2020-07-13T14:31:20-05:00 2019-06-30 470617373 COMMONSPIRIT HEALTH 198 Inverness Drive West ENGLEWOOD CO 80112 990 2018-07-01 300752920 Trinity Health System Group TRIN 7402837000 380 SUMMIT AVENUE STEUBENVILLE OH 43952 Dave Werkin CFO 2020-07-13 true PAMELA KROHN P01210500 3032989100 2018 2021-01-29 14:40:06Z Matt Grimshaw 380 SUMMIT AVENUE STEUBENVILLE OH 43952 237978477 true true 5388 X WWW.TRINITYHEALTH.COM X A COMMUNITY PARTNER DEDICATED TO EXCELLENCE IN SERVING THE HEALTH NEEDS OF THE TRI-STATE AREA. 15 12 1856 40 301843 116184 8261161 432686 238300274 229364179 12334943 6180757 3102126 2000855 261998504 237978477 5619777 2101 0 108899469 118289361 0 0 0 128379794 108949795 242899040 227241257 19099464 10737220 270839254 279385616 23787670 23599514 247051584 255786102 SEE SCHEDULE O. false false 132770562 1355 133630699 OUTPATIENT SERVICES: THROUGH JUNE 2019, THE CENTER REALIZED 8,063 ACUTE ADMISSIONS AND 242,574 OUTPATIENT VISITS. IN LINE WITH TRINITY HEALTH SYSTEM'S VALUES, SERVICE, REVERENCE AND STEWARDSHIP, THE TONY TERAMANA CANCER CENTER CAN MEET THE NEEDS OF CANCER PATIENTS THROUGH A HOLISTIC APPROACH WHICH INCLUDES COMPASSION, CONCERN, DIGNITY AND RESPECT. THIS SERVICE IS DUE LARGELY TO THE GENEROSITY OF THE TONY TERAMANA FAMILY, WHOSE $1 MILLION GIFT MADE THIS CENTER A WORLD-CLASS CANCER TREATMENT FACILITY. TRINITY HEALTH SYSTEM'S CARDIAC REHABILITATION PROGRAM IS DESIGNED TO EFFECT LIFESTYLE CHANGE IN PATIENTS ENROLLED. THESE CHANGES ARE ACHIEVED THROUGH SAFE PHYSICAL CONDITIONING, SOUND EDUCATIONAL SESSIONS, AND GROUP SUPPORT, WHICH EMPHASIZE THE UNDERSTANDING OF RISK FACTORS ASSOCIATED WITH HEART DISEASE. THE PROGRAM'S GOAL IS TO ENHANCE THE QUALITY OF LIFE FOR THE PATIENT. AGE IS NOT A FACTOR. OUR SPECIALLY TRAINED STAFF WORK WITH PATIENTS, THEIR FAMILIES, AND PHYSICIANS TO DEVELOP A PERSONALIZED PROGRAM OF HEALTH AND WELLNESS. THE GOALS OF THE CARDIAC REHAB PROGRAM ARE INCREASED UNDERSTANDING OF HEART DISEASE, INCREASED ENDURANCE, DECREASED HEART RATE AND BLOOD PRESSURE, INCREASED MUSCULAR FITNESS, REDUCED CHOLESTEROL/TRIGLYCERIDE LEVELS, DECREASED BODY FAT, BETTER NUTRITION MANAGEMENT AND IMPROVED SENSE OF WELL-BEING. AN INTEGRAL PART OF THE OVERALL PROGRAM, EDUCATION, INCREASES A PATIENT'S UNDERSTANDING OF THEIR ILLNESS AND HELPS THEM TO IDENTIFY CURRENT HABITS THAT CAN NEGATIVELY AFFECT THEIR CARDIAC CONDITION. WE COVER ISSUES LIKE RISK FACTOR REDUCTION, ANGINA, HEART ATTACK, MEDICATION, DIETARY AND EXERCISE GUIDELINES, SMOKING, AND BREATHING AND RELAXATION METHODS. INDIVIDUALS ENROLLED IN THIS PHASE ARE REFERRED BY THEIR PHYSICIAN. AFTER AN ASSESSMENT OF CONDITION IS MADE, A PATIENT IS SCHEDULED FOR EXERCISE TRAINING WITH MONITORING. RISK FACTORS, DIET, AND LIFESTYLE CHANGES ARE ALSO DISCUSSED. CONVENIENT SESSIONS ARE SCHEDULED THREE TIMES PER WEEK AND LAST APPROXIMATELY ONE HOUR. ONCE THE OUTPATIENT PROGRAM IS CONCLUDED, PATIENTS MAY CONTINUE THIS PHASE IN ORDER TO INSURE THEIR QUALITY OF LIFE. THEIR ONGOING PARTICIPATION IN THE PROGRAM CAN OFFER THEM INCREASED ENDURANCE, DECREASED HEART RATE AND BLOOD PRESSURE, AND INCREASED MUSCULAR FITNESS. TRINITY WORKCARE IS THE OCCUPATIONAL HEALTH DEPARTMENT OF TRINITY HEALTH SYSTEM AND PROVIDES A COMPREHENSIVE OCCUPATIONAL HEALTH SERVICE TO THE BUSINESS COMMUNITY. OUR PROGRAM IS DESIGNED TO ASSIST THE CLIENT COMPANY DECREASE LOST WORK TIME, MEDICAL EXPENSES, INSURANCE PREMIUMS AND MAINTAIN COMPLIANCE WITH COMPANY AND GOVERNMENT REGULATIONS. WORKCARE SERVICES INCLUDE MEDICAL SURVEILLANCE, SUBSTANCE ABUSE TESTING, INJURY TREATMENT AND CASE MANAGEMENT, PHYSICAL THERAPY, WELLNESS PROMOTION AND EMPLOYEE ASSISTANCE PROGRAM. THROUGH JUNE 2019, THERE WERE 8,772 VISITS TO WORKCARE. OUTPATIENT OCCUPATIONAL THERAPY AT TRINITY IS PROVIDED BOTH AS AN EXTENSION OF SERVICES RECEIVED AS AN INPATIENT OR YOU CAN RECEIVE SERVICES AS A NEW PATIENT. WE ARE STAFFED TO PROVIDE EXPERTISE WITH ALL NEUROLOGICAL AND ORTHOPEDIC DISORDERS AND SPECIALIZE IN THE AREA OF HAND DISORDERS. WE PROVIDE EXERCISE, MODALITIES (PARAFFIN, ULTRASOUND, IONTOPHORESIS, FLUIDOTHERAPY AND E-STIM), FUNCTIONAL ACTIVITIES, SPLINTING/BRACING AND ADL TRAINING. PHYSICAL THERAPY ASSESSES YOUR MOVEMENT, STRENGTH AND ENDURANCE AND WILL HELP TO RESTORE QUALITY OF MUSCLE TONE, COORDINATION, BALANCE, STRENGTH, ENDURANCE, JOINT FLEXIBILITY AND FUNCTIONAL MOBILITY. OUR DEPARTMENT IS FULLY EQUIPPED TO ALLOW FOR PRIVATE TREATMENT. ADDITIONALLY A MODERN GYM IS UTILIZED FOR YOUR EXERCISE NEEDS. WE PROVIDE SPECIALIZED PROGRAMS IN EXERCISE, FUNCTIONAL ACTIVITIES AND MODALITIES. OUR SPEECH PATHOLOGY DEPARTMENT IS EQUIPPED TO RENDER A BROAD SPECTRUM OF DIAGNOSTIC AND REHABILITATIVE SERVICES TO CHILDREN, ADOLESCENTS AND ADULTS WITH DISORDERS ASSOCIATED WITH DECREASED COGNITIVE SKILLS, APHASIA, APRAXIA, DYSARTHRIA, VOICE, AND DELAYED SPEECH AND LANGUAGE. WE ALSO SPECIALIZE IN DIAGNOSTIC AND THERAPEUTIC INTERVENTIONS FOR PATIENTS WITH SWALLOWING DISORDERS. TO SUPPORT SENIORS THROUGH TRYING TIMES, WE PROUDLY OFFER THE TRINITY SENIOR PROGRAM, A THERAPEUTIC PROGRAM DESIGNED TO MEET THE EMOTIONAL AND PSYCHOLOGICAL NEEDS OF OLDER ADULTS. WE SEE PATIENTS 55 YEARS OR OLDER THAT ARE EXPERIENCING EMOTIONAL DIFFICULTIES SUCH AS DEPRESSION, ANXIETY, GRIEF, ANGER AND OTHER EMOTIONAL ISSUES. THE SHORT TERM OUTPATIENT PROGRAM INCLUDES SUPPORT GROUPS, OCCUPATIONAL AND RECREATIONAL GROUPS, AND HEALTH/MEDICATION EDUCATION. TRINITY HOME HEALTH IS SPECIAL HOME CARE FOR SPECIAL PEOPLE. THE DISCIPLINES OFFERED ARE SKILLED NURSING CARE, PHYSICAL THERAPY, OCCUPATIONAL THERAPY, MEDICAL SOCIAL SERVICES (OHIO) AND HOME HEALTH AIDES. THROUGH JUNE 2019, THE HOME HEALTH DEPARTMENT REALIZED 15,746 HOME VISITS. 59334581 605 49974897 INPATIENT SERVICES: IN EASTERN OHIO, THE HOSPITAL INCLUDES TRINITY EAST AND TRINITY WEST WHICH HAS A COMBINED CAPACITY OF OVER 500 BEDS. TRINITY EAST OFFERS A VARIETY OF SERVICES INCLUDING SKILLED CARE, LONG-TERM CARE, INPATIENT PHYSICAL REHABILITATION AND BEHAVIORAL MEDICINE SERVICES (MENTAL HEALTH & ADDICTION RECOVERY). TRINITY WEST IS A FULL SERVICE ACUTE CARE FACILITY OFFERING 24-HOUR EMERGENCY CARE, KIDNEY DIALYSIS, LITHOTRIPSY, ENDOSCOPY AND RELATED SERVICES, SURGERY AND MEDICAL SURGICAL INPATIENT UNITS, COMPREHENSIVE CARDIAC CARE, PEDIATRICS, WOMEN'S HEALTH, INPATIENT/OUTPATIENT SURGICAL SERVICES, WOUND CLINIC, OCCUPATIONAL MEDICINE AND A FULL ARRAY OF DIAGNOSTIC CAPABILITIES. THE TRINITY SKILLED CARE CENTER, A HOSPITAL-BASED SKILLED AND LONG TERM CARE NURSING FACILITY, IS FULLY CERTIFIED FOR 50 BEDS AND WAS DEVELOPED TO MEET THE NEEDS OF PATIENTS WHO REQUIRE ADDITIONAL SKILLED CARE BEYOND THE ACUTE PHASE OF ILLNESS OR INJURY. THROUGH JUNE 2019, TRINITY SKILLED CARE CENTER HAD 389 ADMISSIONS AND 8,025 PATIENT DAYS. THE SKILLED CARE CENTER ALSO HAS AN ONGOING ACTIVITY PROGRAM. PATIENTS ARE ENCOURAGED TO PARTICIPATE IN THESE ENJOYABLE ACTIVITIES AS A GROUP OR INDIVIDUALLY. THE ATMOSPHERE IS INFORMAL AND RELAXING TO AID IN THE EMOTIONAL WELL-BEING OF EACH PATIENT. DISCHARGE PLANNING BEGINS ON ADMISSION TO TRINITY SKILLED CARE CENTER. INDIVIDUALIZED GOALS ARE ESTABLISHED WITH THE PATIENT, THE PATIENT'S FAMILY AND A HIGHLY QUALIFIED TEAM OF PROFESSIONALS. THIS TEAM INCLUDES: THE ATTENDING PHYSICIAN, NURSE, SOCIAL SERVICES, DIETITIAN, PHYSICAL THERAPIST, OCCUPATIONAL THERAPIST AND SPEECH THERAPIST. THIS PROCESS ASSURES THE CONTINUITY OF CARE UPON DISCHARGE. TRINITY'S REHABILITATION CENTER PROVIDES AN INTEGRATED AND INTERDISCIPLINARY TEAM APPROACH TO HELP PATIENTS WHO HAVE PHYSICAL IMPAIRMENTS. PROGRAMS ARE AVAILABLE FOR PATIENTS WITH STROKES AND OTHER NEUROLOGICAL DISORDERS, ARTHRITIS, AMPUTATIONS, JOINT REPLACEMENTS AND OTHER ORTHOPEDIC PROBLEMS, BRAIN INJURY, AND SPINAL CORD INJURY. THE CENTER HAS 20 PRIVATE ROOMS, EACH SPECIALLY DESIGNED FOR REHABILITATION. PATIENTS ALSO UTILIZE A HOME-LIKE APARTMENT TO REGAIN SKILLS SUCH AS COOKING, BATHING AND DRESSING.PHYSICAL THERAPY, OCCUPATIONAL THERAPY AND SPEECH-LANGUAGE PATHOLOGY AREAS HAVE STATE-OF-THE-ART EQUIPMENT, AND THE THERAPISTS ARE HIGHLY TRAINED REHABILITATION SPECIALISTS. A VAN IS AVAILABLE FOR COMMUNITY OUTINGS AND HOME VISITS. THESE TRIPS PROVIDE OPPORTUNITIES FOR PATIENTS TO PRACTICE THEIR SKILLS IN THEIR COMMUNITY, HOME AND WORK PLACE WHEN APPROPRIATE. WITH A TEAM APPROACH TO TREATMENT, A PERSONALIZED REHABILITATION PROGRAM IS DESIGNED TO MEET THE UNIQUE NEEDS AND GOALS OF EACH PATIENT. THE TEAM CONSISTS OF THE PATIENT, HIS/HER FAMILY, PHYSICIANS,REHABILITATION NURSES, PHYSICAL THERAPISTS, OCCUPATIONAL THERAPISTS, SPEECH LANGUAGE PATHOLOGISTS, PSYCHOLOGISTS, SOCIAL WORKERS, THERAPEUTIC RECREATIONAL SPECIALISTS, DIETITIANS, RESPIRATORY THERAPISTS, CASE COORDINATORS AND VOCATIONAL COUNSELORS. THROUGH A POSITIVE, PERSONALIZED AND INTERDISCIPLINARY APPROACH, THE TEAM HELPS PATIENTS REGAIN PHYSICAL, EMOTIONAL, SOCIAL AND VERBAL SKILLS. THROUGH JUNE 2019, THE REHAB CENTER HAD 278 ADMISSIONS AND 3,113 PATIENT DAYS. THE WOMEN'S HEALTH & BIRTH CENTER IS PROUD TO OFFER TOTAL MATERNITY CARE. OUR SPECIALLY QUALIFIED STAFF OF DEDICATED NURSES AND PHYSICIANS GUIDE PATIENTS AND THEIR FAMILIES THROUGH A COMPREHENSIVE EDUCATION AND CHILDBIRTH EXPERIENCE. AT THE WOMEN'S HEALTH & BIRTH CENTER BABIES ARE DELIVERED IN A SPECIALLY DESIGNED CHILDBEARING ROOM FOR THEIR ENTIRE HOSPITAL STAY: PRIVATE CHILDBEARING ROOMS ARE EQUIPPED FOR THE ENTIRE BIRTH EXPERIENCE. ALL FORMS OF PAIN RELIEF EXCEPT GENERAL ANESTHESIA MAY BE PROVIDED IN THIS ROOM. CESAREAN DELIVERIES ARE PERFORMED IN IN A MODERN, STATE OF THE ART SURGICAL SUITE, THE SURGICAL SUITE IS AVAILABLE TO THOSE WISHING A MORE TRADITIONAL BIRTH EXPERIENCE. FATHERS ARE ENCOURAGED TO STAY AT THE HOSPITAL; SLEEPING ACCOMMODATIONS ARE PROVIDED AT NO EXTRA CHARGE. AT THE WOMEN'S HEALTH & BIRTH CENTER, ROOMING-IN IS FLEXIBLE AND DESIGNED TO MEET THE PATIENTS NEEDS. CHILDCARE IS AVAILABLE IN OUR WELL EQUIPPED NURSERY FOR PARENTS THAT NEED TO REST OR SPEND TIME ALONE. SPECIALLY TRAINED PERINATAL NURSES ARE ASSIGNED TO EACH MOTHER AND BABY TO PROVIDE PERSONAL, INDIVIDUALIZED CARE. EXTRA TIME AND TEACHING ARE INTEGRAL PARTS OF THE ATTENTION WE GIVE ALL FAMILIES. AFTER DISCHARGE, A PERINATAL NURSE FROM THE WOMEN'S HEALTH & BIRTHING CENTER IS AVAILABLE FOR CONSULTATION THROUGH TELEPHONE CALLS TO ALL PATIENTS. AT ANY TIME OF THE DAY OR NIGHT.THROUGH JUNE 2019, THE WOMEN'S HEALTH & BIRTH CENTER DELIVERED 502 BABIES. 13801561 141 45477550 EMERGENCY ROOM: THE EMERGENCY SERVICES OF TRINITY HEALTH SYSTEM ARE AVAILABLE AT TRINITY MEDICAL CENTER WEST. THE ER HAS BEEN REMODELED AND EXPANDED TO ACCOMMODATE PATIENTS REQUIRING TREATMENT - IT HAS DOUBLED IN SIZE AND NOW HAS TWICE AS MANY TREATMENT BEDS AVAILABLE AND MORE PHYSICIAN, PROFESSIONAL AND SUPPORT STAFF HAVE BEEN ADDED TO PROVIDE CARE. A DEDICATED X-RAY ROOM, HAS BEEN CONSTRUCTED ADJACENT TO THE ER AND SPECIAL TREATMENT AREAS HAVE BEEN CONSTRUCTED FOR CARDIAC EMERGENCIES, TRAUMA, PEDIATRIC EMERGENCIES, OBSTETRICAL EMERGENCIES, SUTURING AND FRACTURES. THE ER IS OPEN 24 HOURS / 7 DAYS A WEEK FOR ALL LEVELS OF EMERGENCY AND URGENT CARE. THROUGH JUNE 2019, WE HAD 38,853 EMERGENCY ROOM VISITS. 205906704 true true false true false false false false true true true false false true true false true false false false false false false false false true true false false true false false false false false false false false false false false false false true false false false true X 154 0 true 1856 true true true false false false false false true false false false false false X 15 12 false false false false true true true true true false false false true true true true true false false false X James Dumpman 7402837000 380 SUMMIT AVENUE STEUBENVILLE OH 43952 MATT GRIMSHAW PRESIDENT & CEO 5.0 55.0 X X 0 473337 24055 MARK MORELLI CHAIRMAN 2.0 5.0 X X 0 0 0 JAMES PADDEN Vice Chairman 2.0 4.0 X X 0 0 0 DAVID SKIVIAT SR Treasurer 2.0 4.0 X X 0 0 0 ERIC EXLEY SECRETARY 2.0 4.0 X X 0 0 0 MICHAEL BIASI Board Member 2.0 3.0 X 0 0 0 DAN DAILY Board Member 2.0 3.0 X 0 0 0 SISTER DIANA LYNN ECKEL Board Member 2.0 3.0 X 0 0 0 JOHN FIGEL MD Board Member 55.0 3.0 X 402388 0 23316 SHEILA HENDRICKS Board Member 2.0 3.0 X 0 0 0 DOUGLAS SCHAEFER Board Member 2.0 3.0 X 0 0 0 LARRY SCHUMACHER BOARD MEMBER 2.0 50.0 X 0 2126971 183226 MARK TROMBETTA BOARD MEMBER 2.0 3.0 X 0 0 0 DENNIS WOLTERS BOARD MEMBER 2.0 3.0 X 0 0 0 MATTHEW COLFLESH MD Board member 2.0 2.0 X 0 0 0 DAVE WERKIN CFO 2.0 55.0 X 0 376170 20879 PAUL WHEELER VP OF OPERATIONS / COO 2.0 55.0 X 0 112892 12054 Kumar Amin MD PHYSICIAN 40.0 0 X 1034026 0 22463 Nasrollah Jahdi MD PHYSICIAN 40.0 0 X 832623 0 4961 SATHISH MAGGE MD PHYSICIAN 40.0 0 X 945995 0 12092 Ramana Murty MD PHYSICIAN 40.0 0 X 1082241 0 25666 RAFAEL SchMULEVICH MD PHYSICIAN 40.0 0 X 1044528 0 24287 FRED BROWER Former PRESIDENT & CEO 0 0.0 0 351025 14297 5341801 3440395 367296 111 true true false ARUP LABS INC 500 CHIPETA WAY SALT LAKE CITY UT 84108 LAB 1478684 WASHINGTON HEALTHCARE STRATEGIES PO BOX 463 BRIDGEVILLE PA 15017 ANESTHESIOLOGISTS 963164 PROCIRCA 3600 FORBES AVENUE PITTSBURGH PA 15213 PERFUSIONISTS 512058 CHECKER TRANSPORTATION 1439 SUNSET BLVD STEUBENVILLE OH 43952 TRANSPORTATION 450864 BIOFIRE DIAGNOSTICS PO BOX 5814 SALT LAKE CITY UT 84158 LAB TESTING 383102 39 X 0 0 0 432623 0 63 0 432686 Net Patient Services 900099 229364179 229083146 281033 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 229364179 3959270 0 20810 3938460 0 0 0 0 0 0 0 0 310775 0 0 0 310775 0 310775 0 0 310775 2214723 6764 0 0 2214723 6764 2221487 0 0 2221487 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Cafeteria 722100 334257 0 0 334257 Management Fees 541610 499617 0 0 499617 Tuition 611600 757033 0 0 757033 99173 0 0 99173 1690080 237978477 229083146 301843 8160802 X 2101 2101 419435 419435 91710083 77894136 13815947 1853411 1575399 278012 18367862 15609202 2758660 5938570 5047785 890785 293532 278855 14677 5399 5399 34155231 32448886 1706345 0 724303 688088 36215 3300082 3135078 165004 175109 166353 8756 6719992 6383992 336000 384874 365630 19244 3148632 2991200 157432 5891042 5596489 294553 1886963 1792615 94348 Medical Supplies 45570343 45570343 State Provider Tax 2835480 2693706 141774 Repairs and maintenance 2796722 2656886 139836 Miscellaneous Expenses 431596 410989 20607 630495 598971 31524 0 227241257 205906704 21334553 0 223685 312641 7863996 31320976 0 0 29196031 34847340 0 0 0 0 0 3801651 3806818 916878 1328776 71258669 23275470 43246074 47983199 1318931 1286743 174511318 147876115 0 210000 210000 9550690 10413008 270839254 279385616 14467449 22806849 0 0 0 0 0 0 0 0 0 0 0 0 0 9320221 792665 23787670 23599514 X 245951475 254685992 23109 23110 1077000 1077000 247051584 255786102 270839254 279385616 X 10737220 3414330 -5417032 X false true X true false X 2 TRINITY HEALTH SYSTEM - TRINITY EAST 340714474 3 true 0 0 TRINITY HEALTH SYSTEM - TRINITY WEST 340875691 3 true 0 0 2 0 0 Schedule A, Part IV, Section A, Line 1 Supporting Organizations TRINITY HOSPITAL HOLDING COMPANY (EIN: 34-1842025) IS THE SOLE MEMBER OF TRINITY EAST (EIN: 34- 0714474) AND TRINITY WEST (EIN: 34-0875691). TRINITY HOSPITAL HOLDING COMPANY, TRINITY EAST AND TRINITY WEST ARE INCLUDED IN THE GROUP RETURN FOR TRINITY HEALTH SYSTEM GROUP. The subordinates of the TRINITY HOSPITAL HOLDING COMPANY do not have the same public charity status. TRINITY HOSPITAL HOLDING COMPANY is a Type II supporting organization pursuant to IRC §509(a)(3). TRINITY EAST and TRINITY WEST are IRC §170(b)(1)(a)(iii) hospital organizations. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 5399 5399 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 ASSOCIATION- $2,537 CATHOLIC HEALTH ASSOCIATION- $1,915 OHIO HOSPITAL ASSOCIATION - $947 1077000 19150 19150 1077000 1077000 34568 34568 1077000 1077000 17315 17315 1077000 1077000 22746 22746 1077000 743000 334000 7560 7560 1077000 0.0 1.0 0.0 false false 7810022 7810022 26086531 9786995 16299536 53367 26015 27352 22362419 13178405 9184014 14946330 284055 14662275 47983199 CHI OIP 147876115 F 147876115 INSURANCE CLAIMS RESERVE 50907 Other current liabilities 14662 Intercompany Dept 183802 Unclaimed Property 145582 Post Employment Benefits 397712 792665 X Schedule D, Part V, Line 4 Intended uses of endowment funds THE INTEREST IS UNRESTRICTED AND USED FOR HOSPITAL OPERATIONS. THE PRINCIPAL IS RESTRICTED AND NOT USED. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote TRINITY HEALTH SYSTEM GROUP'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 49655 1587593 3041749 0 0.0 41574277 26399897 15174380 0.0668 0 0.0 0 49655 43161870 29441646 15174380 0.0668 7 5809 50983 1517 49466 0.0002 7 120 198786 198786 0.0009 1 3190232 1880414 1309818 0.0058 0 0.0 4 113 111440 111440 0.0005 19 6042 3551441 1881931 1669510 0.0073 19 55697 46713311 31323577 16843890 0.0741 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 true 13643952 228000 61959193 56058612 5900581 X true true VALLEY SURGERY CENTER AMBULATORY SURGERY 0.34 0.0 0.34 2 1 TRINITY MEDICAL CENTER WEST 4000 JOHNSON ROAD STEUBENVILLE OH 43952 http://www.trinityhealth.com/ 1208AHR X X X A 2 TRINITY MEDICAL CENTER EAST 380 SUMMIT AVENUE STEUBENVILLE OH 43952 http://www.trinityhealth.com/ 1208AHR X X A A false false true X X X X X X X X X 18 true false false true X http://www.trinityhealth.com/ 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.trinityhealth.com/patients-and-visitors/financial-assistance/ X http://www.trinityhealth.com/patients-and-visitors/financial-assistance/ X http://www.trinityhealth.com/patients-and-visitors/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 3E The significant health needs are included in a prioritized description of the significant health needs of the community and identified through the CHNA. Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - A. TRINITY HEALTH COLLABORATED WITH OTHER LOCAL ORGANIZATIONS AND PROVIDERS TO TAKE INTO ACCOUNT THE INPUT OF PERSONS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY. REPRESENTATIVES INCLUDED A DIVERSE MIX OF INDIVIDUALS FROM THE CITY OF STEUBENVILLE HEALTH DEPARTMENT, JEFFERSON COUNTY HEALTH DEPARTMENT AND REPRESENTATIVE MEMBERS OF OTHER COMMUNITY AGENCIES INCLUDING THE AREA UNITED WAY, PUBLIC SENIOR HOUSING, THE YMCA AND PRIME TIME SERVICES. The Trinity Steering Committee identified target stakeholders to be interviewed. Strategy Solutions, Inc. developed the stakeholder interview guide and created all data collection tools. Strategy Solutions, Inc. staff scheduled and conducted nine (9) interviews and entered data into the collection tools. Interview questions included the following topics: top community health needs, environmental factors driving the needs, efforts currently underway to address needs, and advice for the Steering Committee. The primary data collection process also included conducting a community survey from March 1, 2019 to April 1, 2019, utilizing a mixed-methodology convenience sample, with data collection completed via paper and the Internet. Trinity put a link to the survey on their Facebook page and distributed via email to all internal and external stakeholders. Individuals had the option to print a paper version if they preferred to complete the survey via that modality. A total of 190 surveys were completed by the residents of the Trinity service area. Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - A. THE NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT CONDUCTED IN TAX YEAR 2019 THAT ARE BEING ADDRESSED ARE: MENTAL HEALTH/SUBSTANCE ABUSE, CHRONIC DISEASE, MATERNAL AND INFANT HEALTH, ACCESS TO QUALITY HEALTHCARE, INFECTIOUS DISEASE, PHYSICAL ACTIVITY AND NUTRITION, TOBACCO USE AND INJURY. The majority (94.0%) of focus group participants identified mental health as a top community health problem, while 85.5% of community survey respondents identified it as a top issue. Just under one third of stakeholders (30.0%) identified the need for more mental health providers. Fewer than one in five community survey respondents agree that there is a sufficient number and range of mental/behavioral health providers in the area (18.9%) or substance use providers (16.2%). Furthermore, only one in ten community survey respondents agree that community members know how to access mental health services (10.4%) or substance use services (10.4%). Most community survey respondents think mental health (86.1%), depression (85.5%), alcohol abuse (88.4%) and illegal drug abuse (97.0%) are problems in the community. Focus group participants discussed the need for more behavioral health services in the community. They emphasized the need for more services for children as well as long term and step-down facilities. Participants also talked about the need for detox and rehabilitation programs in the community. Given the rural nature of the community a few groups suggested the need for mobile or tele treatment options. The impact of trauma and drug use on children was also noted by a few groups. Stakeholders talked about the need for additional behavioral health services, indicating a high need in the community. They discussed the need for varying levels of treatment as well as the importance of educating the community about behavioral health. A few talked about the challenges when individuals are experiencing both a mental health concern as well as struggling with addiction as treatment options are very limited. There are also a limited amount of crisis or 24/7 options in the community to get people they help they need when they need it. The cost of care and lack of coordination among providers were mentioned as barriers to treatment. Community survey respondents identified the following as problems in the community: * Obesity (98.8%) * Overweight (98.2%) * Cancer (91.6%) * Diabetes (88.5%) * Heart Disease (86.1%) * High Blood Pressure (83.7%) * Asthma/COPD (83.4%) * Stroke (81.2%) Very few focus group participants talked about chronic disease. The few that did noted that these chronic conditions impact one's overall health and that there is a need for prevention as well as disease management. The school group noted an increase in diabetes and asthma in children in recent years. One stakeholder indicated that there are high rates of cancer in the area. Another talked about the need for more preventative care noting people do not go for routine screenings and check-ups so many conditions could be caught and managed sooner. A few discussed that given the aging population of the community there are likely chronic conditions associated with that population. The percentage of adults without health insurance in Jefferson County has been decreasing since 2011 (18.2%) and in 2016 was 5.7%, which is lower when compared to Ohio (7.7%) and the nation (12.0%). The percentage has also been decreasing in Columbiana County since 2013 (20.6%) and in 2016 (7.1%) was comparable to the state and below the nation. The percentage of adults without health insurance in Harrison County has been decreasing since 2008-2012 (17.8%) and in 2012-2016 (13.7%) was just above the state (11.9%) and below the nation (16.4%). The percentage of disabled individuals in Jefferson County without health insurance has decreased from 17.9% in 2009 to 2.1% in 2016, which is lower when compared to Ohio (6.8%) and the nation (9.8%) and falls short of the Healthy People 2020 Goal to have 100% of individuals have health insurance. The percentage of uninsured adults in Brooke and Hancock counties has decreased since 2013 (20.2%, 20.0% respectively) and in 2019 (6.2%, 7.4%) are both below West Virginia (8.0%). The percentage of uninsured children has also been decreasing since 2013 in Brooke (4.6%) and Hancock (4.5%) counties and in 2019 (2.2% for both) both counties are comparable to West Virginia (2.4%). Focus Group participants were asked to rate the overall health status of the community. Community survey respondents and focus group participants experience both identified limited financial resources, transportation, and literacy/education level as barriers to care. In addition, community survey respondents indicated the lack of a support system, quality child care and discrimination as barriers. Focus group participants also mentioned family challenges, lack of awareness of available services and limited providers as barriers. Stakeholders talked about the fact that many residents do not know where to go for care and often end up in the ER because they do not know where else to go. The lack of providers and free clinics were also noted as needed services in the community. Stakeholders also talked about the lack of transportation as a barrier to accessing the needed care. Strategy by Health Need Below are strategies and program activities the hospital intends to deliver to help address significant health needs identified in the CHNA report. They are organized by health need and include statements of the strategies' anticipated impact and any planned collaboration with other organizations in our community. Health Need: Mental Health and Substance Use Disorder Trinity Health System Mental Health Program: Provide depression screenings and referrals in the ED and direct admissions. Provide screenings and placement for patients with co-occurring mental health and substance use disorder diagnoses. Research the feasibility with CMS of increasing the number of licensed mental health beds Jefferson Behavioral Health Outpatient Mental Health Program. Provide psychiatrists to be located within provider offices. Provide therapists to schools for students' safeTALK Training Program. Suicide Alertness for Everyone (safeTALK) is a half-day training program that teaches participants to recognize and engage persons who might be having thoughts of suicide and to connect them with community resources trained in suicide intervention. SafeTALK stresses safety while challenging taboos that inhibit open talk about suicide. Offer MAT and Vivitrol programs Depression Screenings Various providers and agencies screen for depression and suicide and make referrals as needed. Trinity Health System Behavioral Medicine Addiction Recovery Program: Provide screenings and placement for patients with co-occurring mental health and substance use disorder diagnoses. Offer a detox residential support unit program for teen moms. Provide detox programs, counseling or referrals - all ages - both inpatient and outpatient. Jefferson Behavioral Health Outpatient Addiction Recovery Program: Provides a system of quality services including intervention, and recovery to all clients affected by addiction. Provide loss and grief support groups for those losing a loved one to a drug overdose. Project DAWN: Project DAWN (Deaths Avoided with Naloxone) is a state program focusing on Naloxone administering training and the handing out of Naloxone kits. Medicated Assisted Treatment (MAT) Program: MAT is a treatment resource for those battling chemical dependency. Utilizes specific FDA-approved medications to help patients reduce cravings and mitigate their withdrawal symptoms. Anticipated Impact: The hospital's and partners' initiatives to address depression, suicide, drug dependency and overdose deaths are anticipated to result in improved health care outcomes, improved patient linkages to inpatient and outpatient mental health and substance use disorder services, provide a seamless transition of care, and improve care coordination to ensure individuals are connected to appropriate care and can access services, and create a drug-free community. Planned Collaboration: The hospital will partner with local churches, providers, first responders and law enforcement, A Caring Place Child Advocacy Center, Coleman Professional Services, Community Action Counsel, Family Recovery Center, Jefferson Behavioral Health System, Jefferson County General Health District, Jefferson County Prevention and Recovery, Jefferson County School District, Ohio Valley Health Center, Pastoral Care, Urban Mission, Village Network, Women's Health Center and YMCA. (Continued) Schedule H, Part V, Section B, Line 11 Facility A, 2 Facility A, 2 - A. Health Need: Chronic Disease Chronic Disease Community Outreach: Outreach to community through hospital participation in health fairs, screenings, education, programs. Research the feasibility of having the cafeteria flag menu options that are heart healthy or diabetes friendly for patients, visitors and staff. Chronic Disease Referral System: Research protocols for referrals to outside agencies to provide exercise and/or nutrition programs and referrals to non-hospital providers Fresh food offerings at local food banks. Focus offerings on fresh fruits, vegetables and protein and local food banks. Anticipated Impact: The initiatives and outreach to address this health need by the hospital is anticipated to result in: reduction in hospital readmissions for chronic disease related illnesses, improve the health and quality of life for those who suffer from chronic illness, enable participants to better manage their disease, and create a supportive environment for individuals to learn critical skills and enhance their knowledge on self-management. Planned Collaboration: The hospital will partner with local providers and food banks, Jefferson County General Health District, Jefferson County School District, Ohio Valley Health Center, Urban Mission, and YMCA. Health Need: Maternal and Infant Health Maternal and Infant Health Community Outreach: Outreach to the community through programs, services, supplies and support groups to educate on pre-term births, how to reduce low birth weight babies and infant mortality Referral Services. Offer referrals to women and infant health and abuse services. Partner with Pittsburgh hospital to have addicted newborns transported down to Pittsburgh for detox. Help Me Grow Program. Help Me Grow is Ohio's evidenced-based parent support program that encourages early prenatal and well-baby care, as well as parenting education to promote the comprehensive health and development of children. Help Me Grow System includes Central Intake, Help Me Grow Home Visiting and Help me Grow Early Intervention. Moms Helping Moms WIC breastfeeding peer helper program: WIC mothers supporting new mothers through support and education. Cribs for Kids Program: Program to provide Cribettes and safe sleep education to eligible families. Ohio Partners for Smoke Free Families (OPSFF): A perinatal smoking cessation program to reduce the prevalence of smoking among women of reproductive age, including pregnant women. Anticipated Impact: The initiatives and outreach to address this health need by the hospital is anticipated to result in: reducing the burden of maternal and infant mortality and morbidity and improvement of maternal and newborn health outcomes. Planned Collaboration: The hospital will partner with local providers, A Caring Place Child Advocacy Center, AIM Women's Services, Jefferson County General Health District, Ohio Valley Health Center, Trinity Health System's Comprehensive Women's Care Center, Urban Mission, WIC, and Women's Shelter Services. Health Need: Access to Health Care Patient Financial Assistance Program: Continue to offer patient financial assistance to those residents living in Jefferson, Columbiana and Harrison counties in Ohio and Brook and Hancock counties in West Virginia. Medical Transition Program: Program funded by Trinity Health System for Medicaid patients to receive referrals to hospital providers who are under contract to accept patient at no charge. Assist Uninsured and Underinsured in Enrolling in Coverage. Hospital and community agencies assist in enrolling patients/clients to healthcare coverage Anticipated Impact: The initiatives and outreach to address this health need by the hospital are anticipated to result in: reduction in hospital readmissions for chronic disease related illnesses, improve the health and quality of life for those who suffer from chronic illness, enable participants to better manage their disease, and create a supportive environment for individuals to learn critical skills and enhance their knowledge on self-management. Planned Collaboration: The hospital will partner with local providers and food banks, Jefferson County General Health District, Jefferson County School District, Ohio Valley Health Center, Urban Mission, and YMCA The hospital determines which of the significant needs identified in its CHNA to address and any such needs that won't being addressed according to the prioritization criteria which scores the accountable organization, magnitude of the problem, impact on other health outcomes, and system capacity as low, medium, or high. Issues with low scores are important for the community to address, affect low numbers of people and have no risk for an epidemic, have little impact on health outcomes or other conditions, and are issues for which there is little or no capacity (system and resources) to implement evidence-based solutions. Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - A. 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 Financial Assistance Eligibility 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 I, Line 7g Subsidized Health Services THE ONLY SERVICE INCLUDED IN SUBSIDIZED HEALTH SERVICES REPORTED ON LINE 7G IS BEHAVIORAL MEDICINE. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS ON LINES 7A AND 7B; 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. WORKSHEET 2 WAS UTILIZED TO COMPUTE THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/19 USING THE FOLLOWING FORMULA: OPERATING EXPENSE (LESS NON-PATIENT CARE ACTIVITIES, MEDICARE PROVIDER TAXES, COMMUNITY BENEFIT EXPENSE AND COMMUNITY BUILDING EXPENSE) DIVIDED BY GROSS PATIENT REVENUE (LESS GROSS CHARGES FOR COMMUNITY BENEFIT PROGRAMS). BASED ON THAT FORMULA, $222,726,014 / $718,147,436 RESULTS IN A 31.01% COST-TO-CHARGE RATIO. THE HOSPITAL'S COST ACCOUNTING RECORDS WERE USED TO COMPLETE THE OTHER BENEFITS SECTION (LINE 7E - 7I). 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 31.01%. 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 TRINITY HEALTH SYSTEM GROUP BELIEVES THAT A SMALL PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE. 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 TRINITY HEALTH SYSTEM GROUP 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 Using essentially the same Medicare cost report principles as to the allocation of general services costs and "apportionment" methods, the "CHI Workbook" calculates a payers' gross allowable costs by service (so as to facilitate a corresponding comparison between gross allowable costs and ultimate payments received). The term "gross allowable costs" means costs before any deductibles or co-insurance are subtracted. TRINITY HEALTH SYSTEM GROUP's ultimate reimbursement will be reduced by any applicable copayment/ deductible. Where Medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from Medicare allowable costs because the amounts are typically immaterial. 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: $61,959,193 Total Medicare costs: $56,058,612 Surplus or Shortfall: $5,900,581 TRINITY HEALTH SYSTEM GROUP 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 A - TRINITY MEDICAL CENTER WEST: Line 16a URL: http://www.trinityhealth.com/patients-and-visitors/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website A - TRINITY MEDICAL CENTER WEST: Line 16b URL: http://www.trinityhealth.com/patients-and-visitors/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website A - TRINITY MEDICAL CENTER WEST: Line 16c URL: http://www.trinityhealth.com/patients-and-visitors/financial-assistance/; Schedule H, Part VI, Line 2 Needs assessment Trinity Health System provides care to a service area of just over 200,000 individuals. Trinity is accredited by the Joint Commission on the Accreditation of Hospitals, a member of the American Hospital Association, Voluntary Hospitals of America and the Catholic Hospital Association. The system offers a full array of acute and outpatient services on two campuses. Trinity also maintains physician offices, Walk-in Lab Draw facilities, the Tony Teramana Cancer Center, WorkCare and the Digestive and Nutrition Center throughout the Tri-State area. Additionally, at Trinity we understand patient education is a vital role in maintaining a healthy community. Our staff participates in numerous health fairs and blood screening programs throughout the year. Trinity Health System is part of CommonSpirit Health, a nonprofit, Catholic health system dedicated to advancing health for all people. It was created in February 2019 through the alignment of Catholic Health Initiatives and Dignity Health. CommonSpirit Health is committed to creating healthier communities, delivering exceptional patient care, and ensuring every person has access to quality health care. Our Mission The Mission of Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities. Our Core Values and Quality Principles REVERENCE: Profound respect and awe for all of creation, the foundation that shapes spirituality, our relationships with others and our journey to God. INTEGRITY: Moral wholeness, soundness, fidelity, trust, truthfulness in all we do. COMPASSION: Solidarity with one another, capacity to enter into another's joy and sorrow. EXCELLENCE: Preeminent performance, becoming the benchmark, putting forth our personal and professional best. Trinity Health has developed a Community Health Needs Assessment (CHNA) for the following facilities: - Trinity Medical Center East - Trinity Medical Center West Trinity Health System, a member of Catholic Health Initiatives and CommonSpirit Health is proud to present its 2019 Community Health Needs Assessment (CHNA) Report. This report summarizes a comprehensive review and analysis of health status indicators, public health, socioeconomic, demographic and other qualitative and quantitative data from the primary service area of Trinity Health System. This report also includes secondary/disease incidence and prevalence data from Jefferson County, the primary service area of the hospital. In additional secondary data is provided, where available, for Columbiana and Harrison Counties in Ohio and Brooke and Hancock Counties in West Virginia, the secondary service area of the hospital. The data was reviewed and analyzed to determine the top priority needs and issues facing the region overall. The primary purpose of this assessment was to identify the health needs and issues of the Jefferson County community defined as the primary service area of Trinity Health System. Additionally, Trinity is interested in identifying the needs and issues of the secondary service area which includes Columbiana and Harrison counties in Ohio and Brooke and Hancock counties in West Virginia. The CHNA also provides useful information for public health and health care providers, policy makers, social service agencies, community groups and organizations, religious institutions, businesses, and consumers who are interested in improving the health status of the community and region. The results enable the hospital, as well as other community providers, to more strategically identify community health priorities, develop interventions, and commit resources to improve the health status of the region. Improving the health of the community is the foundation of the mission of Trinity Health System, and an important focus for everyone in the service region, individually and collectively. In addition to the education, patient care, and program interventions provided through the hospital, we hope that the information in this CHNA will encourage additional activities and collaborative efforts to improve the health status of the community that Trinity Health System serves. Trinity Health collaborated with other local organizations and providers to take into account the input of persons representing the broad interests of the community. Representatives included a diverse mix of individuals from the City of Steubenville Health Department, Jefferson County Health Department and representative members of other community agencies including the area United Way, public senior housing, the YMCA and Prime Time Services. "The 2019 Trinity CHNA was conducted to identify primary health issues, current health status, and health needs to provide critical information to those in a position to make a positive impact on the health of the region's residents. The results enable community members to more strategically establish priorities, develop interventions, and direct resources to improve the health of people living in 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 The population in Jefferson County is projected to decrease from 65,632 in 2019 to 64,251 in 2024. There were slightly more females (51.5%) than males (48.5%). The population was predominantly Caucasian (91.1%). The median age was 44.6 and was projected to remain steady. Just under one-third (30.7%) of residents had never been married, while 42.5% were married, 3.7% were separated, 14.9% were divorced and 8.3% were widowed. Just over one in ten residents (11.0%) did not complete high school, while 43.1% were a high school graduate, 10.6% had a bachelor's degree and 5.4% had an advanced degree. The average household income was $59,124, with 11.8% of families living in poverty. Most (93.5%) of the labor force was employed. DEMOGRAPHICS JEFFERSON COUNTY Gender: 48.5% male, 51.5% female Ethnicity: White/Non-Hispanic - 91.1%, black/African American - 5.4%, Hispanic/Latino origin - 1.6%, Asian - 0.4% Age: median age is 44.6 Marital Status: married - 42.5%, never married - 30.7%, divorced - 14.9%, widowed - 8.3%, separated - 3.7% Household Income: average - $59,124. Median - $45,609. Families living in poverty - 11.8% Education: did not complete high school - 11%. High school grad/GED - 43.1%. Bachelor's degree - 10.6%. Advanced degree - 5.4%. Employment: employed - 93.5%. Age 16 or over employed - 49.4%. Age 16 or over unemployed - 3.4%. Hold white collar occupations - 52.8% Overall, the service area of the System has a lower average household income than the State of Ohio and a higher unemployment rate. Jefferson County is economically depressed with a per-capita income lower than State averages. All 3 counties in the System's immediate service area have a high proportion of the population at or below the poverty level. The economic conditions of the area have hindered the growth of the Hospital and more self-pay patients have taken advantage of the Hospital's services. Charity Care and Bad Debt accounts have increased each year for the last few years. As recently unemployed residents lose their health benefits, we expect higher charity care levels. The Payer mix at THS is heavily weighted to the governmental payers, with around 40% of the revenue generated from Medicare and 11% generated from the Medicaid program. With the 2 programs recording significant shortfalls between payment to hospitals and hospital costs, the economic challenges for THS are great. According to the Ohio Department of Health the percentage of students graduating high school for the 2017-2018 school year in Columbiana County (89.3%) increased since the 2011-2012 school year (88.5%) and is higher than Ohio (82.1%) and Healthy People 2020 Goal (87.0%). The percentage in Harrison County has also increased from 88.6% during the 2011-2012 school year to 93.1% during the 2017-2018 school year. According to County Health Rankings the percentage of students graduating high school in Brooke County in 2018 (94.0%) has increased since 2014 (89.0%) and is higher than West Virginia (86.5%). The percentage of students graduating high school in Hancock County in 2018 (88.0%) has also increased since 2014 (80.0%) and is higher than the state. The percentage of children living in poverty in Harrison County has decreased from 2013 (27.5%) to 2019 (21.1%) and is comparable to Ohio (19.8%). The percentage of children living in single parent homes has increased in Jefferson County since 2013 (35.8%) to 2019 (38.3%) which is higher when compared to Ohio (35.7%). The percentage has also increased in Columbiana (30.3% in 2013 to 34.1% in 2019) and Harrison (22.1% in 2013 to 30.8% in 2019) counties. The percentage of children in poverty has decreased in Brooke (23.0% in 2013 to 19.4% in 2019) and Hancock (25.6% in 2013 to 20.4% in 2019) and in 2019 both are lower when compared to West Virginia (24.4%). The percentage of individuals considered living with severe housing problems in 2019 was comparable for residents in Brooke (10.4%) and Hancock (11.8%) counties when compared to West Virginia (11.5%). Housing (90.0%) was identified as a top community need. Community survey respondents identified gun violence (80.7%) and human trafficking (70.3%) as problems in the community. HIV prevalence in Hancock County has decreased since 2013 (63.8 to 46.6 in 2019 and remains below West Virginia (113.3). The Chlamydia incidence rate per 100,000 has been decreasing in Jefferson County since 2015 (372.7) and in 2017 (313.3) was lower when compared to Ohio (528.9). The incidence rate in Columbiana County has been decreasing since 2012 (275.4) and in 2016 was 198.7. The percentage of adults who smoke in Jefferson County has decreased from 2014 (29.3%) to 2019 (21.4%) which is comparable to Ohio (22.5%). The percentage in Columbiana County has remained comparable (21.6% in 2014 to 21.7% in 2019), which is comparable to the state. The percentage in Harrison County has decreased since 2014 (34.2%) to 2019 (20.8%). The percentage of adults who smoke in Brooke (26.6% in 2014 to 19.2% in 2019) and Hancock (24.7% in 2014 to 20.9% in 2019) counties has decreased and in 2019 both counties were lower when compared to West Virginia (24.8%). The unintentional injury death rate per 100,000 in 2009-2011 in Jefferson (63.3), Columbiana (42.7) and Harrison (52.5) counties was higher when compared to Ohio (41.1) and the Healthy People 2020 Goal (36.4). The death rate per 100,000 due to motor vehicle crashes in 2012 for Columbiana (12.4) and Harrison (56.7) counties was higher than Ohio (9.0) and the Healthy People 2020 Goal (1.2). The firearm fatalities rate in 2019 for Brooke County (19.8) was higher than West Virginia (16.6). Schedule H, Part VI, Line 5 Promotion of community health The organization's hospital facility(ies) promote 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(ies) have 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(ies) treat 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. 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 OH true true false false false false false false false MATT GRIMSHAW PRESIDENT & CEO 0 405510 0 0 0 67827 0 2900 0 21155 0 497392 0 0 JOHN FIGEL MD Board Member 344507 0 15749 0 42132 0 0 0 23316 0 425704 0 0 0 LARRY SCHUMACHER BOARD MEMBER 0 1086890 0 682996 0 357085 0 156836 0 26390 0 2310197 0 104000 DAVE WERKIN CFO 0 246468 0 93912 0 35790 0 0 0 20879 0 397049 0 0 Kumar Amin MD PHYSICIAN 850013 0 184013 0 0 0 0 0 22463 0 1056489 0 0 0 Nasrollah Jahdi MD PHYSICIAN 800010 0 32613 0 0 0 0 0 4961 0 837584 0 0 0 SATHISH MAGGE MD PHYSICIAN 850013 0 95982 0 0 0 0 0 12092 0 958087 0 0 0 Ramana Murty MD PHYSICIAN 800010 0 282231 0 0 0 0 0 25666 0 1107907 0 0 0 RAFAEL SchMULEVICH MD PHYSICIAN 841506 0 203022 0 0 0 0 0 24287 0 1068815 0 0 0 FRED BROWER Former PRESIDENT & CEO 0 351025 0 0 0 0 0 0 0 14297 0 365322 0 0 Schedule J, Part I, Line 3 THE CEO IS COMPENSATED BY TRINITY HEALTH SYSTEM, WHO USES A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, TO DETERMINE COMPENSATION. Schedule J, Part I, Line 4b SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN TRINITY HEALTH SYSTEM GROUP MAINTAINS A NONQUALIFIED RETIREMENT PLAN FOR FRED BROWER. THE PLAN IS A SERP AND THE INCREASE IN BENEFITS IS CALCULATED ANNUALLY BASED ON THE TERMS OF THE AGREEMENT. During 2018 the following payments were made by Trinity Health System from the deferred compensation plan: Fred Brower: $147,768. 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: Lawrence P. Schumacher - $86,358 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: Matthew Grimshaw - $20,561 Schedule J, Part I, Line 4a Severance or change-of-control payment Consistent with the terms of a separation agreement and the liquidated damages section of an employment agreement that predated affiliation with CommonSpirit Health, provisions related to a change of control provision were paid by Trinity Health System during a two-year period from September 11, 2016 through September 10, 2018. The payments were included in the individual's W-2 income and reportable compensation on Schedule J: Fred Brower: $351,025 Form 990, Part III, Line 1 MISSION STATEMENT 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. Form 990, Part V, Line 3b FORM 990-T FILING TRINITY HEALTH SYSTEM - TRINITY EAST (EIN 34-0714474), TRINITY HEALTH SYSTEM - TRINITY WEST (EIN 34-0875691), AND TRINITY HOSPITAL HOLDING COMPANY (EIN 34-1842025) ARE SUBORDINATE ORGANIZATIONS OF TRINITY HEALTH SYSTEM GROUP. EACH OF THE SUBORDINATES FILES ITS OWN 990-T. Form 990, Part VI, Line 15 PROCESS FOR DETERMINING COMPENSATION AN EXTERNAL COMPENSATION CONSULTANT REVIEWS ANNUALLY THE BASE SALARY, TOTAL CASH, AND TOTAL REMUNERATION, AS COMPARED TO MARKET, FOR THOSE IDENTIFIED AS OFFICERS/KEY EMPLOYEES. THIS REVIEW IS TO DETERMINE REASONABLENESS OF THE COMPENSATION. NOTE: THE ORGANIZATION'S CEO IS EMPLOYED BY TRINITY HEALTH SYSTEM WITH SALARY THEN CHARGED TO TRINITY HEALTH SYSTEM GROUP. Form 990, Part VI, Line 12c CONFLICT OF INTEREST POLICY 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 1a Delegate broad authority to a committee PURSUANT TO ARTICLE V, SECTION 7 OF THE CODE OF REGULATIONS OF TRINITY HEALTH SYSTEM GROUP, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, AND THE PRESIDENT, EACH OF WHOM SHALL SERVE AS A VOTING MEMBER OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION. PURSUANT TO APPENDIX A OF THE CORPORATION'S CODE OF REGULATIONS, 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 ACCORDING TO THE CODE OF REGULATIONS OF TRINITY HEALTH SYSTEM GROUP, THE ENTITY'S SOLE MEMBER IS TRINITY HEALTH SYSTEM, AN OHIO NONPROFIT ORGANIZATION. THE MEMBERS OF THE SOLE MEMBER ARE SYLVANIA FRANCISCAN HEALTH, AN OHIO NONPROFIT ORGANIZATION AND COMMONSPIRIT HEALTH, A COLORADO NONPROFIT ORGANIZATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body THE MEMBERS OF THE GOVERNING BODY SHALL CONSIST OF THE MEMBERS OF THE CORPORATE MEMBER'S GOVERNING BODY. DIRECTORS OF THE CORPORATE MEMBER, AND THEREFORE OF THE FILING ORGANIZATION, SHALL BE APPOINTED BY THE PARENT CORPORATION NO LATER THAN JUNE 30 OF EACH YEAR. PRIOR TO EACH ANNUAL MEETING OF THE PARENT CORPORATION, OR SUCH OTHER MEETING CALLED FOR THE PURPOSE OF APPOINTING DIRECTORS OF THE CORPORATION, THE GOVERNANCE COMMITTEE SHALL SELECT AND SUBMIT TO THE BOARD A SLATE OF NOMINEES QUALIFIED TO SERVE ON THE BOARD. THE BOARD SHALL REVIEW THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ON THE RECOMMENDED SLATE AND SHALL VOTE TO ACCEPT OR REFUSE EACH NOMINEE. THE NAMES AND QUALIFICATION OF EACH INDIVIDUAL ACCEPTED BY THE BOARD SHALL THEN BE SUBMITTED TO THE PARENT CORPORATION, WHO SHALL THEN APPOINT OR REFUSE EACH NOMINEE WITH THE RECOMMENDATION OF THE PRESIDENT HEALTH SYSTEM DELIVERY AND CHIEF OPERATING OFFICER OR OTHER DESIGNEE. NOTWITHSTANDING ANYTHING IN THIS CODE OF REGULATIONS TO THE CONTRARY, THE PARENT CORPORATION MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD SHOULD THE BOARD FAIL TO FURNISH THE PARENT CORPORATION WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD IN ACCORDANCE WITH THIS SECTION. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders TRINITY HEALTH SYSTEM GROUP HAS ONE CORPORATE MEMBER, TRINITY HEALTH SYSTEM. TRINITY HEALTH SYSTEM MUST APPROVE THE FOLLOWING ACTIONS OF THE CORPORATION OR ANY OF ITS SUBSIDIARIES AS A CONDITION BEFORE THEY BECOME EFFECTIVE: 1) MERGER, CONSOLIDATION, OR SUBSTANTIAL SALE 2) CREATION OF SUBSIDIARIES OF AFFILIATION WITH OTHER ENTITIES 3) CONVEYANCING REAL PROPERTY OR CREATING LIENS THEREON 4) TRANSFER OF PERSONAL PROPERTY, INCURRING OR GUARANTEEING INDEBTEDNESS OR GRANTING LIENS IN EXCESS OF AN AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBERS 5) APPROVAL OF CORPORATION OR SUBSIDIARY TRUSTEES AND DIRECTORS BASED ON AGREED UPON CRITERIA 6) CAPITAL EXPENDITURES OR GRANTS IN EXCESS OF AN AMOUNT PRESCRIBED FROM TIME TO TIME BY THE MEMBERS 7) ADDITION OR TERMINATION OF SERVICES 8) APPROVAL OF SELECTION OF THE SLATE OF CANDIDATES FOR THE OFFICE OF CEO OF THE CORPORATION OR ANY OF ITS SUBSIDIARIES PROVIDED, HOWEVER, THAT A REPRESENTATIVE OF EACH MEMBER WILL SERVE ON THE SELECTION COMMITTEE 9) APPROVAL OF THE ANNUAL BUDGET AND STRATEGIC PLAN FOR THE CORPORATION AND ITS SUBSIDIARIES. Form 990, Part VI, Line 11b Review of form 990 by governing body ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. SUBSEQUENT TO THE CFO'S REVIEW, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE SUBMITTED TO THE CFO. 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. 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. (CONTINUED ON SCHEDULE O) 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: 99173, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 99173; Form 990, Part IX, Line 11g Other Fees Purchased Services - Total Expense: 21230392, Program Service Expense: 20168872, Management and General Expenses: 1061520, Fundraising Expenses: 0; Other Fees for Services - Total Expense: 7646315, Program Service Expense: 7269128, Management and General Expenses: 377187, Fundraising Expenses: 0; Contract Labor - Total Expense: 4624246, Program Service Expense: 4393034, Management and General Expenses: 231212, Fundraising Expenses: 0; Consulting - Total Expense: 580024, Program Service Expense: 551023, Management and General Expenses: 29001, Fundraising Expenses: 0; Contract Services - Total Expense: 74254, Program Service Expense: 66829, Management and General Expenses: 7425, Fundraising Expenses: 0; Form 990, Part XI, Line 9 Other changes in net assets or fund balances PENSION ADJUSTMENT - -4670747; TRANSFER TO AFFILIATES - -746285; 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 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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 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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 INC 25 POCONO RD DENVILLE NJ 07834 222876836 HEALTHCARE NJ 501(c)(3) 10 SCHS false SAINT CLARE'S FOUNDATION INC 25 POCONO RD DENVILLE NJ 07834 222502997 FUNDRAISING FOUNDATION NJ 501(c)(3) 7 SCHS false SAINT CLARE'S HEALTH SERVICES INC 25 POCONO RD DENVILLE NJ 07834 223639733 MANAGEMENT NJ 501(c)(3) 10 CSH false SAINT CLARE'S HOSPITAL INC 25 POCONO RD DENVILLE NJ 07834 223319886 HEALTHCARE NJ 501(c)(3) 3 SCHS false SAINT ELIZABETH FOUNDATION 555 S 70TH ST LINCOLN NE 68510 470625523 FUNDRAISING FOUNDATION NE 501(c)(3) 7 SERMC false SAINT ELIZABETH HEALTH SERVICES 555 S 70TH ST LINCOLN NE 68510 363233120 HOSPITAL NE 501(c)(3) 3 SERMC false SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 S 70TH ST LINCOLN NE 68510 470379836 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false SAINT FRANCIS MEDICAL CENTER 2620 W FAIDLEY GRAND ISLAND NE 68803 470376601 HOSPITAL NE 501(c)(3) 3 CHI NEBRASKA false SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND NE 68802 470630267 FUNDRAISING FOUNDATION NE 501(c)(3) 7 SFMC false Saint Francis Memorial Hospital 900 Hyde Street San Francisco CA 94109 941156295 HOSPITAL CA 501(c)(3) 3 DCC false SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL ST BEREA KY 40403 260152877 FUNDRAISING FOUNDATION KY 501(c)(3) 7 SJHS false SAINT JOSEPH HEALTH SYSTEM INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611334601 HOSPITAL KY 501(c)(3) 3 KOH false SAINT JOSEPH HOSPITAL FOUNDATION INC 701 Bob Olink Dr 200 LEXINGTON KY 40504 611159649 FUNDRAISING FOUNDATION KY 501(c)(3) Type I SJHS false SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON KY 40741 260438748 FUNDRAISING FOUNDATION KY 501(c)(3) 7 SJHS false SAINT JOSEPH MOUNT STERLING FOUNDATION INC 225 FALCON DR MOUNT STERLING KY 40353 272884584 FUNDRAISING FOUNDATION KY 501(c)(3) 7 SJHS false SAINT JOSEPH'S HOSPITAL FOUNDATION 2500 Fairway Street DICKINSON ND 58601 363418207 FUNDRAISING FOUNDATION ND 501(c)(3) Type I SJHHC false San Gabriel Valley Medical Center Foundation 438 West Las Tunas Drive San Gabriel CA 91776 953430341 INACTIVE CA 501(c)(3) Type I DH false SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC 104 W 17TH ST SCHUYLER NE 68661 363630014 FUNDRAISING FOUNDATION NE 501(c)(3) Type I AHMHS false Sierra Nevada Memorial-Miners Hospital 155 Glasson Way Grass Valley CA 95945 941439787 HOSPITAL CA 501(c)(3) 3 DCC false SJRMC JOPLIN MISSOURI 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 440545809 HOSPITAL MO 501(c)(3) 3 CSH false St Francis Foundation of Santa Barbara 2323 De La Vina St Suite 104 Santa Barbara CA 93105 237137119 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Francis Hospital Support Corporation 601 E Micheltorena Street Santa Barbara CA 93103 770022302 INACTIVE CA 501(c)(3) Type I DH false St Johns Healthcare Foundation 1600 North Rose Avenue Oxnard CA 93030 202865781 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Josephs Foundation (Phoenix) 350 West Thomas Road Phoenix AZ 85013 942941245 FUNDRAISING FOUNDATION AZ 501(c)(3) Type I DH false St Josephs Foundation of San Joaquin 1800 N California Street Stockton CA 95204 510432777 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Mary Medical Center Foundation 1050 Linden Avenue Long Beach CA 90813 237153876 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Mary Professional Building Inc 1050 Linden Avenue Long Beach CA 90813 237373088 INACTIVE CA 501(c)(3) Type I DH false St Marys Medical Center Foundation 450 Stanyan Street San Francisco CA 94117 943336143 FUNDRAISING FOUNDATION CA 501(c)(3) Type I DH false St Rose Dominican Health Foundation 3001 St Rose Parkway Henderson NV 89052 880349432 FUNDRAISING FOUNDATION NV 501(c)(3) Type I DH false ST ALEXIUS MEDICAL CENTER 900 EAST BROADWAY AVENUE BISMARCK ND 58501 450226711 HOSPITAL ND 501(c)(3) 3 CSH false ST ANTHONY HOSPITAL 2801 St Anthony Way PENDLETON OR 97801 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MEDICAL CENTER 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 410695598 HOSPITAL MN 501(c)(3) 3 CSH false ST JOSEPH FOUNDATION OF BRYAN TEXAS 2801 FRANCISCAN DRIVE BRYAN TX 77802 742351158 FUNDRAISING FOUNDATION TX 501(c)(3) Type II SJSC false ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742847594 HEALTHCARE TX 501(c)(3) 10 SJSC false ST JOSEPH MEDICAL CENTER INC 201 INTERNATIONAL CIRCLE STE 212 HUNT VALLEY MD 21030 520591461 HOSPITAL MD 501(c)(3) 3 CSH false ST JOSEPH PHYSICIAN ASSOCIATES 2801 FRANCISCAN DRIVE BRYAN TX 77802 203159302 PHYSICIANS TX 501(c)(3) 3 SJSC false ST JOSEPH PHYSICIAN ENTERPRISE INC 201 INTERNATIONAL CIRCLE STE 212 HUNT VALLEY MD 21030 521311775 PHYSICIANS MD 501(c)(3) Type I SJMC false ST JOSEPH REGIONAL HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 741282696 HOSPITAL TX 501(c)(3) 3 SJSC false ST JOSEPH REGIONAL HEALTH PARTNERS 2801 FRANCISCAN DRIVE BRYAN TX 77802 454088170 HOSPITAL TX 501(c)(3) 3 SJSC false ST JOSEPH REGIONAL HEALTH PARTNERS ACO 2801 FRANCISCAN DRIVE BRYAN TX 77802 463265423 HEALTHCARE TX 501(c)(3) 10 SJSC false ST JOSEPH SERVICES CORPORATION 2801 FRANCISCAN DRIVE BRYAN TX 77802 742455161 MANAGEMENT TX 501(c)(3) Type I SLHS false ST JOSEPH'S AREA HEALTH SERVICES 600 PLEASANT AVE PARK RAPIDS MN 56470 410695603 HOSPITAL MN 501(c)(3) 3 CSH false ST JOSEPH'S HOSPITAL AND HEALTH CENTER 2500 Fairway St DICKINSON ND 58601 450226429 HOSPITAL ND 501(c)(3) 3 CSH false ST LEONARD 8100 CLYO ROAD CENTERVILLE OH 45458 341940863 LIVING COMM OH 501(c)(3) 10 FLC false ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - PMC 6624 FANNIN ST STE 2505 HOUSTON TX 77030 273733278 HOSPITAL TX 501(c)(3) 3 SLHS false ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND 6624 FANNIN ST STE 2505 HOUSTON TX 77030 261947374 HOSPITAL TX 501(c)(3) 3 SLHS false ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS 6624 FANNIN ST STE 2505 HOUSTON TX 77030 260335902 HOSPITAL TX 501(c)(3) 3 SLHS false ST LUKE'S COMMUNITY HEALTH SERVICES 6624 FANNIN 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