2019-05-15T12:02:56-05:00 2018-06-30 470617373 CATHOLIC HEALTH INITIATIVES 198 Inverness Drive West ENGLEWOOD CO 80112 990 2017-07-01 450231183 Mercy Medical Center MERC 7017747400 1301 15th Ave W Williston ND 58801 Joseph Ruark CFO 2019-05-15 true MARK STOCKI P00642127 3032989100 2017 2019-02-21 02:37:17Z CHI St Alexius Health Williston Medical Center Dan Bjerknes 1301 15th Ave W Williston ND 58801 105284394 false 0928 X www.chistalexiushealth.org/williston X 1920 ND MERCY MEDICAL CENTER IS A CRITICAL ACCESS HOSPITAL SERVING A LARGE GEOGRAPHICAL AREA. COMMUNITY BENEFITS INCLUDE: UNCOMPENSATED CARE, MEDICAL EDUCATION AND AWARENESS, SUPPORT SERVICES, AND COMMUNITY OUTREACH. 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. 15 8 456 85 100056 -79287 1623472 400506 94819749 102287710 1502630 8688 1813760 2587490 99759611 105284394 1880234 3030104 0 35068614 35318260 0 499496 59029681 60192002 95978529 98540366 3781082 6744028 92100458 99739169 53404004 54803068 38696454 44936101 SEE SCHEDULE O. false false 83761632 3030104 102287710 SEE SCHEDULE H 83761632 true true false true false false false false false true false false true true true false true false false false false false false false false true true true true true false false false false false false false false false false false false false true true true false false true 0 0 456 true true true false false false false false true false false false X 15 8 false false false false true true true true true false false true true true true true false false true false ND X Joseph Ruark 7017747408 1301 15th Ave West Williston ND 58801 JOHN GIESE Chair 1.0 8.0 X X 0 0 0 MICHAEL LEFOR Vice Chair 1.0 6.0 X X 0 0 0 SR NANCY MILLER OSB Secretary / Treasurer 1.0 7.0 X X 0 0 0 TIMOTHY BOPP MD Board Member 1.0 7.0 X 0 0 0 MICHAEL L CASSIDY MD Board Member 1.0 40.0 X 0 429579 32246 Kevin Dahmen MD Board Member 1.0 40.0 X 0 580017 48335 VERNON DOSCH Board Member 1.0 7.0 X 0 0 0 JEFFREY DROP Director/CHI SVP DIVISION OFFICER 1.0 59.0 X 0 1429849 33844 TESSA MARBURGER MD Board Member 40.0 1.0 X 350798 0 24524 LESLIE B OLIVER Board Member 1.0 7.0 X 0 0 0 Todd Preszler MD Board Member 1.0 40.0 X 0 485466 33711 Brandon Price MD Board Member 1.0 40.0 X 0 244629 31443 KURT SCHLEY Director 1.0 60.0 X 0 545053 79911 PATRICK SOGARD BOARD MEMBER 1.0 5.0 X 0 0 0 SR THOMAS WELDER Board Member 1.0 7.0 X 0 0 0 Dan Bjerknes President & CEO 40.0 1.0 X 167814 0 30723 MATT GRIMSHAW Ex-officio/PRESIDENT & CEO (Partial Year) 1.0 40.0 X 0 508994 24964 JOSEPH RUARK CFO/VP OF FINANCE 40.0 22.0 X 0 177640 32985 Ryan Hegge MD Radiologist 40.0 0 X 850427 0 31019 THERESA Hegge MD Plastic- Reconstruction Surgeon 40.0 5.0 X 657222 0 23945 Fareed Kadum MD OB/GYN-SURGEON 40.0 0 X 733928 0 32496 Roxanne Keene MD Physician 40.0 0 X 907886 0 37129 ASHLEY LEMERE GENERAL SURGEON 40.0 0 X 447139 0 28294 Douglas Clark MD Physician, Former HCE 0.0 60.0 X 0 844212 33661 Lori Hahn VP PATIENT CARE SERVICES/Former KE 40.0 0 X 149098 0 9718 4264312 5245439 568948 48 true true false PATIENTS FIRST ER MEDICINE 2907 KERRY FOREST PARKWAY STE 200 TALLAHASSEE FL 32039 MEDICAL SERVICES 2761250 Guardian Healthcare Providers 105 West Park Dr Ste 100 Brentwood TN 370275062 Locum Providers 2077235 AMN Healthcare 12400 High Bluff Drive San Diego CA 92130 Staffing Services 1522035 SHEARWATER HEALTH INC 20 Burton Hills Blvd Suite 400 Nashville TN 37215 Staffing Services 1074101 INTERSTAFF INC PO Box 4652 Dept 980 HOUSTON TX 772104652 Staffing Services 897934 22 X 0 0 0 371113 13125 16268 0 400506 Patient Services 900099 101943233 101943233 0 0 Meaningful Use 900099 168298 168298 0 0 Rental Income 900099 176179 176179 0 0 0 0 0 0 0 0 0 0 0 0 0 0 102287710 3000 0 0 3000 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5688 0 0 0 5688 5688 0 0 5688 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Pharmacy Services 446110 2186735 0 0 2186735 Printing & Nutrition 900099 98281 0 98281 0 Services Sold 900099 52236 0 1775 50461 250238 0 0 250238 2587490 105284394 102287710 100056 2496122 X 24493 24493 3005611 3005611 608651 600460 8191 28888018 27423561 1170088 294369 1233860 1171156 50089 12615 2680092 2544913 108057 27122 1907639 1812257 76306 19076 141722 141722 4363 4363 17868036 16081232 1786803 0 236546 106446 130100 1374881 1319886 41246 13749 8413566 8413566 2262484 1809987 452497 227884 202817 22788 2279 18627 12667 5774 186 681104 681104 1355376 1355376 4543258 4452393 90865 596622 167054 429568 Medical Supplies 10993402 10993402 Bad debts 10304013 10304013 Repairs and maintenance 515929 515929 Recruitment and relocation 281871 281871 372318 356826 15492 0 98540366 83761632 14279237 499496 0 4790 0 0 14335774 16758881 0 0 0 0 2026657 2495894 406554 10916 86621142 44676238 44697183 41944904 0 0 0 0 30634290 38523784 92100458 99739169 6631633 8428931 0 960950 1086635 0 0 0 1727080 1386427 0 44084341 43901075 53404004 54803068 X 38696454 44936101 0 0 0 0 38696454 44936101 92100458 99739169 X 6744028 -504381 X false true X true false X false false false false false true 4363 false false false 4363 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Line 1F: The portion of organization dues that are related to lobbying are as follows: American Hospital Association - $1,172 Catholic Health Association - $1,027 North Dakota Healthcare Association - $2,164 Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Line 1F: The portion of organization dues that are related to lobbying are as follows: American Hospital Association - $1,172 Catholic Health Association - $1,027 North Dakota Healthcare Association - $2,164 328028 328028 43617100 21875739 21741361 1082563 396940 685623 38604416 21681427 16922989 2989035 722132 2266903 41944904 Intercompany Receivables 38098646 INVESTMENTS IN UNCONSOLIDATED ORGS 360000 deposits 65138 Assets Held For Sale 38523784 INTERCOMPANY PAYABLES 28365615 OTHER LIABILITIES 1917905 CHI DEBT 8069595 Deferred Gain on Sale/Leasback-LT 5547960 43901075 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Mercy Medical Center'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." true true X true X 300 true X true true false true true 1211 1512930 0 1512930 0.0171 0 0 0 0 0.0 0 0 0 0 0.0 0 1211 1512930 0 1512930 0.0171 6 1917 315467 0 315467 0.0036 2 983 10180 0 10180 0.0001 1 1346 14495 0 14495 0.0002 0 0 0 0 0 0.0 1 0 4386 0 4386 0.0000 10 4246 344528 0 344528 0.0039 10 5457 1857458 0 1857458 0.0211 0 0.0 0 0.0 1 0 225 0 225 0.0000 0 0.0 0 0.0 1 20 1775 0 1775 0.0000 0 0.0 0 0.0 0 0.0 2 20 2000 0 2000 0.0000 true 10304013 0 14765111 14804260 -39149 X true true 1 1 MERCY MEDICAL CENTER 1301 15TH AVE W WILLISTON ND 58801 https://www.chistalexiushealth.org/locations/williston 5052A X X X X OP CLINICS (PSYCH, FAMILY PRACTICE, GENERAL SURGERY, ORTHO,PAIN MANAGEMENT) MERCY MEDICAL CENTER 1 false false true X X X X X X X X X 15 true false true true X https://www.chistalexiushealth.org/about-us/community-health-assessments 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.chistalexiushealth.org/patients-visitors/our-patients/financial-assistance X https://www.chistalexiushealth.org/patients-visitors/our-patients/financial-assistance X https://www.chistalexiushealth.org/patients-visitors/our-patients/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 and identified through the CHNA. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - MERCY MEDICAL CENTER. To help inform future decisions and strategic planning, Catholic Health Initiatives (CHI) St. Alexius Health - Williston Medical Center and Upper Missouri Health District Health Unit conducted a community health needs assessment. The Center for Rural Health (CRH) at the University of North Dakota School of Medicine and Health Sciences facilitated the assessment process, which included the solicitation of input from area community members and health care professionals as well as analysis of community health-related data. To gather feedback from the community, residents of the counties were given the chance to participate in a survey. Approximately 433 residents of Williams County took the survey. Additional information was collected through 5 key informant interviews with community leaders. The CHNA team conducted one-on-one interviews with five key informants which were conducted in person on March 1, 2016. Interviews were held with selected members of the Community Group as well as other individuals who could provide insights into the community's health needs. Included among the informants were public health professionals with several years of direct experience in the community, including working with medically underserved, low income, minority populations, as well as populations with chronic diseases. The input from all of these residents represented the broad interests of the communities of Williams County. Together with secondary data gathered from a wide range of sources, the information gathered presents a snapshot of health needs and concerns in the community. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - MERCY MEDICAL CENTER. The CHNA was conducted with both St. Alexius Health - Williston Medical Center and Upper Missouri Health District Health Unit. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Mercy Medical Center. The goals below are representative of issues raised by the survey respondents, focus group, and key informants, as well as the secondary research of the community's health. Goal One: Improve access to Addiction Resources Rationale: this is a very pressing need in our five county service area, but also a seemingly intractable problem . . . Finding providers for these services and also a workable model for delivering those services is a big challenge. We pledged support toward Williams County's efforts to evaluate, apply, and qualify for the Heartview Foundation Screening and Recovery Grant. This grant would have offered varying levels of addiction services locally and through technology in cooperation with the Foundation's center in Bismarck. The grant application was completed and submitted by Holly Snellings, Director, Williams County Social Services. Applications were reviewed at the end of September and the beginning of October. Inexplicably, our community was not chosen. We planned to share leaders to support the community coalition in implementing the Heartview program if selected; and provide hospital and clinic resources to ensure the success of the program. A. We will continue to work with local coalitions toward finding solutions for our community. Goal Two: Improve Access to Mental Health Services for the greater Williston Community Rationale: similar to goal one, this was also identified as a great need for our area, but also dependent upon finding providers of mental health services who are willing to move to the area or provide services here. Recruitment is being pursued at the Division level and locally, and has been for years. This is a difficult but necessary goal to pursue. A. Continue ongoing efforts to recruit Psychiatrists to serve the Williston area. B. Continue ongoing efforts to recruit Advanced Practice Clinicians with Mental Health training. C. Improve access to E-Psych for in-patients and out-patients. D. Equip "First Responders" with some level of Mental Health instruction. Goal Three: Increase access to healthcare for the greater Williston Community. Rationale: The rapid growth of the Williston area has made it more difficult to schedule appointments in a timely manner (or as quickly as our customers prefer). Increasing the number of providers is helping this situation and increasing hours for ancillary services will also improve timeliness of patient care. A. Continue recruiting Primary Care providers. B. Continue recruitment of Specialty Physicians. C. Expand hours in CHI St Alexius Health Williston outpatient service areas. Goal Four: Improve consistency of Emergency Department Services A. Solidify Emergency Room Provider schedule by forming new Physician Group. B. Assist new group in recruiting solid providers Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - Mercy Medical Center. 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. 3 Craven-Hagan Clinic 1213 15th Avenue West Williston ND 58801 Medical Clinic Urology Clinic 1219 Knoll Street Williston ND 58801 Medical Clinic Specialty Clinic 1500 14th St West Suite 300 Williston ND 58801 Medical Clinic Schedule H, Part VI Part II and Part VI Lines 2, 4, & 5: Needs assessment and community information INTRODUCTION I. ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE The Mercy Medical Center, doing business as CHI St Alexius Health Williston Medical Center, in Williston, ND, is a 25-bed critical access hospital, with a service population of more than 70,000 people (drawn from portions of three North Dakota counties and three Montana counties). CHI St Alexius Health Williston Medical Center (the Medical Center) roots originated in Dublin, Ireland, where Catherine McCauley established the Sisters of Mercy in 1831. Catherine's mission was to give back to the community by providing for the needs of the poor. To bring health care to western North Dakota, the community invited the Sisters of Mercy from Devils Lake to establish Mercy Hospital in 1920. Since then, Mercy Hospital has continued the legacy of giving back to the communities it serves and carrying on the mission of providing for those in need. In 1974, Mercy Hospital moved to its current location at 1301 15th Avenue West. Along with the move came new changes and an expansion of services. Today, the Medical Center is composed of general acute care services, Primary Care (Family and Pediatrics Clinics), St Alexius Williston Multi-Specialty Clinic, St Alexius Williston Women's Health Clinic, Occupational Health, Interventional Pain Management, St Alexius Williston Urology Clinic, St Alexius Williston Residency Program Clinic, Rehab Services, Outpatient Behavioral Health Services, and the Leonard P. Nelson Family Cancer Treatment Center. The Medical Center provides health care for a region that includes large parts of Western North Dakota and Eastern Montana and provides employment for nearly 450 people. In 1996, the Medical Center became a part of the Catholic Health Initiatives (CHI) system. The Medical Center and CHI continue the essential health care commitment of its founding congregations: To build healthy communities by caring for the vulnerable; caring for the whole person in body, mind and spirit; and going outside the walls of its facilities to care for people in need. The mission of the Medical Center and Catholic Health Initiatives is to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities. Our vision is that the Medical Center will be the preferred regional health care provider and work community, delivering high quality, patient-centered care and excellent service in a welcoming and safe environment. We hold true to our Core Values of Reverence, Integrity, Compassion, and Excellence, and in doing so we strive to collaborate with regional organizations, agencies, and entities to provide community benefits so that together we can build a healthier community. The following report outlines the community benefits and services the Medical Center has provided to the region this past year. As a non-profit, Catholic health care organization, the Medical Center treats all patients regardless of their ability to pay. This is consistent with our Mission and Core Values. In addition, the Medical Center provides thousands of dollars in resources, including time and contributions to many organizations throughout the region. Community service has been a vital component of the organization since its inception. The Medical Center is included in the Official Catholic Directory as a tax-exempt hospital. The Medical Center operates a 24-hour emergency room 365 days per year. The emergency room is open to all individuals. The Medical Center has an open medical staff, participates in Medicare and Medicaid, and has an active charity care program. II. COMMUNITY BENEFIT APPROACH Throughout its history, the Medical Center has been intimately involved in community health collaboration and has played a key role in evaluating area health issues, setting priorities and plans for improvement. The Medical Center continues our deep commitment and involvement in the community's health. The Medical Center's Community Benefit Plan is based on our understanding of unique community needs derived from collaborative needs assessments, focus groups, and surveys conducted with our community partners. Our Community Health Needs Assessments are located on our website. The health of the community is not the responsibility of any one entity, but rather requires the coordinated efforts of many entities - public and private - to realize an improved health status of a community. The Medical Center has been working with public and private entities in our service area to measure and improve the health status of the community. When examining demographic information about this area, it is important to keep in mind that because of the oil boom, downturn, and now return, area population and demographics have been changing very rapidly in the last few years. Interviews with key community leaders revealed that few believe we are yet to have an accurate means to measure the population. Community leaders believe the Census data significantly understates the true nature of how many people are living in the area, due not only to rapid increase in population but also because many of those "living" in the area come for a few weeks at a time, and then return to a home base during off work rotations. The general demographic and geographic data are about Divide, McKenzie, and Williams counties, which comprise most of the North Dakota portion of the Medical Center's service area. The data that we do have indicates that Divide County has a greater percentage of individuals aged 65 or older (24.9%) than the North Dakota average (15.0%), the more populous counties of McKenzie and Williams have a lower percentage of residents 65 or older than the state average (9.3% and 9.8%, respectively). McKenzie and Williams counties have a larger percentage of children under the age of 18 (30.8%, and 27.9% respectively) than the state average (23.3%), which may indicate a need to develop more health care services geared toward children. All three counties lag the state average in terms of individuals with a bachelor's degree or higher (28.9%). The rate of Williams County residents with a bachelor's degree or higher trails the state average by more than six percentage points, with Divide County trailing by more than nine percentage points, and McKenzie County trailing the state average by almost four percentage points. High school graduation rates tend to be closer to the state average. The educational backgrounds of area residents can affect a health care facility's ability to find qualified staff members. Williston State College, a two-year public college, offers associate degrees in health professions such as administrative assistant medical, health information management, medical/billing coding, medical transcription, mental health/addictions technician, nursing, and speech language pathology assistant. It also assists those seeking LPN or RN nursing degrees by connecting to UND via distance learning for its students, most of whom do clinical rotations at the hospital. Schedule H, Part VI Part II and Part VI Lines 2, 4, & 5: Needs assessment and community information III. QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT Benefits for Living in Poverty: Financial Assistance - 1,211 persons served, $1,512,929 Community Services: * Community Health Education - 282 persons served, $7,642 * Community Based Clinical Services - 0 persons served, $153,144 * Healthcare Support Services - 1,635 persons served, $153,281 Totals for community services - 1,917 persons served, $314,067 Totals for living in poverty - 3,128 persons served, $1,826,996 Benefits for Broader Community: Health Professions Education - 983 persons served, $10,180 Subsidized Health Services - 1,346 persons served, $14,495 Financial and In-Kind Contributions - 0 persons served, $4,386 Community Building Activities: * Community Support - 0 persons served, $225 * Coalition Building - 20 people served, $1,775 Community Benefit Operations - 0 people served, $1,400 Benefits for Broader Community Total - 2,349 persons served, $32,461 Total Community Benefit - 5,477 persons served, $1,859,457 Uncompensated Care for the Poor Community benefit programs for the poor are geared to reducing morbidity and mortality in beneficiaries of Medicaid or state or local indigent programs. Our best-known Community Benefit program is the financial assistance we provide to patients who cannot afford to pay for their care. The process is extremely confidential, and our goal is to award financial assistance rather than turn patients over to collection for health care bills. The financial assistance program applies to uninsured/underinsured patients who come to our facilities for treatment. Financial assistance is free or discounted health and health-related services provided to persons who cannot afford to pay for medically necessary health care. Under the financial assistance policy, the Medical Center provides financial relief to patients who qualify based on a comparison of their financial resources and/or income to Federal Poverty Guidelines. The program is designed specifically for non-elective care patients whose household financial resources and/or income are at or below 300 percent of the Federal Poverty Level. Consideration is also given to a patient who has significant or catastrophic medical bills and does not meet the income guidelines. The Medical Center will not delay providing an appropriate medical screening examination required or further medical examination and treatment required, to inquire about the individual's method of payment or insurance status. The Medical Center will not seek, or direct an individual to seek, authorization from the individual's insurance company for screening or stabilization services to be furnished by a physician, or mid-level practitioner until after an appropriate medical screening examination and after any further medical examination and treatment that may be required to stabilize the emergency medical condition. The Medical Center includes information concerning its financial assistance policy on its website (www.chistalexiushealth.org). In addition, financial assistance applications are prominently displayed in obvious locations throughout the hospital, including the emergency room and other patient intake areas, as well as outpatient facilities. Our 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 financial assistance under the financial assistance policy. 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 and procedures including an application for assistance. Our staff will also assist the patient / guarantor with applying for other available coverage (such as Medicare or Medicaid), if necessary. COMMUNITY OUTREACH FOR THE POOR The Medical Center donates excess medical supplies and equipment to ministries in developing nations, through Global Health Ministries. CHI's Fargo Division gathers money, supplies and equipment for an International Sister-to-Sister Hospital partnership with the Indigenous People's Hospital, which opened on May 18, 2012 in Nueva Vizcaya, Philippines. The Medical Center's staff also raise funds each year in conjunction with our division to underwrite shipping costs and other supplies for the IPH. The IPH, located in a remote region of the country, now provides care to impoverished tribal people. The new clinic/ hospital was immediately busy and provided care to more than 600 people on the first day of opening. In addition, our Cancer Treatment Center provides cash and gas cards for those who need to travel for treatments and/or appointments. The Medical Center also collects food and clothing for distribution by the Salvation Army, and Faith United Methodist Church. Both organizations assist people living in poverty with clothing, shelter, meals, utility assistance, and other needs. The Medical Center's employees also participate in an annual School Supply Drive for local elementary schools. This year's drive again provided supplies for each of thirteen area elementary schools. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY The Medical Center is a major employer in the Williston region, and our employees contribute significantly to our community service organizations by donating their time and talents. The Medical Center takes great pride in providing leadership in these important organizations. Hundreds of hours are spent in civic organizations including the Rotary and Lions Clubs, economic development groups such as the Williston Area Development Foundation, Fort Union Association, Chamber of Commerce, Jaycees, Confluence Committee, Workforce Training Advisory Board, Planning and Zoning Commission, United Way board, Williston Ministerial Association, Social Service Board, Governor's Commission on Drugs and Alcohol, Williston Family Shelter Board, Salvation Army Board, and Hometown Williston Committee. Our staff also serve on area Community Boards, and Fire Departments. The Medical Center also provides chapel services to the community to enrich one's spiritual needs. The Medical Center's Primary Care Clinic offers a Sports Physical event each year. Physicians and staff members volunteer their time to provide this valuable service. Students pay a fee, which the clinic donates back to the school of their choice. The Medical Center also participates in many local events that are instrumental in addressing community building needs including the Make-A-Wish Foundation, United Way, Mentors and Friends, Ag Open, health fairs, Bible camps, science fairs, local PTOs, as well as church and youth groups. The Medical Center's employees are active supporters of the Basin United Way campaign. The Medical Center and CHI also sponsor a Violence Prevention program in Williston as part of CHI's commitment to reduce violence in every locale where they have a presence. The Medical Center also provides resources and funding for many rural schools and community organizations to enhance their healthier community initiatives including after prom and after graduation drug and alcohol-free events. COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH Community Health Improvement Services The Medical Center understands its role in providing support services to build a healthier community. The Medical Center's coordinates support groups for patients and families we serve. This past year, the Medical Center sponsored several support programs such as Diabetes Support Group, Weight Loss Support Group, Foot Care Clinics, Grief Support Group, Camp Mend-a-Heart, and the Cancer Support Group. Educational classes include Car Seat Education, Bringing Home Baby, Baby Basics, Breastfeeding Class and Childbirth Classes (Lamaze). In addition, the Medical Center provides hearing screenings for newborns. Schedule H, Part VI Part II and Part VI Lines 2, 4, & 5: Needs assessment and community information The Medical Center also participates in an annual health fair held in conjunction with the Upper Missouri Valley Fair. The Medical Center provided free education such as organ and tissue donation, grief materials, advance directives, proper hand washing, and blood pressure screenings. The Medical Center collaborates with independent physicians and other area health care providers to offer these valuable services to the community. The Medical Center also began the "Lunch and Learn" project in 2014 and offers free educational programs (with lunch) to area residents on various health topics. The Medical Center provides free meeting room space for Parenting Education programs, Cancer Support Group, Diabetes Support Group, and more. The Halloran House, located on the Medical Center's campus, offers patients and their families a local place to stay while being treated in our Leonard P. Nelson Family Cancer Treatment Center or receiving other services at the Medical Center. Given our large geographic area, this service is well received by our patients. Housing and meals at the Halloran House are provided free of charge to those who qualify. Health Professions Education The Medical Center encourages and assists Williston State College to provide a location for their clinical rotations. Both first- and second-year nursing students spend several days each week during the clinical phase of their training. Craven Hagan Clinic provides several internships for Medical and Nursing Students. The Medical Center opened a residency clinic in 2014 with one resident in place; in FY2015, two residents were placed in practice. Beginning in FY2017, three residents are on site seeing patients. In addition, the Medical Center presents scholarships to promote other health occupations. The Medical Center is proud to work with our local high school providing job-shadowing experiences for Health Careers Classes; and many of our staff led presentations at the annual Scrubs Camp held at Williston State College. Scrubs Camp is open to 7th-12th graders from across the county and exposes area youth to all varieties of health careers. Community Building Activities The Medical Center sponsors the closed caption sponsorship for the hearing impaired of the local newscast on KXMD TV. Workforce Development: Physician recruitment is the top priority for our organization as we work to meet the growing health care needs of our population; though our oil-boom related turnover has abated, we continue to recruit a full range of health care personnel to keep our hospital operational. Community Benefit Operations Community benefit operations include costs associated with dedicated staff, community health needs assessment, and other costs associated with community benefit strategy and operations. These hours were not captured well this fiscal year. Dedicated staff hours are counted for the work on Charity Care assisting the patients that are underinsured or uninsured. The mission and community benefit staff continue to build and expand their efforts in providing additional services and ensure employees are tracking their activity. While it is not possible to share all the Medical Center's efforts to give back to the community, this report does outline the large contributions given on behalf of our organization to Williston and the region. The Medical Center, in its tradition of faith and service, will continue to provide community benefits and ultimately build a stronger, safer, and healthier community. The Medical Center, along with its affiliated outpatient facilities are part of Catholic Health Initiatives "CHI". CHI has a written policy (Stewardship Policy No. 15) governing the procedures for determining and informing patients about the entity's financial assistance policy. The hospital facilities included in the filing organization have adopted this policy. The policy states the organization will include information concerning its financial assistance policy on its website. In addition, the Medical Center prominently displays its financial assistance policy in both English and Spanish in obvious locations throughout the hospitals, including the Emergency Rooms and other patient intake areas, as well as in its Outpatient locations. In addition, the Medical Center 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 financial assistance under the Medical Center's financial assistance policy. Upon registration (and once all EMTALA requirements are met), patients who identify as un-insured (and not covered by Medicare or Medicaid) are provided with a packet of information that addresses the financial assistance policy and procedures including an application for assistance. The Medical Center registration clerks read the organization medical assistance policy to those who appear to be incapable of reading and provide translation for non-English speaking individuals. The Medical Center's staff will also assist the parent/guarantor with applying for other available coverage (such as Medicaid), if necessary. Financial counselors assist Medicare eligible patients in enrolling by providing referrals to appropriate government agencies. The Medical Center operates with its wholly owned affiliates and community partners, along with its fundraising arm, the St Alexius Williston Medical Foundation to serve the health care needs of the Williston, North Dakota and area communities. Schedule H, Part I, Line 3c Financial Eligibility Unless eligible for Presumptive Financial Assistance, the following eligibility criteria must be met in order for a patient to qualify for Financial Assistance: * The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. * The patient's Family Income must be at or below 300% of the FPG. * The patient must comply with Patient Cooperation Standards as described [in the FAP]. * The patient must submit a completed Financial Assistance application. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. In particular, presumptive eligibility may be determined on the basis of individual life circumstances that may include: * Recipient of state-funded prescription programs; * Homeless or one who received care from a homeless clinic; * Participation in Women, Infants and Children programs (WIC); * Food stamp eligibility; * Subsidized school lunch program eligibility; * Eligibility for other state or local assistance programs (e.g., Medicaid spend-down); * Low income/subsidized housing is provided as a valid address; or * Patient is deceased with no known estate. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 10304013 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The organization's cost accounting system was used to report financial assistance and community benefits in Part I, Line 7. The organization's cost accounting system addresses all of the patients served by Mercy Medical Center. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE ORGANIZATION HAS REPORTED BAD DEBT EXPENSE AT GROSS CHARGES WRITTEN OFF. THE ORGANIZATION'S BAD DEBT EXPENSE REPRESENTS AMOUNTS BILLED TO PATIENTS THAT WAS DEEMED UNCOLLECTIBLE AND DOES NOT INCLUDE ANY CHARGES THAT WERE ULTIMATELY REIMBURSED OR DISCOUNTED. PATIENT DISCOUNTS ARE RECORDED IN CONTRACTUAL ALLOWANCE OR FINANCIAL ASSISTANCE, AS APPROPRIATE, AS AN OFFSET TO GROSS REVENUE AND ARE NOT INCLUDED IN BAD DEBT EXPENSE. Schedule H, Part III, Line 3 Bad Debt Expense Methodology MERCY MEDICAL CENTER 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 MERCY MEDICAL CENTER 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, taking into consideration 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 MERCY MEDICAL CENTER is designated as a Critical Access Hospital (CAH). CAHs are rural community hospitals that are certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. CAHs are certified under a different set of Medicare Conditions of Participation (CoP). Shortfalls are created when a facility receives payments that are less than the costs of caring for program beneficiaries. Because shortfalls are based on costs, not charges, MERCY MEDICAL CENTER, due to their designation as a CAH, received cost-based reimbursement for Medicare purposes, MERCY MEDICAL CENTER will not experience Medicare related shortfalls. MERCY MEDICAL CENTER believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as "subsidized health services." Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The organization's billing and collections policy applies to all individuals presenting for emergency or other medically necessary care. The policy contains provisions for collecting amounts due from those patients who the organization knows to qualify for financial assistance either through the traditional financial assistance application process or through presumptive eligibility processes. Before engaging in extraordinary collection actions (ECAs) to obtain payment for EMCare, Hospital Facilities must make reasonable efforts through its billing and collections processes, pursuant to Treas. Reg. §1.501(r)-6(c), to determine whether an individual is eligible for Financial Assistance. In no event will an ECA be initiated prior to 120 days from the date the Facility provides the first post-discharge billing statement (i.e., during the Notification Period) unless all reasonable efforts have been made. Hospital Facilities will not refer accounts for collection where the patient has initially applied for Financial Assistance, and the Hospital Facility has not yet made reasonable efforts with respect to the account. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. Patients who qualify for Medicaid are presumed to qualify for full charity write off. Any charges for days or services written off (excluding Medicaid denials related to timeliness of billing, insufficient medical record documentation, missing invoices, authorization, or eligibility issues) as a result of a Medicaid are booked as charity. Some Medicaid plans offer coverage for a limited or restricted list of services. If a patient is eligible for Medicaid, any charges for days or services not covered by the patient's coverage may be written off to charity without a completed application. This does not include any Share of Cost (SOC) or other patient cost-sharing amounts such as deductibles or copayments, as such costs are determined by the state to be an amount that the patient must pay before the patient is eligible for Medicaid. Health and Human Services (HSS) uses the term "Spend Down" instead of Share of Cost. All collection activities conducted by the Facility, a Designated Supplier, or its third-party collection agents will be in conformance with all federal and state laws governing debt collection practices. All third-party agreements governing collection and recovery activities must include a provision requiring compliance with the hospital facilities' financial assistance and billing and collections policy and indemnification for failures as a result of its noncompliance. This includes, but is not limited to, agreements between third parties who subsequently sell or refer debt of the Hospital Facility. Schedule H, Part V, Section B, Line 16a FAP website - MERCY MEDICAL CENTER: Line 16a URL: https://www.chistalexiushealth.org/patients-visitors/our-patients/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - MERCY MEDICAL CENTER: Line 16b URL: https://www.chistalexiushealth.org/patients-visitors/our-patients/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - MERCY MEDICAL CENTER: Line 16c URL: https://www.chistalexiushealth.org/patients-visitors/our-patients/financial-assistance; 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 5 Promotion of community health The organization's hospital facility promote health for the benefit of the community. Medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The organization's hospital facility have an open medical staff. Its board of trustees is composed of prominent citizens in the community. Excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. The facility treat persons paying their bills with the aid of public programs like Medicare and Medicaid. All patients presenting at the hospital for emergency and other medically necessary care are treated regardless of their ability to pay for such treatment. Schedule H, Part VI, Line 6 Affiliated health care system The organization 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. Schedule H, Part VI, Line 7 State filing of community benefit report ND true MERCY MEDICAL FOUNDATION 1301 15TH AVENUE WEST WILLISTON ND 58801 450381803 501(c)(3) 20423 PROGRAM SUPPORT 1 0 FINANCIAL ASSISTANCE/CHARITY CARE 1211 3005611 Book Financial Assistance Schedule I, Part III CHARITY CARE MERCY MEDICAL CENTER RECOGNIZES THE RIGHT TO QUALITY HEALTHCARE REGARDLESS OF AGE, SEX, RACE, RELIGION, NATIONAL ORIGIN, OR ABILITY TO PAY. BUSINESS OFFICE STAFF HELPS PATIENTS SEEK LOCAL, STATE, AND FEDERAL REIMBURSEMENT AT NO CHARGE WHEN NO OTHER SOURCE OF PAYMENT IS AVAILABLE. CHARITY CARE IS PROVIDED TO PATIENTS WITH DEMONSTRATED INABILITY TO PAY FOR MEDICALLY NECESSARY SERVICES. THESE FUNDS ARE DIRECTLY USED TO OFFSET THE PATIENTS' ACCOUNTS RECEIVABLE. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. GRANTS ARE MONITORED THROUGH REPORTS RECEIVED FROM THE GRANTEE ORGANIZATIONS CONTAINING FINANCIAL AND NARRATIVE INFORMATION DESCRIBING THE USE OF THE FUNDS. false true false false false false false true false MICHAEL L CASSIDY MD Board Member 0 405817 0 20150 0 3612 0 16075 0 16171 0 461825 0 0 Kevin Dahmen MD Board Member 0 355676 0 222869 0 1472 0 26400 0 21935 0 628352 0 0 JEFFREY DROP Director/CHI SVP DIVISION OFFICER 0 634544 0 675860 0 119445 0 15900 0 17944 0 1463693 0 0 TESSA MARBURGER MD Board Member 294624 0 44500 0 11674 0 15376 0 9148 0 375322 0 0 0 Todd Preszler MD Board Member 0 475515 0 7329 0 2622 0 10800 0 22911 0 519177 0 0 Brandon Price MD Board Member 0 243967 0 0 0 662 0 10001 0 21442 0 276071 0 0 KURT SCHLEY Director 0 418838 0 81045 0 45170 0 54241 0 25670 0 624964 0 36900 Dan Bjerknes President & CEO 150630 0 14376 0 2808 0 9220 0 21503 0 198537 0 0 0 MATT GRIMSHAW Ex-officio/PRESIDENT & CEO (Partial Year) 0 408009 0 56632 0 44353 0 841 0 24123 0 533958 0 20313 JOSEPH RUARK CFO/VP OF FINANCE 0 154397 0 18463 0 4780 0 10577 0 22408 0 210625 0 0 Lori Hahn VP PATIENT CARE SERVICES/Former KE 132461 0 13027 0 3610 0 8818 0 900 0 158816 0 0 0 Douglas Clark MD Physician, Former HCE 0 646310 0 194250 0 3652 0 15650 0 18011 0 877873 0 0 Ryan Hegge MD Radiologist 782112 0 39375 0 28940 0 16075 0 14944 0 881446 0 0 0 THERESA Hegge MD Plastic- Reconstruction Surgeon 620595 0 8100 0 28527 0 14797 0 9148 0 681167 0 0 0 Fareed Kadum MD OB/GYN-SURGEON 571493 0 89809 0 72626 0 15340 0 17156 0 766424 0 0 0 Roxanne Keene MD Physician 747108 0 159518 0 1260 0 15900 0 21229 0 945015 0 0 0 ASHLEY LEMERE GENERAL SURGEON 394467 0 40000 0 12672 0 7000 0 21294 0 475433 0 0 0 Schedule J, Part I, Line 4a SEVERANCE OR CHANGE-OF-CONTROL PAYMENT 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 TOP MANAGEMENT COMPENSATION COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION AND PAID BY MERCY MEDICAL CENTER. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. (5) WRITTEN EMPLOYMENT CONTRACT 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/Presidents 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 Kurt Schley Matthew Grimshaw During 2017 the following contributions were made by CHI to the deferred compensation plan: Kurt Schley - $38,166 During 2017 the following distributions were made by CHI from the deferred compensation plan: Kurt Schley - $24,113 Matthew Grimshaw - $21,528 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 Matthew Grimshaw - $16,693 Schedule J, Part I, Line 7 Non-fixed payments MERCY MEDICAL CENTER MAINTAINS A VARIABLE PAY PLAN FOR EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE (EXCEPT FOR PHYSICIANS) THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PLAN ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING PERFORMANCE IN RELATION TO BUDGET, AND ACHIEVEMENT OF INDIVIDUAL GOALS. ALL COMPENSATION, INCLUDING ANY INCENTIVE COMPENSATION, IS CAPPED TO ENSURE THAT COMPENSATION REMAINS AT FAIR MARKET VALUE. Form 990, Part III, Line 1 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 15a PROCESS FOR DETERMINING COMPENSATION OF CEO The organization's top management official's compensation is determined 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 14 Document Retention and Destruction Policy The document retention and destruction policy is more of an operational policy. These types of policies usually do not go to the board of directors. This has not been adopted by the board of directors. 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 Mercy Medical Center, the Executive Committee is composed of the board chair, the board vice chair, the President and CEO, each of whom shall serve as an ex officio voting member of the Executive Committee, and two voting members appointed by the Board of Directors. Each individual appointed to the Executive Committee shall serve for a term of one year or until his or her successor is duly appointed by the Board of Directors. The Executive Committee shall consist of only directors of the Corporation. Pursuant to Section 8.1 of the Corporation's bylaws, committees, such as the executive committee, that are granted the authority to act on behalf of the board of directors may include only directors of the corporation. Further, pursuant to Section 8.6 of the Corporation's bylaws, the executive committee has and may exercise such powers as may be delegated to it by the board of directors. The Executive Committee also possesses the power to transact routine business of the corporation in the interim period between regularly scheduled meetings of the board of directors. Form 990, Part VI, Line 6 Classes of members or stockholders ACCORDING TO THE BYLAWS OF MERCY MEDICAL CENTER, THE ENTITY'S SOLE MEMBER IS CATHOLIC HEALTH INITIATIVES, A COLORADO NONPROFIT CORPORATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body Pursuant to Section 6.5 of the organization's bylaws, directors shall be appointed or refused by the corporate member. The corporate member may appoint one or more individuals to the board of directors, and may at any time remove, with or without cause, any member of the board of directors. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation. (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 corporate member is Catholic Health Initiatives ("CHI"). Pursuant to Section 5.4 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 Mercy Medical Center * Amendment of the corporate documents of Mercy Medical Center * Approve members of the Mercy Medical Center board * Removal of a member of the governing body of Mercy Medical Center * Approval of issuance of debt by Mercy Medical Center * Approval of participation of Mercy Medical Center in a joint venture * Approval of formation of a new corporation by Mercy Medical Center * Approval of a merger involving Mercy Medical Center * Approval of the sale of all or substantially all of the assets of Mercy Medical Center * To require the transfer of assets by Mercy Medical Center to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. * Adoption of long range and strategic plans for Mercy Medical Center 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 ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. AN ELECTRONIC COPY OF THE RETURN IS SENT TO EACH BOARD MEMBER BY EMAIL FOR THEIR REVIEW. 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. (Continued on Schedule O) Form 990, Part VI, Line 15b Process to establish compensation of other employees ALL EXECUTIVE COMPENSATION PAID TO OFFICERS AND KEY EMPLOYEES WAS SET BY A COMPENSATION COMMITTEE UTILIZING AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THE BOARD OF DIRECTORS OVERSEES THE COMPENSATION SETTING PROCESS AND ENSURES REASONABLENESS AND COMPLIANCE WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY. Form 990, Part VI, Line 19 Required documents available to the public The organization's financial statements, conflict of interest policy and governing documents are available to the public upon request. The organization's financial statements are included in 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: 250238, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 250238; Form 990, Part IX, Line 11g Other Fees Other Fees for Services - Total Expense: 4172708, Program Service Expense: 3340517, Management and General Expenses: 832191, Fundraising Expenses: 0; Consulting - Total Expense: 500, Program Service Expense: 475, Management and General Expenses: 25, Fundraising Expenses: ; Contract Services - Total Expense: 5396920, Program Service Expense: 4857228, Management and General Expenses: 539692, Fundraising Expenses: ; Contract Labor - Total Expense: 5523650, Program Service Expense: 5247467, Management and General Expenses: 276182, Fundraising Expenses: ; Purchased Services - Total Expense: 2774258, Program Service Expense: 2635545, Management and General Expenses: 138713, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances INTEREST IN MMF - -9388; CAPITAL RESOURCE CONTRIBUTION - -494993; 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 80920 270930004 FUNDRAISING CO 501(c)(3) Type I CHI true CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 HEALTHCARE CO 501(c)(3) Type I CHINS true CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 PHYSICIANS OR 501(c)(3) 10 MMC true CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 480543724 SURGERY CENTER KS 501(c)(3) 3 CHI true CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 HEALTHCARE ND 501(c)(3) 10 CHI true CHI INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(c)(3) Type I CHI true CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(c)(3) Type I CHI true CHI LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE OH 501(c)(3) Type II SFH true CHI Memorial Hospital - Georgia 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE GA 30742 822748395 HEALTHCARE GA 501(c)(3) 3 MHCS true CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(c)(3) 10 CHI NS true CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(c)(3) Type I CHI true CHI NEBRASKA 12809 West Dodge Road Omaha NE 68510 363233121 HEALTHCARE NE 501(c)(3) Type I CHI true CHI ST JOSEPH CHILDREN'S HEALTH 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232342997 HEALTHCARE PA 501(c)(3) Type I CHI true CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(c)(3) Type I CHI true CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER 6624 FANNIN ST 1100 HOUSTON TX 77030 741161938 HEALTHCARE TX 501(c)(3) 3 SLHS true CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 710236913 HEALTHCARE AR 501(c)(3) 3 CHISVHS true CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125064 HOLDING CO AR 501(c)(3) Type II SVIMC true CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125131 HEALTHCARE AR 501(c)(3) 3 CHISVHS true COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(c)(3) Type I NA true COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 237419853 HOLDING CO OH 501(c)(4) GSH true COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY IA 51555 421294399 FUNDRAISING IA 501(c)(3) Type I AH-CMHMV true CONTINUING CARE HOSPITAL One Saint Joseph Drive LEXINGTON KY 40504 611400619 LT ACH KY 501(c)(3) 3 SJHS true East Texas Clinical Services 2801 VIA FORTUNA SUITE 500 AUSTIN TX 78746 454736213 HEALTHCARE TX 501(c)(3) Type I MHSET true ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1455 BATTERSBY AVE ENUMCLAW WA 98022 910715805 HEALTHCARE WA 501(c)(3) 3 FHS true FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 611345363 HEALTHCARE KY 501(c)(3) 3 KOH true FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 562351341 FUNDRAISING KY 501(c)(3) Type I FH true FRANCISCAN CARE CENTER 4111 N HOLLAND-SYLVANIA RD TOLEDO OH 43623 341931806 HEALTHCARE OH 501(c)(3) 10 FLC true FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA WA 98405 911145592 FUNDRAISING WA 501(c)(3) 10 FHS true FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA WA 98405 910564491 HEALTHCARE WA 501(c)(3) 3 CHI true FRANCISCAN HEALTH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BROADWAY TACOMA WA 98402 431882377 PHYSICIANS WA 501(c)(3) 10 CHI true FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA WA 98402 911939739 HEALTHCARE WA 501(c)(3) 10 FHS true FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(c)(3) 10 CHI true GARRISON MEMORIAL HOSPITAL 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 450227752 HEALTHCARE ND 501(c)(3) 3 SAMC true GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 201536108 MINISTRIES CO 501(c)(3) Type I CHI true GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311778403 EDUCATION OH 501(c)(3) 2 GSH true GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311206047 FUNDRAISING OH 501(c)(3) Type I GSH true GOOD SAMARITAN HOSPITAL 110 N MAIN ST STE 500 DAYTON OH 45402 310536981 HEALTHCARE OH 501(c)(3) 3 SHP true GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY NE 68847 470659443 FUNDRAISING NE 501(c)(3) 7 GSH true GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON 110 N MAIN ST STE 500 DAYTON OH 45402 237296923 FUNDRAISING OH 501(c)(3) 7 SHP true HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON WA 98310 910565546 HEALTHCARE WA 501(c)(3) 3 FHS true HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVE BREMERTON WA 98310 911197626 FUNDRAISING WA 501(c)(3) 7 HMC true HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 760761782 FUNDRAISING MN 501(c)(3) Type I SFMC true HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN WA 98166 910712166 HEALTHCARE WA 501(c)(3) 3 FHS true HOUSE OF MERCY 1111 6TH AVE DES MOINES IA 50314 421323808 SHELTER IA 501(c)(3) 7 CHI-IA CORP true JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 250 E Liberty St Ste 500 LOUISVILLE KY 40202 611029768 HEALTHCARE KY 501(c)(3) 3 KOH true KENTUCKYONE HEALTH MEDICAL GROUP INC 100 E Liberty St Ste 800 LOUISVILLE KY 40202 611352729 HEALTHCARE KY 501(c)(3) 10 JHSMH true KENTUCKYONE HEALTH INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029769 HEALTHCARE KY 501(c)(3) Type II CHI true LAKEWOOD HEALTH CENTER 600 MAIN AVE S BAUDETTE MN 56623 410758434 HEALTHCARE MN 501(c)(3) 3 CHI true LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVE S BAUDETTE MN 56623 411893795 FUNDRAISING MN 501(c)(3) 7 LHC true LINUS OAKES INC 2700 STEWART PKWY ROSEBURG OR 97471 930821381 SENIOR LIVING OR 501(c)(3) 10 MMC true LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON ND 58054 820558836 HEALTHCARE ND 501(c)(3) 3 CHI true LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN TX 75901 820563768 PROPERTY MGMT TX 501(c)(3) Type I MHSET true MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742761145 HEALTHCARE TX 501(c)(3) 3 SJSC true MADONNA MANOR INC 2344 AMSTERDAM ROAD VILLA HILLS KY 51017 610654635 LIVING ASSIST KY 501(c)(3) 10 FLC true MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA TN 37404 621839548 FUNDRAISING TN 501(c)(3) 7 MHCS true MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA TN 37404 620532345 HEALTHCARE TN 501(c)(3) 3 CHI true MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA TN 37411 030417049 HEALTHCARE TN 501(c)(3) 10 MHCS true MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN TX 75902 750755367 HEALTHCARE TX 501(c)(3) 3 CHI true MEMORIAL MEDICAL CENTER - LIVINGSTON PO BOX 1447 LUFKIN TX 75902 760436439 HEALTHCARE TX 501(c)(3) 3 MHSET true MEMORIAL MEDICAL CENTER - SAN AUGUSTINE PO BOX 1447 LUFKIN TX 75902 752663904 HEALTHCARE TX 501(c)(3) 3 MHSET true MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVE LUFKIN TX 95904 752721155 PHYSICIANS TX 501(c)(3) Type I MHSET true MEMORIAL SPECIALTY HOSPITAL PO BOX 1447 LUFKIN TX 95902 752492741 HEALTHCARE TX 501(c)(3) 3 MHSET true MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVE DES MOINES IA 50314 426076069 AUXILIARY IA 501(c)(3) Type I MF-DM IA true MERCY CLINICS INC 1111 6TH AVE DES MOINES IA 50314 421193699 PHYSICIANS IA 501(c)(3) 10 CHI-IA CORP true MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVE DES MOINES IA 50314 421511682 EDUCATION IA 501(c)(3) 2 CHI-IA CORP true MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES IA 50314 237358794 FUNDRAISING IA 501(c)(3) 7 CHI-IA CORP true MERCY FOUNDATION INC 2700 STEWART PKWY ROSEBURG OR 97471 936088946 FUNDRAISING OR 501(c)(3) 7 MMC true MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 421461064 FUNDRAISING IA 501(c)(3) Type I AHMH-Corning true MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450435338 FUNDRAISING ND 501(c)(3) Type I MHVC true MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS IA 51503 421178204 FUNDRAISING IA 501(c)(3) Type I AHBMHS true MERCY HOSPITAL OF DEVILS LAKE 1031 7TH ST NE DEVILS LAKE ND 58301 450227012 HEALTHCARE ND 501(c)(3) 3 CHI true MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 7TH ST NE DEVILS LAKE ND 58301 352367360 FUNDRAISING ND 501(c)(3) 7 MHDL true MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450226553 HEALTHCARE ND 501(c)(3) 3 CHI true MERCY MEDICAL CENTER 1301 15TH AVE WEST WILLISTON ND 58801 450231183 HEALTHCARE ND 501(c)(3) 3 CHI true MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 420680308 HEALTHCARE IA 501(c)(3) 3 CHI-IA CORP true MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER 204 N 4th Ave E Newton IA 50314 421470935 PHYSICIANS IA 501(c)(3) 3 CHI-IA CORP true MERCY MEDICAL CENTER INC 2700 STEWART PKWY ROSEBURG OR 97471 930386868 HEALTHCARE OR 501(c)(3) 3 CHI true MERCY MEDICAL FOUNDATION 1301 15TH AVE WEST WILLISTON ND 58801 450381803 FUNDRAISING ND 501(c)(3) Type I MMC true NEBRASKA HEART HOSPITAL 7500 S 91ST ST LINCOLN NE 68526 392031968 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true North Central Health Care Alliance dba PrimeCare Health Group 401 N 9th St BISMARCK ND 585014507 450439894 HEALTHCARE ND 501(c)(3) 7 NHCA true OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES ND 58474 450231675 HEALTHCARE ND 501(c)(3) 3 CHI true OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH ST OAKES ND 58474 710966606 FUNDRAISING ND 501(c)(3) Type I OCH true PINEYWOODS MEDICAL DEVELOPMENT CORP PO BOX 1447 LUFKIN TX 75902 752493116 PROPERTY MGMT TX 501(c)(3) Type I MHSET true PROVIDENCE CARE CENTER 2025 HAYES AVENUE SANDUSKY OH 44870 341658625 HEALTHCARE OH 501(c)(3) 10 FLC true PROVIDENCE CARE CENTERS 2025 HAYES AVENUE SANDUSKY OH 44870 341826099 HOLDING CO OH 501(c)(3) Type II FLC true PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY OH 44870 341896807 LIVING COMM OH 501(c)(3) 10 FLC true PUEBLO STEPUP 1925 E ORMAN AVE STE G52 PUEBLO CO 81004 841234295 COMMUNITY CO 501(c)(3) 7 CHIC true REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE 16251 Sylvester Road SW Burien WA 98166 911170040 HEALTHCARE WA 501(c)(3) 3 FHS true SET OF COLORADO SPRINGS INC 9100 E Mineral Circle Centennial CO 80112 841183335 LTERM CARE CO 501(c)(3) 7 CHIC true SAINT CLARE'S COMMUNITY CARE INC 25 POCONO RD DENVILLE NJ 07834 222876836 HEALTHCARE NJ 501(c)(3) 10 SCHS true SAINT CLARE'S FOUNDATION INC 25 POCONO RD DENVILLE NJ 07834 222502997 FUNDRAISING NJ 501(c)(3) 7 SCHS true SAINT CLARE'S HEALTH SERVICES INC 25 POCONO RD DENVILLE NJ 07834 223639733 MANAGEMENT NJ 501(c)(3) 10 CHI true SAINT CLARE'S HOSPITAL INC 25 POCONO RD DENVILLE NJ 07834 223319886 HEALTHCARE NJ 501(c)(3) 3 SCHS true SAINT ELIZABETH FOUNDATION 555 S 70TH ST LINCOLN NE 68510 470625523 FUNDRAISING NE 501(c)(3) 7 SERMC true SAINT ELIZABETH HEALTH SERVICES 555 S 70TH ST LINCOLN NE 68510 363233120 HEALTHCARE NE 501(c)(3) 3 SERMC true SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 S 70TH ST LINCOLN NE 68510 470379836 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER 2620 W FAIDLEY GRAND ISLAND NE 68803 470376601 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND NE 68802 470630267 FUNDRAISING NE 501(c)(3) 7 SFMC true SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL ST BEREA KY 40403 260152877 FUNDRAISING KY 501(c)(3) 7 SJHS true SAINT JOSEPH HEALTH SYSTEM INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611334601 HEALTHCARE KY 501(c)(3) 3 KOH true SAINT JOSEPH HOSPITAL FOUNDATION INC 701 Bob Olink Dr 200 LEXINGTON KY 40504 611159649 FUNDRAISING KY 501(c)(3) Type I SJHS true SAINT JOSEPH 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