of loan (d) Loan to or from the organization? (e)Original principal amount (f)Balance due (g) In default? (h) Approved by board or committee? (i)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 assistance (d) Type of assistance (e) Purpose of assistance
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 50056A
Schedule L (Form 990 or 990-EZ) 2013
Schedule L (Form 990 or 990-EZ) 2013
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) WESTERN THERAPUTICS
  		DIRECTOR OWNS > 5% 465,075 SEE PART V   No
Part V
Supplemental Information
Provide additional information for responses to questions on Schedule L (see instructions).
Return Reference Explanation
FORM 990, SCHEDULE L, PART IV MIKE MURRAY, M.D. IS A PART OWNER IN WESTERN THERAPEUTICS. WESTERN THERAPEUTICS PROVIDES LITHOTRIPSY SERVICES TO ST. MARY'S HOSPITAL & MEDICAL CENTER. ALL TRANSACTIONS WITH WESTERN THERAPEUTICS ARE NEGOTIATED AT ARMS LENGTH.
Schedule L (Form 990 or 990-EZ) 2013

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.
MediumBullet Information about Schedule O (Form 990 or 990-EZ) and its instructions is at
www.irs.gov/form990.
OMB No. 1545-0047
2013
Open to Public
Inspection
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
Return Reference Explanation
FORM 990, PART III - PROGRAM SERVICE, LINE 4A PROGRAM SERVICE ST. MARY'S HOSPITAL AND MEDICAL CENTER, INC. (ST. MARY'S) IS A FULL-SERVICE HOSPITAL PROVIDING QUALITY HEALTHCARE TO PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. AS THE LARGEST HEALTHCARE FACILITY IN A 250-MILE RADIUS, ST. MARY'S PROVIDES MANY ADVANCED HEALTHCARE SERVICES NOT OFFERED BY ANY OTHER FACILITIES IN WESTERN COLORADO AND EASTERN UTAH, INCLUDING COMPREHENSIVE CARDIAC SERVICES, OPEN HEART SURGERY, COMPREHENSIVE CANCER CARE, A NEWBORN INTENSIVE CARE, AND LEVEL II TRAUMA SERVICES. ST. MARY'S IS LICENSED FOR 346 BEDS, 310 OF WHICH WERE STAFFED BY YEAR END 2013. 2013 ACUTE ADULT AND PEDIATRIC ADMISSIONS NUMBERED 11,991; 2,191 BIRTHS; SUB-ACUTE ADMISSIONS 351. MEDICARE REPRESENTS 40.4% OF THE PAYOR MIX; MEDICAID REPRESENTS 15.9% OF THE PAYOR MIX. THE HOSPITAL PERFORMED 4,071 INPATIENT SURGERIES. (INCLUDING EMERGENCY ROOM VISITS), 78,990 CLINIC VISITS, AND 3,575 OUTPATIENT SURGERIES. MOST OF ST. MARY'S OUTPATIENT HEALTHCARE SERVICES ARE DELIVERED IN CLINIC FACILITIES CONVENIENTLY LOCATED NEAR BUT SEPARATE FROM THE MAIN HOSPITAL CAMPUS. WITH THEIR OWN ENTRANCES AND PARKING LOTS, THESE FACILITIES KEEP PATIENTS OUT OF THE TRAFFIC AND ACTIVITY FLOW OF THE HOSPITAL BUT CLOSE TO THE MAJOR CONCENTRATION OF MEDICAL SERVICES AND PHYSICIAN OFFICES IN THE COUNTY. ST. MARY'S ADVANCED MEDICINE PAVILION HOUSES OUT-PATIENT MEDICAL AND RADIOLOGY CANCER CARE, IMAGING, BLOOD DONATION, AND LABORATORY SERVICES. ST. MARY'S LIFE CENTER CONTAINS REHABILITATION, WELLNESS, AND WEIGHT LOSS/MANAGEMENT SERVICES. A THIRD FREE-STANDING FACILITY HOUSES ST. MARY'S FAMILY MEDICINE RESIDENCY PROGRAM, WHICH TRAINS PHYSICIANS TO CARE FOR FAMILIES IN SMALL TOWNS AND RURAL AREAS; ST. MARY'S FAMILY MEDICINE CENTER, A MEDICAL CLINIC SPECIALIZING IN PRE-NATAL, OBSTETRICAL, PEDIATRIC, FAMILY, AND GERIATRIC CARE; AND ST. MARY'S WOUND CLINIC. ST. MARY'S 2013 OUTPATIENT SERVICES INCLUDED: 108,304 PATIENT VISITS (INCLUDING EMERGENCY ROOM VISITS), 78,990 CLINIC VISITS, AND 3,575 OUTPATIENT SURGERIES. ST. MARY'S OPERATES THE ONLY LEVEL II TRAUMA CENTER BETWEEN DENVER, CO AND SALT LAKE CITY, UT. WITH A 24-7 EMERGENCY DEPARTMENT STAFFED WITH EXPERIENCED EMERGENCY MEDICINE, TRAINED PHYSICIANS AND NURSES, TRAUMA AND NEUROSURGEONS ALWAYS AVAILABLE, AND AIR MEDICAL TRANSPORT SERVICES. ST. MARY'S CARES FOR SERIOUSLY ILL AND INJURED PATIENTS. THE TRANSPORT HELICOPTER ALSO ASSISTS IN RESCUE OR EVACUATION EFFORTS. DURING 2013 ST. MARY'S HELICOPTER MADE 336 TRANSPORT FLIGHTS. THE FIXED-WING AIRCRAFT FLEW 353 TRANSPORTS AND THERE WERE 42 GROUND TRANSPORTS. OF ST. MARY'S 37,835 EMERGENCY DEPARTMENT VISITS DURING 2013, 6,395 PATIENTS WERE ADMITTED AND 31,440 WERE TREATED AS OUTPATIENTS.
FORM 990, PART VI, SECTION A, LINE 6 MEMBERS OR STOCKHOLDERS THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. IS THE SOLE CORPORATE MEMBER OF ST. MARY'S HOSPITAL AND MEDICAL CENTER, INC.
FORM 990, PART VI, SECTION A, LINE 7A CORPORATE MEMBER AS THE SOLE CORPORATE MEMBER THE SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM HAS THE AUTHORITY TO APPOINT BOARD MEMBERS. CERTAIN DECISIONS MADE BY THE COMMUNITY BOARD ARE SUBJECT TO APPROVAL BY THE CORPORATE MEMBER. THESE DECISIONS ARE PRIMARILY THOSE REGARDING DISSOLUTION.
FORM 990, PART VI, SECTION A, LINE 7B DECISIONS RESERVED TO MEMBERS OR STOCKHOLDERS SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM, INC. (SCLHS)HAS CERTAIN RESERVE POWERS TO APPROVE CHANGES TO THE ARTICLES OF INCORPORATION AND THE BYLAWS INCLUDING THE APPOINTMENT OR REMOVAL OF BOARD MEMBERS AND THE PRESIDENT/CEO. SCLHS ALSO HAS CERTAIN RESERVE POWERS OVER ANY CHANGE IN OWNERSHIP OF THE CORPORATION, CHANGE IN MISSION, ACQUISITION OF ASSETS, DISPOSAL OF ASSETS, LEASING OF ASSETS, INCURRENCE OF DEBT, MERGER OR DISSOLUTION, APPROVAL OF STRATEGIC PLANS AND BUDGETS, APPOINTMENT OF AUDITORS AND OVERSIGHT AND APPROVAL OF COMPENSATION AND BENEFITS FOR DIRECTORS, OFFICERS, KEY EMPLOYEES AND PHYSICIANS.
FORM 990, PART VI, SECTION B, LINE 11 BOARD REVIEW OF FORM 990 PRIOR TO SUBMISSION OF THE 990, THE 990 IS REVIEWED EXTERNALLY BY ERNST & YOUNG, LLP AND THE SYSTEM OFFICE. THE BOARD MEMBERS ARE THEN PRESENTED WITH COPIES OF THE FORM 990. AT A SUBSEQUENT BOARD MEETING, MEMBERS ARE ENCOURAGED TO ASK QUESTIONS REGARDING CLARIFICATION OR EXPRESS OPINIONS ON THE INFORMATION PROVIDED.
FORM 990, PART VI, SECTION B, LINE 12C CONFLICT OF INTEREST ST. MARY'S HOSPITAL AND MEDICAL CENTER, INC. REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES ITS CONFLICT OF INTEREST POLICY BY PROVIDING EDUCATION AND TRAINING FOR EACH OF ITS EMPLOYEES, STAFF, OFFICERS ANDDIRECTORS, AS WELL AS HAVING EACH OF THESE INDIVIDUALS COMPLETE A CONFLICT OF INTEREST STATEMENT ON AN ANNUAL BASIS TO DISCLOSE ANY POTENTIAL CONFLICT ISSUES. THESE STATEMENTS ARE CAREFULLY REVIEWED AND A REPORT PROVIDED TO ST. MARY'S PRESIDENT/CEO REGARDING EMPLOYEES AND OFFICERS, AND TO THE CHAIR OF THE BOARD AND CHAIR OF THE GOVERNANCE COMMITTEE REGARDING BOARD MEMBERS. IN THE EVENT OF A CONFLICT OF INTEREST WITH A BOARD MEMBER, THE CONFLICT SHALL PROMPTLY BE REPORTED TO THE BOARD CHAIR WHO WILL PRESENT THE FACTS TO THE GOVERNANCE COMMITTEE FOR EVALUATION AND PRESENTATION TO THE BOARD OF DIRECTORS FOR ITS ACTION.
FORM 990, PART VI, SECTION B, LINE 15 THE PROCESS FOR DETERMINING COMPENSATION: SISTERS OF CHARITY OF LEAVENWORTH HEALTH SYSTEM (SCLHS) EMPLOYS THE EXECUTIVE TEAM AT EACH OF ITS HOSPITAL AFFILIATES. AS PART OF ITS ANNUAL REVIEW PROCESS, SCLHS USES THE FOLLOWING IN ESTABLISHING THE COMPENSATION OF THOSE IN THESE POSITIONS: -COMPENSATION COMMITTEE -INDEPENDENT COMPENSATION CONSULTANT -WRITTEN EMPLOYMENT CONTRACTS -COMPENSATION SURVEYS AND STUDIES -APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE THE ABOVE SUPPORT THE COMPENSATION COMMITTEE'S EFFORTS TO ENSURE THAT THE LEVEL OF COMPENSATION PROVIDED TO ITS EXECUTIVES (OFFICERS, KEY EMPLOYEES, ETC.) IS CONSISTENT WITH MARKET VALUE AND THE PAY PHILOSOPHY SET BY THE BOARD. THE PAY PHILOSOPHY SET BY THE BOARD IS TO PAY AT THE MIDDLE OF THE MARKET FOR EXECUTIVES OF SIMILAR SIZED ORGANIZATIONS OVERALL. SCLHS EXECUTIVE COMPENSATION IS COMPARABLE TO THAT PROVIDED IN SIMILAR, NOT-FOR-PROFIT HEALTHCARE SYSTEMS AND HOSPITALS. FORM 990, PART VI, SECTION B, LINE 16B JOINT VENTURES JOINT VENTURE ARRANGEMENTS ARE REVIEWED WITH INTERNAL AND EXTERNAL LEGAL COUNSEL AT THE LOCAL AND SYSTEM OFFICE LEVELS PRIOR TO ENTERING INTO THE AGREEMENTS.
FORM 990, PART VI, SECTION C, LINE 19 PUBLIC INSPECTION OF DOCUMENTS DOCUMENTS ARE AVAILABLE UPON REQUEST FROM ADMINISTRATIVE OFFICES OF ST. MARY'S HOSPITAL.
FORM 990, PAGE 1, PART B - AMENDED RETURN AMENDED RETURN SUBSEQUENT TO FILING THE 2013 TAX RETURN, THE ORGANIZATION DISCOVERED AN ERROR IN THE REPORTING OF AN INTEREST IN A PARTNERSHIP 75% OWNED BY THE ORGANIZATION. THE BALANCE SHEET, REVENUE AND EXPENSES OF A 75% OWNED PARTNERSHIP WERE INCLUDED IN THE ORIGINALLY FILED FORM 990. THE PARTNERSHIP FILES A SEPARATE TAX RETURN AND SHOULD NOT HAVE BEEN INCLUDED IN THE ORIGINAL FORM 990. THE AMENDED RETURN REMOVED THE ASSETS AND LIABILITIES, OF THE PARTNERSHIP FROM PART X. IN ADDITION, THE REVENUE AND EXPENSES OF THE PARTNERSHIP WERE REMOVED FROM PART VIII AND PART IX. THE AMENDED RETURN PARTS VIII, PART IX AND PART X WERE CORRECTED TO EXCLUDE THE PARTNERSHIP REVENUE, EXPENSES, ASSETS AND LIABILITIES. THE AMENDED PARTS VIII, PART IX AND PART X WERE CORRECTED TO ONLY REFLECT ON THE HOSPITALS ACTIVITIES. PARTS OF THE ORIGINALLY FILED RETURN THAT CHANGED: A SUMMARY OF THE CHANGES TO THE ORIGINAL FORM 990 TO THE AMENDED FORM 990 ARE LISTED BELOW. THE CHANGES ARE DUE TO THE REMOVAL OF THE PARTNERSHIP REVENUE, EXPENSES, ASSETS AND LIABILITIES. PART III, LINE 4A, DECREASE IN EXPENSES $6,554,028 PART III, LINE 4A, DECREASE IN REVENUE $9,206,572 PART III, LINE 4E, DECREASE IN TOTAL PROGRAM EXPENSES $6,554,028 PART VIII, LINE 2G, DECREASE IN TOTAL PROGRAM SERVICE REVENUE $8,466,746 PART VIII, LINE 11D, DECREASE IN ALL OTHER REVENUE $739,826 PART IX, LINE 25, DECREASE IN TOTAL FUNCTIONAL EXPENSES $7,710,204 PART IX, LINE 25, DECREASE IN TOTAL PROGRAM SERVICE EXPENSES $6,554,028 PART IX, LINE 25, DECREASE IN TOTAL MGMT. & GENERAL EXPENSES $1,156,176 PART X, LINE 16, DECREASE IN TOTAL ASSETS BEGINNING OF YEAR $2,954,995 PART X, LINE 26, DECREASE IN TOTAL LIABILITIES BEGINNING OF YEAR $2,954,995 PART X, LINE 16, DECREASE IN TOTAL ASSETS END OF YEAR $3,974,284 PART X, LINE 26, DECREASE IN TOTAL LIABILITIES END OF YEAR $3,974,284 PART XI, LINE 1, DECREASE IN TOTAL REVENUE $9,206,572 PART XI, LINE 2, DECREASE IN TOTAL EXPENSES $7,710,204 PART XI, LINE 3, DECREASE IN REVENUE LESS EXPENSES $1,496,368 PART XI, LINE 9, INCREASE IN OTHER CHANGES IN NET ASSETS $1,496,368 SCHEDULE D, PART IX, DECREASE IN OTHER ASSETS $2,520,475 SCHEDULE D, PART X, DECREASE IN OTHER LIABILITIES $3,004,301 THE CHANGES SHOWN ABOVE ARE ALSO REFLECTED IN PART I, LINES 8-22 FOR BOTH THE PRIOR YEAR AND CURRENT YEAR.
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2013

Additional Data


Software ID:  
Software Version:  
SCHEDULE R
(Form 990)
Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.
MediumBullet Information about Schedule R (Form 990) and its instructions is at www.irs.gov/form990.

OMB No. 1545-0047
2013
Open to Public Inspection
Name of the organization
ST MARY'S HOSPITAL & MEDICAL CENTERINC
 
Employer identification number

84-0425720
Part I
Identification of Disregarded Entities Complete if the organization answered "Yes" on Form 990, Part IV, line 33.
(a)
Name, address, and EIN (if applicable) 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) SCL HLTH MEDICAL GRP-GRAND JUNCTION LLC
2635 N 7TH STREET
GRAND JUNCTION,CO81502
46-3778277 		PHYS SRVCS CO 0 0 ST MARY H&MC
 










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 entity?
Yes No
(1) SISTERS OF CHARITY OF LEAVENWORTH HEALTH

2420 W 26TH AVE SUITE 100D

DENVER,CO80211
23-7379161 		SUPPORT MMBRS CO 501(C)(3) 11B-TYPE II N/A
 
No
(2) CARITAS CLINICS INC

818 NORTH 7TH STREET

LEAVENWORTH,KS66048
48-1009910 		CLINIC SVCS KS 501(C)(3) LINE 3 SCLHS
 
Yes
 
(3) MARIAN CLINIC INC

1001 SW GARFIELD

TOPEKA,KS66604
48-1046905 		CLINIC SVCS KS 501(C)(3) LINE 3 SCLHS
 
Yes
 
(4) MARILLAC CLINIC INC

2333 N 6TH STREET

GRAND JUNCTION,CO81501
84-1085822 		CLINIC SVCS KS 501(C)(3) LINE 3 SCLHS
 
Yes
 
(5) PROVIDENCE MEDICAL CENTER INC

8929 PARALLEL PARKWAY

KANSAS CITY,KS66112
48-0784446 		HEALTHCARE KS 501(C)(3) LINE 3 SCLHS
 
Yes
 
(6) ST JOHN HOSPITAL INC

3500 SOUTH FOURTH STREET

LEAVENWORTH,KS66048
48-0543768 		HEALTHCARE KS 501(C)(3) LINE 3 PMC
 
Yes
 
(7) PROVIDENCEST JOHN FOUNDATION INC

8929 PARALLEL PARKWAY

KANSAS CITY,KS661121689
48-0925688 		SUPPORT 501(C)(3) KS 501(C)(3) LINE 7 PMC
 
Yes
 
(8) ST FRANCIS HEALTH CENTER INC

1700 SW 7TH STREET

TOPEKA,KS66606
48-0547719 		HEALTHCARE KS 501(C)(3) LINE 3 SCLHS
 
Yes
 
(9) ST FRANCIS HEALTH CENTER FOUNDATION

1700 SW 7TH STREET

TOPEKA,KS66606
48-1092520 		SUPPORT 501(C)(3) KS 501(C)(3) LINE 11A, I SFHC
 
Yes
 
(10) ST MARYS HOSPITAL DEVELOPMENT FOUNDATION

2635 N 7TH STREET

GRAND JUNCTION,CO81502
23-7001007 		SUPPORT 501(C)(3) CO 501(C)(3) LINE 11A, I SMHMC
 
Yes
 
(11) HOLY ROSARY HEALTHCARE

2600 WILSON

MILES CITY,MT59301
81-0231792 		HEALTHCARE MT 501(C)(3) LINE 3 SCLHS
 
Yes
 
(12) HOLY ROSARY HEALTHCARE FOUNDATION INC

2600 WILSON

MILES CITY,MT59301
20-2270238 		SUPPORT 501(C)(3) MT 501(C)(3) LINE 11A, I HRHC
 
Yes
 
(13) ST VINCENT HEALTHCARE

1233 NORTH 30TH

BILLINGS,MT59101
81-0232124 		HEALTHCARE MT 501(C)(3) LINE 3 SCLHS
 
Yes
 
(14) ST VINCENT HEALTHCARE FOUNDATION

PO BOX 35200

BILLINGS,MT591075200
81-0468034 		SUPPORT 501(C)(3) MT 501(C)(3) LINE 7 SVHC
 
Yes
 
(15) ST JAMES HEALTHCARE

400 SOUTH CLARK STREET

BUTTE,MT597012328
81-0231785 		HEALTHCARE MT 501(C)(3) LINE 3 SCLHS
 
Yes
 
(16) ST JAMES HEALTHCARE FOUNDATION

400 SOUTH CLARK STREET

BUTTE,MT597012328
65-1202190 		SUPPORT 501(C)(3) MT 501(C)(3) LINE 11A, I SJHC
 
Yes
 
(17) SAINT JOHN'S HEALTH CENTER

2121 SANTA MONICA BLVD

SANTA MONICA,CA904042091
95-1684082 		HEALTHCARE CA 501(C)(3) LINE 3 SCLHS
 
Yes
 
(18) JOHN WAYNE CANCER INSTITUTE

2000 SANTA MONICA BLVD

SANTA MONICA,CA90404
95-4291515 		CANCER R&D CA 501(C)(3) LINE 4 SJHC
 
Yes
 
(19) SAINT JOHN'S HOSPITAL & HLTH CENTER FNDT

2121 SANTA MONICA BLVD

SANTA MONICA,CA904042091
95-6100079 		SUPPORT 501(C)(3) CA 501(C)(3) LINE 7 SJHC
 
Yes
 
(20) SCL HEALTH-FRONT RANGE INC

2420 W 26TH AVE SUITE 100D

DENVER,CO80211
84-1103606 		HEALTHCARE CO 501(C)(3) LINE 3 SCLHS
 
Yes
 
(21) EXEMPLA LUTHERAN MEDICAL CENTER FOUNDATI

2480 W 26TH AVESUITE 360B

DENVER,CO80211
20-8846152 		SUPPORT 501(C)(3) CO 501(C)(3) LINE 7 SCLHEALTH-FR
 
Yes
 
(22) EXEMPLA GOOD SAMARITAN MEDICAL CTR FNDTN

200 EXEMPLA CIRCLE

LAFAYETTE,CO80026
84-1649162 		SUPPORT 501(C)(3) CO 501(C)(3) LINE 7 SCLHEALTH-FR
 
Yes
 
(23) LUTH MED CNTR PRO&GEN LIAB SELF-INS TRS

2480 W 26TH AVESUITE 360B

DENVER,CO80211
74-2571584 		INSURANCE CO 501(C)(3) LINE 11A, I SCLHEALTH-FR
 
Yes
 
(24) SAINT JOSEPH HOSPITAL

1835 FRANKLIN STREET

DENVER,CO80218
84-0417134 		HEALTHCARE CO 501(C)(3) LINE 3 SCLHS
 
Yes
 
(25) SAINT JOSEPH HOSPITAL FOUNDATION

1835 FRANKLIN STREET

DENVER,CO80218
84-0735096 		SUPPORT 501(C)(3) CO 501(C)(3) LINE 11A, I SJH
 
Yes
 
(26) MOUNT ST VINCENT HOME INC

4159 LOWELL BOULEVARD

DENVER,CO80211
84-0405260 		RESIDENT CARE CO 501(C)(3) LINE 11A, I SCLHS
 
Yes
 
(27) BETHANY COMMUNITY PLAZA INC

15 NORTH 12TH STREET

KANSAS CITY,KS66102
48-1207407 		INACTIVE KS 501(C)(3) LINE 3 PMC
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
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) PAVILION IMAGING LLC

750 WELLINGTON
GRAND JUNCTION,CO81501
03-0516198 		RADIOLOGY CO ST MARY'S HOSPITAL
  		RELATED 5,766,523 4,777,079   No     No 75.000 %
(2) HEALTHCARE MGMT

PO BOX 1929
GRAND JUNCTION,CO81502
84-1238904 		MGMT SVCS CO ST MARY'S HOSPITAL
  		RELATED 565,656 2,210,837   No 8,039 Yes   24.000 %
(3) SAN JUAN CANCER CENTER

600 SOUTH 5TH STREET
MONTROSE,CO81401
20-2856331 		OP CANCER CO ST MARY'S HOSPITAL
  		RELATED 627,116 1,497,426   No   Yes   33.000 %
(4) LUTHERAN CAMPUS ASC

3455 LUTHERAN PKWY STE 150
WHEATRIDGE,CO80033
02-0749532 		OP SURGERY CO N/A
 N/A       No     No  
(5) DENVER WEST ENDOSCOPY CTR

382 S ARTHUR AVENUE
LOUISVILLE,CO80027
46-0788218 		OP ENDOSCOPY CO N/A
 N/A       No     No  
(6) COLORADO SURGICAL VENTURES LLC

250 S WACKER DR SUITE 500
CHICAGO,IL60606
20-8038915 		OP SURGERY IL N/A
 N/A       No     No  
(7) COLORADO SURGICAL HOSPITAL LLC

250 S WACKER DR SUITE 500
CHICAGO,IL60606
20-8038977 		OP SURGERY IL N/A
 N/A       No     No  
(8) MED-MAP LLC

PO BOX 1929
BILLINGS,MT59103
81-0491356 		RENTAL REAL ESTATE MT N/A
 N/A       No     No  
(9) YELLOWSTONE SURG CENTER

1144 NORTH 28TH STREET
BILLINGS,MT59101
72-1519467 		OP SURGERY MT N/A
 N/A       No     No  
(10) ATHLETIC MED&PERFORMANCE LLC

1144 NORTH 28TH STREET
BILLINGS,MT59101
27-2270640 		PHYS THERAPY MT N/A
 N/A       No     No  
(11) TWENTIETH STREET GENERAL PARTNERSHIP

201 SOUTH LAKE AVENUE SUITE 507
PASADENA,CA91101
95-3974903 		RENTAL REAL ESTATE CA N/A
 N/A       No     No  
(12) SAINT JOHN'S MEDICAL PLAZA A CA LTD PTSHP

201 SOUTH LAKE AVENUE SUITE 507
PASADENA,CA91101
95-3974903 		RENTAL REAL ESTATE CA N/A
 N/A       No     No  
(13) ALL CARE HOME HEALTH SOLUTIONS

500 ELDORADO BLVE SUITE 4200
DENVER,CO80247
46-2418729 		HOME CARE CO N/A
 N/A       No     No  
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
 		(i)
Section 512(b)(13) controlled entity?
Yes No
(1) CARITAS INC AND SUBSIDIARIES

2420 W 26TH AVE SUITE 100D
DENVER,CO80211
48-0941069 		HEALTHCARE KS N/A
 C       Yes  
(2) LEAVEN INSURANCE COMPANY LTD

23 LIME TREE BAY AVENUE WEST BAY R
  GRAND CAYMAN  
CJ
98-0370522 		INSURANCE CJ N/A
 C       Yes  










Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
Page 3
Part V
Transactions With Related Organizations Complete if the organization answered "Yes" on Form 990, Part IV, line 34, 35b, or 36.
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
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 or (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 Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
Yes
 
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
 
No
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
 
No
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
 
No
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
 
No
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
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 related organization 		(b)
Transaction
type (a-s) 		(c)
Amount involved 		(d)
Method of determining amount involved
(1) GRAND VALLEY SURGICAL CENTER LLC

 J 554,389 FMV
(2) GRAND VALLEY SURGICAL CENTER LLC

 L 147,869 FMV
(3) GRAND VALLEY SURGICAL CENTER LLC

 S 693,932 FMV
(4) PAVILION IMAGING LLC

 A 2,475,893 FMV
(5) PAVILION IMAGING LLC

 L 1,787,606 FMV
(6) PAVILION IMAGING LLC

 O 2,887,043 FMV
(7) PAVILION IMAGING LLC

 Q 1,921,043 FMV
(8) PAVILION IMAGING LLC

 S 6,525,000 FMV
(9) ST MARY'S HOSPITAL DEVELOPMENT FOUNDATION

 B 1,277,910 FMV
(10) ST MARY'S HOSPITAL DEVELOPMENT FOUNDATION

 C 1,531,417 COST
(11) MARILLAC CLINIC

 B 407,580 FMV
(12) MARILLAC CLINIC

 J 61,307 FMV
(13) MARILLAC CLINIC

 O 3,838,043 FMV
(14) MARILLAC CLINIC

 Q 74,968 FMV
(15) SAN JUAN CANCER CENTER LLC

 L 72,000 FMV
(16) SAN JUAN CANCER CENTER LLC

 O 309,736 FMV
(17) SAN JUAN CANCER CENTER LLC

 Q 353,342 FMV
(18) SAN JUAN CANCER CENTER LLC

 S 455,884 FMV
Schedule R (Form 990) 2013
Schedule R (Form 990) 2013
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) 2013
Schedule R (Form 990) 2013
Page 5
Part VII
Supplemental Information
Provide additional information for responses to questions on Schedule R (see instructions).
Return Reference Explanation
Schedule R (Form 990) 2013
Additional Data


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