2019-04-26T14:00:11-05:00 2018-06-30 470617373 Catholic Health Initiatives 198 Inverness Drive West Englewood CO 80112 990 2017-07-01 410721642 Unity Family Healthcare UNIT 3206325441 815 SE 2nd Street Little Falls MN 56345 Steven Smith CFO 2019-04-26 true Mark Stocki P00642127 3032989100 2017 2019-02-21 02:37:17Z Steven Smith 815 SE 2nd Street Little Falls MN 56345 79181056 false 0928 X www.chistgabriels.com X 2001 MN The vision is to create the best healthcare experience by igniting the spirit for superior care and service. The organization was, for the year ended 6/30/18, affiliated with Catholic Health Initiatives ("CHI"). Following the close of the 6/30/2018 tax year, on 2/1/19, in connection with the alignment of the Catholic ministries of CHI and Dignity Health, CHI changed its name to CommonSpirit Health. 11 6 473 268 43716 0 466183 498829 75783078 76139837 596919 1064921 1214669 1440974 78060849 79144561 1092966 1434878 0 0 35747936 35256102 0 0 0 36817875 38756006 73658777 75446986 4402072 3697575 59995230 63836436 22489296 23032422 37505934 40804014 See Schedule O false false 65037838 1434878 76099576 SEE SCHEDULE H 65037838 true true false true false false false false true true true false true true true false true false false false false false false true false true true true true true false false false false false false true false false false false false false true false false false true 0 0 473 true true true false false false false false true false false false X 11 6 false false false false true true true true true false false true true true true true true false true true false MN X Vicki Maleski 3206315674 815 SE 2nd Street Little Falls MN 56345 LEE BOYLES PRESIDENT/CEO 45.0 1.0 X X 0 354875 41269 DEB GRUBER SECRETARY 1.0 1.0 X X 0 0 0 BRIAN MACKINAC CHAIR 1.0 1.0 X X 0 0 0 RICHARD WEAVER VICE CHAIR 1.0 1.0 X X 0 0 0 SR MARY PAT BURGER BOARD MEMBER 1.0 2.0 X 0 0 0 JEFFREY DROP Board Member/CHI SVP Division Officer 1.0 59.0 X 0 1429849 33844 Jill Griffith-McRaith BOARD MEMBER 1.0 1.0 X 0 0 0 GREGORY MCNAMARA MD BOARD MEMBER/PHYSICIAN 45.0 1.0 X 303797 0 37498 VIRGIL MEYER MD BOARD MEMBER/PHYSICIAN 45.0 1.0 X 281782 0 30706 MARK MOE MD BOARD MEMBER/PHYSICIAN 45.0 1.0 X 324771 0 36788 JON VETTER Board Member 1.0 1.0 X 0 0 0 STEVEN SMITH Treasurer/CFO 45.0 1.0 X 0 155516 32777 DAVID EDGERTON JR PHYSICIAN 45.0 0 X 607696 0 39506 PAUL JOHNSON PHYSICIAN 45.0 0 X 882669 0 39506 DAVID JORGENSEN PHYSICIAN 45.0 0 X 731584 0 39506 SAUNG PARK PHYSICIAN 45.0 0 X 586929 0 15683 PHILIP PROSAPIO PHYSICIAN 45.0 0 X 548171 0 31659 RYAN KRAY MD Former Vice Chair/Physician 45.0 1.0 X 245348 0 17020 4512747 1940240 395762 58 true true false NATIONAL GOVERNMENT SERVICES INC 5000 BRITTONFIELD PKWY SUITE 100 EAST SYRACUSE NY 13057 MEDICARE CONTRACTING SERVICES 2186229 LITTLE FALLS ANESTHESIA 808 3RD STREET SUITE 130 LITTLE FALLS MN 56345 ANESTHESIA SERVICES 1521736 EMERGENCY PRACTICE ASSOC PO BOX 1260 WATERLOO IA 50704 ER PHYSICIAN 1518949 AMN HEALTHCARE 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 HEALTHCARE CONSULTING 817184 CENTRAL MN DIAGNOSTIC 150 10TH ST NW PO BOX 158 MILACA MN 56353 RADIOLOGY SERVICES 765790 12 X 0 0 19820 71119 293771 114119 3900 498829 Patient Services 900099 73136885 73136885 0 0 Pharmacy Services 446110 2991455 2951194 40261 0 Equity changes of unconsolidated orgs 900099 6121 6121 0 0 Intercompany Transactions 900099 5376 5376 0 0 0 0 0 0 0 0 0 0 76139837 454353 0 3415 450938 0 0 0 0 0 0 0 0 289618 0 0 0 289618 0 289618 0 0 289618 612353 0 0 1785 612353 -1785 610568 0 0 610568 3496 19820 7490 -3994 0 -3994 0 0 0 0 0 0 48811 27220 21591 0 0 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0 5208 423148 0 0 0 0 0 0 0 0 0 14740640 16668588 22489296 23032422 X 37361708 40617677 136242 177008 7984 9329 37505934 40804014 59995230 63836436 X 3697575 92235 -491730 X false true X true true true X false false false false false true 5141 false false false 5141 false Schedule C, Part II-B, Line 1f THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN ACADEMY OF FAMILY PHYSICIANS: $565 AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS: $27 AMERICAN ASSOCIATION OF CARDIOVASCULAR & PULMONARY REHABILITATION: $3 AMERICAN ASSOCIATION OF ORTHOPAEDIC SURGEONS: $487 AMERICAN COLLEGE OF FOOT AND ANKLE SURGEONS: $30 AMERICAN COLLEGE OF OBSTETRICIANS & GYNECOLOGISTS: $37 AMERICAN HOSPITAL ASSOCIATION: $1,115 AMERICAN MEDICAL ASSOCIATION: $1,008 AMERICAN OSTEOPATHIC ASSOCIATION: $63 CATHOLIC HEALTH ASSOCIATION: $977 MN HOSPITAL ASSOCIATION: $829 7985 1345 9330 5000 2985 7985 0 5000 5000 0 0 0 0 0.0 1.0 0.0 false false 681604 681604 23322010 13616924 9705086 0 0 0 33600578 23085956 10514622 1413470 995355 418115 21319427 CHI OIP CHI OIP Cash Reserved for Restricted Net Assets CHI OIP Fixed Income CHI OIP CHI OIP CHI OIP 15198758 F 15198758 Dividend Receivable 619970 Intercompany Receivables 4114738 4734708 Intercompany Debt 11674974 Environmental Remediation Liability 989857 Vendor Accruals 557149 Deferred Gain on Sale/Leaseback 3446608 16668588 X Schedule D, Part V, Line 4 Intended uses of endowment funds The income from this permanent endowment is to be used to meet the hospital's greatest needs. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Unity Family Healthcare's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2018, reads as follows: "CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management reviews its tax positions annually and has determined that there are no material uncertain tax positions that require recognition in the accompanying consolidated financial statements." Spring Magic 7357 5625 1732 810 1400 Drive Fore Cancer 15959 14195 1764 5280 0 23316 19820 3496 6090 1400 7490 -3994 true true X true X 300 true X true true true false true true 415 733086 733086 0.0100 3946191 3456925 489266 0.0067 0 0 0 0.0 0 415 4679277 3456925 1222352 0.0166 16 3076 282209 32386 249823 0.0034 1 37 19622 0 19622 0.0003 1 4636 281089 0 281089 0.0038 0 0 0 0 0 0.0 5 13935 156511 39247 117264 0.0016 23 21684 739431 71633 667798 0.0091 23 22099 5418708 3528558 1890150 0.0257 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 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 0 61443 5841 55602 0.0008 1 0 61443 5841 55602 0.0008 true 2031283 0 19147277 18902413 244864 X true true 1 1 St Gabriel's Hospital 815 SE Second Street Little Falls MN 56345 www.stgabriels.com 8392027 X X X X St Gabriel's Hospital 1 false false true X X X X X X X X X 15 true false true true X https://www.chistgabriels.com/chna/ X X true 15 false true false true X 300.0 300.0 X X X X true true X X X true X https://www.chistgabriels.com/financial-assistance/ X https://www.chistgabriels.com/financial-assistance/ X https://www.chistgabriels.com/financial-assistance/ X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 3E The significant health needs are a prioritized description of the significant health needs of the community. They were identitifed through the CHNA and are being addressed in the hospital's most recent implementation plan. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - St. Gabriel's Hospital. SEVERAL INDIVIDUALS FROM THROUGHOUT THE COMMUNITY PROVIDED INPUT INTO OUR 2016 COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA). THESE PEOPLE INCLUDED BOTH STAKEHOLDERS AS WELL AS THE GENERAL PUBLIC. A WIDE RANGE OF PEOPLE FROM MORRISON COUNTY PUBLIC HEALTH AND MORRISON COUNTY SOCIAL SERVICES, INCLUDING PUBLIC HEALTH DIRECTOR KATY KIRCHNER, WERE INTERVIEWED. OTHER PUBLIC HEALTH AND SOCIAL SERVICES STAFF INCLUDED LYNETTE GESSELL, RACHEL BARTA, AND PUBLIC HEALTH MEDICAL DIRECTOR DR. GREGORY MCNAMARA. ROUNDING OUT THE LIST OF 20 INDIVIDUALS WHO WERE SPECIFICALLY INTERVIEWED WERE: ANDREA LAUER, MAYOR OF ROYALTON; BEKA SWISHER, EARLY CHILDHOOD EDUCATOR; BRIDGET BRITZ, DIRECTOR OF HORIZON HEALTH; GEORGE WEBER, PIERZ SUPERINTENDENT OF SCHOOLS; GREGG VALENTINE, MORRISON COUNTY CHAPLAIN; JULIE LEIKVOLL, NORTHERN PINES MENTAL HEALTH COUNSELOR; KATE BJORGE FROM LIVE BETTER LIVE LONGER HEALTHY COMMUNITIES COLLABORATIVE; DR. KURT DEVINE, FAMILY PHYSICIAN AND OPIOID TASK FORCE CHAMPION; LINDA LIPPERT, RN, EMERGENCY NURSE; MARILYN KEITH, PIERZ SCHOOLS, JUVENILE JUSTICE; PAUL MCINTYRE,GOLD CROSS AMBULANCE; SHAWN LARSEN, MORRISON COUNTY SHERIFF; SHEILA FUNK, LITTLE FALLS SCHOOLS; SUSAN DORAN, SWANVILLE; TAMMY FILLIPI, EARLY CHILDHOOD SPECIALIST; AND TERRI WEYER, FROM THE SENIOR CENTER. NUMEROUS OTHER INDIVIDUALS PROVIDED INPUT INTO THE IMPLEMENTATION STRATEGY DEVELOPMENT PROCESS. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - St. Gabriel's Hospital. The CHNA was conducted with Morrison County Public Health and Morrison County Social Services. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - St. Gabriel's Hospital. THE CHNA IS ALSO EMAILED TO SPECIFIC INDIVIDUALS THROUGHOUT MORRISON COUNTY. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. Gabriel's Hospital. The implementation strategy development team used a voting process to identify the highest health priorities for CHI St. Gabriel's Health and Morrison County. Team participants were asked to select their top health priorities taking into account all of the information gathered as part of the CHNA as well as the specific visit information available through the Epic electronic health record. Participants were asked to select their top 3-5 health issues as their highest priorities to address in the coming three years. After an objective voting process, the top five priority areas for participants on the implementation team were: 1) mental health (easily the highest priority among team members); 2) substance abuse/chemical dependency; 3) obesity; 4) accessibility to health care; and 5) parenting. Each of the five priority areas will be addressed separately, as well as additional priorities that are the current focus of CHI St. Gabriel's Health's action plans, most notably chronic disease and domestic violence. Out of the highest priorities identified by the CHNA process, the implementation strategy team decided to concentrate efforts on the two highest priorities-mental health and substance abuse/chemical dependency, while continuing to address the other top three priority areas: obesity, accessibility to health care and parenting. The highest priority area not specifically included in the implementation strategy is dental care, although a separate group of individuals from the hospital and county social services are exploring options to expand dental care for low-income individuals in the county. It was determined that since CHI St. Gabriel's Health does not employ dental practitioners, it was not in a position to lead efforts to expand dental care. That being said, the hospital agreed to work with AppleTree Dental and both Morrison County Public Health and Morrison County Social Services to identify potential funding sources to remodel existing hospital space to accommodate an expanded low-income dental clinic. Currently, the clinic is only open a few days a month and demand far exceeds the number of appointment slots available for patients to receive services. Health Priority Area 1: Improve the mental health of the people of Morrison County. Goal 1A) Enhance access to mental health services in Morrison County Objectives: - Utilize new mental health-psychiatric nurse practitioner to provide services to people with mental illness beginning in October 2016. - Increase awareness of mental health services available in Morrison County through advertising and awareness-building strategies. Health Priority 2: Reduce the Impact of Chemical Dependency on Morrison County Individuals, Families and the Community Goal 2A): Reduce youth substance use in Morrison County Objectives: - Reduce the percentage of Morrison County 8th, 9th, and 11th graders reporting any use of alcohol in the past 30 days from 19.5% to 16% by June 30, 2019 (Minnesota rate in 2013 is 16.8%) - Increase the percentage of Morrison County 5th, 8th, 9th, and 11th graders reporting parental disapproval for youth alcohol use from 88.7% to 92% by June 30, 2019 (Minnesota rate in 2013 is 92%) - Decrease the percentage of Morrison County 8th, 9th, and 11th graders reporting smoking one or more cigarettes in the past 30 days from 8.8% to 7% by June 30, 2019 (Minnesota Student Survey, Minnesota rate in 2013 is 7.8%) - Increase the percentage of Morrison County 8th, 9th, and 11th graders reporting a perception of moderate or great risk of harm by using prescription drugs not prescribed for them from 78.5% to 92% by June 30, 2019. (Minnesota rate in 2013 is 81.3%) - Expand the number of school districts/communities engaged in youth substance use prevention initiatives to all Morrison County communities. As previously noted, the implementation strategy team chose five priority areas to focus on in developing a three-year action plan in response to our Community Health Needs Assessment (CHNA). The specific goals, objectives, measures/indicators and evidenced-based strategies for the remaining three priority areas-Obesity, Accessibility and Parenting-will continue to be part of the ongoing community health strategies for CHI St. Gabriel's Health. In addition to the remaining three priority areas, CHI St. Gabriel's Health, in its role as the primary health agency in Morrison County, will continue to address these areas. Each concern will be discussed separately in the following paragraphs. Obesity - The objectives related to obesity fall under two primary categories-workplace wellness and youth/family strategies. CHI St. Gabriel's Health and its community partners will continue to support efforts that encourage healthy activities and eating. Some of the specific partners in this priority area include the Live Better Live Longer Eat, Move and Belong Teams; the Sprout kitchen and CSA shares program, the WIC Supplemental Food Program; the public health Statewide Health Improvement Program (SHIP) grant; Community Gardens; Ruby's Pantry; Oasis Share-A-Meal; Fare for All; local food shelves. Other community assets to address obesity include the Open Streets/Falls Festival on Foot, Climbing Wall at Lindbergh Elementary, the disc golf course, local fitness facilities, Headstart and the extension office. CHI St. Gabriel's Health is continuing to support local efforts to reduce obesity in a variety of ways. Accessibility to Health Care - CHI St. Gabriel's Health is enhancing efforts to increase accessibility to health care, also in a variety of ways. A new telemedicine/virtual clinic in the Little Falls Community Schools began this fall. The integrated electronic medical record (Epic) has made sharing data and communication among providers and patients more effective. A variety of government and non-government community assets are assisting in the expansion of resources, most notably South Country Health Alliance for individuals on Medical Assistance. CHI St. Gabriel's Health has programs to assist with securing financial resources to deliver care. Much effort has been made to expand hours in order to increase access to care and there are a variety of grant programs addressing such issues as the prescription drug initiative and domestic violence and the patient-centered medical home. CHI St. Gabriel's Health will continue to partner with Morrison County Social Services, Morrison County Public Health and other community agencies in the delivery of services. In addition, the hospital has an ongoing recruitment program in order to expand the range of services available locally. Internal medicine and pediatrics are two such critical needs in the community, given the high rate of people age 65 and older in the county. Parenting - Parenting was the fifth and final priority identified by the implementation strategy team. The Love and Logic, Morrison County Families, Nurse-Family Partnership and ASQ screening hub are among the resources being used to address these priorities. Morrison County Public Health and Morrison County Social Services tend to coordinate the parenting strategies through its MCICC, maternal child health, WIC and Headstart programs. The Live Better Live Longer (LBLL) healthy communities collaborative, an arm of CHI St. Gabriel's Health plays a significant role as well. The Belong Team of LBLL helps to connect families with the resources they need to assist with parenting. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - St. Gabriel's Hospital. The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. The patient must submit a completed Financial Assistance application. Patient Cooperation Standards - A patient must exhaust all other payment options, including private coverage, federal, state and local medical assistance programs, and other forms of assistance provided by third-parties prior to being approved. An applicant for Financial Assistance is responsible for applying to public programs for available coverage. He or she is also expected to pursue public or private health insurance payment options for care provided by a CHI Hospital Organization within a Hospital Facility. A patient's and, if applicable, any Guarantor's cooperation in applying for applicable programs and identifiable funding sources, including COBRA coverage (a federal law allowing for a time-limited extension of employee healthcare benefits), shall be required. If a Hospital Facility determines that COBRA coverage is potentially available, and that a patient is not a Medicare or Medicaid beneficiary, the patient or Guarantor shall provide the Hospital Facility with information necessary to determine the monthly COBRA premium for such patient, and shall cooperate with Hospital Facility staff to determine whether he or she qualifies for Hospital Facility COBRA premium assistance, which may be offered for a limited time to assist in securing insurance coverage. A Hospital Facility shall make affirmative efforts to help a patient or patient's Guarantor apply for public and private programs. 6 Little Falls Orthopedics 1108 1st Street SE Little Falls MN 56345 Outpatient clinic Community Medical Center 200 South First Avenue Pierz MN 56364 Outpatient clinic Randall Lakes Area Clinic 250 White Oak Drive Randall MN 56475 Outpatient clinic St Camillus Place 1100 SE Fourth Street Little Falls MN 56345 Long term care facility Family Medical Center 811 SE Second Street Little Falls MN 56345 Outpatient clinic Schedule H, Part VI, Line 7 States Community Benefit Report Filed Minnesota hospitals ARE required to file hospital-specific community benefit information to the Minnesota Department of Health through the Health Care Cost Information System (HCCIS). Hospitals do this by filling out the Hospital Annual Report, which the Minnesota Hospital Association administers for MDH. MHA then files all of the information in the Hospital Annual Report to MDH as public information. A key issue with this report is that it is limited to "hospital-only" costs and the elements included in the community benefits section is limited. For example, MDH does not allow for the counting of the MinnesotaCare provider tax or MA (Medical Assistance) Surcharge as community benefits costs. Through a separate, voluntary effort, MHA collects community benefit data by health system and creates a statewide summary report for advocacy purposes. (MHA) collects this data by requesting access to summary data from all Minnesota facilities using the Community Benefit Inventory for Social Accountability (CBISA) software and UFH grants MHA such access. This advocacy collection effort also includes some of the real life stories of community benefits provided by hospitals that change lives and the health of their communities. MHA does not file that information with the state or share the hospital/system level data publically. Schedule H, Part I, Line 3c ELIGIBILITY CRITERIA FOR FINANCIAL ASSISTANCE Unless eligible for Presumptive Financial Assistance, the following eligibility criteria must be met in order for a patient to qualify for Financial Assistance: * The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. * The patient's Family Income must be at or below 300% of the FPG. * The patient must comply with Patient Cooperation Standards as described [in the FAP]. * The patient must submit a completed Financial Assistance application. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. In particular, presumptive eligibility may be determined on the basis of individual life circumstances that may include: * Recipient of state-funded prescription programs; * Homeless or one who received care from a homeless clinic; * Participation in Women, Infants and Children programs (WIC); * Food stamp eligibility; * Subsidized school lunch program eligibility; * Eligibility for other state or local assistance programs (e.g., Medicaid spend-down); * Low income/subsidized housing is provided as a valid address; or * Patient is deceased with no known estate. Schedule H, Part VI, Line 2 Needs Assessment, continued 2 QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT Community Outreach for the Poor Translation Services - One area that has shown continued growth as the community has become more diverse, has been the increase in translation services. In 2010, the amount spent for providing translation services was approximately $8,500, which has increased to approximately $28,387 in 2013 (an increase of over 300%) and was $30,629 (nearly 400% since 2010) in FY 2014 and slightly decreased to $24,473 in FY2015. In FY2017, the amount was $35,265. In FY2018, the amount was $29,389. Community Financial Application Assistance - UFH financial assistance counselors assist individuals in filling out the paperwork to acquire financial assistance in paying for their medical bills. In 2018 the total number of individuals who received this assistance was 870 and the dollar value of this assistance was $81,563. The amount of assistance has been increasing due to a number of factors influencing their ability to pay their medical bills. Miscellaneous Initiatives for the Poor - Unity Family Healthcare's facilities also donate staff time toward coordinating fund-raising activities for the poor. These range from assisting individuals with accessing financial assistance programs to purchasing school supplies and Christmas presents for needy families, although the individual gifts purchased at Christmas do not qualify as community benefit, since individual staff members make those gifts, the estimated value of these benefits is approximately $2,978 and the number of people impacted is approximately 30. Community Outreach for the Broader Community Youth Development, Partner Violence Prevention, Chronic Disease Management (Patient-Centered Medical Home), and Prescription Drug Abuse Initiatives UFH continues to strategically apply for, receive and manage grants that align both with our community health needs assessment (CHNA) implementation plan and the health needs and issues of the people of Morrison County. In 2013, UFH received a two-year grant that specifically targeted improving the health of the people of Morrison County through a youth development and breastfeeding enhancement initiative. This initiative had two primary focuses: 1) making mini-grants to youth-led, youth-initiated projects, and 2) increasing the number of women in Morrison County who breastfeed their babies. The grant initiative met with overall success (a summary is available upon request) and the initiative ended on June 30, 2015. A second grant UFH has received continuously since 2009 has been focused on reducing partner violence (domestic violence) in Morrison County as measured by the number of domestic assaults charged, the number of Orders for Protection issued and the number of charged violations of Orders for Protection. By all three measures, things improved. In July 1, 2014, this grant initiative received another three years of funding. Thirdly, the patient-centered medical home development initiative (PCMHDI), which seeks to improve the health of residents of Morrison County, especially those with chronic disease, by using a Triple AIM approach, has been very well-received in the community and in FY 2014 received certification from the Minnesota Department of Health (MDH) as a medical home. The PCMH recently received re-certification as a medical home by MDH. Finally, the aforementioned prescription drug abuse reduction initiative is making a difference in the lives impacted by such abuse. Together, these grant initiatives (and a few minor initiatives) resulted in $39,877 in community benefits in FY2018. The prescription drug abuse grant initiative has received funding for fiscal year 2019 so these community benefit efforts are continuing. Furthermore, in a time of tight government budgets, the grant initiatives are enabling the hospital to pursue projects that address well-defined community needs as outlined in our CHNA. Youth Recreation Initiative In 1997, St. Gabriel's Hospital received a CHI Mission & Ministry Fund grant to enhance recreation opportunities in partnership with the Little Falls Area Schools. Prior to 1997, there had been substantial cuts in a collaborative between the City of Little Falls and the local school district to address youth recreation. The Youth Recreation Initiative, as it is called, has continued despite the fact that grant funding through the Mission & Ministry has long been discontinued. The program has been so favorably received in the community that the leadership of St. Gabriel's Hospital has chosen to continue supporting the program. That level of support totaled more than $63,486 in fiscal year 2018 and impacted 7,568 people. Early on in the program's history, there was a noticeable decline in youth delinquency as measured by interactions with the judicial system and that decline has been maintained. We believe the decline was due to the increased opportunities created for area youth. Support Groups UFH facilities offer a variety of support groups and similar activities, including such activities as the Prostate Cancer Support Group, Eating Disorders Support Group, Adoption Support group, the Alanon Group, the Hospice Family Support activities and the special spiritual services (empty arm for miscarriages, hospice memorial services, etc.). In 2018, the value of the support for this activity was $2,617. The support groups served approximately 188 people in 2018. Health Screenings/Health Fairs UFH facilities, especially St. Gabriel's Hospital, offer a variety of free health screenings and health fairs for the communities in which we serve. The total value of these activities was nearly $7,888 in FY 2018, with 695 people participating in the health fairs/screenings. The screenings include such things as blood pressure checks at a local extended care facility (not part of UFH), other screenings, firemen physicals, pulmonary screening and flu shots. The Little Falls Area Health Fair, which was held in the spring of 2018 had over 300 participants. Schedule H, Part VI, Line 2 Needs assessment, continued 3 Donated Space UFH facilities donate the use of our facilities to non-profit organizations. Some of these include TOPS (Take Off Pounds Sensibly), the Mental Health Support Group, and OASIS Share-A-Meal, to name just a few. The total value of the donated space in fiscal year 2018 was $8,985. In addition, UFH donated space for Apple Tree Dental to provide free services to the poor in the area. The value of this donated space is estimated at $11,571. This assistance results in improved access to dental care in the county. UFH Participation on Community Health Initiatives One of the larger community benefit activities that UFH supports is the participation on community health initiatives. This involves everything from the Healthy Communities Collaborative to the Violence Prevention Council to the Morrison County EMS board to the Morrison County Ministerial Association and the Elder Network. This activity directly impacted over 252 people in 2018, and was valued at more than $19,041. Senior Companion Program Finally, health care providers and community service organizations recognize the benefits provided through the St. Gabriel's Hospital Senior Companions program. Patients connect with their individual "companions" before they leave the hospital. Once home, the companions continue to regularly visit with the patients while they continue their recovery. In fiscal year 2018, the program served 30 different people in the community, with a total community benefit of $2,137. Donations In fiscal year 2018, UFH donated over $26,606 in cash to local/regional entities to such local entities as the Morrison County Relay for Life sponsored by the American Cancer Society, Oasis Share-A-Meal and other not-for-profit organizations. Subsidized Health Services UFH has one much-needed and appreciated community service that operates as a loss to the organization. That service is St. Gabriel's Hospital's home care program-CHI Health at Home Little Falls (formerly Unity Family Home Care). In fiscal year 2018, it generated over $281,089 in community benefit. The home care provided 4.636 visits in fiscal 2018 so the benefit to the community is substantial. Physician Recruitment Our primary service area (Morrison County, MN) has a population of approximately 33,821 of which 18.4% are age 65 or older. This elderly population, in particular, requires the skills of two medical specialties--internal medicine and general surgery. Based on the community health needs assessment and physician specialty by population studies, it was determined that at least one and up to four (depending upon the mix of family practice and internal medicine) internists and two general surgeons are needed in the community to adequately serve patients' health needs. In addition, due to the retirement of one pediatrician, a second is needed. Similarly, our two OB/GYNs left in early 2017 creating a significant community need. Physician/provider recruitment has been complicated and created additional challenges due to the fact that there are Health Professional Shortage Areas in Morrison County. The total cost of expenses associated with physician recruitment and retention in these much-needed specialties was over $55,602 in fiscal year 2018. Health Professions Education UFH's acute care facility--St. Gabriel's Hospital--serves as clinical education sites for medical professionals. In fiscal year 2018, St. Gabriel's Hospital assisted in the education of the following health professionals: medical students (through the Rural Physician Associate Program); nursing students; pharmacists, radiologic technologists, pharmacists; and nurse anesthetists. The community benefit claimed for that training totaled $19,622 and 37 people received those services. Community Building Activities Live Better Live Longer (formerly the Healthy Communities Collaborative of Morrison County) is a collaborative effort of over 20 organizations. It is a county-wide community health status improvement initiative. LBLL's mission is, "Through collaboration, we build and nurture the total health and well-being of people in Morrison County." Its vision reads, "Morrison County stands out as a vibrant, interconnected community for all to live, work, learn, worship and play." Unity Family Healthcare is the sponsoring agency for LBLL and UFH staff members serve on its board and communities. LBLL has on three tenets Eat, Move, and Belong, which encourages people in the county to eat better, more nutritious meals (including breast milk for young children); exercise regularly; and become involved in the Morrison County community, whether it's through recreation, book clubs, churches or whatever the individual chooses. Unity Family Healthcare staff members are not only involved in the LBLL board and committees, it also partners with other public and private entities on many other health initiatives such as 5-2-1-0, community transformation, etc., in order to improve the health of the people of Morrison County. Individual staff members also donate significant time to coaching and other leadership positions in the community. The Live Better Live Longer program was discontinued June 30, 2018 due to a lack of funding. St. Gabriel's Health Foundation is resuming its main event which is the Rock N Run to be held May 18, 2019. This event was the group's cornerstone to promote healthy, family, physical activity. There were over 400 participants last year at the 10th Annual Rock N Run event. The foundation will also resume the Run For Fun Challenge in which runners/walkers can participate in three or four Morrison County race challenges and be eligible for extra prizes. This was an extra challenge promoted by the Live Better Live Longer team as well. Schedule H, Part VI, Line 2 Needs Assessment - Continued 1 Community Health Needs Assessment Process UFH regularly performs a community health needs assessment (CHNA) every three years in compliance to the Affordable Care Act (ACA). Prior to implementation of the ACA, the CHNAs were performed every three to five years in partnership with Morrison County Social Services (MCSS) and Morrison County Public Health (MCPH). The CHNAs include a written survey as well as stakeholder interviews (health, social services, school and court staff, elected officials, etc.). Occasionally, focus groups around particular community health issues or access concerns are also included as part of the assessment process. The three partners have shared the expenses for the CHNAs that were performed in 1989, 1994, 1999, 2004, 2009, 2013 and 2016. The most recent CHNA was conducted in FY2016 and it is posted on the UFH website (www.chistgabriels.com) along with the 2013 CHNA. St. Gabriel's Hospital has always taken the leadership role in coordinating the community health needs assessment. This past year, in addition to the three long-term partners (MCPH, MCSS and the hospital), the hospital was asked to participate in a regional effort that included the public health agencies in Todd and Wadena counties in addition to Morrison County. As was done in 2013, additional collaborators will be part of the implementation strategy development for the CHNA. For the 2016 CHNA, among the people involved were the St. Gabriel's Health Foundation director, the director of the Healthy Communities Collaborative of Morrison County (HCC), the largest school district in the county, Camp Ripley (an Army National Guard training facility located in Morrison County) and the Violence Prevention Council of Morrison County. Thanks to a Catholic Health Initiatives (CHI) Mission and Ministry Fund planning grant, St. Gabriel's Hospital led the formation of the Healthy Communities Collaborative (HCC) in 2005. In the past year, the HCC changed its name to Live Better Live Longer (LBLL). The hospital was the corporate sponsor of the LBLL, but unfortunately had to close the program due to lack of future funding. The hospital's foundation office will assume some of the major activity from this community initiative. UFH also sponsors the Violence Prevention Initiative (VPI) of Morrison County, a community-based project and local Violence Prevention Council with representation from local enforcement, courts, social services, other not-for-profit organizations and individuals (including former victims) that addresses partner violence, a significant community health concern in the county. The VPI has three core goals: 1) reduce the number of domestic assaults charged in Morrison County; 2) reduce the number of Orders for Protection issued in the county each year; and 3) reduce violations of Orders for Protection that occur each year. In January of 2015 CHI St. Gabriel's Health was awarded $368,112 from a State Innovation Model (SIM) grant through the Minnesota Department of Health and Human Services to focus on prescription drug abuse, specifically opioids. Local data had revealed that the number one reason for emergency room visits at CHI St. Gabriel's Health was patients seeking narcotics for pain. Also, almost 30% of the Medical Assistance population had filled between 8 and 20 narcotic prescriptions in the first eight months of 2014. Realizing this issue went beyond hospital walls, a community prescription drug abuse task force was formed in January of 2015. Representatives from law enforcement, long term care facilities, two hospice agencies, Morrison County Public Health, Morrison County Social Services, Morrison County Drug Court and Probation, Northern Pines Mental Health Center, Coborn's Pharmacy, Little Falls School District, along with three physicians, the emergency room director and clinical nursing staff. There were issues with an increase in narcotic thefts; multiple opioid prescriptions at overdose crime scenes and deaths from heroin overdoses. One out of four local pharmacies reported that 40,000 doses of opioids were being filled each month in a town of 8,200 people. With funding, a controlled substance care team (CSCT) was developed with two physicians leading the team to reduce prescribing within the clinic. The team would also include a social worker, a registered nurse and a mental health coordinator to address physical health, social determinants and behavioral health issues. The school district would provide a prevention platform with a Drug Free Communities grant they also received. Morrison County Sheriff's Office, along with the county prosecutor, would provide names to the CSCT of those charged with drug crimes to reduce diversion in the community which included informing the physicians of sales of prescriptions and having the CSCT address those issues rather than more arrests and jail time. Impact: Currently, 670 patients were completely tapered from opioids no longer needed. Other methods of pain relief were utilized successfully. The accumulative tapering removed almost 700,000 doses each year at a cost savings primarily to Medical Assistance of $2 million based on hospital reimbursement rates. Coborn's Pharmacy also showed a reduction of 60% in opioid prescriptions also after 3 years of program implementation. Law enforcement reports less diversion of opioids on the streets of Morrison County. Lessons Learned: The opioid epidemic requires community-based collaboration. No one entity can attempt to address it successfully in its own silo. Future Goals: This initiative has been expanded with Minnesota Legislation passed in 2017 to provide $1 million dollars for other communities to replicate this community care model. Operating Expenses: $232,000 was spent last fiscal year for care coordination. $24,000 in supplies, travel, meeting space, luncheons, printing and marketing costs. Funding: Along with $293,000 in additional grant funding from the MN Department of Health, St. Gabriel's clinic became a certified medical home so care coordination for patients could be billed. The in-kind task force collaboration funding was provided by all the partners as stated in the overview section. CHI St. Gabriel's provided in-kind costs of $6,600 for meeting space, marketing materials, luncheons and printing/marketing costs and staff time. As previously stated, the most-recent (2016) CHNA has been posted on the UFH website (www.chistgabriels.com. The report reflects the compilation and analysis of extensive data sources to identify issues having a significant impact on the health and general well-being of area residents. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 2031283 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING THE ORGANIZATION'S COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. THE COST-TO-CHARGE RATIOS FOR THE YEAR ENDED JUNE 30, 2018 WERE COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE. BASED ON THAT FORMULA, ST. GABRIEL'S HOSPITAL COST-TO-CHARGE RATIO IS 43.81%. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO. 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 Unity Family Healthcare's cost/charge ratios of 43.81% for St. Gabriel's Hospital. 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 Unity Family Healthcare does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Unity Family Healthcare does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of Catholic Health Initiatives. The consolidated footnote reads as follows: "The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Management routinely assesses the adequacy of the allowances for uncollectible accounts based upon historical write-off experience by payor category. The results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. After satisfaction of amounts due from insurance, CHI follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. The provision for bad debts is presented in the consolidated statement of operations as a deduction from patient services revenues (net of contractual allowances and discounts) since CHI accepts and treats all patients without regard to the ability to pay." Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Unity Family Healthcare is designated as a Critical Access Hospital ("CAH"). CAHs are rural community hospitals that are certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. CAHs are certified under a different set of Medicare Conditions of Participation (CoP). Surpluses are created when a facility receives payments that are greater than the costs of caring for program beneficiaries. Because surpluses are based on costs, not charges, Unity Family Healthcare, due to its designation as a CAH, received cost-based reimbursement for Medicare purposes, and will not experience significant Medicare-related shortfalls. The total surplus for FY2018 was $244,864 or approximately 1.3%. 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: $19,147,277 Total Medicare costs: $18,902,413 Surplus (or Shortfall): $244,864 Unity Family Healthcare 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." At Unity Family Healthcare, our hospice and home care department-CHI Health at Home (formerly) Unity Family Home Care & Hospice-is an example subsidized health service. * Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The organization's billing and collections policy applies to all individuals presenting for emergency or other medically necessary care. The policy contains provisions for collecting amounts due from those patients who the organization knows to qualify for financial assistance either through the traditional financial assistance application process or through presumptive eligibility processes. Before engaging in extraordinary collection actions (ECAs) to obtain payment for EMCare, Hospital Facilities must make reasonable efforts through its billing and collections processes, pursuant to Treas. Reg. §1.501(r)-6(c), to determine whether an individual is eligible for Financial Assistance. In no event will an ECA be initiated prior to 120 days from the date the Facility provides the first post-discharge billing statement (i.e., during the Notification Period) unless all reasonable efforts have been made. Hospital Facilities will not refer accounts for collection where the patient has initially applied for Financial Assistance, and the Hospital Facility has not yet made reasonable efforts with respect to the account. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. Patients who qualify for Medicaid are presumed to qualify for full charity write off. Any charges for days or services written off (excluding Medicaid denials related to timeliness of billing, insufficient medical record documentation, missing invoices, authorization, or eligibility issues) as a result of a Medicaid are booked as charity. Some Medicaid plans offer coverage for a limited or restricted list of services. If a patient is eligible for Medicaid, any charges for days or services not covered by the patient's coverage may be written off to charity without a completed application. This does not include any Share of Cost (SOC) or other patient cost-sharing amounts such as deductibles or copayments, as such costs are determined by the state to be an amount that the patient must pay before the patient is eligible for Medicaid. Health and Human Services (HSS) uses the term "Spend Down" instead of Share of Cost. All collection activities conducted by the Facility, a Designated Supplier, or its third-party collection agents will be in conformance with all federal and state laws governing debt collection practices. All third-party agreements governing collection and recovery activities must include a provision requiring compliance with the hospital facilities' financial assistance and billing and collections policy and indemnification for failures as a result of its noncompliance. This includes, but is not limited to, agreements between third parties who subsequently sell or refer debt of the Hospital Facility. Schedule H, Part V, Section B, Line 16a FAP website - St. Gabriel's Hospital: Line 16a URL: https://www.chistgabriels.com/financial-assistance/; Schedule H, Part V, Section B, Line 16b FAP Application website - St. Gabriel's Hospital: Line 16b URL: https://www.chistgabriels.com/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - St. Gabriel's Hospital: Line 16c URL: https://www.chistgabriels.com/financial-assistance/; Schedule H, Part VI, Line 2 Needs assessment ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE Unity Family Healthcare's (UFH/CHI St. Gabriel's Health) mission 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 vision is to create the best possible health care experience by igniting the spirit for superior care and service. UFH was founded by the Franciscan Sisters of Little Falls to carry out the organization's healing ministry. The cornerstone of UFH (also commonly and collectively referred to as CHI St. Gabriel's Health) is St. Gabriel's Hospital, a 25-bed Critical Access Hospital (CAH), which originally was organized in May of 1891 and received its first patients in January of 1892. St. Gabriel's Hospital and the other organizations that comprise UFH-Family Medical Center, Little Falls Orthopedics and CHI Health at Home (Little Falls)-serve all persons in the community on a non-discriminatory basis. The hospital operates emergency services departments that is open to all persons regardless of their ability to pay and have open medical staffs with privileges available to all qualified physicians and advanced practice clinicians (ACPs) such as physician assistants, nurse practitioners, etc. The UFH board of directors is an eleven-member governing board of individuals who serve as representatives of the community and oversee operations of the UFH facilities. Only two members of the governing board are not directly serving as representatives of the community-the market president and the senior vice president of operations from the Catholic Health Initiatives (CHI) division office in Fargo, ND. St. Gabriel's Hospital engages in the training of health professionals, especially nurses, pharmacists, radiologic technologists, physical therapists, nurse anesthetists and physician assistants. St. Gabriel's Hospital also has been an active participant in the University of Minnesota's Rural Physician Associate Program (RPAP) since its inception in 1973. RPAP provides a "hands-on" experience of serving the primary care needs of people in rural areas. UFH facilities participate in all government-sponsored health care programs such as Medicaid, Medicare, CHAMPUS, MinnesotaCare, MNsure, Tri-Care, and other government health care programs (i.e., the SAGE program, formerly called the Minnesota Breast & Cervical Cancer Control Program, which provides free or low-cost breast and cervical cancer screening services to women at or below 200% of federal poverty guidelines). St. Gabriel's Hospital is a critical access hospitals (CAH) and operates a 24-hour emergency room, open 365 days per year. The emergency room is open to all individuals regardless of ability to pay. Furthermore, the hospital has an open medical staff, participates in Medicare and Medicaid, and has an active charity care/financial assistance program. The hospital does not discriminate on the basis of any non-merit factor, including race, national origin, color, religion, sex, sexual orientation, gender identity, disability (physical or mental), age, status as a parent, or genetic information. Community service and improving the health of the people we serve have always been at the core of UFH activities. For example, UFH was the first organization in the region to offer prenatal education to expectant mothers through St. Gabriel's Hospital in the 1950s. Other notable efforts to improve health from recent years include: the Youth Recreation Initiative, Youth as Resources (YAR), the Live Better Live Longer breastfeeding initiative, the Bridges: Youth, Family, Community program, which provided behavioral health counseling and other services to youth in the public schools and other services to families utilizing community resources, the Violence Prevention Initiative and the Prescription Drug Abuse Reduction Initiative. The programs and services described throughout this report not only serve all persons in the community, but also help to reduce the burdens on local government through a spirit of collaboration thanks to, in large, part, our success in securing grant funding for community-based health initiatives, some of which will be discussed later in this document. St. Gabriel's Hospital provides charity care, in addition to a wide range of community benefit activities associated with serving the needs of the poor. Performing these services and picking up the related costs helps local government agencies which might otherwise have to fund the services. UFH also contributes to the quality of life for area residents in one additional significant way-- through its extensive volunteer program. Apart from the many community benefit hours donated to such activities as the emergency medical system and other community health initiatives, UFH has multiple staff members who donate volunteer time to coaching, serving on church boards, etc., that enhance life in central Minnesota. Beyond these efforts, many community members donate their time and talents to serve the people who utilize our facilities. Our volunteer services department is well known throughout the community and the entire Fargo Division of Catholic Health Initiatives for having a comprehensive, well-developed volunteer program. How well-developed? In FYE June 30, 2018, a total of 268 volunteers contributed 21,784 hours of service to UFH. These hours not only contribute mightily to UFH facilities, but also offer a variety of intrinsic rewards that the volunteers say give meaning to their lives. Finally, the hospital is included in the Official Catholic Directory as a tax-exempt hospital. 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 St. Gabriel's Hospital is located in central Minnesota in the city of Little Falls and serves the people of Morrison County, Minnesota, and small portions in the surrounding counties. Morrison County has a population of 32,821 according the most recent (July 2016) estimate from the U.S. Census Bureau (QuickFacts Morrison County, Minnesota, July 2016. Source: U.S. Census Bureau, Population Division). On average, Morrison County is older and "poorer" on average than the population of the state of Minnesota overall. In the county, 18.4% of the population is age 65 or older compared to 15.1% of Minnesotans. The median age for Morrison County is 41.9 and for Minnesota, it is 37.9. The median household income for the county is $51,456 and the per capita income is $26,442, in comparison to $63,217 and $33,225, respectively for Minnesota. The percentage of persons below the poverty level (2009-2013) in the county is 11.9%, while in the state, it is 9.9% Morrison County has a largely Caucasian population with 97.3% of the population "white." This is in comparison to the state of Minnesota as a whole, which is 85.0% white. Similarly, only 0.9% of the population is foreign born in the county, while Minnesota's foreign-born population is 7.8%. There are 29.5 persons per square mile in the county and for Minnesota as a whole, there are 66.6 persons per square mile. The percentage of people in Morrison County with a disability is 7.8%, compared to 7.2% for the state. A few areas of the county have been designated as Health Professional Shortage Areas (HPSAs), primarily due to economic factors. According to the U.S. Census Bureau, the median earnings per job is $30,329 for Morrison County compared to $34,819 for all of Minnesota. The county unemployment rate is currently (December 2017) 6.9%. The state rate is 3.3%. Over the past year, the unemployment rate for the county has ranged from 2.9 (October 2017) to 9.3% (January 2017) in the county and in the state it has ranged from 2.4 to 5.0% (again, October and January 2017, respectively). The total number of jobs in the county (BEA estimates) is 17,908 with approximately two-thirds (66.5%) of these jobs wage and salary positions. The average hourly rate in the county (actually Region 5) is $19.29/hour compared to $25.11/hour for Minnesota. Similarly, the average weekly wage for the county is $663/week, or 36.5% less than the state average of $1,044/week. Since its inception in 1891, St. Gabriel's Hospital has been intimately involved in community health collaboration, initially working with local lumbering companies to develop plans to care for their workers in the late 1800s and early 1900s. More recently, St. Gabriel's has been collaborating with Morrison County Public Health and Morrison County Social Services since the 1980s to examine area health issues, enabling the three partners to set priorities and plans for health improvement. St. Gabriel's Hospital continues our deep commitment and involvement in the community health assessment and action planning today. Schedule H, Part VI, Line 5 Promotion of community health The organization's hospital facility promotes health for the benefit of the community. Medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The organization's hospital facility has an open medical staff. Its board of trustees is composed of prominent citizens in the community. Excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. The facility treats persons paying their bills with the aid of public programs like Medicare and Medicaid. All patients presenting at the hospital for emergency and other medically necessary care are treated regardless of their ability to pay for such treatment. Schedule H, Part VI, Line 6 Affiliated health care system The organization was, for the year ended 6/30/18, affiliated with Catholic Health Initiatives ("CHI"). Following the close of the 6/30/2018 tax year, on 2/1/19, in connection with the alignment of the Catholic ministries of CHI and Dignity Health, CHI changed its name to CommonSpirit Health. The narrative below reflects the activities of the organization's affiliate, CHI, as of and for the year ended 6/30/18: CHI, a nonprofit, faith-based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where we provide care. One of the nation's largest nonprofit health systems, Englewood, Colorado-based CHI serves as the Parent company of the system. It operates in 18 states and comprises 100 hospitals, including two academic health centers, major teaching hospitals as well as 29 critical-access facilities; community health-services organizations; accredited nursing colleges; home-health agencies; living communities; and other facilities and services that span the inpatient and outpatient continuum of care. In fiscal year 2018, CHI provided more than $1.1 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 $2.0 billion with the inclusion of the unpaid costs of Medicare. The health system, which generated operating revenues of $14.98 billion in fiscal year 2018, has total assets of approximately $20.6 billion. CHI provides strategic planning and management services as well as centralized "share services" for the MBOs. 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 MBOs. The cost savings achieved through CHI's centralization enable MBOS to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society. UFH operates with its wholly owned affiliates and community partners, along with its fundraising arm, the St. Gabriel's Health Foundation, to serve the health care needs of Morrison County. Schedule H, Part VI, Line 7 State filing of community benefit report MN true HANDS OF HOPE RESOURCE CENTER PO BOX 67 LITTLE FALLS MN 56345 411740880 501C3 1000 6498 FMV MEALS, ADS VIOLENCE PREVENTION YOUTH FRONTIERS INC 6009 EXCELSIOR BOULEVARD MINNEAPOLIS MN 55416 411598977 501C3 7410 VIOLENCE PREVENTION 2 0 SCHOLARSHIPS 4 2000 PATIENT INTERPRETERS 238 24109 Book PAYMENTS TO INTERPRETERS FOR NON-ENGLISH SPEAKING PATIENTS CHARITY CARE 2032 1319789 BOOK FINANCIAL ASSISTANCE Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. Requests for grants to be paid to individuals or organizations are sent to the manager of communications and/or the foundation director for approval. These requests are reviewed to ensure their purpose benefits the community and are in line with Unity Family Healthcare's mission and values. Large grant fund requests are reviewed and signed off on by the President/CEO. The foundation director is responsible for working with each grantee to meet their reporting guidelines as stipulated to ensure grant awards are used according to the contract signed by both parties. Grant contracts are maintained in MediTract with reminders of expiration dates to ensure timely reporting and completion. false true false false false false false false false RYAN KRAY MD Former Vice Chair/Physician 177593 0 66983 0 772 0 14829 0 2191 0 262368 0 0 0 LEE BOYLES PRESIDENT/CEO 0 251597 0 75110 0 28168 0 15605 0 25664 0 396144 0 0 JEFFREY DROP Board Member/CHI SVP Division Officer 0 634544 0 675860 0 119445 0 15900 0 17944 0 1463693 0 0 GREGORY MCNAMARA MD BOARD MEMBER/PHYSICIAN 215126 0 85837 0 2834 0 16276 0 21222 0 341295 0 0 0 VIRGIL MEYER MD BOARD MEMBER/PHYSICIAN 125959 0 144642 0 11181 0 16075 0 14631 0 312488 0 0 0 MARK MOE MD BOARD MEMBER/PHYSICIAN 271018 0 53172 0 581 0 15563 0 21225 0 361559 0 0 0 STEVEN SMITH Treasurer/CFO 0 136022 0 16447 0 3047 0 9519 0 23258 0 188293 0 0 DAVID EDGERTON JR PHYSICIAN 588914 0 16498 0 2284 0 16075 0 23431 0 647202 0 0 0 PAUL JOHNSON PHYSICIAN 575283 0 306546 0 840 0 16075 0 23431 0 922175 0 0 0 DAVID JORGENSEN PHYSICIAN 323278 0 402762 0 5544 0 16075 0 23431 0 771090 0 0 0 SAUNG PARK PHYSICIAN 585023 0 0 0 1906 0 6625 0 9058 0 602612 0 0 0 PHILIP PROSAPIO PHYSICIAN 257466 0 287093 0 3612 0 15641 0 16018 0 579830 0 0 0 Schedule J, Part I, Line 4a POST-TERMINATION PAYMENTS POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Compensation for the top management official was established and paid by Catholic Health Initiatives (CHI), a related organization. CHI used the following to establish the top management official's compensation: (1) Compensation Committee; (2) Independent Compensation Consultant; (3) Written Employment Contracts; (4) Compensation Survey or Study; (5) Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan DURING THE 2017 CALENDAR YEAR CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: JEFFREY DROP AND LEE BOYLES. DUE TO THE "SUPER" VESTING RULES UNDER THE CHI DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS AGE, YEARS OF SERVICE OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2017 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2017, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: JEFFREY DROP - $94,433 LEE BOYLES - $13,486 STEPHANIE KRAY SPOUSE OF FORMER DIRECTOR 181545 EMPLOYEE PAYROLL WAGES false Form 990, Part III, Line 1 ORGANIZATION'S MISSION The mission of the Corporation is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges the Corporation to emphasize human dignity and social justice as it creates healthier communities. The Corporation, sponsored by a lay-religious partnership, calls other Catholic sponsors and systems to unite to ensure the future of Catholic health care. To fulfill this mission, the Corporation, as a values-based organization, will assure the integrity of the ministry in both current and developing organizations and activities; research and develop new ministries that integrate health, education, pastoral, and social services; promote leadership development and formation for ministry throughout the entire organization; advocate for systemic changes with specific concern for persons who are poor, alienated, and underserved; and steward resources by general oversight of the entire organization. Form 990, Part VI, Line 16b JOINT VENTURE POLICY UNITY FAMILY HEALTHCARE HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER CHI'S SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S-LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. ANY JOINT VENTURE AGREEMENTS THAT DO NOT CONFORM TO THE MODEL AGREEMENT ARE GENERALLY REVIEWED BY COUNSEL. Form 990, Part VI, Line 15a PROCESS FOR DETERMINING COMPENSATION OF TOP MANAGEMENT OFFICIAL THE ORGANIZATION'S CEO'S COMPENSATION IS PAID BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI HAS A DEFINED COMPENSATION PHILOSOPHY. BOTH THE EXECUTIVE AND NON-EXECUTIVE COMPENSATION STRUCTURES AND RANGES ARE REVIEWED ANNUALLY IN COMPARISON TO MARKET DATA. CHI USES THE KORN FERRY HAY GROUP AS THE INDEPENDENT THIRD PARTY TO ASSESS EXECUTIVE COMPENSATION PROGRAMS AND TO ENSURE THE REASONABLENESS OF ACTUAL SALARIES AND TOTAL COMPENSATION PACKAGES. COMPENSATION OF THE SENIOR MOST EXECUTIVES IS REVIEWED ANNUALLY. THE KORN FERRY HAY GROUP REVIEWS BOTH CASH AND TOTAL COMPENSATION FOR OVERALL REASONABLENESS, FOR ADHERENCE TO CHI'S COMPENSATION PHILOSOPHY, AND FOR COMPARABILITY TO THE NOT-FOR-PROFIT HEALTHCARE MARKET. THIS INDEPENDENT REVIEW IS DELIVERED BY KORN FERRY HAY GROUP TO THE HR COMMITTEE OF THE CHI BOARD OF STEWARDSHIP TRUSTEES ANNUALLY AT THEIR SEPTEMBER MEETING AND MINUTES ARE SHARED WITH THE FULL BOARD AT THE DECEMBER MEETING. THE LAST REVIEW WAS SEPTEMBER 11, 2017. IN ADDITION, KORN FERRY HAY GROUP COMPLETED A COMPREHENSIVE REVIEW OF ALL POSITIONS AT THE LEVEL OF VICE PRESIDENT AND ABOVE IN THE FALL OF 2014 TO DETERMINE AND VALIDATE APPROPRIATE COMPENSATION LEVELS. THESE LEVELS HAVE BEEN REVIEWED ANNUALLY SINCE AND REVISED BASED ON MARKET DATA, WHERE APPLICABLE. Form 990, Part VI, Line 12c Conflict of Interest Policy The Board Chair or designee shall make such 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 will assume the Chair's role outlined in the COI Policy. Based on review and evaluation of the relevant facts and circumstances, the Board Chair will make 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, will be made. The Board Chair shall then make an appropriate report to the Executive Committee of the Board concerning such 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 within the COI Policy, the matter shall be submitted to the Board's Executive Committee, which shall make a final determination as to the matter presented. Such determination, including relevant facts and circumstances, will be reflected in the Executive Committee minutes and will be reported to the Board. The Board shall carefully scrutinize 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 Corporate Officer either: * Has a material financial interest; or * Is a Trustee or Corporate Officer of the other party (other than a CHI-affiliated organization). The Board must approve the transaction by a majority of the Trustees on the Board, without counting the vote of any individual who has an interest in the transaction. 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 shall act no more or less favorably than it would in reviewing transactions with unrelated third parties. The transaction will not be approved unless the Board determines that the transaction is fair to CHI or the CHI Entity. The Board shall carefully review and scrutinize 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.). By a majority vote of the disinterested Trustees, the Board shall take whatever action is deemed appropriate with respect to the Trustee or Corporate Officer under the circumstances, including possible disciplinary or corrective action, in order to best protect the interests of CHI or the CHI Entity. The Board should consult with the General Counsel of CHI or his or her designee when considering disciplinary or corrective action. When any conflict of interest is considered by the Board, the Trustee or Corporate Officer, as appropriate, must disclose all of the material facts to the Board. The Trustee shall not vote and the Trustee or Corporate Officer shall not use his or her personal influence on the 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 of significant importance. The Trustee or Corporate Officer shall be excused from the meeting during discussion and vote on the conflict of interest. Minutes of the Board shall reflect the following: 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. If the Board reasonably believes that a Trustee or Corporate Officer has failed to disclose either an actual or potential conflict of interest, or all material facts surrounding an actual or possible conflict as required by the COI Policy, the Trustee or Corporate Officer will be given an opportunity to explain such alleged failure to disclose. After hearing the response of the Trustee or Corporate Officer, the Board will conduct such additional investigation as may be appropriate. If the Board determines that the Trustee or Corporate Officer has in fact failed to disclose as required by the COI Policy, the Board shall take appropriate disciplinary or corrective action. All determinations of conflicts of interest are reported as required by law, regulations, and CHI policy. Form 990, Part VI, Line 1a Delegate broad authority to a committee Pursuant to Section 8.6 of the bylaws of Unity Family Healthcare, the Executive Committee shall consist of only directors of the corporation and shall be composed of the Chairperson, Vice Chairperson, and the President and CEO, each of whom shall serve as an ex officio voting member of the Executive Committee. Each individual appointed shall serve a term of one year or until his or her successor is duly appointed by the Board of Directors. Except as provided by law, the Executive Committee shall have and may exercise such powers as may be delegated to it by the board of directors. Additionally, the Executive Committee shall have and may exercise such powers to transact routine business of the corporation in the interim period between regularly scheduled meetings of the board of directors, provided that such actions taken shall be consistent with and not conflict with any actions or policies of the board of directors or of the corporate member, with the bylaws, or with applicable laws. Form 990, Part VI, Line 6 Classes of members or stockholders The organization's sole corporate member is Catholic Health Initiatives, a Colorado non-profit corporation. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body The sole corporate member has the power to appoint, replace or remove the members of the board of directors. (CHCF Reserved Rights) Except as otherwise provided in the Corporation's Articles of Incorporation or the laws of the State of organization, Catholic Health Care Federation ("CHCF") shall have such rights as are reserved to the Corporate Member, acting in its capacity as the membership body of CHCF, under the Governance Matrix. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The organization's sole corporate member is Catholic Health Initiatives ("CHI"). Pursuant to Section 5.5.1 of the organization's bylaws, the Corporate Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: - Substantial change in the mission or philosophy of Unity Family Healthcare ("UFH"); - Amendment of the corporate documents of UFH; - Approve members of the UFH board; - Removal of a member of the governing body of UFH; - Approval of issuance of debt by UFH; - Approval of participation of UFH in a joint venture; - Approval of formation of a new corporation by UFH; - Approval of a merger involving UFH; - Approval of the sale of all or substantially all of the assets of UFH; - To require the transfer of assets by UFH to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts; and - Adoption of long range and strategic plans for UFH. Pursuant to Section 5.5.2 of the organization's bylaws, CHI may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. (CHCF Reserved Rights) Except as otherwise provided in the Corporation's Articles of Incorporation or the laws of the State of organization, Catholic Health Care Federation ("CHCF") shall have such rights as are reserved to the Corporate Member, acting in its capacity as the membership body of CHCF, under the Governance Matrix. Form 990, Part VI, Line 11b Review of form 990 by governing body Unity Family Healthcare's VP of Finance is responsible for reviewing the Form 990 as prepared by the CHI tax department. The Form 990 is posted to a community board portal where all board members are able to access and review prior to filing. Subsequent to the return being provided to the board 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 board. Form 990, Part VI, Line 12c Conflict of interest policy Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy (the "Policy") in place to maintain the integrity of all of its activities. The Policy applies to CHI Board of Stewardship Trustees and members of its committees; all CHI Entity board and board committee members; all CHI employees; and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure review process. Each Person must 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 where the Person may be in doubt, a full disclosure should be made to permit an impartial and objective determination. In addition to the general ongoing obligation, there are initial disclosure obligations. At the time of initial appointment, a copy of the Policy shall be distributed to the board or committee member along with a conflict of interest disclosure. The board or committee member will complete and submit the disclosure. The completed disclosure shall be maintained in confidence and access shall be limited to persons who have a reasonable need to know the contents. At the time of hiring, a copy of the Policy shall be distributed to all Employees. In addition, a conflict of interest disclosure will be provided. The Employee must complete and submit a conflict of interest disclosure. The completed disclosure shall be maintained in confidence and access shall be limited to persons who have a reasonable need to know the contents. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. On an annual basis, the following Persons must complete a new conflict of interest disclosure: * Board and board committee members; * Employees at the level of vice president and above; * Researchers; * Supply Chain Employees at the level of vice president and above and those employees involved in contracting regardless of employment level; * Other Employees as deemed applicable by CHI Leadership; Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC"), National or Regional Legal Services, National, Entity, or Research Corporate Responsibility Program, or the Executive Committee of the Board or Board Chair, for review depending on the position of the person involved. Among the factors that should be considered in determining whether a conflict exists are the nature and magnitude of the opportunity, transaction or arrangement, the degree to which it is related to CHI's business, whether the Person with the conflict is the ultimate decision-maker or holds significant influence over the ultimate decision-maker (i.e., degree of independence of the decision-making process), the unique nature of the opportunity, transaction or arrangement, the existence of other viable alternatives and the quality of those alternatives, and what is customary and reasonable in the health care or research industry. When a Person has, or is considering initiating, a business interest or relationship outside of CHI but is uncertain whether the interest constitutes a conflict of interest requiring disclosure under this Policy, the Person should consult with local Corporate Responsibility Program (CRP) staff or CHI Legal Services Group (LSG) staff, as appropriate. As appropriate, a COI management plan will be developed. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such COI management plan in collaboration with local CRP staff or CHI LSG staff, as appropriate. This plan will include documentation of the C-CIRC's determinations and recommendations. As necessary, reports to an appropriate governmental agency or sponsor will be made according to the relevant appendices to this Policy to provide required information regarding how the conflict of interest will be managed, reduced, or eliminated. Designated CHI Entity staff are responsible for monitoring the COI management plan and for documenting monitoring activities. At its sole discretion, a CHI 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. The C-CIRC will determine whether a disclosed or otherwise identified interest is a conflict of interest. If the C-CIRC determines that a potential or actual conflict of interest exists that does not currently have appropriate controls to address the conflict of interest, it may recommend that the disclosing Person be allowed to participate in the activity or transaction subject to restrictions as outlined in a written COI management plan. All determinations of conflicts of interest will be reported as required by law, regulations, and CHI policy. If a Person, other than a board or board committee member or corporate officer, required to complete a COI disclosure 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 following steps should be followed. Within a reasonable period of time after receiving notice of the C-CIRC's decision, the Person must present the matter to the Person's immediate direct manager or supervisor (or in the case of a Researcher, to [fill in the title or position to whom Researchers report]) and request reconsideration, submitting at that time any new or additional information that may support or recommend reconsideration. If the Person's manager individually or in consultation with the manager's Vice President (or higher if the manager is a Vice President) finds that new information supporting reconsideration has been presented, the manager will contact local or National CRP staff, as appropriate, and request that the matter be re-presented to the C-CIRC. The C-CIRC will be reconvened for this purpose and, following such reconsideration, issue a final determination. This appeals process is intended to be narrowly applied, as Persons seeking conflict of interest exemptions or exceptions are expected to offer all available information supporting an exemption or exception at the time the matter is first presented to the C-CIRC. Management of actual or potential conflicts of interest of board or board committee members and corporate officers will be determined by the appropriate board, as reflected in the Policy. Reviews and determinations involving board and board committee members and corporate officers will be the responsibility of the board, board executive committee, or board chair, with guidance from the Legal Services Group (LSG). Each Trustee and Corporate Officer must promptly and fully report to the Board Chair situations that may create a conflict of interest when he or she becomes aware of such situations. In any situation when a Trustee or Corporate Officer is in doubt, full disclosure should be made to permit an impartial and objective determination. A written record of the disclosure will be made. In addition to the ongoing disclosure obligation, all Trustees and Corporate Officers shall complete a COI disclosure questionnaire on an annual basis. A copy of the COI Policy shall be available to Trustees and Corporate Officers. Definitions of terms used in the disclosure questionnaire/form shall also be included. Each Trustee and Corporate Officer must promptly complete the COI disclosure. COI disclosures that involve no disclosures of conflicts of interest will not require review. Disclosures of perceived, potential or actual conflicts of interest on the COI questionnaire involving financial interests will be reviewed by National or Regional LSG. Form 990, Part VI, Line 15b Process to establish compensation of other employees It is the policy of Unity Family Healthcare that each executive compensation arrangement between Unity Family Healthcare and any person of substantial influence shall be targeted at the 65th percentile of total executive remuneration for comparably sized tax-exempt organizations in the health care industry. The Fargo Division meets annually to review and approve the compensation of all Senior Leadership Team members, including other officers and key employees. In addition, the CEO presents a recommendation and supporting documentation to the committee for all other Senior Leadership Team positions based on survey data from the hospital association and other data sources for comparable positions. Divisional HR reports to the board for CFO and CEO compensation. Executive compensation arrangements with any physician who is a person of substantial influence (i.e. also a voting board member) are not subject to this policy, but shall be reviewed and approved in accordance with Unity Family Healthcare's physician transaction review policy. According to the policy, all terms of the physician employment contracts, including any and all compensation matters, are reviewed and approved by the Employed Physician Integration Council (EPIC) and Physician Transaction Review Committee (PTRC). Only after EPIC recommendation and PTRC approval is a physician employment contract created. In addition, during the tax year ended 6/30/18, various officers and directors received compensation from related organizations. Any executive compensation paid to officers and directors by related organizations was set by the related organization's compensation committee utilizing both an independent consultant and comparability studies to determine compensation. Form 990, Part VI, Line 19 Required documents available to the public The Organization's conflict of interest policy and governing documents are not publicly available. The organization's financial statements are included in Catholic Health Initiatives' consolidated audited financial statements that are available at www.CatholicHealthInitiatives.org. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 94076, Related or Exempt Function Revenue: , Unrelated Business Revenue: 40, Revenue Excluded from Tax Under Sections 512, 513, or 514: 94036; Form 990, Part IX, Line 11g Other Fees Other Fees for Services - Total Expense: 3892714, Program Service Expense: 873251, Management and General Expenses: 3019463, Fundraising Expenses: 0; Consulting - Total Expense: 65278, Program Service Expense: 48959, Management and General Expenses: 16320, Fundraising Expenses: ; Contract Services - Total Expense: 4683479, Program Service Expense: 3512609, Management and General Expenses: 1170870, Fundraising Expenses: ; Contract Labor - Total Expense: 163491, Program Service Expense: 122618, Management and General Expenses: 40873, Fundraising Expenses: ; Purchased Services - Total Expense: 5286419, Program Service Expense: 3968671, Management and General Expenses: 1317748, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Capital Resource Pool Contribution - -491730; ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HEALTHCARE NE 501(c)(3) 3 ACH true ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true ALEGENT CREIGHTON HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING NE 501(c)(3) 7 ACH true ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HEALTHCARE IA 501(c)(3) 3 CHI NEBRASKA true ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HEALTHCARE IA 501(c)(3) 3 CHI NEBRASKA true ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(c)(3) 10 CHI true APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(c)(3) 10 SFH true 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 true BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON TX 77030 760458535 PHYSICIANS TX 501(c)(3) 3 SLHS true BELLEVILLE ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 274005511 HEALTHCARE TX 501(c)(3) 3 SHSC true BISHOP DRUMM RETIREMENT CENTER 5837 Winwood Dr Johnston IA 50131 420725196 LTERM CARE IA 501(c)(3) 10 CHI-IA CORP true BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232187242 HEALTHCARE CO 501(c)(3) Type I CHI true BRAZOSPORT HEALTH FOUNDATION INC 1 West Way Ct LAKE JACKSON TX 77566 760080110 FUNDRAISING TX 501(c)(3) Type I BRHS true BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 HEALTHCARE TX 501(c)(3) 3 BRHS true BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HEALTHCARE TX 501(c)(3) 3 SJSC true BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 HEALTHCARE TX 501(c)(3) 10 SJSC true CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HEALTHCARE ND 501(c)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES - COLORADO 9100 East Mineral Circle Centennial CO 80112 840405257 HEALTHCARE CO 501(c)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES IA 50314 420680448 HEALTHCARE IA 501(c)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS CO 80920 840902211 FUNDRAISING CO 501(c)(3) 7 CHIC true CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 1150 Kelly Johnson Blvd 204 COLORADO SPRINGS CO 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