2020-07-10T14:01:34-05:00 2019-06-30 470617373 CommonSpirit Health 198 Inverness Drive West Englewood CO 80112 990 2018-07-01 470443636 St Mary's Community Hospital STMA 4028733321 1301 Grundman Boulevard Nebraska City NE 68410 Jeanette Wojtalewicz CFO, CHI Health 2020-07-10 true Angela Noel CPA P01051055 3032989100 2018 2020-09-23 17:36:50Z CHI Health St Mary's Cliff Robertson 12809 West Dodge Road Omaha NE 68154 33694527 false 0928 X www.chihealth.com X 1927 NE St. Mary's is a not for profit critical access hospital that provides acute care for the benefit of all regardless of ability to pay and promotes health through community outreach initiatives and partnerships. 14 10 232 10 59599 24068 718 1320530 33643468 30966636 857395 1205972 147889 186099 34649470 33679237 1200531 260979 0 0 12920602 13789457 0 0 0 17336303 16047648 31457436 30098084 3192034 3581153 87862247 62435343 58008422 29831632 29853825 32603711 X As an affiliate of CommonSpirit Health, we make the healing presence of God known in our world by improving the health of the people we serve, especially those who are vulnerable, while we advance social justice for all. false false 5050362 25919 3075483 St. Mary's Community Hospital HAS STRIVED TO IMPROVE THE HEALTH STATUS OF CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS IN THIS RURAL COMMUNITY. St. Mary's Community Hospital IS PROUD TO OFFER HEALTHCARE SERVICES CLOSE TO HOME WITHIN THE COMMUNITY. St. Mary's Community Hospital PROVIDES A VARIETY OF DIAGNOSTIC SERVICES TO THE COMMUNITY, SUCH AS CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND. 3065684 82781 9822389 St. Mary's Community Hospital Offers patients THE MOST COMFORTABLE AND COMPREHENSIVE operating room SERVICES. 3001812 34813 4130723 St. Mary's Community Hospital PROVIDES SEVERAL SPECIALTY CLINICS IN THE FOLLOWING AREAS: AUDIOLOGY, EAR, NOSE AND THROAT, CARDIOVASCULAR SERVICES, DERMATOLOGY, GASTROENTEROLOGY, GENERAL SURGERY/WOUND CARE, GYNECOLOGY/OBSTETRICS, ONCOLOGY, OPTHALMOLOGY, ORTHOPEDIC SURGERY, PODIATRY, UROLOGY, SPEECH AND OCCUPATIONAL THERAPY AND PSYCHIATRY. 11099915 117466 13938041 All other program services 11099915 117466 13938041 22217773 true true false true false false false false true true false false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true X 0 0 232 true true true false false false false false true false false false false false X 14 10 false false false false true true true true true false false true true true true true true false true false X Jeanette Wojtalewicz 4023434671 12809 West Dodge Road Omaha NE 68154 CLIFF ROBERTSON MD Board Member/CEO CHI Health 1.0 49.0 X X 0 2055384 202344 LARRY BUTLER Treasurer 1.0 11.0 X X 0 0 0 FR JAMES CLIFTON SJ Secretary 1.0 11.0 X X 0 0 0 RICHARD HERINK BOARD CHAIR 1.0 12.0 X X 0 0 0 ROBERT LANIK VICE CHAIR 1.0 11.0 X X 0 0 0 JENNIFER BEATY MD BOARD MEMBER 1.0 11.0 X 0 0 0 NATHANIEL BRACKETT MD BOARD MEMBER 1.0 59.0 X 0 0 0 SUSANNE L HRUZA MD BOARD MEMBER 1.0 11.0 X 0 0 0 ANTHONY JONES Board Member 1.0 49.0 X 0 0 0 JASON KRUGER MD BOARD MEMBER 1.0 59.0 X 0 307842 45216 AMY L MCGAHA md BOARD MEMBER 1.0 59.0 X 0 330726 19423 Thomas Murray PHD Board Member 1.0 11.0 X 0 0 0 BARRY SANDSTROM Board Member 1.0 11.0 X 0 0 0 SISTER MAURITA SOUKUP BOARD MEMBER 1.0 12.0 X 0 0 0 Bill T Yates Board Member 1.0 11.0 X 0 0 0 DANIEL DEFREECE MD PRESIDENT 49.0 1.0 X 36850 238191 43180 DEBRA GOLDSMITH PRESIDENT, REGIONAL HOSPITAL 1.0 49.0 X 0 262922 43867 JEANETTE WOJTALEWICZ CFO, CHI Health 5.0 45.0 X 0 853951 78360 PAULA ALDANA VP-PATIENT CARE SERVICES 40.0 0 X 126858 0 32414 JOAN BECCARD PHARMACY DIRECTOR 40.0 0 X 148446 0 19394 Donald Duval CRNA 40.0 0 X 209915 0 38426 MISTY HILL CRNA 40.0 0 X 209645 0 37644 KRISTIN MILLER NURSE PRACTITIONER 40.0 0 X 114581 14315 35245 Tim Schnack VP Operational Finance 5.0 45.0 X 0 288254 35207 STEVE HOUSTON SVP -STRATEGY BUSINESS DVLP 5.0 45.0 X 0 410126 34991 NANCY WALLACE FORMER SVP HR CHI HEALTH 5.0 45.0 X 0 466734 35744 MIKE WATTERS FORMER VP-SENIOR COUNSEL 5.0 45.0 X 0 326548 24681 DANIEL KELLY FORMER PRESIDENT 49.0 1.0 X 201089 0 9257 CARY WARD MD CHIEF MEDICAL OFFICER 5.0 45.0 X 0 623597 42666 1047384 6178590 778059 14 true true false Ketter & Associates 1819 F St Auburn NE 68305 Business Consulting 588869 Allevant Solutions 4714 Gettysburg Road Mechanicsburg PA 17055 Medical Consulting Services 314000 CORAM ALTERNATE SITE SERVICES INC 555 17TH STREET SUITE 1500 DENVER CO 80202 HEALTH CARE SERVICES 135392 3 X 0 0 0 1320530 0 0 0 1320530 Net Patient Services 900099 28941192 28941192 0 0 Pharmacy Services 446110 2025444 2025444 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 30966636 157112 0 222 156890 0 0 0 0 0 0 0 0 6236 0 0 0 6236 0 6236 0 0 6236 1048860 0 0 0 1048860 0 1048860 0 0 1048860 0 0 0 0 0 0 0 0 0 0 0 0 22515 15290 7225 0 0 7225 Cafeteria 722100 82496 0 0 82496 Laboratory Services 621500 60811 0 59377 1434 Services Sold 900099 17700 0 0 17700 11631 0 0 11631 172638 33679237 30966636 59599 1332472 X 260479 260479 500 500 10902398 8721918 2180480 481471 385176 96295 1746555 1397244 349311 659033 527226 131807 2047 2047 3074081 2460903 613178 0 20184 16148 4036 123735 111220 12515 27305 21844 5461 429574 343659 85915 32971 26376 6595 11385 9108 2277 409049 409049 2343219 2343219 46644 46644 Medical Supplies 4678709 4678709 Intercompany Allocations 4327512 4327512 Repairs and maintenance 232491 220866 11625 Bad debts 200109 200109 88633 84020 4613 0 30098084 22217773 7880311 0 28928 0 29622155 14191620 0 0 6730017 5422386 0 0 0 0 0 377238 606897 0 0 53867851 14843561 41219353 39024290 3267 3270 9251039 2556630 0 0 0 630250 630250 87862247 62435343 2261269 2529603 0 0 0 0 0 0 0 0 0 0 0 0 0 55747153 27302029 58008422 29831632 X 29850563 32600449 3262 3262 0 0 29853825 32603711 87862247 62435343 3581153 -831267 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 2047 false false false 2047 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCATION - $776 CATHOLIC HEALTH ASSOCIATION - $586 NEBRASKA HOSPITAL ASSOCIATION - $685 1741452 377375 4589 1335239 788177 1310561 411228 20943 1280 1741452 1059818 234820 15923 1310561 3479828 258791 8669 2687470 1059818 726599 2761799 1455 10025 3479828 1.0 0.0 0.0 false true true 756821 756821 41195561 5688098 35507463 0 0 0 11827327 9154773 2672554 88142 690 87452 39024290 Intercompany Payables 27291117 Other Liabilities 10912 27302029 X Schedule D, Part V, Line 4 Intended uses of endowment funds THE ENDOWMENT FUND WILL BE USED FOR BUILDING PROJECTS AT CHI HEALTH ST. MARY'S. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote St. Mary's Community Hospital's financial information is included in the consolidated audited financial statements of CommonSpirit Health, a related organization. CommonSpirit Health's FIN 48 (ASC 740) footnote for the year ended June 30, 2019, reads as follows: "CommonSpirit has established its status as an organization exempt from income taxes under the Internal Revenue Code Section 501(c)(3) and the laws of the states in which it operates, and as such, is generally not subject to federal or state income taxes. However, CommonSpirit's exempt organizations are subject to income taxes on net income derived from a trade or business, regularly carried on, which does not further the organizations' exempt purposes. No significant income tax provision has been recorded in the accompanying consolidated financial statements for net income derived from unrelated trade or business. CommonSpirit's for-profit subsidiaries account for income taxes related to their operations. The for-profit subsidiaries recognize deferred tax assets and liabilities for temporary differences between the financial reporting basis and the tax basis of their assets and liabilities, along with net operating loss and tax credit carryovers, for tax positions that meet the more-likely-than-not recognition criteria. Changes in recognition or measurement are reflected in the period in which the change in judgement occurs. Income tax interest and penalties are recorded as income tax expense. For the years ended June 30, 2019 and 2018, CommonSpirit's taxable entities recorded an immaterial amount of interest and penalties as part of the provision for income taxes. CommonSpirit's taxable entities did not have any material unrecognized income tax benefits as of June 30, 2019 and 2018. CommonSpirit reviews its tax positions quarterly and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements". true true X true X 300 true X true true true false true true 632 627340 627340 0.0208 1271 2093478 1375399 718079 0.0239 0 0 0 0 0.0 0 1903 2720818 1375399 1345419 0.0447 12 1876 157779 4503 153276 0.0051 7 71 40213 0 40213 0.0013 1 0 3869975 2701294 1168681 0.0388 2 0 2432 2432 0.0001 9 1523 75994 11966 64028 0.0021 31 3470 4146393 2717763 1428630 0.0475 31 5373 6867211 4093162 2774049 0.0922 0 0 0 0 0 0.0 1 152 1165 0 1165 0.0000 0 0 0 0 0 0.0 1 166 2210 0 2210 0.0001 1 10 1055 0 1055 0.0000 1 0 2820 0 2820 0.0001 1 0 62 0 62 0.0000 4 295 2184 0 2184 0.0001 0 0 0 0 0 0.0 9 623 9496 0 9496 0.0003 true 1490070 0 11237408 11298284 -60876 X true true 1 1 St Mary's Community Hospital 1301 Grundman Blvd Nebraska City NE 68410 www.chihealthstmarys.com H000128 X X X X St Mary's Community Hospital 1 false false true X X X X X X X X X 18 true false true true X www.chihealth.com/chna X X true 19 false true false true X 300.0 300.0 X X X X true true X X X true X http://www.chihealth.com/financial-assistance X http://www.chihealth.com/financial-assistance X http://www.chihealth.com/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - St. Mary's Community Hospital. As part of the CHNA process, Southeast District Health Department (SEDHD) conducted a community survey of the five-county area to gain primary input on the health status and needs of the community. Surveys were available from June, 2018 up until September, 2018 and were emailed to community stakeholders by each of the hospitals participating in the CHNA planning with SEDHD, promoted on social media through SEDHD and hospital channels, as well as paper copies made available at hospital and clinic locations throughout the SEDHD region. SEDHD held a series of focus group meetings to present survey findings, review secondary data, and engage key community members in determining top needs in the community. Stakeholders attending the focus group meeting at St. Mary's represented those who serve minority, at-risk, uninsured, and aging populations, as well as those affected by violence. Following completion of the SEDHD process and the CHI Health St. Mary's internal Community Benefit Action Team (CBAT) validation process described above, CHI Health St. Mary's presented findings and top needs for validation at the CHI Health St. Mary's Community Board meeting on March 22, 2019. Public health leadership from SEDHD participated in this review and validation session. All parties who reviewed the data as part of this overall process found the data to accurately represent the needs of the community. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - St. Mary's Community Hospital. CHI Health St. Mary's participated in the SEDHD process and expanded on this work to complete the Hospital's CHNA. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - St. Mary's Community Hospital. Shared with St Mary's Community Board at meeting in March 2019. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. Mary's Community Hospital. The most recent CHNA and corresponding implementation plan was completed in the tax reporting year 2018. The following outlines the current implementation plan priorities and strategies. This plan was posted publicly on www.chihealth.com/chna. The community identified the following priorities as top health needs through review of primary and secondary data presented, validated and prioritized by community stakeholders convened through SEDHD and CHI Health St. Mary's. Top Health Needs (from 2018 CHNA): 1. Access to Healthcare Services 2. Aging 3. Behavioral Health (includes mental health, suicide and substance abuse) 4. Cancer 5. Cardiovascular Disease 6. Maternal and Child Health 7. Nutrition, Physical Activity & Weight Status 8. Violence For this plan the hospital prioritized the following health needs: Priority Health Need #1: Social Determinants of Health To address this need the hospital will implement the following strategies in 2019-2021: * 1.1: Provide leadership and funding support to the P4OC steering committee to build capacity and support growth of the coalition - To serve as the backbone agency for larger, community-based, collective impact work addressing health, social, and economic factors to build a healthy community where every child and family thrives * 1.2: Support evidence-based, community-based trainings or programming such as Bridges Out of Poverty or Mental Health First Aid as supported and aligned with P4OC Coalition objectives * 1.3: Support Southeast District Health Department to offer the Growing Great Kids home visiting program serving families with children 0-3 and at risk for substance abuse and poor infant/maternal outcomes * 1.4: Operate the Nebraska City Community Garden, offering plots to those in need, as well as building capacity of community ownership and educational activities related to food production, harvesting, preparation, and sustainability The hospital will not address the following health needs for the following reasons: In acknowledging the range of priority health issues that emerged from the CHNA process, CHI Health St. Mary's prioritized Social Determinants of Health in order to most effectively focus resources and meaningfully impact the selected health issues. As described in the process above, the hospital took into consideration existing partnerships, available resources, the hospital's level of expertise, existing initiatives (or lack thereof), potential for impact, and the community's interest in the hospital engaging in that area in order to select the priorities. Having basic and social needs is a critical component of a person's health and unmet social determinants are often key drivers of other health needs. Therefore, the hospital seeks to indirectly address the following health needs by addressing social needs as a root causes of poor health outcomes. In order to maximize resources and impact on the prioritized health need area above, CHI Health St. Mary's will not write strategies to directly address the following needs, although relevant related work is highlighted where applicable below. Access. In addition to the rationale stated above, access to care is a fundamental component of CHI Health's Mission and strategy. CHI Health and CHI Health Clinic are currently working to expand the portfolio of primary care access points including extended clinic hours and virtual care to ensure access to specialty care. Aging. In addition to the rationale stated previously, the hospital considers the work outlined on the plan above to be across the life span, and the aging population will be given special consideration during planning and implementation of relevant activities given the partners and existing work happening that aligns with the overall strategy described above. Behavioral Health. In addition to the rationale stated above, CHI Health St. Mary's has been leading an effort to address behavioral health needs through a local coalition for the past three years. Now community partners that have been participating in this coalition will be participating in the work described on the plan above to build community capacity to address identified health needs in the community, to include behavioral health. Cancer. CHI Health St. Mary's continues its efforts around improving screening rates for cancer through consistent quality improvement efforts. The recently implemented practices to screen 80% or more of the eligible patients for colon cancer, and participate in the Every Woman Matters campaign to improve breast cancer screening rates. CHI Health St. Mary's also provides specialty cancer care clinics on-site in the rural location regularly. Cardiovascular Disease. Beyond the rationale state above, there is not additional work prioritized in this health need area. However, as a Critical Access Hospital, CHI Health St. Mary's recognizes the need to increase access to specialty care and holds a partnership with the Nebraska Heart Institute to provide superior heart and vascular care to the region. Maternal & Child Health. In addition to the rationale stated above, St. Mary's has long supported, and will continue to support the Growing Great Kids program led by Southeast District Health Department, which is a home visiting program to support healthy development for pregnant mothers and babies age zero to three years of age, in the home. The hospital provides financial support and administrative guidance to the program that serves Otoe County and four other surrounding counties. Nutrition, Physical Activity, and Weight Status (Obesity). This need will be addressed in part through the work of the team to operate and maintain the Nebraska City Community Garden, which is outlined in the plan above. Additionally, the team has begun offering an evidence-based program for families of children 8-18 with a high body mass index (BMI) and referred by a doctor, to receive a free eight-week course on healthy eating, active living, and setting healthy goals as a family. The team will monitor progress and enrollment of this program to evaluate continued offering. Violence. St. Mary's has long supported violence prevention efforts in Otoe County by leading a United Against Violence coalition that brings together a multi-disciplinary community stakeholder group to implement social emotional learning curriculum in the schools, support the implementation of policies that prevent violence in the workplace and community, and generally promote awareness around the need to reduce violent behaviors. The hospital will work to sustain this work through the continuation of the coalition as part of the broader work led by the community. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - St. Mary's Community Hospital. The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. The patient must submit a completed Financial Assistance application. Patient Cooperation Standards - A patient must exhaust all other payment options, including private coverage, federal, state and local medical assistance programs, and other forms of assistance provided by third-parties prior to being approved. An applicant for Financial Assistance is responsible for applying to public programs for available coverage. He or she is also expected to pursue public or private health insurance payment options for care provided by a CHI Hospital Organization within a Hospital Facility. A patient's and, if applicable, any Guarantor's cooperation in applying for applicable programs and identifiable funding sources, including COBRA coverage (a federal law allowing for a time-limited extension of employee healthcare benefits), shall be required. If a Hospital Facility determines that COBRA coverage is potentially available, and that a patient is not a Medicare or Medicaid beneficiary, the patient or Guarantor shall provide the Hospital Facility with information necessary to determine the monthly COBRA premium for such patient, and shall cooperate with Hospital Facility staff to determine whether he or she qualifies for Hospital Facility COBRA premium assistance, which may be offered for a limited time to assist in securing insurance coverage. A Hospital Facility shall make affirmative efforts to help a patient or patient's Guarantor apply for public and private programs. 0 Schedule H, Part I, Line 3c Unless eligible for Presumptive Financial Assistance, the following eligibility criteria must be met in order for a patient to qualify for Financial Assistance: * The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. * The patient's Family Income must be at or below 300% of the FPG. * The patient must comply with Patient Cooperation Standards as described [in the FAP]. * The patient must submit a completed Financial Assistance application. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. In particular, presumptive eligibility may be determined on the basis of individual life circumstances that may include: * Recipient of state-funded prescription programs; * Homeless or one who received care from a homeless clinic; * Participation in Women, Infants and Children programs (WIC); * Food stamp eligibility; * Subsidized school lunch program eligibility; * Eligibility for other state or local assistance programs (e.g., Medicaid spend-down); * Low income/subsidized housing is provided as a valid address; or * Patient is deceased with no known estate. Schedule H, Part VI, Line 5 PROMOTION OF COMMUNITY HEALTH - Academic affiliation with Creighton University and its Health Professions Programs, including the School of Medicine, College of Arts & Sciences, School of Dentistry, School of Pharmacy and Health Professions, College of Nursing. - Physician residency and fellowship programs train more than 250 residents and fellows annually * Subsidized health services - healthcare services including clinical care in the rural health setting * Research- - Unfunded staff support of the National Cancer Institute Community Oncology Research Program (NCORP) - Trauma Informed Care-this was an identified need on the community health improvement plan. CHI Health is partnering to implement staff training for awareness of trauma and its impact and completing a research study on the effectiveness of the training to help build public training and education resources. * Financial and in-kind contributions- - Corporate sponsorships - Tanzania health ministry-CHI Health is a ministry partner with the Machame Lutheran Hospital in Tanzania which provides full service health care in a desperately impoverished area of the country including a full service hospital, pharmacy, hospice outreach, clinics, Clinical Officer School, and the recently established School of Nursing. - Staff service on health related board and coalitions - Participation in and funding of maternal health, substance abuse, food access, violence prevention, cancer and other community health coalitions. - Participation in and sponsorship of mental health coalitions including Voices for Children, Community Alliance Foundation and Project Harmony. - Employee costs of coordinating community events not sponsored by CHI Health (Relay for Life, Blood drives, etc.) - In-kind staff time organizing the donation of items to various non-profit groups and volunteering time at Food Bank of the Heartland - In-kind donations of space, food and staff time providing strategic planning, facilitation and consulting services for not-for-profit organizations and community groups - In-kind donations (staff time, space, etc.) supporting grants for Behavioral Health, Violence Prevention, and Community Link. - Hospital hosted blood drives onsite and employees donated blood on paid time - Meals on Wheels- food donations, including Meals on Wheels subsidies and donations to food shelters, and cost for staff time to prepare and deliver meals. * Community building activities- - Healthcare Career Exploration Camp-day camp funded by CHI Health for students grades 10-12 to give them the opportunity to explore a variety of healthcare professions - Presentations to high school students about healthcare careers - Staff time spent with high school shadow students - Hospital staff participated in the Nebraska Workforce Development board meetings - Community and economic development including support of local Chambers of Commerce - Hospital president participated in the Nebraska City Area Economic Development meetings - Hospital staff presented to Leadership Nebraska City to train them on leadership development - Partners for Otoe County-time spent working with Partners for Otoe County coalition to work with local community members to reduce drug and alcohol use; increase positive relationships, provide after school clubs, and to build a community where every family thrives. - Sharps and prescription drug disposal-in an effort to safely remove contaminated waste in the community, St. Mary's provided sharps containers free of charge to any persons or organizations in the community. They also maintain a medication collection box in which individuals can safely and appropriately discard unused prescriptions. Schedule H, Part I, Line 6a NAME OF RELATED ORGANIZATION THAT PREPARED COMMUNITY BENEFIT REPORT THE 2018 COMMUNITY BENEFIT REPORT FOR SAINT MARY'S COMMUNITY HOSPITAL WAS PREPARED BY ALEGENT CREIGHTON HEALTH, DBA CHI HEALTH, A RELATED ORGANIZATION. THE COMMUNITY BENEFIT REPORT CONTAINS INFORMATION FOR SEVERAL RELATED ORGANIZATIONS IN IOWA AND NEBRASKA. Schedule H, Part I, Line 7g Subsidized Health Services Included in subsidized health services is the following physician clinic: CHI Health Nebraska City Rural Health Clinic The total expenses associated with operating this clinic were $3,869,975. Revenue offsets were $2,701,294. Accordingly, the total subsidized cost of these necessary services was $1,168,681. The clinic meets a community need for primary care services outside of the emergency room setting. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using Worksheet 2 to compute the cost-to-charge ratio. The cost-to-charge ratio covers all patient segments. Schedule H, Part II Community Building Activities CHI Health has a history of centralized community benefit investments, as well as hospital specific investments that address community health needs which include support of local health coalitions, investments in partnerships and programs that address top community health needs, participation in local committees and boards tied to top health needs, and investments in many other ways as described in other areas of the Schedule H narrative. Below are specific examples of work that falls within the definition of community building activities. These activities are critical in helping build social, health, and economic opportunities in our community that ultimately drive health status and quality of life for our residents: * Workforce development-the following activities work to strengthen the community's capacity to promote the health and well-being of our residents by driving entry into healthcare careers: - Healthcare career exploration camp-day camp funded by CHI Health for students grades 10-12 to give them the opportunity to explore a variety of healthcare professions - Presentations to high school students about healthcare careers - Staff time spent with high school shadow students - Hospital staff participated in the Nebraska Workforce Development board meetings * Community and economic development including support of local Chambers of Commerce * Hospital president participated in the Nebraska City Area Economic Development meetings * Hospital staff presented to Leadership Nebraska City to train them on leadership development * Partners for Otoe County-time spent working with Partners for Otoe County coalition to work with local community members to reduce drug and alcohol use; increase positive relationships, provide after school clubs, and to build a community where every family thrives. * Sharps and prescription drug disposal-in an effort to safely remove contaminated waste in the community, St. Mary's provided sharps containers free of charge to any persons or organizations in the community. They also maintain a medication collection box in which individuals can safely and appropriately discard unused prescriptions. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Costing methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 75.93 % (updated annually). When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. Schedule H, Part III, Line 3 Bad Debt Expense Methodology St. Mary's Community Hospital does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote St. Mary's Community Hospital does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of CommonSpirit Health. The consolidated footnote reads as follows: CommonSpirit relies on the results of detailed reviews of historical write-offs and collections in estimating the collectability of accounts receivable. Updates to the hindsight analysis is performed at least quarterly using primarily a rolling eighteen-month collection history and write-off data. Subsequent changes to estimates of the transaction price are generally recorded as adjustments to net patient revenue in the period of change. Subsequent changes that are determined to be the result of an adverse change in a third-party payor's ability to pay are recorded as bad debt expense in purchased services and other in the accompanying consolidated statements of operations and change in net assets. Bad debt expense for 2019 was not significant. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs St. Mary's Community Hospital is designated as a Critical Access Hospital (CAH). CAHs are rural community hospitals that are certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. CAHs are certified under a different set of Medicare Conditions of Participation (CoP). Shortfalls are created when a facility receives payments that are less than the costs of caring for program beneficiaries. Because shortfalls are based on costs, not charges, St. Mary's Community Hospital, due to their designation as a CAH, received cost-based reimbursement for Medicare purposes, St. Mary's Community Hospital will not experience Medicare related shortfalls. Although not presented on the Medicare cost report, in order to facilitate a more accurate understanding of the "true" cost of services (for "shortfall" purposes) the CHI Workbook allows a health care facility not to offset costs that Medicare considers to be non-allowable, but for which the facility can legitimately argue are related to the care of the facility's patients. In addition, although not reportable on the Medicare cost report, the CHI workbook includes the cost of services that are paid via a set fee-schedule rather than being reimbursed based on costs (e.g. outpatient clinical laboratory). Finally, the CHI Workbook allows a facility to include other health care services performed by a separate facility (such as a physician practice) that are maintained on separate books and records (as opposed to the main facility's books and records which has its costs of service included within a cost report). True costs of Medicare computed using this methodology: Total Medicare Revenue: $11,237,408 Total Medicare costs: $11,298,284 Surplus or Shortfall ($60,876) St. Mary's Community Hospital believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as "subsidized health services." Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The organization's billing and collections policy applies to all individuals presenting for emergency or other medically necessary care. The policy contains provisions for collecting amounts due from those patients who the organization knows to qualify for financial assistance either through the traditional financial assistance application process or through presumptive eligibility processes. Before engaging in extraordinary collection actions (ECAs) to obtain payment for EMCare, Hospital Facilities must make reasonable efforts through its billing and collections processes, pursuant to Treas. Reg. §1.501(r)-6(c), to determine whether an individual is eligible for Financial Assistance. In no event will an ECA be initiated prior to 120 days from the date the Facility provides the first post-discharge billing statement (i.e., during the Notification Period) unless all reasonable efforts have been made. Hospital Facilities will not refer accounts for collection where the patient has initially applied for Financial Assistance, and the Hospital Facility has not yet made reasonable efforts with respect to the account. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. Patients who qualify for Medicaid are presumed to qualify for full charity write off. Any charges for days or services written off (excluding Medicaid denials related to timeliness of billing, insufficient medical record documentation, missing invoices, authorization, or eligibility issues) as a result of a Medicaid are booked as charity. Some Medicaid plans offer coverage for a limited or restricted list of services. If a patient is eligible for Medicaid, any charges for days or services not covered by the patient's coverage may be written off to charity without a completed application. This does not include any Share of Cost (SOC) or other patient cost-sharing amounts such as deductibles or copayments, as such costs are determined by the state to be an amount that the patient must pay before the patient is eligible for Medicaid. Health and Human Services (HSS) uses the term "Spend Down" instead of Share of Cost. All collection activities conducted by the Facility, a Designated Supplier, or its third-party collection agents will be in conformance with all federal and state laws governing debt collection practices. All third-party agreements governing collection and recovery activities must include a provision requiring compliance with the hospital facilities' financial assistance and billing and collections policy and indemnification for failures as a result of its noncompliance. This includes, but is not limited to, agreements between third parties who subsequently sell or refer debt of the Hospital Facility. Schedule H, Part V, Section B, Line 16a FAP website - St. Mary's Community Hospital: Line 16a URL: http://www.chihealth.com/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - St. Mary's Community Hospital: Line 16b URL: http://www.chihealth.com/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - St. Mary's Community Hospital: Line 16c URL: http://www.chihealth.com/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment In order to assess the health needs of Otoe County, CHI Health St. Mary's took two primary actions: 1. Engage in the CHNA process led by SEDHD, the local public health department, to include primary and secondary data collection, as well as stakeholder focus groups to review data and prioritize needs. 2. Gain validation of the SEDHD prioritized needs through engagement of the hospital's internal Community Benefit Action Team (CBAT) and the hospital's community board. SEDHD covers five counties: Johnson, Nemaha, Otoe, Pawnee and Richardson. In order to assess the health needs across the five-county area, SEDHD convened the hospital leadership from hospitals in the region to support planning efforts. The group planned and implemented a community survey across all five counties and held five stakeholder focus groups to review community survey data as well as secondary data. SEDHD sourced secondary data from a variety of sources to include: * State of Nebraska - Department of Health and Human Services, Crime Commission, Department of Education, and Risk and Protective Factor Surveillance Systems * County Health Rankings & Roadmaps * U.S. Census Bureau and the American Community Survey CHI Health St. Mary's co-hosted one of the CHNA's five focus group meetings in December, 2018 and upon review of the primary and secondary data, the focus groups engaged in a facilitated conversation to determine drivers of poor health outcomes and prioritize health needs for specific counties. Following the focus groups, SEDHD supplied CHI Health St. Mary's with a report detailing meeting highlights and identified needs. CHI Health St. Mary's CBAT then reviewed results from the SEDHD CHNA process, and validated with CHI Health St. Mary's hospital community board. Summary of Assessment Findings In order to prioritize the top health needs for Otoe County and this hospital CHNA, the CBAT reviewed the SEDHD-led process to validate data and process methodology. Prioritization of the top health needs for the purposes of this CHNA took into account the following: * Prevalence and severity * Trend * Disparities * Community and stakeholder input, and * Impact on overall health outcomes All parties who reviewed the data found the data to accurately represent the needs of the community. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Notification about the availability of Financial Assistance from CHI Hospital Organizations shall be disseminated by various means, which may include, but not be limited to: * Conspicuous publication of notices in patient bills; * Notices posted in emergency rooms, urgent care centers, admitting/registration departments, business offices, and at other public places as a Hospital Facility may elect; and * Publication of a summary of this Policy on the Hospital Facility's website, www.catholichealth.net, and at other places within the communities served by the Hospital Facility as it may elect. Such notices and summary information shall include a contact number and shall be provided in English, Spanish, and other primary languages spoken by the population served by an individual Hospital Facility, as applicable. Referral of patients for Financial Assistance may be made by any member of the CHI Hospital Organization non-medical or medical staff, including physicians, nurses, financial counselors, social workers, case managers, chaplains, and religious sponsors. A request for assistance may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. In addition, Hospital registration clerks are trained to provide consultation to those who have no insurance or potentially inadequate insurance concerning their financial options including application for Medicaid and for assistance under the Financial Assistance Policy. Counselors assist Medicare eligible patients in enrollment by providing referrals to the appropriate government agencies. Once it is determined that the patient does not qualify for any third party funding, the patient is verbally notified about the existence of Financial Assistance Application and additional screening takes place by a Hospital employee to determine if the patient is eligible for charity service prior to discharge. Upon registration (and once all EMTALA requirements are met), patients who are identified as uninsured (and not covered by Medicare or Medicaid) are provided with a packet of information that addresses the Financial Assistance Policy, the plain language summary of that policy, and an application for assistance. Hospital registration clerks read the organization's medical assistance policy to those who appear to be incapable of reading, and provide translators for non-English-speaking individuals. Patients that have been discharged prior to charity screening, such as emergency room patients, receive a written notification of possible eligibility for services. If the patient is determined not to be eligible for government assistance, he/she may notify the hospital that they seek charity assistance. The appropriate charity form is sent to the patient/guarantor for completion and then returned to the hospital for evaluation and qualification. Once determination of eligibility is made, the patient is sent a notice informing him/her if they qualify for full, partial, or no charity care services. Hospital Facilities must make reasonable efforts through its billing and collections processes, pursuant to Treas. Reg. §1.501(r)-6(c), to determine whether any individual is eligible for Financial Assistance. Schedule H, Part VI, Line 4 Community information Otoe County is considered the primary service area of CHI Health St. Mary's, as a critical access hospital and is therefore the identified as the community for the purposes of this CHNA. As a critical access hospital, CHI Health St. Mary's serves a largely rural population over 616 square miles in Otoe County, Nebraska. Otoe County is home to ten communities with four school districts. The population of these communities range from 61 in Lorton, to 1,600 in Syracuse and 6,547 in Nebraska City. CHI Health St. Mary's is located in Nebraska City, which also serves as the County Seat for Otoe County and is approximately 50 miles from the Omaha Metropolitan Area and 50 miles from the northern Kansas border. Overall, Otoe County is growing at a slower rate than the State, has a slightly higher percentage of the population over age 65, and is less diverse (predominantly non-Hispanic White) compared to the State. The Hispanic population increased from 902 to 1,342 people between 2010 and 2017, or by 48.8 percent. Nebraska City's population shows lower income and lower education than the County and State. Otoe County Demographics: * 16,027 total population for Otoe County * 24.1% of population below 18 years of age * 19.3% of population is aged 65 or older * 5.1% of population is Non-Hispanic African American * 0.6% of population is American Indian or Alaska Native * 0.7% of population is Asian * 0.1% of population is Native Hawaiian/ Pacific Islander * 8.4% of population is Hispanic * 88.5% of population is Non-Hispanic White * 9.1% of population living below the poverty line (100% FPL) * 91.2% of eligible persons hold high school diploma * 21.4% of eligible persons hold bachelor's degree or higher * $54,605 is the median household income for Otoe County * 3.4 is the County unemployment rate * 8.7% of population under 65 is uninsured Nebraska City Demographics: * 7,313 total population for Nebraska City * 25.0% of population below 18 years of age * 19.1% of population is aged 65 or older * 0.4% of population is Non-Hispanic African American * 1.1% of population is American Indian or Alaska Native * 1.1% of population is Asian * 0.0% of population is Native Hawaiian/ Pacific Islander * 15.3% of population is Hispanic * 79.9% of population is Non-Hispanic White * 13.6% of population living below the poverty line (100% FPL) * 88.6% of eligible persons hold high school diploma * 16.7% of eligible persons hold bachelor's degree or higher * $44,243 is the median household income for Nebraska City * 11.8% of population under 65 is uninsured in Nebraska City Schedule H, Part VI, Line 5 Promotion of community health The organization's hospital facility promotes health for the benefit of the community. Medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The organization's hospital facility has an open medical staff. Its board of trustees is composed of prominent citizens in the community. Excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. The facility treats persons paying their bills with the aid of public programs like Medicare and Medicaid. All patients presenting at the hospital for emergency and other medically necessary care are treated regardless of their ability to pay for such treatment. CHI Health has a history of centralized community benefit and hospital specific community benefit investments to address community health needs of the particular service area. Examples of how CHI Health furthers its exempt purpose by promoting the health of the community include: * Financial Assistance and Unpaid costs of Medicaid * Community health improvement services- - Community education, classes and programs (community behavioral health support and education, diabetes, cancer, physical activity and healthy eating and cooking) - Support groups (cancer, bereavement, youth, etc.) - Community health fairs and screenings - School based healthcare services - Mental Health Hotline-staff and operate 717-HOPE mental health hotline for anyone in the community to access. This program averages over 5,000 phone calls per month from community members in need. - Parish Nursing Program and Faith Community Health Network-the CHI Health Faith Community Health Network partners with congregations of all faiths to build capacity and support the growth of Health Ministries which promote health, healing and wholeness in the communities served. - 5-4-3-2-1Go!- Healthy lifestyle campaign for kids; operated in schools, out of school settings, clinics, community settings in Douglas, Sarpy, Cass, and Colfax counties in NE. Initial work completed by CHI Health in FY19 and following contractor departure, work was transitioned through a grant to Live Well Omaha for the broader Omaha community strategy in Douglas County as part of a 2-year grant. - United Against Violence-provided funding and staff time for this multi-year project to move towards a culture of non-violence in southeast Nebraska. - Infant hearing screening testing-nursing staff provided retesting for community families whose infants failed the initial hearing test - Provided counseling and assistance in enrolling individuals in means tested insurance programs to improve access to care. - Support to health coalitions and investments in social and environmental improvement strategies. These are programs, activities and partnerships that improve the health of persons in the community by addressing the determinants of health, which includes the social, economic and physical environment. See specific examples by community below: Regional - Nebraska Appleseed-provided funds to support hunger/food access efforts; this includes summer meals program outreach, enrichment programming at summer meals sites and support to launch state's first SNAP Employment & Training (E&T) third party partnership, which provides job training for SNAP recipients. Also providing funding to support Enroll Nebraska efforts for outreach and education during annual insurance enrollment period. - Alzheimer's Association-provided funds to support the continued offering of free support services for families with a loved one with dementia/alzheimer's. Supports include assistance in finding memory units, appropriate levels of care or specialty providers, caregiver support groups, etc. - Nebraska Breastfeeding Coalition-provided funds that supports the building of coalition infrastructure to include evaluation of existing work and development of long-term strategic plan to secure sustainable funding. Future focus is moving toward strategies that connect breastfeeding and breastfeeding support with mental health. - Nebraska Extension-provided funds to support Double Up food Bucks in Omaha and Lincoln; program for SNAP recipients to receive an additional $1 for every $1 they spend on fruits and vegetables at participating sites; nutrition/cooking education is also provided at all sites. Nebraska City * Partners for Otoe County-provided financial support for Partners for Otoe County, a non-profit organization dedicated to building a healthy community where every child and family thrives. P4OC collaborates with individuals, organizations, local businesses, institutions, and agencies to take responsibility for improving the health and quality of life in our community. * Southeast District Health Department-provided support to the local health department to convene and conduct regional CHNA and planning process which St. Mary's participated in, along with two other regional hospitals and numerous community partners. * Growing Great Kids-provided support for Growing Great Kids, which is a program housed out of Southeast District Health Department (SEDHD). The program provides home visiting services delivered by nursing staff, for families at risk for adverse childhood experiences during the prenatal to age 3 timeframe, to offer support in the prenatal time period as well as parenting support and resources as baby grows. * Health professional education- - Clinical preceptorships and clinical rotations for healthcare professionals - Administration and student onboarding costs for nursing preceptorships and clinicals - Staff time facilitating the small-group ethics case discussions with medical students - Clinical pastoral education - Scholarships for healthcare education Schedule H, Part VI, Line 6 Affiliated health care system The organization is affiliated with CommonSpirit Health. CommonSpirit Health was created by the alignment of Catholic Health Initiatives and Dignity Health as a single ministry in early 2019. CommonSpirit Health, a nonprofit, faith-based health system is committed to building healthier communities, advocating for those who are poor and vulnerable, and innovating how and where healing can happen - both inside its hospitals and out in the community. CommonSpirit Health owns and operates health care facilities in 21 states and comprises 142 hospitals, including three academic health centers, major teaching hospitals as well as 31 critical-access facilities; community health services organizations; accredited nursing colleges; home health agencies; living communities; a medical foundation and other affiliated medical groups; and other facilities and services that span the inpatient and outpatient continuum of care. In fiscal year 2019, CommonSpirit Health provided more than $2.1 billion in financial assistance and community benefit for programs and services for the poor, free clinics, education and research. Financial assistance and community benefit totaled more than $4.4 billion with the inclusion of the unpaid costs of Medicare. The health system, which generated operating revenues of $20.96 billion in fiscal year 2019, has total assets of approximately $40.6 billion. CommonSpirit Health provides strategic planning and management services as well as centralized "share services" for its Divisions. The provision of centralized management and shared services including areas such as accounting, human resources, payroll and supply chain provides economies of scale and purchasing power to the Divisions. The cost savings achieved through CommonSpirit Health's centralization enable Divisions to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society. Schedule H, Part VI, Line 7 State filing of community benefit report IA, NE true St Mary's Hospital Foundation 1301 GRUNDMAN BLVD NEBRASKA CITY NE 68410 470707604 501(c)(3) 257179 GENERAL SUPPORT 1 0 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. MOST DISBURSEMENTS IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PROGRAMS ARE MADE DIRECTLY IN THE ACTIVE CONDUCT OF THE ACTIVITIES CONSTITUTING THE EXEMPT PURPOSE OR FUNCTION OF THE ORGANIZATION. OTHERWISE, DISTRIBUTIONS IN FURTHERANCE OF THE INSTITUTION'S EXEMPT PROGRAMS ARE MADE IN ACCORDANCE WITH PROCEDURES SUBJECT TO CONDITIONS ESTABLISHED BY THE INSTITUTION'S GOVERNING BOARD OR MANAGEMENT DESIGNED TO ENSURE THAT RECIPIENTS OF SUCH DISBURSEMENTS FROM THE ORGANIZATION ARE ADEQUATELY INVESTIGATED AND GRANTED TO QUALIFIED RECIPIENTS. true true false false false false false true false CLIFF ROBERTSON MD Board Member/CEO CHI Health 0 1021091 0 870115 0 164178 0 173553 0 28791 0 2257728 0 133018 JASON KRUGER MD BOARD MEMBER 0 307024 0 0 0 818 0 16469 0 28747 0 353058 0 0 AMY L MCGAHA md BOARD MEMBER 0 330100 0 0 0 626 0 16276 0 3147 0 350149 0 0 DANIEL KELLY FORMER PRESIDENT 77751 0 0 0 123338 0 1783 0 7474 0 210346 0 0 0 CARY WARD MD CHIEF MEDICAL OFFICER 0 491125 0 109860 0 22612 0 15706 0 26960 0 666263 0 0 DANIEL DEFREECE MD PRESIDENT 35938 222153 0 15005 912 1033 16267 0 22945 3968 76062 242159 0 0 DEBRA GOLDSMITH PRESIDENT, REGIONAL HOSPITAL 0 201987 0 45885 0 15050 0 25457 0 18410 0 306789 0 0 JEANETTE WOJTALEWICZ CFO, CHI Health 0 537238 0 228748 0 87965 0 51400 0 26960 0 932311 0 47128 Tim Schnack VP Operational Finance 0 248995 0 34299 0 4960 0 16515 0 18692 0 323461 0 0 STEVE HOUSTON SVP -STRATEGY BUSINESS DVLP 0 315850 0 72105 0 22171 0 16375 0 18616 0 445117 0 0 NANCY WALLACE FORMER SVP HR CHI HEALTH 0 356671 0 80543 0 29520 0 16361 0 19383 0 502478 0 0 MIKE WATTERS FORMER VP-SENIOR COUNSEL 0 273409 0 31500 0 21639 0 643 0 24038 0 351229 0 0 PAULA ALDANA VP-PATIENT CARE SERVICES 100018 0 23859 0 2981 0 4623 0 27791 0 159272 0 0 0 JOAN BECCARD PHARMACY DIRECTOR 143208 0 0 0 5238 0 2336 0 17058 0 167840 0 0 0 Donald Duval CRNA 209697 0 0 0 218 0 12984 0 25442 0 248341 0 0 0 MISTY HILL CRNA 209447 0 0 0 198 0 12182 0 25462 0 247289 0 0 0 KRISTIN MILLER NURSE PRACTITIONER 109989 14315 4516 0 76 0 8009 0 26671 565 149261 14880 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation During the calendar year 2018, compensation for the top management official was established and paid by Catholic Health Initiatives ("CHI"), a related organization. CHI used the following to establish the top management official's compensation: (1) Compensation Committee; (2) Independent Compensation Consultant; (3) Written Employment Contracts; (4) Compensation Survey or Study; (5) Approval by the Board or Compensation Committee. COMPENSATION FOR THE OTHER OFFICERS OF ST. MARY'S COMMUNITY HOSPITAL WAS ESTABLISHED BY THE CHI HEALTH CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE. Schedule J, Part I, Line 4a Severance or change-of-control payment During the calendar year 2018, post-termination payments were addressed in executive employment agreements for Catholic Health Initiatives and related organizations' employees at the level of Vice President and above, including the MBO CEOs. These employment agreements require that in order for the executive to receive post-termination payments, these individuals must execute a general release and settlement agreement. Post-termination payment arrangements are periodically reviewed for overall reasonableness in light of the executive's overall compensation package. The following reportable individual received severance payments from St. Mary's Community Hospital during the 2018 calendar year, and these severance payments were included in the individual's W-2 income and reportable compensation on Schedule J: Daniel Kelly - $112,733 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan During the 2018 calendar year, Catholic Health Initiatives ("CHI"), a related organization, maintained a supplemental non-qualified deferred compensation plan for MBO CEOs/Presidents and other CHI employees at the level of Senior Vice President and above. During 2018 the following distributions were made by CHI from the deferred compensation plan: Cliff Robertson - $139,166 Jeanette Wojtalewicz - $65,054 Due to the "super" vesting rules under the CHI deferred compensation plan, participants who had met certain requirements such as involuntary termination without cause, age, age and years of service, or more than 5 years of plan participation were eligible to receive their 2018 contributions in cash during the calendar year. These cash payouts are included in the participant's reportable compensation in column (iii) Other Reportable Compensation on Schedule J Part II. During 2018, the following contributions and any associated investment income, gain or loss that would have been made by CHI to the deferred compensation plan were paid in cash: Daniel Kelly - $4,072 Schedule J, Part I, Line 7 Non-fixed payments CATHOLIC HEALTH INITIATIVES (CHI) MAINTAINS A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES, QUALITY IMPROVEMENT, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON HITTING MINIMUM LEVELS OF OPERATING MARGIN AND CHARITY CARE LEVELS, UNLESS THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES USES THEIR DISCRETION TO APPROVE AN EXCEPTION. Form 990, Part III, Line 4d Description of other program services (Expenses $ 11,099,915 including grants of $ 117,466)(Revenue $ 13,938,041) All other program services Form 990, Part V, Line 1c Payment to Vendors PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF CATHOLIC HEALTH INITIATIVES (CHI) ARE MADE BY CHI. THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT CREIGHTON HEALTH. CHI FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY CHI ON BEHALF OF ALEGENT CREIGHTON HEALTH ARE REPORTED TO THE IRS. Form 990, Part VI, Line 12c CONFLICT OF INTEREST POLICY b) If it is determined that a potential or actual conflict may exist, I. In the case of board or committee members or officers, issues are elevated to the executive committee of the board or board chair. II. In the case of other persons, conflicts issues are elevated to the conflicts of interest review committee ("C-CIRC"). C. Conflicts determination and management: 1. Matters elevated to C-CIRC: a) The C-CIRC determines whether a disclosed or otherwise identified interest is a conflict of interest. If the C-CIRC determines that a COI exists, and adequate controls are not in place to mitigate the conflict, the C-CIRC facilitates development of a COI management plan designed to mitigate the conflict. Designated entity staff are responsible for monitoring the COI management plan and for documenting monitoring activities. Notwithstanding the foregoing, at its sole discretion, an entity may reject a person's request to enter into the relationship in question, or require the relationship be sufficiently altered to avoid a potential conflict of interest. b) Appeal - if a person does not agree with a determination made by the C-CIRC, its interpretation of the COI policy, still seeks an exemption or exception, or seeks further clarification of the C-CIRC 's decision, the individual may appeal the decision through his or her manager for reconsideration by the C-CIRC, and the C-CIRC will review and issue a final determination based upon any new or additional information presented. 2. Matters elevated to the executive committee or board chair: a) Determination of existence of conflict - the board chair or his or her designee performs any further investigation of any conflict of interest disclosures as he or she may deem appropriate. If the conflict involves the board chair, the vice chair assumes the chair's role outlined in the COI policy. Based on review and evaluation of the relevant facts and circumstances, the board chair makes an initial determination as to whether a conflict of interest exists and whether, pursuant to the COI policy, review and approval or other action by the board is required. A written record of the board chair's determination, including relevant facts and circumstances, is made. The board chair then makes an appropriate report to the executive committee of the board concerning the COI review, evaluation and determination. If a difference of opinion exists between the board chair and another trustee as to whether the facts and circumstances of a given situation constitute a conflict of interest or whether board review and approval or other action is required under the COI policy, the matter is submitted to the board's executive committee, which makes a final determination as to the matter presented. That determination, including relevant facts and circumstances, is reflected in the executive committee minutes and is reported to the board. b) Board evaluation of transactions involving an officer / board member conflict of interest - I. The board carefully scrutinizes and must in good faith approve or disapprove any transaction in which CHI or a CHI entity is a party and in which the trustee or a corporate officer either: 1. Has a material financial interest; or 2. Is a trustee or corporate officer of the other party (other than a CHI affiliated organization). II. The board must approve the transaction by a majority of the trustees on the board (not counting any interested trustee). In reviewing such transactions between CHI or CHI entities and vendors or other contractors who are, or are affiliated with, trustees or corporate officers, the board acts no more or less favorably than it would in reviewing transactions with unrelated third parties. The transaction is not approved unless the board determines that the transaction is fair to CHI or the CHI entity. III. A conflicted trustee or corporate officer is not permitted to use his or her personal influence with respect to the approval or disapproval of the conflicted transaction. However, if requested, such trustee or corporate officer is not prevented from briefly stating his or her position in the matter, nor from answering pertinent questions from trustees, as his or her knowledge may be relevant. The trustee or corporate officer is excused from the meeting during discussion and vote on the conflict of interest. c) Board evaluation of non-transactional conflicts - I. The board carefully reviews and scrutinizes any non-transactional conflict of interest (e.g., disclosure of nonpublic information, competition with CHI or a CHI entity, failure to disclose a corporate opportunity, excessive gifts or entertainment, etc.). II. In such circumstances, by a majority vote of the disinterested trustees, the board takes whatever action is deemed appropriate with respect to the trustee or corporate officer under the circumstances (including possible disciplinary or corrective action) to best protect the interests of CHI or the CHI entity. The board is encouraged to consult with the general counsel of CHI or his or her designee when considering disciplinary or corrective action. III. The conflicted trustee or corporate officer is not permitted to use his or her personal influence with respect to the conflict matter. However, if requested, such trustee or corporate officer is not prevented from briefly stating his or her position in the matter, nor from answering pertinent questions from trustees, as his or her knowledge may be relevant. The trustee or corporate officer is excused from the meeting during discussion and vote on the conflict of interest. d) Record of proceedings - with respect to board member and officer conflicts of interest, minutes of the board are expected to reflect the identity of the individual making the disclosure, the nature of the disclosure, discussion regarding any proposed transaction, the decision made by the board, and that the interested trustee or corporate officer was excused during the discussion, and that the interested trustee abstained from voting. D. Conflicts reporting: All conflicts of interest are reported by CHI as required by law, regulations, and policy. Form 990, Part VI, Line 15a Process used to establish compensation of top management official The organization's top management official's compensation was paid by Catholic Health Initiatives ("CHI"), a related organization. CHI had a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges were reviewed annually in comparison to market data. Catholic Health Initiatives used Korn Ferry as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives was reviewed annually. Korn Ferry reviewed both cash and total compensation for overall reasonableness, for adherence to Catholic Health Initiatives' compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review was delivered by Korn Ferry to the CHI HR committee of the Board of Stewardship Trustees annually at their September meeting and minutes shared with the full board at the December meeting. The last review was September 25, 2018. In addition, Korn Ferry completed a comprehensive review of all positions at the level of vice president and above in the fall of 2014 to determine and validate appropriate compensation levels. These levels were reviewed annually and revised based on market data, where applicable. COMPENSATION FOR THE OTHER OFFICERS OF ST. MARY'S COMMUNITY HOSPITAL WAS ESTABLISHED BY THE CHI HEALTH CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE. Form 990, Part VI, Line 1a Delegate broad authority to a committee Pursuant to Section 8.1 of the Corporation's bylaws, committees, such as the executive committee, that are granted the authority to act on behalf of the board of directors may include only directors of the corporation. Further, pursuant to Section 8.6 of the Corporation's bylaws, the executive committee has and may exercise such powers as may be delegated to it by the board of directors. The Executive Committee also possesses the power to transact routine business of the corporation in the interim period between regularly scheduled meetings of the board of directors. Form 990, Part VI, Line 6 Classes of members or stockholders THE SOLE MEMBER OF THE ORGANIZATION IS CHI NEBRASKA, A NEBRASKA NON-PROFIT CORPORATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body According to the organization's bylaws, directors shall be appointed or refused by the corporate member. The corporate member may appoint one or more individuals to the board of directors, and may at any time remove, with or without cause, any member of the board of directors. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The organization's corporate member is CHI Nebraska. Pursuant to Section 5.4.1 of the organization's bylaws, both CHI Nebraska and Commonspirit Health (CHI Nebraska's sole corporate member) have reserved powers as outlined in the CommonSpirit Health governance matrix. Pursuant to the governance matrix the following rights are held by the CHI Nebraska's Board: * Approve members of the St. Mary's Community Hospital. * Amendment of the corporate documents of the St. Mary's Community Hospital. *Approve removal of a member of the governing body of the St. Mary's Community Hospital. * Adoption of long range and strategic plans for the St. Mary's Community Hospital. The following rights are reserved to the CommonSpirit Health Board directly or through powers delegated to the CommonSpirit Health Chief Executive Officer: * Substantial change in the mission or philosophy of the St. Mary's Community Hospital. * Removal of a member of the governing body of the St. Mary's Community Hospital. * Approval of issuance of debt by St. Mary's Community Hospital. * Approval of participation of St. Mary's Community Hospital in a joint venture. *Approval of formation of a new corporation by St. Mary's Community Hospital. * Approval of a merger involving the St. Mary's Community Hospital. * Approval of the sale of all or substantially all of the assets of the St. Mary's Community Hospital. * To require the transfer of assets by St. Mary's Community Hospital to CommonSpirit Health to accomplish CommonSpirit Health's goals and objectives, and to satisfy CommonSpirit Health debts. Pursuant to Section 5.5.2 of the organization's bylaws, CHI Nebraska or CommonSpirit Health may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and its President and the Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. Form 990, Part VI, Line 11b Review of form 990 by governing body FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE COMMONSPIRIT HEALTH TAX DIRECTOR AND THE LOCAL CHIEF FINANCIAL OFFICER. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW AND ARE ABLE TO ASK THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR QUESTIONS PRIOR TO FILING WITH THE IRS. UPON CHIEF FINANCIAL OFFICER APPROVAL AND SIGNATURE, THE TAX ANALYST FILES THE FINAL FORM 990 AS PRESENTED TO THE BOARD AND FINANCE COMMITTEE, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. Form 990, Part VI, Line 12c Conflict of interest policy The organization has a conflicts of interest ("COI") policy (the "policy") in place to maintain the integrity of its activities. Through February 7, 2019, conflicts were administered solely through Catholic Health Initiatives' ("CHI") Governance Policy No. 1 (described below). On February 8, 2019, in connection with the alignment of the Catholic Health Ministries of CHI and Dignity Health, the CommonSpirit Health Board of Stewardship Trustees approved CommonSpirit Health Corporate Responsibility Policy No. G-001, a CommonSpirit Health conflicts of interest policy. This policy stipulates that, at minimum, the pre-closing CHI COI policies and pre-closing Dignity Health COI policies identify the individuals that are covered under the new policy. In addition, subject to certain exceptions, pre-closing CHI COI policies shall continue to apply to the CHI entities and the individuals who were subject to the Pre-Closing CHI COI policies; and the Pre-Closing Dignity Health COI policies shall continue to apply to the Dignity Health entities and the individuals who were subject to the Pre-Closing Dignity Health COI policies. Until CommonSpirit Health adopts a single process for identifying and managing conflicts of interest for all system entities, the following individuals shall be subject to the Pre-Closing CHI COI policies from and after the effective date of Corporate Responsibility Policy No. G-001: 1. Members of the CommonSpirit Health Board of Stewardship Trustees and members of the committees of the Board of Stewardship Trustees; 2. Corporate officers of CommonSpirit Health; 3. Members of the Board of Directors of Dignity Health and members of the committees of the Board of Directors of Dignity Health. CHI Governance Policy No. 1: The policy applies to the following persons: members of the CHI board of stewardship trustees and its committees; members of any CHI direct affiliate or subsidiary (each a CHI entity) board and their committees; employees of CHI entities, and all CHI researchers (as defined in the policy). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure review process. A. Disclosure obligations: 1. Ongoing: Each person is required to promptly and fully disclose to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The person must disclose the actual or potential conflict as soon as she/he becomes aware of it. In any situation in which the person is in doubt it is expected that full disclosure be made to permit an impartial and objective determination as to the existence of a conflict. 2. Periodic written: In addition to the ongoing disclosure obligation, periodic written conflict of interest disclosure forms must be completed as follows: a) Initially: 1) Upon hiring (employees), 2) Appointment (board / committee members), 3) Upon consideration of affiliation with research sponsor (researchers). b) Annually: 1) Board / committee members, 2) Employees at the level vice president or above, 3) Researchers, 4) Supply chain employees at the level of vice president and above and those employees involved in contracting regardless of employment level, 5) Other employees as determined by CommonSpirit Health leadership. 3. Failure to disclose - an individual who fails to disclose a perceived, potential, or actual conflict of interest, or all material facts surrounding an actual or potential conflict or fails to abide by the final decision regarding the conflict may be subject to disciplinary or corrective actions such as termination of employment, removal from a board or committee, loss or restriction of clinical privileges, or restrictions on research activities in accordance with applicable laws, regulations, rules, contracts, and bylaws. B. Conflicts review: 1. No disclosed conflicts: In the absence of perceived, potential or actual conflicts of interest, no follow-up conflicts review is required or performed. 2. Disclosure of perceived, potential or actual conflicts: a) Are initially reviewed by national or regional legal or corporate responsibility team members (depending upon the role of the individual disclosing the actual or potential conflict) to determine whether an actual or potential for a conflict may exist. Form 990, Part VI, Line 15b Process to establish compensation of other employees SEE DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public The organization's financial statements, conflict of interest policy and governing documents are available to the public upon request. The organization's financial statements are included in CommonSpirit Health's consolidated audited financial statements that are available at www.commonspirit.org or www.catholichealthinitiatives.org. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 11631, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 11631; Form 990, Part IX, Line 11g Other Fees Purchased Services - Total Expense: 2075665, Program Service Expense: 1662170, Management and General Expenses: 413495, Fundraising Expenses: 0; Contract Labor - Total Expense: 809909, Program Service Expense: 647927, Management and General Expenses: 161982, Fundraising Expenses: 0; Other Fees for Services - Total Expense: 113934, Program Service Expense: 91147, Management and General Expenses: 22787, Fundraising Expenses: 0; Contract Services - Total Expense: 60642, Program Service Expense: 48514, Management and General Expenses: 12128, Fundraising Expenses: 0; Consulting - Total Expense: 13931, Program Service Expense: 11145, Management and General Expenses: 2786, Fundraising Expenses: 0; ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HOSPITAL NE 501(c)(3) 3 ACH false ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HOSPITAL IA 501(c)(3) 3 CHI NEBRASKA false ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(c)(3) 10 CSH false APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(c)(3) 10 SFH false Arroyo Grande Community Hospital Foundation 345 S Halcyon Rd Arroyo Grande CA 93420 203256066 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Bakersfield Memorial Hospital 420 34TH Street Bakersfield CA 93301 951802779 HOSPITAL CA 501(c)(3) 3 DCC false Barrow Neurological Foundation 350 West Thomas Road Phoenix AZ 85013 860174371 FUNDRAISING AZ 501(c)(3) 7 DH false BAYLOR ST LUKE'S HEALTH VENTURES 17200 ST LUKES WAY STE 170 THE WOODLANDS TX 77384 274499340 PHYSICIANS TX 501(c)(3) Type I SLCHS false BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON TX 77030 760458535 PHYSICIANS TX 501(c)(3) 3 SLHS false BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232187242 HEALTHCARE PA 501(c)(3) Type I CSH false BRAZOSPORT HEALTH FOUNDATION INC 1 West Way Ct LAKE JACKSON TX 77566 760080110 FUNDRAISING FOUNDATION TX 501(c)(3) Type I BRHS false BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(c)(3) 3 BRHS false BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HOSPITAL TX 501(c)(3) 3 SJSC false BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 HEALTHCARE TX 501(c)(3) 10 SJSC false California Hospital Medical Center Foundation 1401 South Grand Avenue Los Angeles CA 90015 954000909 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DCC false CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HOSPITAL ND 501(c)(3) 3 CSH false CATHOLIC HEALTH INITIATIVES - COLORADO 9100 East Mineral Circle Centennial CO 80112 840405257 HOSPITAL CO 501(c)(3) 3 CSH false CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES IA 50314 420680448 HOSPITAL IA 501(c)(3) 3 CSH false CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS CO 80920 840902211 FUNDRAISING FOUNDATION CO 501(c)(3) 7 CHIC false CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS CO 80920 270930004 HEALTHCARE CO 501(c)(3) Type I CSH false CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 PHYSICIANS CO 501(c)(3) Type I CHINS false CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 SURGERY CENTER OR 501(c)(3) 10 MMC false CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 480543724 HOSPITAL KS 501(c)(3) 3 CSH false CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 FUNDRAISING FOUNDATION MN 501(c)(3) 10 CSH false CHI HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING FOUNDATION NE 501(c)(3) 7 ACH false CHI INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(c)(3) Type I CSH false CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(c)(3) Type I CSH false CHI LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE OH 501(c)(3) Type II SFH false CHI Memorial Hospital - Georgia 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE GA 30742 822748395 HOSPITAL GA 501(c)(3) 3 MHCS false CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(c)(3) 10 CHI NS false CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(c)(3) Type I CSH false CHI NEBRASKA 12809 West Dodge Road Omaha NE 68510 363233121 HEALTHCARE NE 501(c)(3) Type I CSH false CHI ST JOSEPH CHILDREN'S HEALTH 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232342997 HEALTHCARE PA 501(c)(3) Type I CSH false CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(c)(3) Type I CSH false CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 710236913 HOSPITAL AR 501(c)(3) 3 CHISVHS false CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125064 HOLDING CO AR 501(c)(3) Type II SVIMC false CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125131 PHYSICIANS AR 501(c)(3) 3 CHISVHS false COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(c)(3) Type I NA false Community Hospital of San Bernardino 1805 Medical Center Drive San Bernardino CA 92411 951643373 HOSPITAL CA 501(c)(3) 3 DCC false COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 237419853 HOLDING CO OH 501(c)(4) GSH false COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY IA 51555 421294399 FUNDRAISING FOUNDATION IA 501(c)(3) Type I AH-CMHMV false CONTINUING CARE HOSPITAL One Saint Joseph Drive LEXINGTON KY 40504 611400619 HOSPITAL KY 501(c)(3) 3 SJHS false Dignity Community Care 185 Berry Street Suite 300 San Francisco CA 94107 815009488 HOSPITAL CO 501(c)(3) 3 NA false DIGNITY HEALTH 185 BERRY STREET STE 300 SAN FRANCISCO CA 94107 941196203 HOSPITAL CA 501(c)(3) 3 CSH false Dignity Health Connected Living 200 Mercy Oaks Drive Redding CA 96003 237115371 Senior Center Services CA 501(c)(3) 7 DH false Dignity Health Foundation 185 Berry Street San Francisco CA 94107 462037641 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Dignity Health Foundation - Inland Empire 2101 N Waterman Avenue San Bernardino CA 92404 237440086 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Dignity Health Foundation East Valley 475 South Dobson Road Chandler AZ 85224 742418514 FUNDRAISING FOUNDATION AZ 501(c)(3) Type I DH false Dignity Health HPL Self-Insurance Trust 185 Berry Street San Francisco CA 94107 943006034 Self Insurance CA 501(c)(3) Type I DH false Dignity Health Insurance Nevada Ltd 185 Berry Street San Francisco NV 94107 813800752 Self Insurance NV 501(c)(3) Type I DH false Dignity Health Medical Foundation 3400 Data Drive Rancho Cordova CA 95670 680220314 MULTI-SPECIALTY OUTPATIENT MEDICAL CLINIC CA 501(c)(3) Type I DCC false Dignity Health Workers Comp Self-Insurance Trust 185 Berry Street San Francisco CA 94107 946612446 Self Insurance CA 501(c)(3) Type I DH false Dominican Health Services 1555 Soquel Drive Santa Cruz CA 95065 770056778 Community Health System CA 501(c)(3) Type I DH false Dominican Hospital Foundation 1555 Soquel Drive Santa Cruz CA 95065 942450442 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Dominican Oaks Corporation 1555 Soquel Drive Santa Cruz CA 95065 770127719 Operation and management of housing complex to elderly persons CA 501(c)(3) 10 DHS false East Texas Clinical Services 2801 VIA FORTUNA SUITE 500 AUSTIN TX 78746 454736213 HEALTHCARE TX 501(c)(3) Type I SLHS false ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1455 BATTERSBY AVE ENUMCLAW WA 98022 910715805 HOSPITAL WA 501(c)(3) 3 FHS false FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 611345363 HOSPITAL KY 501(c)(3) 3 KOH false FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 562351341 FUNDRAISING FOUNDATION KY 501(c)(3) Type I FH false FRANCISCAN CARE CENTER 4111 N HOLLAND-SYLVANIA RD TOLEDO OH 43623 341931806 HEALTHCARE OH 501(c)(3) 10 FLC false FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA WA 98405 911145592 FUNDRAISING FOUNDATION WA 501(c)(3) 10 FHS false FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA WA 98405 910564491 HOSPITAL WA 501(c)(3) 3 CSH false FRANCISCAN HEALTH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BROADWAY TACOMA WA 98402 431882377 PHYSICIANS MO 501(c)(3) 10 CSH false FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA WA 98402 911939739 HEALTHCARE WA 501(c)(3) 10 FHS false FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(c)(3) 10 CSH false French Hospital Medical Center Foundation 1911 Johnson Avenue San Luis Obispo CA 93401 203256125 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DCC false GARRISON MEMORIAL HOSPITAL 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 450227752 HOSPITAL ND 501(c)(3) 3 SAMC false Glendale Memorial Health Foundation 1420 South Central Avenue Glendale CA 91204 953625651 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DCC false GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 201536108 MINISTRIES CO 501(c)(3) Type I CSH false GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311778403 EDUCATION OH 501(c)(3) 2 GSH false GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311206047 FUNDRAISING FOUNDATION OH 501(c)(3) Type I GSH false GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY NE 68847 470659443 FUNDRAISING FOUNDATION NE 501(c)(3) 7 GSH false HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON WA 98310 910565546 HOSPITAL WA 501(c)(3) 3 FHS false HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVE BREMERTON WA 98310 911197626 FUNDRAISING FOUNDATION WA 501(c)(3) 7 HMC false HEALTH FOUNDATION OF KENTUCKYONE INC 1451 HARRODSBURG RD STE D-308 LEXINGTON KY 40504 832170324 FUNDRAISING FOUNDATION KY 501(c)(3) Type II KOH false HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 760761782 FUNDRAISING FOUNDATION MN 501(c)(3) Type I SFMC false HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN WA 98166 910712166 HOSPITAL WA 501(c)(3) 3 FHS false HOUSE OF MERCY 1111 6TH AVE DES MOINES IA 50314 421323808 SHELTER IA 501(c)(3) 7 CHI-IA CORP false JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 250 E Liberty St Ste 500 LOUISVILLE KY 40202 611029768 HOSPITAL KY 501(c)(3) 3 KOH false KENTUCKYONE HEALTH MEDICAL GROUP INC 100 E Liberty St Ste 800 LOUISVILLE KY 40202 611352729 HEALTHCARE KY 501(c)(3) 10 JHSMH false KENTUCKYONE HEALTH INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029769 HEALTHCARE KY 501(c)(3) Type II CSH false LAKEWOOD HEALTH CENTER 600 MAIN AVE S BAUDETTE MN 56623 410758434 HOSPITAL MN 501(c)(3) 3 CSH false LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVE S BAUDETTE MN 56623 411893795 FUNDRAISING FOUNDATION ND 501(c)(3) 7 LHC false LINUS OAKES INC 2700 STEWART PKWY ROSEBURG OR 97471 930821381 SENIOR LIVING OR 501(c)(3) 10 MMC false LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON ND 58054 820558836 HOSPITAL ND 501(c)(3) 3 CSH false LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN TX 75901 820563768 PROPERTY MGMT TX 501(c)(3) Type I MHSET false MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742761145 HOSPITAL TX 501(c)(3) 3 SJSC false MADONNA MANOR INC 2344 AMSTERDAM ROAD VILLA HILLS KY 51017 610654635 LIVING ASSIST KY 501(c)(3) 10 FLC false Marian Regional Medical Center Foundation 1400 E Church Street Santa Maria CA 93454 953818027 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false Mark Twain Medical Center 768 Mountain Ranch Road San Andreas CA 95249 680127677 HOSPITAL CA 501(c)(3) 3 NA false MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA TN 37404 621839548 FUNDRAISING FOUNDATION TN 501(c)(3) 7 MHCS false MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA TN 37404 620532345 HOSPITAL TN 501(c)(3) 3 CSH false MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA TN 37411 030417049 HEALTHCARE TN 501(c)(3) 10 MHCS false MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN TX 75902 750755367 HOSPITAL TX 501(c)(3) 3 SLHS false MEMORIAL MEDICAL CENTER - LIVINGSTON PO BOX 1447 LUFKIN TX 75902 760436439 HOSPITAL TX 501(c)(3) 3 MHSET false MEMORIAL MEDICAL CENTER - SAN AUGUSTINE PO BOX 1447 LUFKIN TX 75902 752663904 HOSPITAL TX 501(c)(3) 3 MHSET false MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVE LUFKIN TX 95904 752721155 PHYSICIANS TX 501(c)(3) Type I MHSET false MEMORIAL SPECIALTY HOSPITAL PO BOX 1447 LUFKIN TX 95902 752492741 HOSPITAL TX 501(c)(3) 3 MHSET false MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVE DES MOINES IA 50314 426076069 AUXILIARY IA 501(c)(3) Type I MF-DM IA false MERCY CLINICS INC 1111 6TH AVE DES MOINES IA 50314 421193699 PHYSICIANS IA 501(c)(3) 10 CHI-IA CORP false MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVE DES MOINES IA 50314 421511682 EDUCATION IA 501(c)(3) 2 CHI-IA CORP false Mercy Foundation Bakersfield PO Box 119 Bakersfield CA 93302 770201321 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES IA 50314 237358794 FUNDRAISING FOUNDATION IA 501(c)(3) 7 CHI-IA CORP false MERCY FOUNDATION INC 2700 STEWART PKWY ROSEBURG OR 97471 936088946 FUNDRAISING FOUNDATION OR 501(c)(3) 7 MMC false MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 421461064 FUNDRAISING FOUNDATION IA 501(c)(3) Type I AHMH-Corning false MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450435338 FUNDRAISING FOUNDATION ND 501(c)(3) Type I MHVC false MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS IA 51503 421178204 FUNDRAISING FOUNDATION IA 501(c)(3) Type I AHBMHS false MERCY HOSPITAL OF DEVILS LAKE 1031 7TH ST NE DEVILS LAKE ND 58301 450227012 HOSPITAL ND 501(c)(3) 3 CSH false MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 7TH ST NE DEVILS LAKE ND 58301 352367360 FUNDRAISING FOUNDATION ND 501(c)(3) 7 MHDL false MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450226553 HOSPITAL ND 501(c)(3) 3 CSH false Mercy McMahon Terrace 3865 J Street Sacramento CA 95816 680117340 Senior Citizen's Housing/Retirement Communities CA 501(c)(3) 10 DCC false MERCY MEDICAL CENTER 1301 15TH AVE WEST WILLISTON ND 58801 450231183 HOSPITAL ND 501(c)(3) 3 CSH false MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 420680308 HOSPITAL IA 501(c)(3) 3 CHI-IA CORP false MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER 204 N 4th Ave E Newton IA 50314 421470935 HOSPITAL IA 501(c)(3) 3 CHI-IA CORP false Mercy Medical Center Merced Foundation 301 E 13th Street Merced CA 95340 770035928 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false MERCY MEDICAL CENTER INC 2700 STEWART PKWY ROSEBURG OR 97471 930386868 HOSPITAL OR 501(c)(3) 3 CSH false MERCY MEDICAL FOUNDATION 1301 15TH AVE WEST WILLISTON ND 58801 450381803 FUNDRAISING FOUNDATION ND 501(c)(3) Type I MMC false NEBRASKA HEART HOSPITAL 7500 S 91ST ST LINCOLN NE 68526 392031968 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false Northland Healthcare Alliance 2223 East Rosser Avenue Bismarck ND 58501 911845296 MANAGEMENT ND 501(c)(3) 7 NCHA false Northridge Hospital Foundation 18300 Roscoe Blvd Northridge CA 91328 237444901 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DCC false OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES ND 58474 450231675 HOSPITAL ND 501(c)(3) 3 CSH false OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH ST OAKES ND 58474 710966606 FUNDRAISING FOUNDATION ND 501(c)(3) Type I OCH false Pacific Central Coast Health Centers 1400 E Church Street Santa Maria CA 93454 770447575 Clinic CA 501(c)(3) 3 DH false PINEYWOODS MEDICAL DEVELOPMENT CORP PO BOX 1447 LUFKIN TX 75902 752493116 PROPERTY MGMT TX 501(c)(3) Type I MHSET false Port City Operating Company LLC 3400 Data Drive Rancho Cordova CA 95670 465322209 HOSPITAL CA 501(c)(3) 3 DH false PROVIDENCE CARE CENTER 2025 HAYES AVENUE SANDUSKY OH 44870 341658625 HEALTHCARE OH 501(c)(3) 10 FLC false PROVIDENCE CARE CENTERS 2025 HAYES AVENUE SANDUSKY OH 44870 341826099 HOLDING CO OH 501(c)(3) Type II FLC false PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY OH 44870 341896807 LIVING COMM OH 501(c)(3) 10 FLC false PUEBLO STEPUP 1925 E ORMAN AVE STE G52 PUEBLO CO 81004 841234295 COMMUNITY CO 501(c)(3) 7 CHIC false REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE 16251 Sylvester Road SW Burien WA 98166 911170040 HOSPITAL WA 501(c)(3) 3 FHS false SET OF COLORADO SPRINGS INC 9100 E Mineral Circle Centennial CO 80112 841183335 Senior Center Services CO 501(c)(3) 7 CHIC false SAINT CLARE'S COMMUNITY CARE 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WA NA C Corporation false HeartlandPlains Health 198 INVERNESS DRIVE WEST Englewood CO 80112 464368223 Insurance NE NA C Corporation false Highline Medical Group 1717 S J Street Tacoma WA 98405 911407026 Medical Services WA NA C Corporation false Integrated Medical Services 9250 N 3rd Street Suite 4010 Phoenix AZ 85020 860783428 Multi-specialty physicians group AZ NA C Corporation false KOMG-Louisville Region Inc 201 Abraham Flexner Way Louisville KY 40202 832481198 Healthcare KY NA C Corporation false Management Services Organization of Santa Maria Inc 1400 E Church Street Santa Maria CA 93454 770318135 Health Care Mgmt CA NA C Corporation false Medical Office Building Horizontal Property Regime Inc 300 Werner St Hot Springs AR 71913 710720429 Real Estate AR NA C Corporation false Medquest 1301 15TH AVENUE WEST Williston ND 58801 450392137 Sale of DME ND NA C Corporation false Memorial CV Service Line Management Company LLC 1201 W Frank Ave Lufkin TX 75904 463622849 Heath Care TX NA C 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Insurance WA NA C Corporation false QualChoice Health Plan Services Inc (fka CollabHealth Plan Services Inc) 198 INVERNESS DRIVE WEST Englewood CO 80112 461224037 Admin Services CO NA C Corporation false QualChoice Health Inc (fka CollabHealth Managed Solutions Inc) 198 INVERNESS DRIVE WEST Englewood CO 80112 461222808 Holding Co CO NA C Corporation false QualChoice Holdings Inc 198 INVERNESS DRIVE WEST Englewood CO 80112 274075520 Holding Co AR NA C Corporation false QualChoice Life and Health Insurance Company Inc 12615 Chenal Parkway STE 300 Little Rock AR 72211 710386640 Insurance AR NA C Corporation false QualChoice of Nebraska 2401 S 73rd St Omaha NE 68124 810738827 Inactive NE NA C Corporation false RiverLink Health 198 INVERNESS DRIVE WEST Englewood CO 80112 464380824 Insurance OH NA C Corporation false RiverLink Health of Kentucky Inc 198 INVERNESS DRIVE WEST Englewood CO 80112 464828332 Insurance KY NA C Corporation false Ross Park Pharmacy Inc 380 SUMMIT AVE STEUBENVILLE OH 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Corporation false St Luke's Health System Holdings Inc 6624 Fannin STE 800 Houston TX 77030 760637138 Holding Co TX NA C Corporation false St Mary's Multi Specialty Clinic 1625 Prater Way Suite 102 Sparks NV 89434 113763590 Healthcare NV NA C Corporation false St Vincent Community Health Services Inc TWO ST VINCENT CIRCLE Little Rock AR 72205 710710785 Healthcare AR NA C Corporation false StableView Health Inc 198 INVERNESS DRIVE WEST Englewood CO 80112 464373713 Insurance KY NA C Corporation false STE Holdings 12809 West Dodge Rd Omaha NE 68154 822383629 Holding Co NE NA C Corporation false Sugar Land Doctor Group 1317 Lake Point Parkway Sugar Land TX 77478 454270163 Medical Clinic TX NA C Corporation false Towson Management Inc 7601 OSLER DR Towson MD 21204 521710750 Mgmt Services MD NA C Corporation false TRINITY MANAGEMENT SERVICES ORGANIZATION 380 SUMMIT AVE STEUBENVILLE OH 43952 341471026 Mgmt Services OH NA C Corporation false US HealthWorks Inc 25124 Springfield Court Suite 200 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C Corporation false USHW of California Inc 25124 Springfield Court Suite 200 Valencia CA 91355 954585828 Occupational Medical Services CA NA C Corporation false USHW of Texas Inc 25124 Springfield Court Suite 200 Valencia CA 91355 742785392 Occupational Medical Services TX NA C Corporation false false true true false false false false false false false false true false true true true false false false SAINT MARY'S HOSPITAL FOUNDATION B 257179 BOOK SAINT MARY'S HOSPITAL FOUNDATION C 1320530 BOOK