2017-05-11T16:11:57-05:00 2016-06-30 470617373 Catholic Health Initiatives 12809 WEST DODGE ROAD OMAHA NE 68154 990 2015-07-01 470399853 ALEGENT HEALTH-MEMORIAL HOSPITAL SCHUYLER ALEG 4023434323 104 W 17TH STREET SCHUYLER NE 68661 Jeanette Wojtalewicz CFO 2017-05-09 true Angela Noel P01051055 4023434413 2015 2021-01-29 14:40:06Z CLIFF ROBERTSON 104 W 17TH STREET SCHUYLER NE 68661 13198167 false X WWW.CHIHEALTH.COM X 1950 NE THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. 16 11 113 28 0 0 6084 10235 11864601 13063181 34092 45572 74695 77547 11979472 13196535 400198 349184 0 6587791 6298628 0 0 5448661 5869343 12436650 12517155 -457178 679380 12025729 11657337 3010501 2004971 9015228 9652366 X 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. false false 1265961 130264 4882914 ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER PROVIDES PATIENTS WITH ACCESS TO MEDICAL SPECIALTY SERVICES THROUGH VISITING SPECIALISTS IN THE FOLLOWING AREAS: CARDIOLOGY, EAR, NOSE AND THROAT, GASTROENTEROLOGY, GENERAL SURGERY, WOUND CARE, ONCOLOGY, OPHTHALMOLOGY, ORTHOPAEDICS AND UROLOGY. EACH ONE OF THESE SPECIALTY CLINICS ALLOWS US TO TREAT EACH PATIENT WITH ONE ON ONE SPECIALTY CARE. 1197368 28843 1081172 ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER PROVIDES RESIDENTS OF COLFAX COUNTY WITH 24 HOUR EMERGENCY DEPARTMENT CARE AND MEDICAL AND SURGERY SERVICES. 805560 74421 2789661 ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER HAS STRIVEN TO CONTINUALLY IMPROVE THE HEALTH STATUS OF COLFAX COUNTY RESIDENTS --- CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS BY PROVIDING DIAGNOSTIC IMAGING SERVICES TO AREA RESIDENTS - CLOSE TO HOME --- RIGHT IN THEIR OWN COMMUNITY. THE DIAGNOSTIC IMAGING SERVICES PROVIDED INCLUDE THE FOLLOWING: CAT SCAN, MRI, NUCLEAR MEDICINE AND BONE DENSITY SCREENING IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND. 8689126 115656 4335318 OTHER PROGRAM SERVICES 8689126 115656 4335318 11958015 true true false true false false false false false true true true false false true true false true false false false false false false false false true true false true true false false false false false false false false false false false false false true true false false false true 0 0 113 true false false false false false false false false false false X 16 11 false false false false true true true true true false false true true true true true true true true false X JEANETTE WOJTALEWICZ 4023434671 12809 WEST DODGE ROAD OMAHA NE 68154 MICHAEL DEFREECE SECRETARY/TREASURER 1.0 11.0 X X 0 0 0 RICHARD HERINK MD BOARD CHAIR 1.0 11.0 X X 0 0 0 CLIFF ROBERTSON MD Board Member/CEO CHI Health 1.0 59.0 X X 0 1505835 179645 SR Maryanne Stevens RSM VICE CHAIR 1.0 11.0 X X 0 0 0 LARRY BUTLER Board Member 1.0 11.0 X 0 0 0 FR JAMES CLIFTON SJ Board Member 1.0 11.0 X 0 0 0 GREGORY HEIDRICK Board Member 1.0 11.0 X 0 0 0 Sister Nadine Heimann Board Member 1.0 11.0 X 0 0 0 ROBERT LANIK Board Member 1.0 59.0 X 0 342925 13268 MICHAEL ROWAN FACHE Board member/CHI EVP & COO 1.0 59.0 X 0 3895913 57577 BARRY SANDSTROM Board Member 1.0 11.0 X 0 0 0 NATHANIEL BRACKETT MD BOARD MEMBER 1.0 59.0 X 0 0 0 SUSANNE L HRUZA BOARD MEMBER 1.0 11.0 X 0 0 0 AMY L MCGAHA md BOARD MEMBER 1.0 59.0 X 0 263770 14202 Edward R O'Connor Ph d Board Member 1.0 11.0 X 0 0 0 Bill T Yates Board Member 1.0 11.0 X 0 0 0 JOAN NEUHAUS CHI HEALTH SVP COO 5.0 55.0 X 0 1115034 44362 CARY WARD MD CHI HEALTH SVP CMO 8.0 52.0 X 0 634091 53201 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 5.0 55.0 X 0 874016 82856 CONNIE PETERS OL REGIONAL HOSPITAL ADMINISTRATOR 59.0 1.0 X 163952 0 21610 RODNEY TRIPLETT NETWORK EXECUTIVE 20.0 41.0 X 0 214079 22427 NANCY WALLACE SVP HR CHIEF OFFICER 5.0 55.0 X 0 465368 36239 STEVE HOUSTON SVP STRATEGY AND TECHNOLOGY 18.0 42.0 X 0 396238 41690 MIKE WATTERS VP-SENIOR COUNCEL 1.0 59.0 X 0 358800 32338 RENEE SAYER NURSE PRACTIONER 40.0 0.0 X 164972 0 9779 THOMAS WONG MD PHYSICIAN 60.0 0.0 X 212634 0 15681 FRANCISCO MACHUCA MD PHYSICIAN 60.0 0.0 X 204229 0 34069 JOHANNA MISSAK PHYSICIAN 60.0 0.0 X 279494 0 63311 Naila Haroon Physician 60.0 0.0 X 253618 0 7649 Schnack Tim VP OPERATIONAL FINANCE 9.0 92.0 X 0 314003 36566 JASON YUNGTUM VP/REG GENERAL COUNSEL 2.0 58.0 X 0 130857 70552 CINDY ALLOWAY FORMER DIRECTOR 0.0 57.0 X 0 533574 39911 PATRICIA MASEK FORMER DIRECTOR 0.0 57.0 X 0 223850 37202 1278899 11268353 914135 9 true true false JE DUNN CONSTRUCTION COMPANY 17110 Mercy Street Omaha NE 68118 Construction 154299 Butler County Health Care Center 372 S 9th Street David City NE 68632 Medical Services 146491 EAST CENTRAL NEBRASKA THERAPY 879 N 11TH STREET DAVID CITY NE 68632 PHYSICAL THERAPY 125841 Siemens Medical Solutions 40 Liberty Blvd Melvern PA 19355 Medical Diagnostics 106631 4 X 0 0 0 10235 0 0 0 10235 Net patient services 900099 12412885 12412885 0 0 Medicare/Medicaid 900099 149800 149800 0 0 Laboratory Services 621500 85542 85542 0 0 Product Sales 446199 393138 393138 0 0 Cafeteria 722100 21816 21816 0 0 0 0 0 0 13063181 45541 0 0 45541 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 31 0 0 0 31 31 0 0 31 2357 0 50 2307 0 2307 911 100 811 0 0 811 2641 1482 1159 0 0 1159 Pharmacy Services 446110 25884 25884 0 0 0 0 0 0 0 0 0 0 47386 0 0 47386 73270 13196535 13089065 0 97235 X 790 790 348394 348394 146578 146578 4785841 4539220 246621 258135 245228 12907 778744 739807 38937 329330 312864 16466 2668399 2534979 133420 0 30309 28794 1515 409874 389380 20494 206114 195809 10305 29882 28388 1494 889 845 44 44776 42537 2239 548702 521267 27435 Bad debts 985169 985169 Medical Supplies 625891 594596 31295 Repairs and maintenance 101435 96363 5072 Intercompany Allocations 185732 176445 9287 32171 30562 1609 0 12517155 11958015 559140 0 3634443 4049794 0 0 1467540 1143578 0 0 0 0 181038 142182 0 0 7542143 2273155 5686046 5268988 259880 261592 796782 791203 0 0 0 0 0 12025729 11657337 186904 809174 0 0 0 0 0 0 0 0 715673 660970 0 2107924 534827 3010501 2004971 X 9012772 9649910 2456 2456 0 0 9015228 9652366 12025729 11657337 679380 -42242 0 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 1403 false false false 1403 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: NEBRASKA HOSPITAL ASSOCIATION - $739 AMERICAN HOSPITAL ASSOCIATION - $413 CATHOLIC HEALTH ASSOCIATION - $251 Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: NEBRASKA HOSPITAL ASSOCIATION - $739 AMERICAN HOSPITAL ASSOCIATION - $413 CATHOLIC HEALTH ASSOCIATION - $251 -5039 39130 10215 23876 -19067 19680 5652 -5039 -37802 20562 0 0 1827 0 -19067 -29707 21443 0 0 29538 0 -37802 24659 24678 0 0 79044 0 -29707 0.0 0.06 0.94 false true true 1575977 1575977 3657141 888773 2768368 0 0 0 2016268 1288830 727438 292757 95552 197205 5268988 CHI OIP CHI OIP 791203 F 791203 Notes Payable Notes Payable 534827 534827 X Schedule D, Part V, Line 4 Intended uses of endowment funds ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF SCHUYLER MEMORIAL HOSPITAL FOUNDATION, INC AND ALEGENT HEALTH-MEMORIAL HOSPITAL, SCHUYLER. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote ALEGENT HEALTH-MEMORIAL HOSPITAL, SCHUYLER'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, 2016 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 false false true true true false true true 237 300396 300396 0.0240 243 1262636 1262396 240 0.0000 6361 6360 1 0.0000 0 480 1569393 1268756 300637 0.0240 15 1217 37561 1867 35694 0.0029 4 15 381 0 381 0.0000 2 2671171 1771663 899508 0.0719 1 934 0 934 0.0001 10 693 27095 815 26280 0.0021 32 1925 2737142 1774345 962797 0.0769 32 2405 4306535 3043101 1263434 0.1009 0 0.0 1 84 84 0.0000 0 0.0 0 0.0 0 0.0 1 1438 1438 0.0001 0 0.0 1 75 75 0.0000 0 0.0 3 0 1597 0 1597 0.0001 true 985169 0 6797108 8282466 -1485358 X true true 1 1 ALEGENT HEALTH MEMORIAL HOSPITAL 104 WEST 17TH STREET SCHUYLER NE 68661 WWW.CHIHEALTH.COM 170001 X X X ALEGENT HEALTH MEMORIAL HOSPITAL 1 false false true X X X X X X X X X 15 true true true true X HTTP://WWW.CHIHEALTH.COM/CHNA X www.ecdhd.com X X true 16 true HTTP://WWW.CHIHEALTH.COM/CHNA false false true X X X X X true true X X X true X HTTP://WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X HTTP://WWW.CHIHEALTH.COM/DOCUMENTS/FINANCIAL_ASSISTANCE_APPLICATION.PDF X HTTP://WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - ALEGENT HEALTH MEMORIAL HOSPITAL. To obtain feedback from the general public, a community engagement session co-sponsored by CHI Health Schuyler and East Central District Health Department (ECDHD) was held in Colfax County to solicit the community's opinion about the important health, social, and environmental issues for the community. These stakeholders represent low-income, minority populations, medically underserved populations and the aging population. Several surveys and assessments engaged the public to gain input for the assessment (additional details can be found in the full CHNA report). In addition to this community engagement, sessions were held within Colfax County and the other counties included within the East Central District. CHI Health Schuyler considered the outcomes of Colfax County Community Health Improvement Plan (CHIP) meetings during the implementation planning. The CHIP meetings included brainstorming sessions with community stakeholders to review data, narrow down the list of health priorities, and identify threats and opportunities to address the health issue. Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - ALEGENT HEALTH MEMORIAL HOSPITAL. Boone County Health Center Genoa Community Hospital Columbus Community Hospital CHI Health Schuyler Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - ALEGENT HEALTH MEMORIAL HOSPITAL. The East Central District Health Department conducted the CHNA while other organizations participated in the CHNA process. Please see the CHNA report for complete list on participating partners. Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - ALEGENT HEALTH MEMORIAL HOSPITAL. The CHNA was shared with the CHI Health Schuyler community board and the local health department. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - ALEGENT HEALTH MEMORIAL HOSPITAL. The new CHNA and corresponding implementation plan was completed in the tax reporting year 2015. The following outlines the current implementation plan priorities and strategies. This plan was posted publicly on www.chihealth.com/chna. For this plan the hospital prioritized the following health needs: Priority Health Need #1: Nutrition, Physical Activity, and Weight Status To address this need the hospital will implement the following strategies in 2016-2018: * Build infrastructure to support and implement Healthy Families Program for families with a child 4 to 18 years in Colfax County with a BMI in the 85th percentile or higher. * Promote healthy lifestyles through 5-4-3-2-1 Go! campaign in children ages 5 to 12 years old in Colfax County. Priority Health Need #2: Behavioral Health To address this need the hospital will implement the following strategies in 2016-2018: * Increase the overall awareness of existing and potential resources among community stakeholders through an established behavioral health community coalition in Colfax County. * Increase the knowledge and skills of local community members through behavioral trainings offered through Region 4. * Develop a collaborative process among regional providers, law enforcement, schools, probation and the hospital to address families in crisis that include prevention and intervention strategies that considers the diversity of community members. Priority Health Need #3: Access to Care To address this need the hospital will implement the following strategies in 2016-2018: * Provide Colfax and Platte County infants and their families, local family-centered comprehensive care beginning at birth and continuing throughout childhood. Priority Health Need #4: Support for Families with Children in Poverty To address this need the hospital will implement the following strategies in 2016-2018: * Prevent families from unnecessary entry or re-entry into higher end systems of care-(alternative response, probation, behavioral health, juvenile justice, child welfare systems, etc) in Colfax and Platte Counties. The hospital will not address the following health needs for the following reasons: In acknowledging the range of priority health issues that emerged from the CHNA process, CHI Health Schuyler prioritized the health issues above in order to most effectively focus resources and meaningfully impact the selected health issues. CHI Health Schuyler selected the same top health needs as identified by the community and will address each of those needs as described in the section above. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - ALEGENT HEALTH MEMORIAL HOSPITAL. ALEGENT HEALTH MEMORIAL HOSPITAL BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - ALEGENT HEALTH MEMORIAL HOSPITAL. The organization will not charge individuals who are eligible for financial assistance more than amounts generally billed to those who have insurance. 5 AH MEMORIAL HOSPITAL HOME HEALTH 104 W 17TH STREET SCHUYLER NE 68661 HOME HEALTH CHI HEALTH CLINIC CLARKSON 329 PINE STREET CLARKSON NE 68629 RURAL HEALTH CLINIC CHI HEALTH CLINIC SCHUYLER 1721 COLFAX STREET SCHUYLER NE 68661 RURAL HEALTH CLINIC CHI HEALTH CLINIC HOWELLS 121 SOUTH 6TH STREET HOWELLS NE 68641 RURAL HEALTH CLINIC AH MEM HOSPITAL SKILLED NURSING FACILITY 104 W 17TH STREET SCHUYLER NE 68661 SKILLED NURSING FACILITY Schedule H, Part I, Line 6a Community Benefit Report available to the public Yes, the Alegent Creighton Health system produces an annual public community benefit report that is mailed to a core constituency, placed in key places throughout the organization and distributed in community meetings. It is also available on the company's intranet site, and on its public website at http://www.chihealth.com/community-benefit. Schedule H, Part VI, Line 5 Promotion of Community Health (Continued) * Health professional education- - Administration of nursing preceptorships and clinical rotations - Clinical pastoral education - Scholarships for healthcare education - Academic affiliation with Creighton University and its Health Professions Programs - Physician residency and fellowship programs training more than 230 residents and fellows annually * Subsidized health services - healthcare services including emergency care and clinical care in the rural health setting * Research - unfunded staff support of the National Cancer Institute Community Oncology Research Program (NCORP) * Financial and in-kind contributions- - Corporate sponsorships - Tanzania health ministry - Staff service on health related board and coalitions - Participation in and funding of maternal health, breastfeeding, substance abuse, cancer, diabetes and other community health coalitions. - Participation in and sponsorship of mental health coalitions including Kim Foundation, Community Alliance Foundation, Voices for Children, Youth Emergency Service, Project Harmony and El Centro de las Americas. - Employee costs of coordinating community events not sponsored by CHI Health (hospital staff organized a donation to the Salvation Army for a family in need) - In-kind donations (staff time, space, etc.) supporting grants for Behavioral Health, Telepsych, Community Link and 54321Go!. - Purchased car seats for participants in the Sixpence program who do not have access to adequate car seats. - Hospital hosted a blood drive onsite and employees donated blood on paid time - In-kind donations of meeting room space and staff time for not-for-profit organizations and community groups * Community building activities- - Healthcare career exploration camp-day camp funded by CHI Health for students grades 10-12 to give them the opportunity to explore a variety of healthcare professions - Presentations to high school students about healthcare careers - Community and economic development including support of local Chambers of Commerce - Strategic planning and consulting services for community - Hospital president serves on the Board of Directors for the East Central Health Department-involves strategic planning around initiatives, building committee for Good Neighbor, etc. * The primary care and pediatric physician clinics that are part of the parent corporation provide access to care through the system's Financial Assistance Policy and participate in medical student preceptorships that advance the healthcare provider education process. * CHI Health has Open Medical staffs * CHI Health is the sole, comprehensive mental health provider in the Omaha MSA area operating a breakeven point of revenue. * CHI Health is a joint venture partner in a not-for-profit Hospice inpatient hospital and provides the management support contract. ALEGENT CREIGHTON HEALTH SYSTEM IS GOVERNED BY A BOARD OF DIRECTORS PRIMARILY COMPRISED OF VOLUNTEER MEMBERS OF OUR LOCAL COMMUNITY WHO ARE LEADERS IN THE FIELDS OF BUSINESS, HEALTHCARE, ACCOUNTING AND MEDICINE AND UNDERSTAND THEIR ROLE IN PROVIDING STRONG CORPORATE GOVERNANCE. THE ALEGENT CREIGHTON HEALTH HOSPITALS HAVE FULL-TIME EMERGENCY DEPARTMENTS THAT ARE OPEN TO THE PUBLIC AND PROVIDE MEDICAL SCREENING EXAMINATIONS AND STABILIZING TREATMENT WITHIN THE CAPABILITIES AND CAPACITIES OF THE HOSPITALS REGARDLESS OF BUT NOT LIMITED TO THE PATIENT'S RACE, COLOR, SEX, AGE, AND/OR ABILITY TO PAY. THE HOSPITALS ARE IN COMPLIANCE WITH THE FEDERAL EMTALA REGULATIONS. IN ADDITION, TOGETHER WITH UNRELATED HOSPITALS IN THE AREA, WORK CLOSELY WITH LOCAL FIRE AND RESCUE DEPARTMENTS TO ENSURE THAT AMBULANCES TAKE PATIENTS TO THE APPROPRIATE HOSPITAL. THIS IS GENERALLY THE HOSPITAL THAT IS CLOSEST GEOGRAPHICALLY WITH EXCEPTIONS BASED ON PATIENT PREFERENCE, PATIENT'S PHYSICIAN PREFERENCE, AND CAPACITY OR THE AVAILABILITY OF SPECIALIZED FACILITIES OR PROGRAMS RELATED TO THE PATIENT'S CONDITION. FINALLY, THE ALEGENT CREIGHTON HEALTH HOSPITALS MAINTAIN DETAILED PROCEDURES REGARDING WHEN AND UNDER WHAT CIRCUMSTANCES A PATIENT CAN BE TRANSFERRED. UNDER THIS POLICY, NO PATIENT WILL BE TRANSFERRED BASED ON RACE, CREED, RELIGION OR ABILITY TO PAY. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER, NE) ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY IT WAS DETERMINED THAT ESTABLISHING A HOUSEHOLD INCOME SCALE BASED ON THE HUD VERY LOW INCOME GUIDELINES MORE ACCURATELY REFLECTS THE SOCIOECONOMIC DISPERSIONS AMONG URBAN AND RURAL COMMUNITIES IN 17 STATES SERVED BY CHI HOSPITALS AND HEALTH CARE FACILITIES. IN COMPARING HUD GUIDELINES TO THE FEDERAL POVERTY GUIDELINES ("FPG"), WE FIND THAT ON AVERAGE HUD GUIDELINES COMPUTE TO APPROXIMATELY 200% TO 250% (AND SOMETIMES 300%) OF FPG. ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. Schedule H, Part I, Line 6a Community benefit report prepared by related organization ALEGENT CREIGHTON HEALTH Schedule H, Part I, Line 7g Subsidized Health Services CHI Health Schuyler Rural Health Clinic CHI Health Howells Rural Health Clinic CHI Health Clarkson Rural Health Clinic The total expenses associated with operating these clinics were $2,671,171. Revenue offsets were $1,771,663. Accordingly, the total subsidized cost of these necessary services was $899,508. The clinics meet a community need for primary care services outside of the emergency room setting. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using Worksheet 2 to compute the cost-to-charge ratio. The cost-to-charge ratio covers all patient segments. Schedule H, Part II Community Building Activities CHI Health has a history of centralized community benefit investments, as well as hospital specific investments that address community health needs which include support of local health coalitions, investments in partnerships and programs that address top community health needs, participation in local committees and boards tied to top health needs, and investments in many other ways as described in other areas of the Schedule H narrative. Below are specific examples of work that falls within the definition of community building activities. These activities are critical in helping build social, health, and economic opportunities in our community that ultimately drive health status and quality of life for our residents: * Workforce development-the following activities work to strengthen the community's capacity to promote the health and well-being of our residents by driving entry into healthcare careers: o Healthcare career exploration camp-day camp funded by CHI Health for students grades 10-12 to give them the opportunity to explore a variety of healthcare professions o Presentations to high school students about healthcare careers * Community and economic development including support of local Chambers of Commerce * Strategic planning and consulting services for community partners to build capacity to address health and social needs of the community * Hospital president serves on the Board of Directors for the East Central Health Department-involves strategic planning around initiatives, building committee for Good Neighbor, etc. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 83.19%. WHEN DISCOUNTS ARE EXTENDED TO SELFPAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. Schedule H, Part III, Line 3 Bad Debt Expense Methodology ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASISTANCE 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 Alegent Health Memorial Hospital Schuyler 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. In accordance with Accounting Standards Update (ASU) No. 2011-07, Presentation and Disclosure of Patient Services Revenue, Provision for Bad Debts, and Allowances for Doubtful Accounts for Certain Health Entities, the provision for bad debts is presented on 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 The Alegent Creighton Health system does not consider Medicare shortfalls to be community benefit, per the recommendation of the Catholic Health Association. The Medicare charges reported on lines 5 and 6 are from Medicare cost reports which used a cost to charge ratio. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER'S DEBT COLLECTION POLICY PROVIDES THAT ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAUMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G MEDICAID) AND TO NOT QUALIFY FOR COVERAGE UNDER THE FINANCIAL ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO MEET THE ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER'S FINANCIAL ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO (NAME OF ENTITY) FOR APPROPRIATE FOLLOW-UP. ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER REQUIRES ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FINANCIAL ASSISTANCE. ALL OF CATHOLIC HEALTH INITIATIVES' HOSPITALS' CONTRACTS WITH THIRD-PARTY COLLECTION AGENCIES INCLUDE THE FOLLOWING STANDARDS: 1. NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL REQUEST BENCH OR ARREST WARRANTS AS A RESULT OF NON-PAYMENT; 2. NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL SEEK LIENS THAT WOULD REQUIRE THE SALE OR FORECLOSURE OF A PRIMARY RESIDENCE; AND 3. NO CHI COLLECTION AGENCY MAY SEEK COURT ACTION WITHOUT HOSPITAL APPROVAL FINALLY, COLLECTION AGENCIES ARE TRAINED ON THE CHI MISSION, CORE VALUES AND STANDARD OF CONDUCT TO MAKE SURE ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT. Schedule H, Part V, Section B, Line 16a FAP website - ALEGENT HEALTH MEMORIAL HOSPITAL: Line 16a URL: HTTP://WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE; Schedule H, Part V, Section B, Line 16b FAP Application website - ALEGENT HEALTH MEMORIAL HOSPITAL: Line 16b URL: HTTP://WWW.CHIHEALTH.COM/DOCUMENTS/FINANCIAL_ASSISTANCE_APPLICATION.PDF; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ALEGENT HEALTH MEMORIAL HOSPITAL: Line 16c URL: HTTP://WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE; Schedule H, Part VI, Line 2 Needs assessment The process of identifying the community health needs in Colfax County was accomplished by utilizing the Mobilizing for Action through Planning and Partnerships (MAPP) strategy, led by the East Central District Health Department. This process was used to gather data, select priorities, and foster collaboration among health care providers. * East Central District Health Department (ECDHD) is a state-approved district health department that serves four Nebraska counties- Boone, Colfax, Nance, and Platte. * Schmeeckle Research, Inc. - ECDHD and the partnering district hospitals contracted with Schmeeckle Research, Inc. to assemble the community health needs assessment based largely upon the data collected through the Mobilizing for Action through Planning and Partnerships process. Facilitated by public health leaders, MAPP is a community-driven strategic planning approach used to improve community health through applying strategic thinking to prioritize public health issues and identify the resources to address them. This approach utilized both primary and secondary data collected throughout the process. Primary data included four MAPP assessments and secondary data consisted of public health, vital statistics, and other data collection. The assessment also incorporates a broad range of both qualitative and quantitative data. The quantitative data is primary (as derived from the ECDHD Community Health Survey) and secondary (as derived from statistics from large datasets, as well as hospital-specific data); these resources allow for trend analysis and comparisons to both state and national levels. Qualitative data input is also derived from the ECDHD Community Health Survey and focus group meetings. More information regarding the process can be found in the CHNA attached. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance There are several financial assistance access points throughout a patient's care cycle. Bills contain financial assistance verbiage; signs are posted in clinics and hospital, and there is information on financial assistance posted at registration points throughout clinics and hospitals. Information on The Alegent Creighton Health System's financial assistance policies are located several places on the system's website- www.alegentcreighton.com. All efforts are made to establish whether patients are eligible for financial assistance prior to service if possible, otherwise as soon as possible following service. Alegent Creighton Health representatives help patients seek reimbursement from local, state and federal programs at no charge to the patient. After these efforts and resources have been exhausted, patients are assisted in the application process for financial assistance consistent with Alegent Creighton Health's Financial Assistance Policy. The application process requires that the patient complete a personal financial application and provide verification documents. Verification includes employment verification and obtaining documentation of the applicant's financial condition such as federal tax return, pay stub, net worth and/or liquid assets and reasonable household or business expenses. Financial assistance may still be granted in certain circumstances involving a catastrophic occurrence resulting in medical bills grossly exceeding the patient's ability to pay, and in these situations, the patient's responsibility will be limited to 20% of the family's gross annual income. Schedule H, Part VI, Line 4 Community information CHI Health Schuyler is located in Schuyler, NE and largely serves the Colfax County area. Colfax County was identified as the community for this CHNA, as it is the primary service area for CHI Health Schuyler. Schuyler is the most populated city in the county, with 6,169 residents and is the county seat in Colfax County. Population data shows a largely diverse population with 65.4% of the population of Schuyler as Hispanic and 32.5% Non-Hispanic White. Colfax County is similarly diverse with 43.1% Hispanic and 53.9% Non-Hispanic White, compared to 10.2% Hispanic and 80.5% Non-Hispanic White in Nebraska overall. Town of Schuyler: Largest Hispanic population (65.4%) Younger population with 33.8% of residents below the age of 18 Colfax County: 29.6% of population below 18 years of age 13.58% of persons living below the poverty line (100% FPL) in Colfax County Median income of households in in 2014 in Colfax County was $52,086 County unemployment rate is 2.8% Graduation rate of 82.8% 14.94% of population is uninsured Schedule H, Part VI, Line 5 Promotion of community health CHI Health has a history of centralized community benefit and hospital specific community benefit investments to address community health needs of the particular service area. Examples of how CHI Health furthers its exempt purpose by promoting the health of the community include: * Financial Assistance and Unpaid costs of Medicaid * Community health improvement services- - Community education, classes and programs (cardiac, CPR, car seat safety checks, community behavioral health support, diabetes, cancer, physical activity and healthy eating and cooking) - Support groups (cancer, bereavement, youth, etc.) - Community health fairs and screenings (blood pressure check clinics monthly and discount labs provided to residents of Clarkson & Howells) - Parish nursing program and faith community outreach - School based healthcare services - Healthy Families-this program is a free, 8-week health and nutrition program for families with a child between the ages of 4-18 who has been identified in the top 85th percentile of body mass index. This program invites the whole family to participate in learning about physical activity, eating healthy, and setting realistic goals as a family. - Childcare-provided the Nutrition & Physical Activity Self-Assessment in Child Care (NAP SACC) Learning Collaborative for child care programs in Douglas, Sarpy and Cass Counties in Nebraska. Ten child care programs sent a total of 30 providers through a series of five workshops to learn about best practices for teaching healthy eating and physical activity habits to young children. - Breastfeeding-provided funding and planning support to host a 5 day training in York, NE for clinic and community healthcare workers to obtain their Certified Lactation Counselor (CLC) designation. CHI Health also provided funds towards the planning of a continuing education event (Beyond Best Practices: Creating a Supportive Environment for Breastfeeding Parents) for clinic and hospital professionals (nurses, medical assistants, dieticians, health coaches/navigators and providers) in addition to support for an online course called Breastfeeding the NICU Infant for hospital-based NICU nursing staff. Eighty professionals were enrolled in February of 2016. - Subsidized 50 sports physical vouchers for students who cannot afford a high school physical, thus keeping them from being able to participate in school sports. - Subsidized 86 flu shots for the Schuyler Public Schools district - Provided counseling and assistance in enrolling individuals in means tested insurance programs to improve access to care. - Provide support to health coalitions and investments in social and environmental improvement strategies. These are programs, activities and partnerships that improve the health of persons in the community by addressing the determinants of health, which includes the social, economic and physical environment. See specific examples by community below: Omaha/Council Bluffs Metro - Hope Medical Outreach Coalition-Board service and annual operating subsidy. CHI Health hospitals and physicians are one of three health systems that provide access for the patients of three area federally qualified healthcare centers to specialty physician services and hospital based diagnostics and treatment that are unable to afford medical services. - Metro Area Continuum of Care for the Homeless-Board service and financial support to this coalition addressing homelessness in the service area. - Live Well Omaha-a coalition founded by Alegent Creighton Health (now CHI Health) and the county health department that serves as convener of business, healthcare and community leaders to review health trends and catalyze community action to address health issues. - Live Well Omaha Kids-a community coalition using a collective impact approach to address childhood obesity. - African American Empowerment Network- Support of the Step Up summer jobs program a workforce development initiative serving a typically low-income part of the community. - Community Link-a partnership with Catholic Health Initiatives to improve the health and socioeconomic status of patients by assessing and treating their non-medical needs and barriers, which are important factors of their health. - Violence Prevention-a partnership with Catholic Health Initiatives, Women's Center for Advancement and Creighton University to implement a campus based violence prevention program known as "Green Dot". - Together, Inc.- provided funds to support the newly developed homeless case management project to be housed out of the CUMC emergency department and then at University Campus. The program will connect high utilizers of the emergency department, who are identified as homeless, with a case manager who will then assist them in finding sustainable housing and accessing other resources associated with social determinants of health. - YMCA-provided support of the Omaha Metro YMCA's Strong Community Campaign to provide for youth programming, medically based wellness, and youth and family memberships for low-income community members. - Pottawattamie County Development-provided support for the administration and delivery of The Big Garden project serving families identified by local healthcare agencies as needing support to access healthy foods at low cost. The program builds the family's skill for self-sustaining a garden and year-round preparation, planning, care, and harvest in a personal garden. - Project Extra Mile-provided funding for the evaluation of a clinic based Screening, Brief Intervention & Referral to Treatment (SBIRT) program that was piloted at the CHI Health 161st and Maple clinic, then implemented at the 132nd & West Center CHI Health Clinic. Lincoln - Partnership for a Healthy Lincoln-provided financial and partnership support as part of the community health improvement plan to PHL, a non-profit health coalition dedicate to improving the health, wellness, and fitness of all those in our community. -Clinic with a Heart-in addition to staffing free clinics each month, provided financial support for infrastructure and program implementation to this free clinic serving the uninsured and underinsured. Kearney - Buffalo County Community Health Partners-provided financial support and leadership to this health coalition that is a county-wide effort to address the leading health issues in the county. - Be Well Buffalo County Program-provided funding that supported establishment of Be Well coalition to advocate for a healthy community culture through infrastructure, education and programs to support healthy choices. Grand Island - Third City Community Clinic-provided funding to support the Access to Healthcare project which aims is to be proactive in the treatment and management of chronic disease in low-income and minority patients to 1) ensure a better quality of life for the patient 2) minimize their emergency room visits and hospital admissions to reduce costs to the patients and the healthcare provider(s). Nebraska City - People United for Families-provided financial support for Partners for Otoe County, a non-profit organization dedicated to building a healthy community where every child and family thrives. P4OC collaborates with individuals, organizations, local businesses, institutions, and agencies to take responsibility for improving the health and quality of life in our community. - Growing Great Kids-provided support for this program, which is a program housed out of Southeast District Health Department (SEDHD). The program provides home visiting services delivered by nursing staff, for families at risk for adverse childhood experiences during the prenatal to age 3 timeframe, to offer support in the prenatal time period as well as parenting support and resources as baby grows. Missouri Valley - Harrison County Home & Public Health-provided funding to Harrison County Home & Public Health (HCHPH) to host a Milk Mob Training (evidence based program) to train community health workers in breastfeeding support. Funding also allowed HCHPH to host R.E.S.P.E.C.T. program at local school assemblies for elementary-age students to learn to recognize bullies as being in danger of child abuse and neglect in their home, and how to help them as a peer. - Healthy Harrison Coalition-provided funding for referrals and vouchers distributed through local agencies such as WIC and West Central Community Action Partnership to families with low access to healthy foods. Vouchers offered participating families transportation to the County Farmer's Market, as well as a $20 voucher for fruits and vegetables. Schedule H, Part VI, Line 6 Affiliated health care system CHI Health Memorial Hospital Schuyler along with its affiliated outpatient facilities, are part of Catholic Health Initiatives. Catholic Health Initiatives (CHI) is a national faith-based nonprofit health care organization with headquarters in Englewood, Colorado. CHI's exempt purpose is to serve as an integral part of its national system of hospitals and other charitable entities, which are described as market-based organizations, or MBOs. An MBO is a direct provider of care or services within a defined market area that may be an integrated health system and/or a stand-alone hospital or other facility or service provider. CHI serves as the parent corporation of its MBOs which are comprised of 104 hospitals, including four academic medical centers, and 30 critical access facilities; community health service organizations; accredited nursing colleges; home health agencies; and other facilities that span the inpatient and outpatient continuum of care. Together, these facilities provided $1.1 billion in financial assistance and community benefit in the 2016 fiscal year, including services for the poor, free clinics, education and research. CHI provides strategic planning and management services as well as centralized "shared 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. CHI Health Memorial Hospital Schuyler operates with its wholly owned affiliates and community partners, along with its fundraising arm, the Schuyler Memorial Hospital Foundation, to serve the health care needs of the Colfax County communities. Schedule H, Part VI, Line 7 State filing of community benefit report IA, NE true FINANCIAL ASSISTANCE 237 348394 BOOK WRITE OFF OF PATIENT SERVICES Schedule I, Part III, Column (b) Estimated Number of Recipients ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER 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. FINANCIAL ASSISTANCE 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. MOST DISBURSEMENTS IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PROGRAMS ARE MADE DIRECTLY IN THE ACTIVE CONDUCT OF THE ACTIVITIES CONSTITUTING THE EXEMPT PURPOSE OR FUNCTION OF THE ORGANIZATION. OTHERWISE, DISTRIBUTIONS IN FURTHERANCE OF THE INSTITUTION'S EXEMPT PROGRAMS ARE MADE IN ACCORDANCE WITH PROCEDURES SUBJECT TO CONDITIONS ESTABLISHED BY THE INSTITUTION'S GOVERNING BOARD OR MANAGEMENT DESIGNED TO ENSURE THAT RECIPIENTS OF SUCH DISBURSEMENTS FROM THE ORGANIZATION ARE ADEQUATELY INVESTIGATED AND GRANTED TO QUALIFIED RECIPIENTS. false true false false false false false true false CLIFF ROBERTSON MD Board Member/CEO CHI Health 0 790178 0 500149 0 215508 0 139775 0 39870 0 1685480 0 65659 CINDY ALLOWAY FORMER DIRECTOR 0 362835 0 54084 0 116655 0 15775 0 24136 0 573485 0 0 PATRICIA MASEK FORMER DIRECTOR 0 166186 0 11683 0 45981 0 12398 0 24804 0 261052 0 0 ROBERT LANIK Board Member 0 1 0 0 0 342924 0 6636 0 6632 0 356193 0 0 MICHAEL ROWAN FACHE Board member/CHI EVP & COO 0 1273340 0 1763164 0 859409 0 15775 0 41802 0 3953490 0 242516 AMY L MCGAHA md BOARD MEMBER 0 263705 0 0 0 65 0 13149 0 1053 0 277972 0 0 JOAN NEUHAUS CHI HEALTH SVP COO 0 597348 0 324078 0 193608 0 17075 0 27287 0 1159396 0 0 CARY WARD MD CHI HEALTH SVP CMO 0 440912 0 65962 0 127217 0 15775 0 37426 0 687292 0 0 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 0 516339 0 229990 0 127687 0 60392 0 22464 0 956872 0 0 Schnack Tim VP OPERATIONAL FINANCE 0 245685 0 17167 0 51151 0 14900 0 21666 0 350569 0 0 JASON YUNGTUM VP/REG GENERAL COUNSEL 0 80564 0 0 0 50293 0 11056 0 59496 0 201409 0 0 CONNIE PETERS OL REGIONAL HOSPITAL ADMINISTRATOR 132076 0 6511 0 25365 0 8181 0 13429 0 185562 0 0 0 RODNEY TRIPLETT NETWORK EXECUTIVE 0 161334 0 19862 0 32883 0 11438 0 10989 0 236506 0 0 NANCY WALLACE SVP HR CHIEF OFFICER 0 338407 0 42780 0 84181 0 15039 0 21200 0 501607 0 0 STEVE HOUSTON SVP STRATEGY AND TECHNOLOGY 0 293673 0 36655 0 65910 0 16442 0 25248 0 437928 0 0 MIKE WATTERS VP-SENIOR COUNCEL 0 236217 0 31846 0 90737 0 15688 0 16650 0 391138 0 0 RENEE SAYER NURSE PRACTIONER 161090 0 0 0 3882 0 9579 0 200 0 174751 0 0 0 THOMAS WONG MD PHYSICIAN 171174 0 37060 0 4400 0 10048 0 5633 0 228315 0 0 0 FRANCISCO MACHUCA MD PHYSICIAN 199977 0 0 0 4252 0 12569 0 21500 0 238298 0 0 0 JOHANNA MISSAK PHYSICIAN 279251 0 0 0 243 0 14576 0 48735 0 342805 0 0 0 Naila Haroon Physician 252871 0 0 0 747 0 0 0 7649 0 261267 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Compensation for the top management official was established and paid by Catholic Health Initiatives (CHI), a related organization. CHI used the following to establish the top management official's compensation: (1) Compensation Committee; (2) Independent Compensation Consultant; (3) Written Employment Contracts; (4) Compensation Survey or Study; (5) Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan DURING THE 2015 CALENDAR YEAR, CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MARKET BASED ORGANIZATION CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN CHI'S SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON MICHAEL ROWAN JEANETTE WOJTALEWICZ DURING 2015 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON - $124,000 JEANETTE WOJTALEWICZ - $44,617 DURING 2015 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON - $65,659 MICHAEL ROWAN - $242,516 DUE TO THE "SUPER" VESTING RULES UNDER THE CHI DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS TERMINATION, AGE, OR YEARS OF SERVICE WERE ELIGIBLE TO RECEIVE THEIR 2015 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 2015, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: Michael Rowan - $313,628 Joan Nauhaus - $53,190 Schedule J, Part I, Line 7 Non-fixed payments CATHOLIC HEALTH INITIATIVES (CHI) MAINTAINS A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES, QUALITY IMPROVEMENT, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON HITTING MINIMUM LEVELS OF OPERATING MARGIN AND CHARITY CARE LEVELS, UNLESS THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES USES THEIR DISCRETION TO APPROVE AN EXCEPTION. Form 990, Part III, Line 4d Description of other program services (Expenses $ 8,689,126 including grants of $ 115,656)(Revenue $ 4,335,318) OTHER PROGRAM SERVICES Form 990, Part V, Line 1c PAYMENTS TO VENDORS PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF CHI ARE MADE BY CHI, THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT Health-Memorial Hospital, Schuyler. CHI FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY CHI ON BEHALF OF ALEGENT Health-Memorial, Schuyler ARE REPORTED TO THE IRS. Form 990, Part VI, Line 6 Classes of members or stockholders CHI Nebraska IS THE SOLE MEMBER OF ALEGENT HEALTH-MEMORIAL HOSPITAL, SCHUYLER. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body According to the organization's bylaws, directors shall be appointed or refused by the corporate member. The corporate member may appoint one or more individuals to the board of directors, and may at any time remove, with or without cause, any member of the board of directors. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The organization's corporate member is CHI Nebraska. Pursuant to Section 5.4.1 of the organization's bylaws, both CHI Nebraska and Catholic Health Initiatives ("CHI") have reserved powers as outlined in the CHI governance matrix. Pursuant to the governance matrix the following rights are held by the CHI Nebraska's Board: * Approve members of the Alegent Health- Memorial Hospital, Schuyler board. * Amendment of the corporate documents of the Alegent Health- Memorial Hospital, Schuyler. *Approve removal of a member of the governing body of the Alegent Health- Memorial Hospital, Schuyler. * Adoption of long range and strategic plans for the Alegent Health- Memorial Hospital, Schuyler. 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 the Alegent Health- Memorial Hospital, Schuyler. * Removal of a member of the governing body of the Alegent Health- Memorial Hospital, Schuyler. * Approval of issuance of debt by Alegent Health- Memorial Hospital, Schuyler. * Approval of participation of Alegent Health- Memorial Hospital, Schuyler in a joint venture. *Approval of formation of a new corporation by Alegent Health- Memorial Hospital, Schuyler. * Approval of a merger involving the Alegent Health- Memorial Hospital, Schuyler. * Approval of the sale of all or substantially all of the assets of the Alegent Health- Memorial Hospital, Schuyler. * To require the transfer of assets by the Alegent Health- Memorial Hospital, Schuyler to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. Pursuant to Section 5.5.2 of the organization's bylaws, CHI Nebraska or CHI may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and its President and the Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. Form 990, Part VI, Line 11b Review of form 990 by governing body FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE CHI TAX DIRECTOR AND THE LOCAL CHIEF FINANCIAL OFFICER. AFTER INCORPORATION OF ANY CHANGES RESULTING FROM THIS REVIEW, THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD A WEEK IN ADVANCE OF THE FINANCE COMMITTEE MEETING. THE FORM 990 IS REVIEWED AT THE FINANCE COMMITTEE MEETING AND THE CHIEF FINANCIAL OFFICER AND CHI TAX DIRECTOR ARE PRESENT AT THE MEETING TO ANSWER QUESTIONS. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW AND ARE ABLE TO ASK THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR QUESTIONS PRIOR TO FILING WITH THE IRS. UPON CHIEF FINANCIAL OFFICER APPROVAL AND SIGNATURE, THE TAX Analyst FILES THE FINAL FORM 990 AS PRESENTED TO THE BOARD AND FINANCE COMMITTEE, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. Form 990, Part VI, Line 12c Conflict of interest policy ALEGENT HEALTH MEMORIAL HOSPITAL, SCHUYLER HAS ADOPTED THE CONFLICT OF INTEREST POLICY AND CONFLICT INVESTIGATION PROCESS OF CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION. ALL OFFICERS, TRUSTEES AND EMPLOYEES ARE COVERED BY A CONFLICT OF INTEREST POLICY. ADDITIONALLY, ALL OFFICERS, TRUSTEES AND EMPLOYEES ARE REQUIRED TO ACT IN ACCORDANCE WITH CHI'S STANDARDS OF CONDUCT, WHICH INCLUDE THE AVOIDANCE OF CONFLICTS OF INTEREST OR THE APPEARANCE OF CONFLICTS. THE CHI CONFLICT OF INTEREST POLICY PROVIDES THAT ALL MEMBERS OF THE BOARD OF DIRECTORS AND OF ANY BOARD COMMITTEE ARE REQUIRED TO PROMPTLY AND FULLY DISCLOSE TO THE ENTITIES BOARD CHAIR SITUATIONS THAT MAY CREATE A CONFLICT OF INTEREST WHEN THEY BECOME AWARE OF THE SITUATION. IN ADDITION, ALL MEMBERS OF THE BOARD ARE REQUIRED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST VIA COMPLETION OF THE CONFLICT OF INTEREST DISCLOSURE FORM WHICH IS REVIEWED BY THE CORPORATE RESPONSIBILITY TEAM AND GENERAL COUNSEL. Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure process. Each person has a general ongoing obligation to promptly and fully report 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 report 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. The board, board committee members, and new employees are required to make disclosures at the time of their initial hiring/appointment. All non-employed, credentialed or contracted physicians are required to make disclosures at the time of their credentialing and during any subsequent reappointment or recredentialing. All researchers are required to make disclosures upon consideration of affiliation with a research sponsor. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. All corporate officers, board and board committee members, employees at the level of manager and above, researchers, supply chain employees, employed physicians, physician administrators and leaders, and employed advanced practice clinicians must complete a new conflict of interest disclosure annually. Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC") or Legal Services Group for review depending on the position of the person involved. The C-CIRC reviews COI questionnaires containing disclosures of perceived or possible conflicts for employees at a level of manager or above, supply chain employees, researchers and physicians, physician administrators and leaders, and advanced practice clinicians (both employed and non-employed). In the determination of a conflict, a COI management plan will be developed for that person. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such conflict of interest management plan in collaboration with local CRP staff. A designated CHI Entity staff will be 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 COI. If the C-CIRC determines that there is a potential or actual conflict of interest 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 the COI management plan. If a Person does not agree with a determination made by the C-CIRC, its interpretation of the Policy or Addenda, or seeks an exemption or exception, the following steps should be followed. The Employee disputing the review decision, interpretation of the Policy, or seeking exemption or exception must present the matter to the Employee's immediate direct manager or supervisor for review and determination. If the Employee and the manager do not agree with the review decision, interpretation of the Policy, or seek exemption or exception, the manager shall consult with the manager's Vice President (or higher if the manager is a Vice President) to reach a determination. If the matter remains unresolved, it shall be referred to the CHI Vice President of Human Resources and the CHI Corporate Responsibility Officer. If they are unable to reach agreement, the matter shall be referred to the CHI General Counsel, whose decision shall be final. 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). Annual COI disclosures of all trustee and corporate officers will be reviewed by the CHI Senior Vice President, Legal Services, and General Counsel or his or her designee who will report potential conflicts to the applicable Board Chair. 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. 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. 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. The trustee or corporate officer shall be excused from the meeting during discussion and vote on the conflict of interest. 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 will act as it would in reviewing transactions with unrelated third parties. The transaction is not be approved unless the Board determines that the transaction is fair to CHI or the CHI Entity. 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. All determinations of conflicts of interest are reported as required by law, regulations, and CHI policy. Form 990, Part VI, Line 15a Process to establish compensation of top management official The organization's top management official's compensation is paid by Catholic Health Initiatives (CHI), a related organization. CHI has a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges are reviewed annually in comparison to market data. CHI uses The Korn Ferry Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives is reviewed annually. The Korn Ferry Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Korn Ferry Hay Group to the HR committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September 13, 2016. 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. For other members of management who were paid under CHI Health for calendar year 2015, CHI Health completes a compensation market study to determine salary. Form 990, Part VI, Line 15b Process to establish compensation of other employees SEE DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT. IN ADDITION, THE ARTICLES OF INCORPORATION ARE AVAILABLE FROM THE NEBRASKA (IOWA) SeCRETARY OF STATE WEBSITE HTTP://WWW.SOS.NE.GOV/BUSINESS THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.ORG. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 47386, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 47386; Form 990, Part IX, Line 11g Other Fees Other Fees for Services - Total Expense: 2668399, Program Service Expense: 2534979, Management and General Expenses: 133420, Fundraising Expenses: 0; 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 9 CHI true APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(c)(3 9 SFH true BAYLOR ST LUKE'S HEALTH VENTURES 17200 ST LUKES WAY STE 170 THE WOODLANDS TX 77384 274499340 PHYSICIANS TX 501(c)(3 9 SLCHS 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 1111 6TH AVE DES MOINES IA 50314 420725196 LTERM CARE IA 501(c)(3 9 CHI-IA CORP true BORNEMANN HEALTHCARE CORPORATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 232187242 HEALTHCARE PA 501(c)(3 Type I CHI true BRAZOSPORT HEALTH FOUNDATION INC 129 CIRCLE WAY STE 102 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 9 SJSC true CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HEALTHCARE ND 501(c)(3 3 CHI true CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(c)(3 Type I NA true CATHOLIC HEALTH INITIATIVES - COLORADO 188 INVERNESS DRIVE WEST STE 500 ENGLEWOOD 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 6385 CORPORATE DR STE 301 COLORADO SPRINGS CO 80919 840902211 FUNDRAISING CO 501(c)(3 7 CHIC true CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 6385 CORPORATE DR COLORADO SPRINGS CO 80919 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 9 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 MN 501(c)(3 9 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 NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(c)(3 9 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 6940 O ST STE 200 LINCOLN 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 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 1 MERCY LANE STE 201 HOT SPRINGS AR 71913 261125131 HEALTHCARE AR 501(c)(3 3 CHISVHS true COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 237419853 HOLDING CO OH 501(c)(2 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 150 NORTH EAGLE CREEK DR LEXINGTON KY 40509 611400619 LT ACH KY 501(c)(3 3 SJHS true COVENANT HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232028429 HOME HEALTH PA 501(c)(3 Type II CHI NHC true ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1450 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 9 FLC true FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA WA 98405 911145592 FUNDRAISING WA 501(c)(3 9 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 MO 501(c)(3 9 CHI true FRANCISCAN LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE OH 501(c)(3 Type I SFH true FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA WA 98402 911939739 HEALTHCARE WA 501(c)(3 9 FHS true FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(c)(3 9 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 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 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029768 HEALTHCARE KY 501(c)(3 3 KOH true KENTUCKYONE HEALTH MEDICAL GROUP INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611352729 HEALTHCARE KY 501(c)(3 9 JHSMH true KENTUCKYONE HEALTH INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029769 HEALTHCARE KY 501(c)(3 9 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 ND 501(c)(3 7 LHC true LINUS OAKES INC 2700 STEWART PKWY ROSEBURG OR 97471 930821381 SENIOR LIVING OR 501(c)(3 9 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 III-FI 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 1 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 9 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 III-FI 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 9 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 1111 6TH AVE DES MOINES IA 50314 421470935 PHYSICIANS IA 501(c)(3 9 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 9 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 III-FI MHSET true PROVIDENCE CARE CENTER 2025 HAYES AVENUE SANDUSKY OH 44870 341658625 HEALTHCARE OH 501(c)(3 9 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 9 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 12844 MILITARY RD S TUKWILA WA 98168 911170040 HEALTHCARE WA 501(c)(3 3 FHS true SET OF COLORADO SPRINGS INC 2864 S CIRCLE DR STE 450 COLORADO SPRINGS CO 80906 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 Type II 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 Type II 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 ONE SAINT JOSEPH DRIVE LEXINGTON KY 40504 611159649 FUNDRAISING KY 501(c)(3 Type I SJHS true SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON KY 40741 260438748 FUNDRAISING KY 501(c)(3 7 SJHS true SAINT JOSEPH MOUNT STERLING FOUNDATION 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