2019-05-11T10:31:54-05:00 2018-06-30 990 2017-07-01 630288861 Providence Hospital PROV 3147338000 6801 Airport Boulevard Mobile AL 36608 Tonya Mershon Tax Officer 2019-05-11 2017 2019-02-21 02:37:17Z JASON P ALEXANDER 6801 Airport Boulevard Mobile AL 36608 210877876 false 0928 X https://healthcare.ascension.org/Locations/Alabama/ALMOB/Mobile-Providence-Hospital X 1958 AL To improve the health and well-being of all people in the communities we serve. 11 9 1854 267 0 0 438930 390316 220074911 208119849 392856 277766 2879632 1859234 223786329 210647165 0 3581187 0 77427989 78661575 0 0 0 135714192 131916139 213142181 214158901 10644148 -3511736 183960108 151386366 121524230 106395662 62435878 44990704 Our Mission as part of a Catholic health care system is to further the healing ministry of Jesus by continually improving the health and well-being of all people, especially the poor, in the communities we serve. false false 149125973 3581187 208129968 PROVIDENCE HOSPITAL is a 302-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2018, PROVIDENCE HOSPITAL treated 14,147 adults and children for a total of 68,429 patient days of service. The hospital also provided services for 143,076 outpatient visits, which included 8,382 outpatient surgeries and 50,949 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions. 149125973 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 false true false false false false false false false false false false false false false true true true true false true 143 0 true 1854 true true true false false false false false true false false false X 11 9 false false false false true true true true true false false false true true true true true false false true true X SARA OBRIEN 3147338070 11775 BORMAN DRIVE MARYLAND HEIGHTS MO 63146 CHRISTOPHER H BROWN MD VICE CHAIR 1.0 1.0 X X 0 0 0 LAWRENCE RUSS G FORD JR CHAIR (START 8/2017) 1.0 0 X X 0 0 0 G TIMOTHY GASTON CHAIR (END 8/2017) 1.0 0 X X 0 0 0 TODD S KENNEDY PRESIDENT 46.0 4.0 X X 609435 0 37548 WINDY TAYLOR ASSISTANT SECRETARY 1.0 0 X X 0 0 0 ADINE B WADDELL ASSISTANT SECRETARY (END 9/2017) 1.0 59.0 X X 0 217668 28263 RICHARD WILKINS SECRETARY 1.0 0 X X 0 0 0 TYRONE FENDERSON JR MEMBER 1.0 0 X 0 0 0 R MICHAEL HUDDLE MD MEMBER 40.0 0 X 128130 0 19080 CONNIE L HUDSON RN MEMBER 1.0 0 X 0 0 0 HENRY J KOCH MD MEMBER 1.0 0 X 0 0 0 RICHARD OYLER MEMBER 1.0 0 X 0 0 0 JOSHUA TANNER MEMBER 1.0 0 X 0 0 0 JASON P ALEXANDER FACHE CEO, MINISTRY MARKET 0.0 50.0 X 0 472184 27767 C SUSAN CORNEJO CFO (END 6/2018) 7.0 43.0 X 666356 37316 37265 BRANDON M WILLIAMS CFO, MINISTRY MARKET (START 8/2017) 10.0 44.0 X 0 152113 9142 KATRINA R BROWN CNO/COO 50.0 0 X 191896 0 35996 IJAZ IQBAL CMO 50.0 0 X 363078 0 38632 DON E KING COO (START 1/2018) 7.0 43.0 X 0 782385 41936 ASTON GAMALIE ARCHIBALD MD PHYSICIAN 50.0 0 X 417647 0 38080 DAVID CHRISTOPHER BRASWELL MD PHYSICIAN 50.0 0 X 421409 0 37703 WILFRED JOSEPH FONTENOT MD PHYSICIAN 50.0 0 X 416721 0 38157 DANIEL CURTIS HARRISON MD PHYSICIAN 50.0 0 X 420565 0 37970 PRESTON TODD SPEAKMAN MD PHYSICIAN 50.0 0 X 445359 0 38730 WILLIAM M LIGHTFOOT MD FORMER KEY EMPLOYEE (END 12/2016) 0.0 50.0 X 0 573442 35741 JOHN E STONE JR MD FORMER KEY EMPLOYEE (END 12/2016) 0.0 0 X 268307 0 23580 CLARK P CHRISTIANSON FORMER OFFICER (END 9/2015) 0.0 0.0 X 323392 0 2660 4672295 2235108 528250 85 true true false HOLMES HEALTHCARE INC 20 MILL CREEK RD WARRIOR AL 351805100 Medical Services 1023107 MOBILE BAY LITHOTRIPSY LLC 300 TOWNPARK DR NW STE 260 KENNESAW GA 30144 Medical Services 611250 BIO-MEDICAL APPLICATIONS OF ALABAMA INC 16343 COLLECTION CENTER DR CHICAGO IL 606930163 Medical Services 446070 ARUP LABORATORIES 500 S CHIPETA WAY SALT LAKE CITY UT 841081221 Lab Services 331873 MICHAEL HOUSTON 1298 N MCKENZIE ST FOLEY AL 36535 Physician Services 185502 9 X 174477 37619 178220 19089 390316 Net Patient Service Revenue 621990 205850622 205850622 Services to Affiliates 561000 2268692 2268692 Lab Services 621500 500 500 Management Fees 561000 35 35 0 0 0 0 208119849 -54798 -54798 246708 246708 0 246708 246708 563276 230711 0 332565 332564 332564 Cafeteria/Vending Revenue 722514 1228063 1228063 Medical Staff Dues 900099 25250 25250 Escheatment Revenue 900099 15535 15535 343678 10119 0 333559 1612526 210647165 208129968 0 2126881 3581187 3581187 2124841 1912356 212485 60143537 54125452 6018085 3479813 3131619 348194 8489712 7640224 849488 4423672 3981039 442633 435107 752 434355 -38317 -38317 25186 25186 1456225 825972 630253 0 33441 20911 12530 602010 278339 323671 40048 12022 28026 3407703 771061 2636642 158281 51757 106524 73911 18057 55854 2426117 2426117 9700196 4294394 5405802 3822897 3822897 Medical Supplies 43234471 43401681 -167210 Purchased Services 26579089 4737684 21841405 Management Fee to Affiliate 19236540 19236540 Provider Tax 10913666 10913666 9809568 9427800 381768 0 214158901 149125973 65032928 0 4655044 15695 0 31414 30156832 25930083 0 0 0 0 5039117 4966546 566905 553985 218914557 169052051 52525250 49862506 0 10000000 15010057 18088212 66006903 51937925 183960108 151386366 13196363 12295358 20500 32881 0 0 108307367 94067423 121524230 106395662 X 61823843 44435134 612035 555570 62435878 44990704 183960108 151386366 X -3511736 -41485 -13891953 X false true X true false X false false false false false false false false true 25186 25186 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Providence Hospital does not participate in or intervene in (including the publishing or distributing or statements), any political campaign on behalf of (or in opposition to) any candidate for public office. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Providence Hospital does not participate in or intervene in (including the publishing or distributing or statements), any political campaign on behalf of (or in opposition to) any candidate for public office. 8297513 8297513 99890798 81677004 18213794 166093 166093 0 94598822 81565847 13032975 15961331 5643107 10318224 49862506 Restricted Funds 215959 Other Assets -8329 Due from Affiliates 50715461 Other Receivables 555393 Deferred Compensation/Retirement/Pension Asset Estimated 3rd Party Payor Settlements 459441 51937925 OTHER MISC LIABILITIES RECEIVABLES SOLD WITH RECOURSE 464995 VALUATION ALLOWANCE 271752 Due to Affiliates 25413069 Deferred Compensation/Retirement/Pension Liability Savings Plan Liability Estimated 3rd Party Payor Settlement 528408 Recovery Tail Liability 831691 Debt with Ascension Health Alliance 66557508 94067423 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2018. true true X true X true X true true false true true 11703659 0 11703659 0.0546 26268609 25456731 811878 0.0038 0 0.0 0 0 37972268 25456731 12515537 0.0584 6 6863 298337 59833 238504 0.0011 0 0.0 0 0.0 0 0.0 10 167 24634 0 24634 0.0001 16 7030 322971 59833 263138 0.0012 16 7030 38295239 25516564 12778675 0.0597 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 1 9 37924 0 37924 0.0002 0 0.0 1 9 37924 0 37924 0.0002 false 2343758 232720 104927658 107201108 -2273450 X true true 1 1 PROVIDENCE HOSPITAL 6801 AIRPORT BLVD MOBILE AL 36608 https://healthcare.ascension.org/Locations/Alabama/ALMOB/Mobile-Providence-Hospital H4905 X X X PROVIDENCE HOSPITAL 1 false false true X X X X X X X X 15 true false false true X https://healthcare.ascension.org/Locations/Alabama/ALMOB/Mobile-Providence-Hospital X true 15 true https://healthcare.ascension.org/Locations/Alabama/ALMOB/Mobile-Providence-Hospital false true X 200.0 300.0 X X X X X true true X X X X true X See Pt VI X See Pt VI X See Pt VI 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 To better target community resources on the service area's most pressing health needs, the hospital participated in a group discussion with organizational decision makers and community leaders to prioritize the significant community health needs while considering several criteria: alignment with Ascension Health strategies of healthcare that leaves no one behind; care for the poor and vulnerable; opportunities for partnership; availability of existing programs and resources; addressing disparities of subgroups; availability of evidence-based practices; and community input. The significant health needs are a prioritized description of the significant health needs of the community as identified through the CHNA. See Schedule H, Part V, Line 7 for the link to the CHNA and Schedule H, Part V, Line 11 for how those needs are being addressed. Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Providence Hospital. From September 2015 through March 2016, Providence Hospital ("Providence"), in collaboration with other community organizations and agencies, conducted a community health needs assessment ("assessment") for Mobile County. This needs assessment is for Mobile County, Alabama, the county of residence for approximately 83 percent of Providence inpatients. Input from the community included persons with a broad knowledge of the community, health and human services providers, stakeholders and representatives of the public. This assessment was led by Providence Hospital, with active participation by the following community organizations and public and private agencies: American Cancer Society, American Diabetes Association, American Heart Association, Bayou Clinic, Big Brothers Big Sisters, Feeding America, Grand Bay Senior Center, Guadalupe Center, Infirmary Health, Live Better Mobile, March of Dimes, Mobile Area Chamber of Commerce, Mobile County Health Department, North Baldwin Chamber of Commerce, Providence Hospital Senior Center, Rotary Rehab, USA Center for Health Communities, USA College of Nursing, and USA Health System. Special attention was given to obtaining input from the medically underserved and vulnerable populations. Key informants included individuals with public health expertise, state and local officials, community leaders and healthcare consumers. Quantitative data were obtained from county, state, and national sources in order to develop a social, economic, and health assessment of Mobile County. The indicators included public health surveillance data, such as deaths and births. Sixty-six health indicators for Mobile County were compared and contrasted to those for the state and surrounding counties. In addition, local data were compared to previous years' data from Mobile County, highlighting improvements and statistical trends. To identify the issues of greatest priority for the community, the indicator results were evaluated using the County Health Rankings Model created by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The model emphasizes factors that, when improved, can help improve the overall health of a community. This model has three major components: Health Outcomes, Health Factors, Programs and Policies. Of the 66 health status indicators, Mobile County was worse than the state average on 44 indicators. Prioritization of the community health issues was a multi-step process that included: Review and discussion of all of the top health concerns and associated indicator data. Identification and discussion of consequences of not addressing the issue. Consideration of key criteria for impacting change. Through the assessment process described in further detail in this report, the top priority health issues identified for Mobile County are: Access to Care Weight Mental Health and Substance Abuse Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Providence Hospital. THE PROVIDENCE HOSPITAL FY2015-2016 IMPLEMENTATION STRATEGY SPECIFICALLY ADDRESSES THE FOLLOWING THREE SYSTEM WIDE HEALTH IMPROVEMENT PRIORITIES: FROM THE MOST RECENT CHNA (2015-2016), THE TOP ISSUES CONSIDERED TO BE OF GREATEST NEED IN THE COMMUNITY WERE AS FOLLOWS: 1. ACCESS TO CARE 2. WEIGHT 3. MENTAL HEALTH/SUBSTANCE ABUSE. STRATEGIES HAVE BEEN ADOPTED TO ADDRESS THESE NEEDS. RESOURCES IN MOBILE COUNTY AVAILABLE TO ADDRESS THE ACCESS TO CARE PRIORITY ISSUE INCLUDE: BAYOU CLINIC, FRANKLIN PRIMARY HEALTH CENTERS, MOBILE COUNTY HEALTH DEPARTMENT, MOSTELLAR CLINIC, STANTON ROAD CLINIC, VA OUTPATIENT CLINIC, VICTORY HEALTH PARTNERS, PROVIDENCE HOSPITAL OUTREACH IN SOUTH MOBILE COUNTY, PROVIDENCE HOSPITAL CARE PROGRAM, OZANAM CHARITABLE PHARMACY, MERCY LIFE AND AREA AGENCY ON AGING. SPECIFICALLY, THE BAYOU CLINIC FOCUSED REDUCING LANGUAGE AND CULTURAL BARRIERS TO SELF -MAINTENANCE OF HEALTH WITH A SPECIFIC DIABETES SELF-MANAGEMENT EDUCATION (DSME) FOR VIETNAMESE, CAMBODIAN, AND LAOTIAN PATIENTS COMING TO THE CLINIC. THE EDUCATION ADDRESSES HEALTH DISPARITIES AND BARRIERS TO CARE BY PROVIDING CULTURALLY SPECIFIC EDUCATION AND MONITORING A1CS. PARTICIPANTS ARE DEFINED AS CLIENT/PATIENT COMPLETING DSME CLASS AND RECEIVING A BLOOD GLUCOSE MONITOR/TEST SUPPLIES. IT WAS ANTICIPATED THAT BY JUNE 2018 THAT THE NUMBER OF DIABETES RELATED ED VISITS AMONG ASIAN RESIDENTS IN SOUTH MOBILE COUNTY WOULD DECREASE BY 20 PERCENT. INITIAL DATA SHOWED INACCURATE CLASSIFICATION BY NATIONALITY AT REGISTRATION AND UNABLE TO MEASURE ASIAN POPULATION ALONE. PROGRAM DEVELOPED TO SCREEN ALL RESIDENTS REGARDLESS OF NATIONALITY WHEN REGISTERED AS INPATIENT OR ED VISITS. 100% SCREENED AS OF JUNE 2018 AND PROGRAM ONGOING. RESOURCES IDENTIFIED TO ADDRESS HEALTHY WEIGHT INCLUDE: PROVIDENCE HOSPITAL DIABETES CENTER, FEEDING THE GULF COAST NUTRITION PROGRAMS, JUNIOR LEAGUE OF MOBILE, CITY OF MOBILE, MOBILE COUNTY PUBLIC SCHOOLS, PROVIDENCE FARMERS MARKET, PROVIDENCE COMMUNITY GARDEN, AND LIVE BETTER MOBILE/MOBILE UNITED. THE DIABETES CENTER FOCUSED ON PROVIDING A CLASS FOR HEALTHY EATING FOR UNINSURED OBESE/OVERWEIGHT PATIENTS. THE PROGRAM OFFERED A SINGLE DAY CLASS THAT COMBINED DIABETES SELF MANAGEMENT AND KEY ELEMENTS OF THE COOKING MATTERS PROGRAM. THE REGISTERED PROGRAM WHICH WAS A 6-8 WEEK CLASS WAS MODIFIED AND TAUGHT IN ONE DAY. THE PROGRAM WAS COMPLETED IN 2017. RESOURCES THAT HAVE BEEN IDENTIFIED TO HELP WITH THE MENTAL HEALTH/SUBSTANCE ABUSE ISSUE INCLUDE: PROVIDENCE HOSPITAL ED SOCIAL WORKER AND FAITH AND COMMUNITY NURSES. COMMUNITY PARTNERS INCLUDE ALABAMA MEDICAID REGIONAL CARE ORGANIZATION (AMRCO), ALTA POINTE, HEALTHY GULF COAST TRANSITION IHGCCT) AND NATIONAL ASSOCIATION OF MENTAL ILLNESS (NAMI). THE CAMPAIGN ASSESSED BARRIERS TO MENTAL HEALTH TREATMENT BY TRACKING THE NUMBER OF PATIENTS WHO WERE UNABLE TO ACCESS CARE DUE TO LACK OF INSURANCE OR INABILITY TO PAY. PROVIDENCE HOSPITAL ACUTE CARE VOLUME FOR FY 16 REFLECTED 116 OF THE 277 ACUTE CARE SERVICES FOR MENTAL HEALTH DIAGNOSES WERE UNINSURED OR MEDICAID RECIPIENTS. 20% WERE READMITTED WITHIN 90 DAYS. MORE THAN 60% OF THE ACUTE CARE CONDITIONS RELATED TO SUBSTANCE ABUSE. THE STRATEGIES INCLUDED DEVELOPING A METHOD OF ASSESSING AND DOCUMENTING ED PATIENTS EXPERIENCES RELATED TO BARRIERS IN ADDRESSING THEIR MENTAL HEALTH ISSUES. A NETWORK WAS ESTABLISHED WITH PROVIDENCE AND AMG PRIMARY CARE PROVIDERS TO ADVANCE POLICIES FOR ASSESSMENTS AND TREATMENTS/REFERRAL FOR PATIENTS WITH MENTAL HEALTH ISSUES. A MENTAL HEALTH RESOURCE GUIDE WAS PRODUCED FOR PROVIDENCE STAFF AND FAITH COMMUNITY NURSES (FCN). FCN DOCUMENTED THE NUMBER OF CHURCH MEMBERS REQUIRING ASSISTANCE WITH MENTAL HEALTH/SUBSTANCE ABUSE ISSUES. A TRACKING TOOL WAS COMPLETED BY FCN. COLLECTED DATA WAS SHARED WITH LOCAL MENTAL HEALTH PROVIDERS AND OTHER PARTICIPATING ORGANIZATIONS. THE DATA WAS REVIEWED AND ANALYZED AS TO BARRIER DATA FOR PROCEDURAL/POLICY FOR PROVIDENCE HEALTH. PROVIDENCE HOSPITAL STRATEGY FOR IMPROVING ACCESS TO MENTAL HEALTH BY RESHAPING THE CASE MANAGEMENT MODEL IN THE EMERGENCY DEPARTMENT ALONG WITH THE INTEGRATION OF NEW TELE-PSYCHIATRY SERVICES. A COLLABORATIVE TEAM OF CASE MANAGERS, ED PROVIDERS AND MENTAL HEALTH PROVIDERS DEVELOPED THE PATHWAY FOR ACCESSING TELE-PSYCHIATRY SERVICES. ACCESS TO PSYCHIATRIC INPATIENT SERVICES FOR THE UNDERSERVED IMPROVED BY 71%. IN 2017 IT WAS LESS THAN 40%. NEEDS THAT WILL NOT BE ADDRESSED: THE HOSPITAL WILL BE ADDRESSING ALL NEEDS THAT WERE IDENTIFIED. 1 Guadalupe Center 3810 Wulff Road E Semmes AL 365755256 Medical Clinic Schedule H, Part I, Line 6a Community Benefit Report This report illustrates the significant degree to which Providence Hospital contributes to the positive health status of the people and communities it serves. As a member of Ascension Health, the nation's largest Catholic healthcare system, Providence Hospital continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of Providence Hospital is to perpetuate the healing mission of the Church. Providence Hospital advances this goal through the delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community, and medical research. Our concern for all human life and the dignity of each person leads the organization to provide medical and social services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. Providence Hospital has engaged in many activities to ensure that our mission is accomplished some of which are highlighted in this report. Unreimbursed Services Provided to the Elderly and the Poor: Providence Hospital provides a large portion of its services to the elderly and poor. During the fiscal year ending June 30, 2017, approximately 53% of admissions were elderly patients enrolled in the Medicare program, and approximately $18 million in services were provided to persons who were poor or vulnerable under state, county, or Providence Hospital guidelines. In the spirit of principles adopted by Ascension Health, Providence Hospital has taken proactive steps to address those issues that will affect accessibility, the financing and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the under served. Patient Services: During the fiscal year ending June 30, 2017, Providence Hospital treated 14,964 inpatient adults and children in the community for a total of 75,954 patient days of service. Our health ministry also provided services for 340,610 outpatient visits, including 9,654 outpatient surgery visits, and 49,183 emergency department visits. For over 160 years the Daughters of Charity and Providence Hospital have cared for the medically needy in Mobile and the surrounding area. Over time, the needs of our community and the way we meet those needs have changed, but our compassion for those in need has never wavered. We remain committed to sharing our mission, our vision, our values and our gifts with our community. As caregivers we see the devastating impact acute and chronic illnesses have on our patients, our family members and our community. Coordinating and participating in local and national fundraisers is one of the ways we contribute towards research and financial assistance for those suffering from these illnesses. In the past year Providence has supported the ALS "Ice Bucket Challenge, the Kidney Foundation Walk, the American Cancer Society Vintage Affair, Colors for a Cause, Ozanam Charitable Pharmacy and others. Our Diabetes Center staff collaborated with Bay Area Food Bank to offer the "Diabesity Conference" to patients and professionals in addition to providing free screenings and education classes on an ongoing basis. They are also offering a "Living Well" series to help community members learn to live with Diabetes. Our Vision: We envision a strong, vibrant Catholic health ministry in the United States which will lead to the transformation of healthcare. We will ensure service that is committed to health and well-being for our communities and that responds to the needs of individuals throughout the life cycle. We will expand the role of laity, in both leadership and sponsorship, to ensure a Catholic health ministry of the future. Our Values: - Service of the Poor: Generosity of spirit, especially for persons most in need - Reverence: Respect and compassion for the dignity and diversity of life - Integrity: Inspiring trust through personal leadership - Wisdom: Integrating excellence and stewardship - Creativity: Courageous innovation - Dedication: Affirming the hope and joy of our ministry Our People & Our Gifts: Providence Hospital, like the Daughters of Charity, is committed to serving the needs of the poor and vulnerable in our community. The Guadalupe Center and the Senior Center continue to serve the needs of low income Hispanics and seniors and we have expanded our outreach program in south Mobile County to include a full-time client navigator who assists residents with both social and health related needs. Staff members from the USDA, Gulf Coast PPO, Franklin Clinic, and a local disability attorney use the office free of charge so that clients in this rural area can better access their services. The Pastoral Care Department collaborated with Goodwill Easter Seals to offer clothes to patients in need through the Sister Mary Louise Clothes Closet. When Providence employees donate to Goodwill, the resulting credit allows the Pastoral Care staff to purchase clothes for the closet. This program also allows the hospital to give vouchers to needy patients and clients who use these vouchers to obtain clothes and household items. Assessment of Community Needs: Providence Hospital is in the process of conducting an assessment of the health needs of our community. Community leaders from the Mobile County Health Department, area hospitals, and local civic and social service organizations were invited to participate in the process as were staff members, participants in local health screenings, and other community residents. As it was in 2013, the information collected will be presented to the Providence Hospital Board for their review and for the development of future goals and implementation strategies. The top five issues considered to be of greatest need in the community were as follows: 1. Good Nutrition/Obesity Prevention 2. Diabetes Education and Support 3. Free/Subsidized Healthcare Services 4. Cardiac Health Education and Support 5. Mental Health Access and Support Strategies adopted to address these needs included the establishment of a community garden; the development of a disease management program for indigent, diabetic clients; the development of the CARE program to assist individuals with accessing and enrolling in healthcare coverage; support for cardiac health education services; and increased support and education related to mental illness. We believe that healing is ultimately the work of God and that our involvement in health care is a participation in the healing ministry of Christ, a mission that we share with all those who assist in this work. Schedule H, Part V, Section B, Line 16a FAP https://healthcare.ascension.org/error?aspxerrorpath=/Locations/Alabama/ALMOB/Mobile-Providence-Hospital/Financial-Assistance Schedule H, Part V, Section B, Line 16b FAP Application https://healthcare.ascension.org/error?aspxerrorpath=/Locations/Alabama/ALMOB/Mobile-Providence-Hospital/Financial-Assistance Schedule H, Part V, Section B, Line 16c FAP Plain Language Summary https://healthcare.ascension.org/error?aspxerrorpath=/Locations/Alabama/ALMOB/Mobile-Providence-Hospital/Financial-Assistance Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The cost of providing charity care, means-tested government programs, and other community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied. Schedule H, Part II Community Building Activities PROVIDENCE HOSPITAL PARTICIPATES IN SUMMER SCRUBS, A FREE, THREE-DAY CAREER EXPLORATION OPPORTUNITY FOR CURRENT 11TH GRADE STUDENTS IN MOBILE AND BALDWIN COUNTIES WHO WANT TO EXPLORE CAREERS IN HEALTHCARE. PARTICIPANTS SPEND EACH DAY AT A DIFFERENT HEALTHCARE SITES AND INTERACT WITH AND OBSERVE HEALTH PROFESSIONALS ON THE JOB IN A "REAL-WORLD" ENVIRONMENT. PROVIDENCE HOSPITAL PARTICIPATES IN THE PROJECT SEARCH HIGH SCHOOL TRANSITION PROGRAM. THIS IS A UNIQUE ONE-YEAR SCHOOL-TO-WORK PROGRAM THAT TAKES PLACE ENTIRELY AT THE BUSINESS. INTERNS PARTICIPATE IN EMPLOYMENT-RELATED INSTRUCTION AND ARE ASSIGNED INTERNSHIPS WITHIN EITHER MOBILE INFIRMARY OR PROVIDENCE HOSPITAL. THE PROGRAM PROVIDES REAL-LIFE WORK EXPERIENCE COMBINED WITH TRAINING IN EMPLOYABILITY AND INDEPENDENT LIVING SKILLS. PROJECT SEARCH HELPS YOUNG ADULTS WITH DISABILITIES MAKE SUCCESSFUL TRANSITIONS FROM SCHOOL TO PRODUCTIVE ADULT LIFE. THE GOAL FOR EACH INTERN IS COMPETITIVE EMPLOYMENT. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2018 was $9,765,659 at charges, ($2,343,758 at cost). Schedule H, Part III, Line 3 Bad Debt Expense Methodology The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 21. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance THE ORGANIZATION HAS A WRITTEN DEBT COLLECTION POLICY THAT ALSO INCLUDES A PROVISION ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IF A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE CERTAIN COLLECTION PRACTICES DO NOT APPLY. Schedule H, Part V, Section B, Line 16a FAP website - PROVIDENCE HOSPITAL: Line 16a URL: See Pt VI; Schedule H, Part V, Section B, Line 16b FAP Application website - PROVIDENCE HOSPITAL: Line 16b URL: See Pt VI; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - PROVIDENCE HOSPITAL: Line 16c URL: See Pt VI; Schedule H, Part VI, Line 2 Needs assessment The staff in our outreach programs are constantly assessing community needs by working with individuals in the community and participating in multi-agency meetings. This includes the seniors, the Hispanic community, and the residents of south Mobile County. The Vice President of Population Health, Director of Case Management and the Outreach and Advocacy Manager are also part of a state-wide collaboration with AQAF and area health care providers to assess and meet the health related needs of residents. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance PATIENTS OR PERSONS WHO MAY BE BILLED FOR PATIENT CARE ARE INFORMED AND EDUCATED ABOUT THEIR POTENTIAL ELIGIBILITY FOR FEDERAL STATE LOCAL OR HOSPITAL ASSISTANCE IN THE FOLLOWING MANNER: - AN EXPLANATION OF THE HOSPITAL'S BILLING PROCESS AND CONTACT INFORMATION FOR FINANCIAL COUNSELORS IS POSTED ON THE HOSPITAL'S WEB SITE AND IN ALL INPATIENT AND OUTPATIENT REGISTRATION AREAS. A SUMMARY OF THE HOSPITAL'S BILLING AND PAYMENT PHILOSOPHY IS INCLUDED IN EVERY PATIENT'S REGISTRATION PACKET. THE INFORMATION IS PROVIDED IN ENGLISH AND SPANISH AND INTERPRETER SERVICES FOR OTHER LANGUAGES ARE AVAILABLE AS NEEDED. - FINANCIAL COUNSELORS VISIT EVERY UNINSURED PATIENT ON THE DAY AFTER THEIR ADMISSION TO EXPLAIN AVAILABLE RESOURCES AND WHEN APPROPRIATE, INITIATE THE APPLICATION PROCESS FOR ASSISTANCE. FINANCIAL COUNSELORS HAVE COMPLETED SPECIFIC TRAINING FOR MEDICAID, CHIPS, SOBRA, AND ALL-KIDS AND WILL RECEIVE ADDITIONAL TRAINING AS THE NEED IS IDENTIFIED. IF THE FINANCIAL COUNSELORS IDENTIFY ADDITIONAL FINANCIAL OR SOCIAL NEEDS THEY WILL REFER THE PATIENT TO A HOSPITAL SOCIAL WORKER. - A LISTING OF COMMUNITY RESOURCES IS INCLUDED IN EACH PATIENT'S DISCHARGE MATERIALS. - WITHIN 24 HOURS OF ADMISSION THE CASE MANAGEMENT DEPARTMENT CONDUCTS A SCREENING FOR POTENTIAL DISCHARGE NEEDS ON EVERY PATIENT. THOSE PATIENTS IDENTIFIED AS NEEDING ASSISTANCE WITH THEIR HOSPITAL BILL OR APPLYING FOR STATE AND FEDERAL ASSISTANCE ARE REFERRED TO THE FINANCIAL COUNSELORS BY THE HOSPITAL SOCIAL WORKERS. Schedule H, Part VI, Line 4 Community information MOBILE COUNTY IS LOCATED ON THE ALABAMA GULF COAST AND BORDERED BY MISSISSIPPI TO THE WEST AND FLORIDA TO THE EAST. ECONOMIC GROWTH, MILD CLIMATE AND COASTAL APPEAL ENTICE RESIDENTS TO LIVE IN THIS COMMUNITY. IN SUMMER 2013, CONSTRUCTION BEGAN ON A $350 MILLION JETLINER ASSEMBLY PLANT WHICH WILL BRING THOUSANDS OF JOBS TO THE AREA. THE LAND AREA OF THE COUNTY IS 1,233.09 (75%) SQUARE MILES WITH 410.93 (25%) SQUARE MILES OF WATER. ACCORDING TO THE US CENSUS 2010 RESULTS THE POPULATION OF MOBILE COUNTY IS APPROXIMATELY 412,992 PEOPLE FROM 2000 TO 2010, THE MOBILE COUNTY POPULATION GROWTH PERCENTAGE WAS 3.3%. THE COUNTY SHOWS A SLIGHTLY HIGHER PERCENTAGE OF WOMEN AS OPPOSED TO MEN; THIS IS CONSISTENT WITH STATE AND NATIONAL DATA. THE PERCENTAGE OF PERSONS 65 YEAR AND OLDER IS 13.0%, SLIGHTLY LOWER THAN THE STATE'S 14%. THE DOMINANT LANGUAGE IS ENGLISH, WITH 4.8% SPEAKING ANOTHER LANGUAGE IN THE HOME. IN MOBILE, THERE ARE 35,538 VETERANS THE COMMUNITY. THE, POPULATION OF COUNTY IS 60.8% WHITE, 34.9% BLACK, AND 2.9% OTHER WITH 1.4% REPORTING TWO OR MORE RACES. PROVIDENCE HOSPITAL COMMUNITY IS DEFINED BY THE ZIP CODE OF 75% OF THE HOSPITAL'S DISCHARGES AND INCLUDES THE FOLLOWING: 36522 36575 36606 36618 36541 36582 36608 36619 36544 36587 36609 36693 36571 36605 36613 36695 39452. Schedule H, Part VI, Line 5 Promotion of community health PROVIDENCE HOSPITAL IS LOCATED AT 6801 AIRPORT BLVD MOBILE, AL 36608. SINCE ITS FOUNDING IN 1854 PROVIDENCE HAS BEEN, HOSPITAL SERVING, CARING FOR AND HEALING THE PEOPLE OF MOBILE COUNTY AND SURROUNDING AREAS. SPONSORED BY ASCENSION HEALTH THE NATION'S LARGEST CATHOLIC NOT FOR PROFIT HEALTHCARE SYSTEM, THE HOSPITAL'S MISSION IS TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO SOUTH ALABAMA AND SOUTHEAST MISSISSIPPI, WITH A SPECIAL CONCERN FOR PERSONS WHO ARE POOR AND VULNERABLE. PROVIDENCE PROVIDES MANY COMMUNITY BENEFITS SUCH AS SOCIAL SERVICES, PASTORAL CARE, COMMUNITY MEETING SPACE, AND HEALTH EDUCATION, ALL AT NO CHARGE. THE HOSPITAL'S 500-PLUS MEMBER MEDICAL STAFF INCLUDES REPRESENTATIVES FROM EVERY MAJOR MEDICAL SPECIALTY. A MAJORITY OF THE PROVIDENCE HOSPITAL BOARD IS COMPRISED OF PERSONS WHO RESIDE IN THE COUNTY WHO ARE NEITHER EMPLOYEES NOR INDEPENDENT CONTRACTORS OF THE ORGANIZATION, NOR FAMILY MEMBERS THEREOF. PROVIDENCE HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. Schedule H, Part VI, Line 6 Affiliated health care system PROVIDENCE HOSPITAL IS A MEMBER OF ASCENSION HEALTH ALLIANCE ("THE SYSTEM"). ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13, 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. ASCENSION HEALTH ALLIANCE SERVES AS THE MEMBER OR SHAREHOLDER OF VARIOUS SUBSIDIARIES. ASCENSION HEALTH ALLIANCE AND ITS MEMBER ORGANIZATIONS ARE HEREAFTER REFERRED TO COLLECTIVELY AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. PROVIDENCE HOSPITAL, LOCATED IN MOBILE ALABAMA IS A NONPROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF MOBILE. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. THE HOSPITAL IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. THE ENTITIES COMPRISING THE HEALTH MINISTRY ARE UNDER COMMON MANAGEMENT AND CONTROL BY ASCENSION HEALTH AND SERVE THE SAME COMMUNITY. THE COMBINED FINANCIAL STATEMENTS INCLUDE THE ACCOUNTS OF THE HOSPITAL, PROVIDENCE AND PROVIDENCE'S MEMBER ENTITIES. ALL SIGNIFICANT INTERCOMPANY ACCOUNTS HAVE BEEN ELIMINATED. MEMBER ENTITIES OF PROVIDENCE INCLUDE: - PROVIDENCE FOUNDATION OF MOBILE (THE FOUNDATION) - ESTABLISHED TO RECEIVE MAINTAIN AND ADMINISTER FUNDS TO BE USED FOR THE DEVELOPMENT AND EXPANSION OF THE HOSPITAL OR ITS RELATED ORGANIZATIONS AND TO SUPPORT THE CORPORATE PURPOSES OF ASCENSION HEALTH. THE FOUNDATION IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. - PROVIDENCE BUILDING CORPORATION OF MOBILE - ESTABLISHED TO HOLD TITLE TO PROPERTY AND TO COLLECT INCOME THEREFROM AND TO SUPPORT THE CORPORATE PURPOSES OF ASCENSION HEALTH. PROVIDENCE BUILDING CORPORATION OF MOBILE IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(2) OF THE INTERNAL REVENUE CODE. - PROVIDENCE HEALTHCARE SERVICES OF MOBILE - ESTABLISHED TO OPERATE AND SUPPORT HEALTHCARE INSTITUTIONS WHICH ARE SPONSORED BY OR AFFILIATED WITH ASCENSION HEALTH. PROVIDENCE HEALTHCARE SERVICES OF MOBILE IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. - PROVIDENCE PARK, INC. - ESTABLISHED TO MAINTAIN AND DEVELOP PROPERTY ADJACENT TO THE HOSPITAL FOR PURPOSES OF ASCENSION HEALTH. PROVIDENCE PARK INC. IS TAXABLE UNDER THE INTERNAL REVENUE CODE. - SETON MEDICAL MANAGEMENT - ESTABLISHED TO OWN AND OPERATE PHYSICIAN PRACTICES. SETON MEDICAL MANAGEMENT IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. - ANESTHESIA SOLUTIONS - ESTABLISHED TO PROVIDE ANESTHESIA SERVICES FOR THE HOSPITAL ANESTHESIA SOLUTIONS IS A TAXABLE ORGANIZATION THE INTERNAL REVENUE CODE. - ALABAMA PROVIDENCE HEALTHCARE SERVICES HAS BEEN FORMED TO EMPLOY PHYSICIANS, MID-LEVEL PROVIDERS, AND PHYSICIAN PRACTICE STAFF AND TO COORDINATE THE PROVISION OF INPATIENT AND OUTPATIENT PHYSICIAN AND RELATED MEDICAL CARE FOR THE PATIENTS AND COMMUNITY MEMBERS SERVED BY ORGANIZATIONS AFFILIATED WITH PROVIDENCE HEALTH SYSTEM IN ALABAMA. THE ENTITY'S APPLICATION FOR TAX-EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE IS PENDING. - MISSISSIPPI PROVIDENCE HEALTHCARE SERVICES HAS BEEN FORMED TO EMPLOY PHYSICIANS, MID-LEVEL PROVIDERS, AND PHYSICIAN PRACTICE STAFF AND TO COORDINATE THE PROVISION OF INPATIENT AND OUTPATIENT PHYSICIAN AND RELATED MEDICAL CARE FOR THE PATIENTS AND COMMUNITY MEMBERS SERVED BY ORGANIZATIONS AFFILIATED WITH PROVIDENCE HEALTH SYSTEM IN MISSISSIPPI. MISSION THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING, AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTHCARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS. - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF EACH ENTITY'S TOTAL OPERATING EXPENSES TO THE ENTITY'S BILLED CHARGES FOR PATIENT CARE. true PROVIDENCE FOUNDATION 6801 AIRPORT BLVD MOBILE AL 36608 630915493 501(C)(3) 1300113 86671 FMV EQUIPMENT OPERATING/CAPITAL SUPPORT MISSISSIPPI PROVIDENCE HEALTHCARE SERVICES INC 6801 AIRPORT BLVD MOBILE AL 36608 461130426 2194403 OPERATING SUPPORT 1 1 Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. PROVIDENCE HOSPITAL PROVIDED SUPPORT TO RELATED ENTITIES WHOSE OPERATIONS ARE CLOSELY MONITORED THROUGH SHARED LEADERSHIP AND GOVERNANCE TO ENSURE SUPPORT GIVEN IS USED AS INTENDED. true true false false false false false false false TODD S KENNEDY PRESIDENT 330401 0 228379 0 50655 0 16200 0 21348 0 646983 0 0 0 ADINE B WADDELL ASSISTANT SECRETARY (END 9/2017) 0 122356 0 43943 0 51368 0 9867 0 18396 0 245931 0 0 CLARK P CHRISTIANSON FORMER OFFICER (END 9/2015) 0 0 0 0 323392 0 0 0 2660 0 326052 0 17423 0 JASON P ALEXANDER FACHE CEO, MINISTRY MARKET 0 414474 0 0 0 57710 0 11406 0 16361 0 499951 0 0 C SUSAN CORNEJO CFO (END 6/2018) 365157 36565 248229 0 52971 750 15629 571 19061 2004 701047 39891 0 0 BRANDON M WILLIAMS CFO, MINISTRY MARKET (START 8/2017) 0 119738 0 30000 0 2376 0 3231 0 5911 0 161255 0 0 WILLIAM M LIGHTFOOT MD FORMER KEY EMPLOYEE (END 12/2016) 0 519708 0 32948 0 20786 0 15380 0 20361 0 609184 0 0 JOHN E STONE JR MD FORMER KEY EMPLOYEE (END 12/2016) 203676 0 44300 0 20331 0 13334 0 10246 0 291887 0 0 0 KATRINA R BROWN CNO/COO 164563 0 22420 0 4912 0 12484 0 23512 0 227891 0 0 0 IJAZ IQBAL CMO 332377 0 29147 0 1553 0 14850 0 23782 0 401710 0 0 0 DON E KING COO (START 1/2018) 0 456783 0 276549 0 49054 0 14850 0 27086 0 824321 0 0 ASTON GAMALIE ARCHIBALD MD PHYSICIAN 392903 0 20617 0 4127 0 13500 0 24580 0 455727 0 0 0 DAVID CHRISTOPHER BRASWELL MD PHYSICIAN 387586 0 29617 0 4206 0 13500 0 24203 0 459112 0 0 0 WILFRED JOSEPH FONTENOT MD PHYSICIAN 385998 0 26617 0 4106 0 13500 0 24657 0 454878 0 0 0 DANIEL CURTIS HARRISON MD PHYSICIAN 392822 0 23617 0 4127 0 13500 0 24470 0 458535 0 0 0 PRESTON TODD SPEAKMAN MD PHYSICIAN 417478 0 23617 0 4264 0 13500 0 25230 0 484089 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation ASCENSION HEALTH, A RELATED ORGANIZATION OF PROVIDENCE HOSPITAL, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO: - COMPENSATION COMMITTEE, - INDEPENDENT COMPENSATION CONSULTANT, - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. Schedule J, Part I, Line 4a Severance or change-of-control payment The following individual(s) received severance payments from the organization or a related organization: Clark P Christianson - $301,344 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. The following individuals received current year distributions during calendar year 2017: CLARK P CHRISTIANSON - $17,423 Form 990, Part IV, Line 20b Explanation of Financial Statements THE ACTIVITY OF PROVIDENCE HOSPITAL IS REPORTED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE. NO INDIVIDUAL AUDIT OF PROVIDENCE HOSPITAL IS COMPLETED. THEREFORE, THE ATTACHED AUDITED FINANCIAL STATEMENTS ARE OF ASCENSION HEALTH ALLIANCE AND AFFILIATES, WHICH INCLUDE THE ACTIVITY OF PROVIDENCE HOSPITAL. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICAL In determining the compensation of the Organization's President, the process performed by Ascension Health, a related organization of Providence Hospital, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The Compensation Committee reviewed and approved the compensation. In the review of the compensation, the President was compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the Committee minutes. The individual was not present when his compensation was decided. Form 990, Part VI, Line 15b Process to establish compensation of other officers or key employees IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS, THE PROCESS PERFORMED BY GULF COAST HEALTH SYSTEM, INC., A RELATED ORGANIZATION OF PROVIDENCE HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE GULF COAST HEALTH SYSTEM, INC. EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED. Form 990, Part VI, Line 6 Classes of members or stockholders PROVIDENCE HOSPITAL HAS A SINGLE CORPORATE MEMBER, Gulf Coast Health System, Inc. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body PROVIDENCE HOSPITAL HAS A SINGLE CORPORATE MEMBER, Gulf Coast Health System, Inc., WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF PROVIDENCE HOSPITAL Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders Ascension Health has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations and major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic and financial plans; assets; system policies and procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Form 990, Part VI, Line 11b Review of form 990 by governing body DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD. Form 990, Part VI, Line 12c Conflict of interest policy The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. Form 990, Part VII, Section A Related Entities The organization utilizes an affiliate as the common pay agent. Employees reported in Part VII may have duties that impact multiple related entities. Total average hours worked and compensation and benefits paid are reported. In doing so, if available, a common law employer analysis is used to determine whether the hours and compensation/benefits are reportable as attributable directly to the filing organization or another entity; otherwise, the best available information has been used as the basis for allocations utilized in the reporting. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Community Services - Total Revenue: 7864, Related or Exempt Function Revenue: 7864, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; Education Revenue - Total Revenue: 2255, Related or Exempt Function Revenue: 2255, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; Medical Records Fees - Total Revenue: 11131, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 11131; Miscellaneous Revenue - Total Revenue: 322428, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 322428; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfers with Alpha Fund - -13891953; Form 990, Part XII, Line 2c oversight of audit or selection of independent accountant Providence Hospital is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole. 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