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ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE, AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2016 OR 2015. true true X true X 175. true X true true true false true true 1434136 1434136 0.06580 4064575 3660132 404443 0.01860 203910 52250 151660 0.00700 5702621 3712382 1990239 0.09140 5911 5911 0.00030 2971 2971 0.00010 8882 8882 0.00040 5711503 3712382 1999121 0.09180 false 1630851 3295085 5753924 -2458839 X true true 1 1 METHODIST HOSPITAL LEVELLAND 1900 COLLEGE AVENUE LUBBOCK TX 793366508 WWW.COVENANTHOSPITALLEVELLAND.ORG 307 X X X RURAL HEALTH CLINIC METHODIST HOSPITAL LEVELLAND false false true X X X X X X X X X 13 true false false true X SEE SCHEDULE H, PART V, SECTION C X true 13 true SEE SCHEDULE H, PART V, SECTION C false true X 175. 300. X X X X X true true X X X X true X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT WAS GATHERED THROUGH FOCUS GROUPS, INTERVIEWS AND AN ON-LINE SURVEY CONDUCTED DURING JANUARY 2014. INPUT WAS GATHERED BASED ON THE HEALTH NEEDS THAT SURFACED IN THE 2012 PRC HEALTH NEEDS ASSESSMENT (FULL PDF REPORT AVAILABLE UPON REQUEST) PREPARED FOR COVENANT HEALTH. THE PRC NEEDS ASSESSMENT ANALYZED BOTH PRIMARY AND SECONDARY DATA FOR COVENANT HEALTH INCLUDING PHONE SURVEYS OF COMMUNITY RESIDENTS. FOCUS GROUPS, INTERVIEWS AND SURVEYS WERE CONDUCTED. PERSONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY AND WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH WERE ASKED TO PARTICIPATE IN ONE OF MORE OF THE DATA GATHERING SESSIONS. INPUT WAS GATHERED FROM GOVERNMENTAL HEALTH AGENCIES, PERSONS REPRESENTING MEDICALLY UNDERSERVED AND LOW INCOME POPULATIONS, AS WELL AS INDIVIDUALS REPRESENTING MINORITY HEALTH NEEDS AND REPRESENTATIVES FROM PUBLIC HEALTH OR OTHER DEPARTMENTS OR AGENCIES. COVENANT HEALTH LEVELLANDS COMMUNITY ASSESSMENT ENGAGED A BROAD SPECTRUM OF THE COMMUNITY INCLUDING: PHYSICIANS AND MID-LEVEL PROVIDERS, PUBLIC HEALTH REPRESENTATIVES, OTHER MEDICAL CARE REPRESENTATIVES, CIVIC LEADERS (CITY, COUNTY, ASSOCIATIONS), BUSINESS AND PRINCIPLE INDUSTRY LEADERS, MANAGED CARE REPRESENTATIVES AND REPRESENTATIVES OF ALL SIGNIFICANT SOCIO-ECONOMIC, RACIAL AND ETHNIC GROUPS. THE FOLLOWING RESIDENTS, AGENCIES, ORGANIZATIONS AND NON-PROFITS WERE INCLUDED: SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, CITY MANAGER LEVELLAND, VETERANS SERVICES OFFICER, TRI-CARE MEDICAL, SHERIFFS DEPARTMENT, LEVELLAND NURSING HOME, INDEPENDENT INSURANCE AGENCY, HICKORY HOUSE ASSISTED LIVING, RETIRED RESIDENT, LEVELLAND EMS, LYNWOOD NURSING HOME, PLATINUM BANK, COUNTY JUDGE, LEVELLAND ISD, HOSPICE OF LUBBOCK, AMERICAN STATE BANK, SOUTH PLAINS COLLEGE, LOCAL PASTOR, 3 LEVELLAND HOSPITAL PATIENTS, SOUTH PLAINS COMMUNITY ACTION ASSOCIATION, ALLIED OILFIELD SERVICES, LOCAL CPA, CALVERT HOME HEALTH, FARMERS COOP ELEVATOR MANAGER, HEALTH & HUMAN SERVICES SUPERVISOR, SODEXO, BEEHIVE ASSISTED LIVING, AIM BANK, RETIRED TEACHER, HOSPITAL AUXILIARY, CITY OF LEVELLAND, DUARTE FUNERAL HOME, COMMUNITY LEADER REPRESENTING THE HISPANIC COMMUNITY, ST. MICHAELS CATHOLIC CHURCH, SOUTH PLAINS COMMUNITY ACTION AND TELEPHONE INTERVIEWS WERE CONDUCTED WITH A MANAGED CARE REPRESENTATIVE, CAREFIRST HEALTH PLAN AND TEXAS A&M AGRI-LIFE EXTENSION SERVICE ON PUBLIC HEALTH AND COMMUNITY EDUCATION. HEALTH ISSUES FOR THE BROADER COMMUNITY AND ECONOMICALLY POOR IN THE PRIMARY SERVICE AREA WERE IDENTIFIED IN PART THROUGH COMMUNITY INTERVIEWS. THESE INTERVIEWS IDENTIFIED ISSUES AND NEEDS FOR WHICH THERE ARE NO ADEQUATE RESOURCES IN PLACE BY OTHER PROVIDERS TO ADDRESS THOSE NEEDS. COMMUNITY INTERVIEWEES INCLUDED STAFF FROM THE FOLLOWING ORGANIZATIONS: - SOUTH PLAINS COMMUNITY ACTION - CITY OF LEVELLAND - HOSPICE OF LUBBOCK - BEEHIVE ASSISTED LIVING - TEXAS A&M AGGIE LIFE EXTENSION SERVICE ON PUBLIC HEALTH AND COMMUNITY EDUCATION - FORESIGHT CONSULTING - COVENANT LEVELLAND HOSPITAL - VETERANS SERVICES OFFICER - SOUTH PLAINS COMMUNITY ACTION ASSOCIATION - COMMUNITY LEADER REPRESENTING THE HISPANIC COMMUNITY THE CHNA AND IMPLEMENTATION PLANS ARE PUBLICALLY POSTED AT HTTP://WWW.COVENANTHEALTH.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT.ASPX WITH AN EMAIL ADDRESS TO SEND FURTHER COMMENTS. NO WRITTEN COMMENTS HAVE BEEN SUBMITTED. SCHEDULE H, PART V, SECTION B, LINE 7A CHNA WEBSITE ADDRESS IS: http://www.covenanthealth.org/documents/CHNA-Levelland-Updated-2014.pdf SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY WEBSITE IS: HTTP://WWW.COVENANTHEALTH.ORG/DOCUMENTS/LEVELLAND-FY15-17-CB-IMPLEMENATION -PLAN-FINAL.PDF SCHEDULE H, PART V, SECTION B, LINE 11 ALTHOUGH THERE IS NO FORMAL PROGRAM TO ADDRESS PREMATURE DEATH AND HIGH CHRONIC DISEASE INCIDENCE, THE FINDINGS OF THE CHNA WILL BE THE FIRST STEP TO ENCOURAGE LOCAL COORDINATION OF SERVICES AND RESOURCES. THERE ARE OTHER NEEDS, NAMELY, OBESITY, ACCESS TO PREVENTIVE CARE, LACK OF TRANSPORTATION TO HEALTH AND HUMAN SERVICES, LINGUISTIC ISOLATION, PREMATURE DEATH AND SEXUALLY TRANSMITTED DISEASE THAT COVENANT LEVELLAND DOES NOT HAVE THE CURRENT RESOURCES TO ADDRESS OR THE STAFF AVAILABLE TO DEVELOP A FORMAL INITIATIVE AT THIS TIME. HOWEVER AFTER THE NEXT COMMUNITY BENEFIT CYCLE, THESE AREAS OF NEED WILL BE REVISITED FOR POSSIBLE INCLUSION IN FUTURE PROGRAMMING. AS IN ANY COMMUNITY, THERE ARE MANY UNMET HEALTH NEEDS. WE WILL WORK WITH OTHER COMMUNITY PARTNERS TO REFER PATIENTS TO PROGRAMS THAT ADDRESS UNMET HEALTH NEED. COVENANT HEALTH LEVELLAND WILL MONITOR AND EVALUATE STRATEGIES LISTED BELOW FOR THE PURPOSE OF TRACKING PROGRESS ON THE IMPLEMENTATION OF THOSE STRATEGIES AND DOCUMENT ANTICIPATED IMPACT. EVALUATION EFFORTS TO MONITOR EACH STRATEGY WILL INCLUDE THE COLLECTION AND DOCUMENTATION OF STRATEGY MEASURES, NUMBER OF PARTNERSHIPS MADE, PERCENT IMPROVEMENT IN HEALTH-RELATED METRICS, INCLUDING BEHAVIORAL AND HEALTH OUTCOMES AS APPROPRIATE. INITIATIVE: THE DENTAL SEALANT PROGRAM FOR 3RD GRADERS GOAL (ANTICIPATED IMPACT): TO IMPROVE THE ORAL HEALTH OF THE CHILDREN ENROLLED IN THIRD GRADE AT HOCKLEY AND COCHRAN COUNTIES SCHOOLS BY REDUCING CAVITIES. OUTCOME MEASURE: THE PERCENT OF 3RD GRADERS IN HOCKLEY AND COCHRAN COUNTIES IN NEED OF SEALANTS WHO RECEIVE THEM. STRATEGIES: 1. ESTABLISH AN UNDERSTANDING WITH LOCAL SCHOOL DISTRICTS GRANTING PERMISSION TO PROVIDE DENTAL EXAMS FOR DENTAL SEALANTS FOR 3RD GRADERS. 2. SCREEN 3RD GRADE CHILDREN FOR ORAL HEALTH ISSUES. 3. STRENGTHEN 3RD GRADERS KNOWLEDGE AND SKILLS ABOUT ORAL HYGIENE THROUGH INFORMATION PROVIDED TO THE STUDENTS THE DAY OF THE DENTAL EXAMS AND SEALANT APPLICATION. KEY COMMUNITY PARTNERS: COVENANT HEALTH COMMUNITY OUTREACH DENTAL PROGRAM, LOCAL DENTISTS, LOCAL SCHOOL DISTRICTS IN HOCKLEY AND COCHRAN COUNTIES. INITIATIVE: SUICIDE PREVENTION PROGRAM GOAL: TO PROVIDE THE COMMUNITY INFORMATION THAT WILL HELP REDUCE THE NUMBER OF SUICIDES IN HOCKLEY COUNTY. OUTCOME MEASURE: A REDUCTION IN THE NUMBER OF SUICIDES IN HOCKLEY COUNTY. STRATEGIES: 1. PROVIDE A SUICIDE PREVENTION CONFERENCE OPEN TO THE ENTIRE COMMUNITY. 2. PROVIDE INFORMATION ON THE WARNING SIGNS OF SUICIDE. 3. PROVIDE INFORMATION ON THE QUESTION, PERSUADE, AND REFER (QPR) METHOD FOR THE LAY COMMUNITY TO PROVIDE HELP TO A SUICIDAL PERSON TO GET PROFESSIONAL COUNSELING. KEY COMMUNITY PARTNERS: LICENSED PROFESSIONAL COUNSELORS, SOUTH PLAINS RURAL HEALTH, SOUTH PLAINS COMMUNITY ACTION, THE CHAMPS PROGRAM, LEVELLAND Independent School District (ISD), SOUTH PLAINS COLLEGE, THE FAITH COMMUNITY, LEVELLAND LAW ENFORCEMENT, CATHOLIC FAMILY SERVICES, BOY SCOUTS AND GIRL SCOUTS. INITIATIVE: THE STORK'S NEST PRE-NATAL EDUCATION PROGRAM GOAL: TO PROVIDE FREE PRE-NATAL EDUCATION TO PREGNANT WOMEN AND TEENS IN HOCKLEY AND COCHRAN COUNTY. OUTCOME MEASURE: TO INCREASE CLASS ATTENDANCE BY 10% IN 2015. STRATEGIES: 1. INCREASE RADIO MARKETING ON KLVT RADIO. 2. INCREASE NEWSPAPER MARKETING IN THE LEVELLAND NEWS PRESS NEWSPAPER. 3. COLLABORATE WITH LEVELLAND ISD AND ALL SCHOOLS IN HOCKLEY & COCHRAN COUNTY TO ADVERTISE THE STORK'S NEST PROGRAM CLASSES TO ENCOURAGE PREGNANT TEENS TO ATTEND. 4. PROVIDE INFORMATION TO COCHRAN COUNTY PHYSICIANS ABOUT THE STORK'S NEST PROGRAM. 5. CONTACT SOUTH PLAINS RURAL HEALTH TO ENCOURAGE ATTENDANCE TO THE STORK'S NEST PROGRAM. KEY COMMUNITY PARTNERS: KLVT RADIO, THE LEVELLAND NEWS PRESS, LEVELLAND ISD AND SCHOOLS IN HOCKLEY & COCHRAN COUNTY, COCHRAN COUNTY PHYSICIANS, SOUTH PLAINS RURAL HEALTH. IN ADDITION TO THE PRECEDING PRIORITY AREAS, COVENANT HEALTH LEVELLAND PLANS TO PROVIDE OTHER COMMUNITY BENEFIT PROGRAMS RESPONSIVE TO THE HEALTH NEEDS IDENTIFIED IN THE 2014 CHNA. COMMUNITY BENEFIT PROGRAMS LISTED BELOW ONLY INCLUDES ADDITIONAL COMMUNITY SERVICES FOR THE LOW-INCOME AND BROADER COMMUNITY THAT HAVE NOT BEEN PREVIOUSLY COVERED IN THIS Community Benefit PLAN/IMPLEMENTATION STRATEGY REPORT. FOOD INSECURITY - HOSPITAL FOOD DRIVE, SHARE THE WARMTH COAT DRIVE, FREE PROSTATE SCREENING CLINIC, DIABETES EDUCATION - DIABETES EDUCATION SEMINAR. THE FOLLOWING COMMUNITY HEALTH NEEDS IDENTIFIED IN THE MINISTRY CHNA WILL NOT BE DIRECTLY ADDRESSED THROUGH PROGRAMMING OR FUNDING AND AN EXPLANATION IS PROVIDED BELOW: o SEXUALLY TRANSMITTED DISEASES o PREMATURE DEATH o OBESITY o COMMUNITY LIVING IN FOOD DESERTS o LACK OF TRANSPORTATION TO HEALTH & HUMAN SERVICES COVENANT HEALTH LEVELLAND WILL COLLABORATE WITH SOUTH PLAINS RURAL HEALTH, SOUTH PLAINS COMMUNITY ACTION, TEXAS AGRI-LIFE EXTENSION AND OTHER LOCAL NON PROFIT SOCIAL SERVICE THAT ADDRESS AFOREMENTIONED COMMUNITY NEEDS, TO COORDINATE CARE AND REFERRAL AND ADDRESS THESE UNMET NEEDS. SCHEDULE H, PART V, SECTION B, LINE 13H THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT. SCHEDULE H, PART V, SECTION B, LINE 16A THE FAP IS MADE WIDELY AVAILABLE AT: http://www.covenanthealth.org/documents/Patient-Financial-Assistance/Finan cial-Assistance-Policy-ENGLISH_4.20.16.pdf SCHEDULE H, PART V, SECTION B, LINES 16B THE FAP APPLICATION FORM IS MADE WIDELY AVAILABLE AT: http://www.covenanthealth.org/documents/Patient-Financial-Assistance/Finan cial-Assistance-Application-ENGLISH_2.24.16.pdf SCHEDULE H, PART V, SECTION B, LINE 16C THE FAP PLAIN LANGUAGE SUMMARY IS MADE WIDELY AVAILABLE AT: http://www.covenanthealth.org/documents/Patient-Financial-Assistance/Coven ant_FABrochure_2016.pdf SCHEDULE H, PART V, SECTION B, LINE 16I THE ORGANIZATION POSTS ITS SUMMARIZED FINANCIAL ASSISTANCE NOTICE IN ALL ADMITTING AREAS IN BOTH ENGLISH AND SPANISH AND PROVIDES THE FULL POLICY UPON REQUEST. SUMMARIZED NOTICES OF THE POLICY ARE AVAILABLE ON ITS WEBSITE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR UNINSURED PATIENTS. BILINGUAL PATIENT ACCOUNT REPRESENTATIVES ARE AVAILABLE TO ADDRESS QUESTIONS AND ASSIST IN THE COMPLETION OF A FINANCIAL ASSISTANCE APPLICATION IN ENGLISH OR SPANISH. SCHEDULE H, PART V, SECTION B, LINE 22D FOR PATIENTS WITH A FAMILY INCOME BETWEEN 176% AND 300% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USED MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR CATASTROPHIC CASES WITH A PATIENT RESPONSIBILITY GREATER THAN $75,000, THE HOSPITAL FACILITY USED MEDICARE RATES TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED. 4 FAMILY MEDICINE CLINIC 116 A JOHN DUPREE LEVELLAND TX 79339 RURAL HEALTH CLINIC LEVELLAND CLINIC SOUTH 1804 S COLLEGE AVE LEVELLAND TX 79336 RURAL HEALTH CLINIC LEVELLAND CLINIC NORTH 103 JOHN DUPREE LEVELLAND TX 79336 RURAL HEALTH CLINIC SUNDOWN RHC 209 E RICHARDSON SUNDOWN TX 79372 RURAL HEALTH CLINIC SCHEDULE H, PART I, LINE 3C IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES WERE ALSO CONSIDERED WHEN DETERMINING ELIGIBILITY, INCLUDING BUT NOT LIMITED TO, DISABILITY AND HOMELESSNESS. SCHEDULE H, PART I, LINE 6A COVENANT HEALTH PREPARES AN ANNUAL REPORT AS A SYSTEM WHICH INCLUDES COVENANT MEDICAL CENTER, COVENANT CHILDREN'S HOSPITAL AND COVENANT SPECIALTY HOSPITAL (JOINT VENTURE), AND IT IS PUBLICLY AVAILABLE AT http://www.covenanthealth.org/For-Community/Community-Benefit.aspx SCHEDULE H, PART I, LINE 7 THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. THE ORGANIZATION'S COST ACCOUNTING SYSTEM ADDRESSED ALL PATIENT SEGMENTS. SCHEDULE H, PART III, SECTION A, LINE 2 THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND TRENDS TO ESTIMATE THE APPROPRIATE BAD DEBT EXPENSE. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED PRIOR TO CALCULATING BAD DEBT EXPENSE. SCHEDULE H, PART III, SECTION A, LINE 3 THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USED AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT WERE INITIALLY CLASSIFIED AS BAD DEBT. COLLECTION ACTIONS WERE NOT PURSUED ON THESE ACCOUNTS ONCE THEY WERE RECLASSIFIED BECAUSE RECLASSIFIED ACCOUNTS RECEIVED A 100% WRITE-OFF OF THE BALANCE DUE. AFTER THE RECLASSIFICATION THERE WAS NO REMAINING AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART III, SECTION A, LINE 4 FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT THE ORGANIZATION RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE ORGANIZATION BELIEVES THERE ARE NO SIGNIFICANT CREDIT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED PAYORS ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE ORGANIZATION. THE ORGANIZATION REGULARLY ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, SECTION B, LINE 8 TREATMENT OF MEDICARE SHORTFALL AS COMMUNITY BENEFIT THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED FROM THE MEDICARE COST REPORT USING CMS STANDARD COSTING METHODS. THIS INCLUDES STEP-DOWN ALLOCATION PROCESSES WHICH ARE APPLIED TO CALCULATE ALLOWABLE MEDICARE COSTS. SCHEDULE H, PART III, SECTION C, LINE 9B APPLICATION OF COLLECTION PRACTICES TO THOSE QUALIFYING FOR FINANCIAL ASSISTANCE PATIENT ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTION POLICY ALSO APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR DISCOUNTED CARE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESMENT THE COMMUNITY health NEEDS ASSESSMENT (CHNA) WAS DEVELOPED TO ASSIST THE COMMUNITY IN ITS DELIBERATIONS TO IDENTIFY HEALTH PRIORITIES AND ISSUES. THE COMMUNITY health NEEDS ASSESSMENT HAD TWO MAJOR COMPONENTS. THE FIRST WAS A PRIMARY DATA COLLECTION PHASE IN THE COMMUNITY CONDUCTED THROUGH INTERVIEWS (CONDUCTED FEBRUARY AND APRIL) WITH A CROSS-SECTION OF COMMUNITY REPRESENTATIVES AND LEADERS TO DETERMINE LOCAL ISSUES AND CONCERNS THAT AFFECTED THE HEALTH OF THE COMMUNITY. THE SECOND PHASE WAS THE COLLECTION AND COMPILATION OF SECONDARY DATA FROM PUBLIC SOURCES THAT COULD BE USED TO DEFINE THE STATUS OF THE COMMUNITYS HEALTH AND WELL-BEING. THESE TWO DATA SOURCES WERE COMBINED INTO A SUMMARY REPORT THAT COULD BE USED BY COVENANT HOSPITAL LEVELLAND LEADERSHIP TO DETERMINE PRIORITIES AND DEVELOP A PLAN AND STRATEGIES TO IMPROVE COMMUNITY HEALTH. THE COVENANT HOSPITAL LEVELLAND CHNA RELIED HEAVILY ON DATA COMPILED BY HTTP://WWW.CHNA.ORG. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION COVENANT HOSPITAL LEVELLAND SERVES PATIENTS FROM HOCKLEY AND COCHRAN COUNTY AS WELL AS OTHER SURROUNDING COUNTIES. ACCORDING TO RESULTS FROM THE COVENANT HOSPITAL LEVELLAND 2013 CHNA REPORT, INFORMED BY HTTP://WWW.CHNA.ORG, HOCKLEY AND COCHRAN COUNTIES' PER CAPITA INCOME ($20,255 AND $16,018, RESPECTIVELY) IS SIGNIFICANTLY LOWER THAN THE STATE OF TEXAS ($24,870) AND THE U.S. ($27,334). THE PERCENTAGE OF INDIVIDUALS WHOSE PRIMARY LANGUAGE IS SPANISH AND WHO SPEAK ENGLISH LESS THAN VERY WELL ARE COMPARABLE TO TEXAS (43.4%) AND THE U.S. AVERAGE (46.1%). THE PERCENTAGE OF CHILDREN BELOW POVERTY LEVEL IN HOCKLEY COUNTY IS 22% AND 42.7% IN COCHRAN COUNTY COMPARED TO 23.8% IN TEXAS AND 19.2% IN THE U.S. THE PERCENTAGE OF AGED 65+ BELOW THE POVERTY LEVEL IS 18.1% IN HOCKLEY COUNTY AND 6.9% IN COCHRAN COUNTY WHILE THAT OF THE STATE IS 11.6% AND 9.5% IN THE U.S. THE OTHER SURROUNDING COUNTIES HAVE HEALTH CARE FACILITIES WHICH PROVIDE SERVICES TO THEIR RESIDENTS. OTHER HOSPITAL IN THE COMMUNITY INCLUDES: COCHRAN MEMORIAL HOSPITAL. ACCORDING TO HTTP://WWW.CHNA.ORG, THE LACK OF HEALTH INSURANCE IS CONSIDERED A KEY DRIVER OF HEALTH STATUS. THIS INDICATOR REPORTS THE PERCENTAGE OF THE TOTAL CIVILIAN NON-INSTITUTIONALIZED POPULATION WITHOUT HEALTH INSURANCE COVERAGE. THIS INDICATOR IS RELEVANT BECAUSE LACK OF INSURANCE IS A PRIMARY BARRIER TO HEALTHCARE ACCESS INCLUDING REGULAR PRIMARY CARE, SPECIALTY CARE, AND OTHER HEALTH SERVICES THAT CONTRIBUTES TO POOR HEALTHSTATUS. OVERALL, HOCKLEY COUNTY REPORTS A LOWER PERCENTAGE OF UNINSURED (21.47%) THAN TEXAS AS A WHOLE (23.55%), HOWEVER, THE PERCENTAGE OF UNINSURED IS FIVE PERCENTAGE POINTS HIGHER THAN THE U.S (15.05%). FOR A COMPLETE LIST OF OTHER HEALTH CARE FACILITIES WITHIN THE HOCKLEY COUNTY AND COCHRAN COUNTY SERVICE AREA GO TO APPENDIX 3 OF COVENANT HOSPITAL LEVELLAND'S COMMUNITY HEALTH NEEDS ASSESSMENT AVAILABLE ONLINE AT: HTTP://WWW.COVENANTHEALTH.ORG/DOCUMENTS/CHNA-LEVELLAND-UPDATED-2014.PDF. SCHEDULE H, PART VI, LINE 5 THE GOVERNING BODY IS COMPRISED OF PERSONS WHO RESIDE IN HOCKLEY COUNTY AND WHO ARE NOT EMPLOYEES, CONTRACTORS, OR FAMILY MEMBERS. THE GOVERNING BOARD, ACTING AS THE COMMUNITY BENEFIT COMMITTEE, OVERSAW THE DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN. THE COMMITTEE ALSO PROVIDES GENERAL DIRECTION TO COVENANT HOSPITAL LEVELLAND COMMUNITY BENEFIT REPORTING. MEDICAL STAFF PRIVILEGES ARE EXTENDED TO ALL QUALIFIED PHYSICIANS IN THE COMMUNITY. GIVING BACK TO THE COMMUNITY IS INTEGRATED INTO EVERY ASPECT OF OUR ORGANIZATION. AS A MEMBER OF THE FAITH-BASED HEALTH MINISTRY OF ST. JOSEPH HEALTH SYSTEM, WE PROVIDE FREE AND DISCOUNTED CARE VIA OUR FINANCIAL ASSISTANCE PROGRAM AND HAVE A FUNDING STREAM TO ADDRESS THE NEEDS OF THE ECONOMICALLY POOR AND VULNERABLE IN THE COMMUNITIES WE SERVE. THIS PAST FISCAL YEAR OUR HOSPITAL PROMOTED HEALTH AND ACCESS TO CARE BY PROVIDING CLINIC COVERAGE DURING BUSINESS WORKING DAYS, WEEKEND CLINICS, COMMUNITY SCREENINGS AND OTHER HEALTHCARE RELATED EVENTS AND EDUCATION ACTIVITIES. COVENANT HOSPITAL LEVELLAND BELIEVES THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY COVENANT HOSPITAL LEVELLAND, AS A MINISTRY OF ST. JOSEPH HEALTH SYSTEM, HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. LOCAL COMMUNITY BENEFIT COMMITTEE: THE ROLE OF THE MISSION HOSPITAL'S COMMUNITY BENEFIT COMMITTEE IS TO SUPPORT THE BOARD OF TRUSTEES IN OVERSEEING COMMUNITY BENEFIT EFFORTS. THE COMMITTEE ACTS IN ACCORDANCE WITH A BOARD-APPROVED CHARTER. THE COMMUNITY BENEFIT COMMITTEE IS CHARGED WITH DEVELOPING POLICIES AND PROGRAMS THAT ADDRESS IDENTIFIED NEEDS IN THE SERVICE AREA PARTICULARLY FOR UNDERSERVED POPULATIONS, OVERSEEING DEVELOPMENT AND IMPLEMENTATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY BENEFIT PLAN/IMPLEMENTATION STRATEGY REPORTS, AND PROVIDING DIRECTION OF COMMUNITY BENEFIT ACTIVITIES. THE COMMUNITY BENEFIT COMMITTEE HAS A MINIMUM OF EIGHT MEMBERS INCLUDING THREE MEMBERS OF THE BOARD OF TRUSTEES. CURRENT MEMBERSHIP INCLUDES THREE MEMBERS OF THE BOARD OF TRUSTEES AND EIGHT COMMUNITY MEMBERS. A MAJORITY OF MEMBERS HAVE KNOWLEDGE AND EXPERIENCE WITH THE POPULATIONS MOST LIKELY TO HAVE DISPROPORTIONATE UNMET HEALTH NEEDS. THE COMMUNITY BENEFIT COMMITTEE GENERALLY MEETS BI-MONTHLY. SCHEDULE H, PART VI, LINE 6 affiliated health care system COVENANT HOSPITAL LEVELLAND IS A HEALING MINISTRY OF ST. JOSEPH HEALTH SYSTEM, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH SYSTEM IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. IN 1986, ST. JOSEPH HEALTH SYSTEM CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH SYSTEM CREATED THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND (FORMERLY KNOWN AS THE ST. JOSEPH HEALTH SYSTEM FOUNDATION) TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. EVERY YEAR, EACH ST. JOSEPH HEALTH HOSPITAL CONTRIBUTES 10% OF THEIR NET INCOME TO THE ST. JOSEPH HEALTH COMMUNITY PARTNERSHIP FUND TO SUPPORT OUTREACH EFFORTS FOR THE ECONOMICALLY POOR. THE FOUNDATION THEN FUNDS PROGRAMS IN COMMUNITIES SERVED BY ST. JOSEPH HEALTH HOSPITALS THAT EXEMPLIFY THE FOUR CORE VALUES OF ST. JOSEPH HEALTH: SERVICE, EXCELLENCE, DIGNITY, AND JUSTICE. JUSTICE. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT TEXAS false true false false false false false true false Greg McKay Physician Assistant 38799 0 0 0 108476 0 13919 0 21196 0 182390 0 0 0 Mike Bailey CHIEF OF STAFF/BOARD MEMBER 0 221195 0 0 0 3959 0 8000 0 13937 0 247091 0 0 Marty Cottenoir Manager, Pharmacy Clinical 134766 0 18569 0 6039 0 13079 0 12374 0 184827 0 0 0 Bruce White CEO COVENANT LEVELLAND/BD MBR 142365 0 50260 0 17673 0 11874 0 15253 0 237425 0 0 0 SHARON PRATHER FORMER OFCR/BOARD MEMBER 0 249994 0 89922 0 33166 0 23029 0 15774 0 411885 0 0 SCHEDULE J, PART I, LINE 3 THE COMPENSATION OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS DETERMINED BY ITS CORPORATE MEMBER, COVENANT HEALTH SYSTEM. SEE SCHEDULE O OF FORM 990, PART VI, LINE 15A NARRATIVE FOR THE PROCESS THAT IS COMPLETED BY THE RELATED ORGANIZATION. SCHEDULE J, PART I, LINE 4B BEGINNING IN JULY 2015, NEW EXECUTIVES PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PLAN PROVIDES FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND ARE SUBJECT TO A FIVE YEAR OR AGE 65 VESTING SCHEDULE. SCHEDULE J, PART I, LINE 7 DESCRIPTION OF NON-FIXED PAYMENTS A PORTION OF EXECUTIVES SALARIES ARE PLACED 'AT RISKARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE STRATEGIC OBJECTIVES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT RISK PAY. FORM 990, PART III, LINE 4A REALIZING OUR MISSION COVENANT HEALTH LEVELLAND HAS BEEN MEETING THE HEALTH AND QUALITY OF LIFE NEEDS OF THE PEOPLE IN THE LOCAL COMMUNITY FOR OVER 16 YEARS. COVENANT HOSPITAL LEVELLAND IS DEDICATED TO PROVIDING WORLD CLASS HEALTH CARE CLOSE TO HOME FOR HOCKLEY AND COCHRAN COUNTIES. COVENANT HEALTH LEVELLAND PROVIDES QUALITY CARE IN THE AREAS OF 24-HOUR EMERGENCY CARE, OUTPATIENT SURGERY, MATERNITY SERVICES, PHYSICAL THERAPY, REHAB SERVICES, CLINIC AND HOSPITAL LAB SERVICES, DIGITAL MAMMOGRAPHY, MRI SERVICES, CAT SCANS, AND 3-D ULTRASOUND SERVICES. COVENANT HEALTH LEVELLAND IS A HOSPITAL WITHIN COVENANT HEALTH WHICH HAS OVER 4,000 EMPLOYEES COMMITTED TO REALIZING THE MISSION, COVENANT HEALTH IS ONE OF THE LARGEST EMPLOYERS IN THE WEST TEXAS REGION. AS A MEMBER OF THE ST. JOSEPH HEALTH, COVENANT HEALTH IS COMMITTED TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE. THIS MISSION HAS GUIDED OUR CATHOLIC HEALTHCARE MINISTRY SINCE THE OPENING OF OUR FIRST HOSPITAL IN EUREKA, CALIFORNIA NEARLY 100 YEARS AGO. THE SISTERS OF ST. JOSEPH OF ORANGE TRACE THEIR ROOTS BACK TO 17TH CENTURY FRANCE AND THE UNIQUE VISION OF A JESUIT PRIEST NAMED JEAN-PIERRE MEDAILLE. HE SOUGHT TO ORGANIZE AN ORDER OF RELIGIOUS WOMEN WHO, RATHER THAN REMAINING SAFELY CLOISTERED IN A CONVENT, VENTURED OUT INTO THE COMMUNITY TO SEEK OUT "THE DEAR NEIGHBORSMINISTER TO THEIR NEEDS. THE CONGREGATION MANAGED TO SURVIVE THE TURBULENCE OF THE FRENCH REVOLUTION AND EVENTUALLY EXPANDED, NOT ONLY THROUGHOUT FRANCE, BUT THROUGHOUT THE WORLD. IN 1912 A SMALL GROUP OF SISTERS OF ST. JOSEPH WENT TO EUREKA, CALIFORNIA, AT THE INVITATION OF THE LOCAL BISHOP, TO ESTABLISH A SCHOOL. A FEW YEARS LATER, THE GREAT INFLUENZA EPIDEMIC OF 1918 CAUSED THE SISTERS TO TEMPORARILY SET ASIDE THEIR EDUCATION EFFORTS TO CARE FOR THE ILL. THEY REALIZED IMMEDIATELY THAT THE SMALL COMMUNITY DESPERATELY NEEDED A HOSPITAL. THROUGH BOLD FAITH, FORESIGHT, AND FLEXIBLITY IN 1920, THE SISTERS OPENED THE 28-BED ST. JOSEPH HOSPITAL OF EUREKA, THE FIRST ST. JOSEPH HEALTH SYSTEM MINISTRY. FINANCIAL ASSISTANCE PROGRAM COVENANT HEALTH LEVELLAND BELIEVES THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY COVENANT HEALTH LEVELLAND HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM (FAP) THAT PROVIDES FREE OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. IN FY16, COVENANT HEALTH LEVELLAND PROVIDED $1,434,136 IN FREE AND DISCOUNTED CARE. MEDICAID PROGRAM COVENANT HEALTH LEVELLAND PROVIDED ACCESS TO UNINSURED AND UNDERINSURED PERSONS BY PARTICIPATING IN THE FEDERAL AND STATE SPONSORED MEDICAID PROGRAM. IN FY16, COVENANT HEALTH LEVELLAND PROVIDED $404,443 IN MEDICAID SHORTFALL. PROGRAM SERVICE ACCOMPLISHMENTS DURING THE YEAR WE SAW MORE THAN 42,006 PATIENTS IN OUR THREE RURAL HEALTH CLINICS. THERE WERE MORE THAN 6,366 PATIENTS EVALUATED IN OUR EMERGENCY ROOM AND OVER 33,419 OUT PATIENT DIAGNOSTIC AND TREATMENT TEST PERFORMED WITHIN OUR HOSPITAL. THROUGHOUT THE YEAR WE PROVIDED A VARIETY OF PROGRAMS FOR THE COMMUNITIES IN WHICH WE SERVE. THROUGHOUT THE YEAR COVENANT HOSPITAL LEVELLAND PROVIDES VARIOUS FREE EVALUATIONS AND CONSULTATIONS FOR PROSTRATE SCREENING AND HIGH BLOOD PRESSURE. FOR MORE INFORMATION ABOUT COVENANT LEVELLAND PLEASE VISIT: WWW.COVENANTHEALTH.ORG FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT: WWW.STJHS.ORG FORM 990, PART V, LINE 1A ST. JOSEPH HEALTH SYSTEM (SJHS) PAYS ALL VENDORS FOR SJH ENTITIES UNDER SJH AP SHARED SERVICES. THEREFORE, SJHS ISSUES FORM 1099-MISC UNDER ITS TAX ID. SJHS complies with backup withholding rules for reportable payments to vendors. FORM 990, PART VI, LINE 6 DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS COVENANT HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF COVENANT HOSPITAL LEVELLAND. FORM 990, PART VI, LINE 7A DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS COVENANT HOSPITAL LEVELLAND HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE COVENANT HOSPITAL LEVELLAND BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE COVENANT HOSPITAL LEVELLAND BOARD AS NOMINATIONS MUST BE APPROVED BY THE COVENANT HEALTH SYSTEM (CHS), AS THE CORPORATE MEMBER, AND THE ST. JOSEPH HEALTH SYSTEM, AS THE TAX-EXEMPT PARENT OF CHS, AND THE ST. JOSEPH HEALTH MINISTRY, AS THE ORGANIZATIONAL SPONSOR. FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQ APPR & TYPE OF VOTING RIGHTS THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE ST. JOSEPH HEALTH SYSTEM MEMBER OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS. FORM 990, PART VI, LINE 11B DESCR THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 IS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AS APPLICABLE. THE FORM 990 IS THEN REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 FILING IS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD FOR THE APRIL 2017 MEETING. DURING THE FINANCE MEETING, MANAGEMENT PRESENTS AND DISCUSSES CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDES A SUMMARY AT THE FULL BOARD MEETING. FORM 990, PART VI, LINE 12C DESCRIPTION OF PROCESS TO MONITOR TRANSACTIONS FOR CONFLICTS OF INTEREST OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT IN CONNECTION WITH THAT INDIVIDUAL SATISFYING THEIR FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WITH GUIDANCE FROM THE ST. JOSEPH HEALTH SYSTEM CHIEF COMPLIANCE OFFICER (CCO), THE CHIEF EXECUTIVE AND/OR THE GOVERNING BOARD CHAIRPERSON, AS APPROPRIATE, CONSIDERS THE MATTER INITIALLY. IF THE MATTER CANNOT BE RESOLVED AT THAT LEVEL, THE MATTER IS ESCALATED TO THE CCO. THE CCO, IN CONSULTATION WITH THE ST. JOSEPH HEALTH SYSTEM GENERAL COUNSEL, REVIEWS THE MATTER AND PRESENTS RECOMMENDATIONS TO THE GOVERNING BOARD AND/OR BOARD COMMITTEE, AS APPROPRIATE, FOR DISCUSSION AND VOTE. THE INDIVIDUAL WHOSE POTENTIAL CONFLICT IS BEING REVIEWED MAY BE REQUESTED TO BE PRESENT DURING ANY MEETING IN WHICH THE BOARD OR BOARD COMMITTEE CONDUCTS ITS EVALUATION BUT SHALL BE EXCUSED FOR ANY DISCUSSION OR VOTE. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE COMMITTEE FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE. FORM 990, PART VI, LINES 15A & 15B THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY COVENANT HOSPITAL LEVELLAND. EXECUTIVE COMPENSATION IS APPROVED BY THE COVENANT HEALTH SYSTEM CONFLICTS AND COMPENSATION COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT PERSONS. THE COMMITTEE REVIEWS COMPARABILITY DATA PREPARED FOR AND COMPILED BY THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE, A COMMITTEE OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES COMPRISED OF INDEPENDENT MEMBERS. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE ACTS IN ACCORDANCE WITH A COMMITTEE CHARTER APPROVED BY THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES AND AN EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER DIRECTS THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND TO APPROVE PROGRAM CHANGES, AS NECESSARY, TO ENSURE ALIGNMENT WITH THE STATED PHILOSOPHY AND ENSURE CONTINUED COMPLIANCE WITH FEDERAL AND STATE REGULATIONS ON BEHALF OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS RETENTION OF KEY MANAGEMENT TALENT. THE EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF FOR PROFIT AND NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. ST. JOSEPH HEALTH SYSTEM PROVIDES COMPENSATION TO ITS EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO ENSURE COMPENSATION PHILOSOPHY ADHERENCE AND GENERAL FAIR MARKET VALUE COMPENSATION, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA AND ENGAGES LEGAL COUNSEL AND CONSULTING SUPPORT, AS NEEDED. THEY USE THIS INFORMATION TO SUPPORT ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE MEETS AT LEAST 3 TIMES A YEAR AND TAKES ACTION IN EXECUTIVE SESSION. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. A FULL COMPENSATION REVIEW IS CONDUCTED ON A BIENNIAL BASIS AND THE LAST REVIEW WAS PERFORMED IN JUNE 2016. DURING THE YEAR, THE COVENANT HEALTH SYSTEM CONFLICTS AND COMPENSATION COMMITTEE REVIEWED AND APPROVED ANY CHANGES IN COMPENSATION FOR KEY EXECUTIVES PREDICATED ON THE ANALYSIS AND RECOMMENDATION BY AN INDEPENDENT THIRD PARTY CONSULTING FIRM WITH EXPERTISE IN HEALTHCARE EXECUTIVE COMPENSATION. IN ADDITION, ANNUAL INCENTIVE AWARDS ARE REVIEWED AND APPROVED PRIOR TO PAYMENT CONSISTENT WITH THE MOST RECENT COMPENSATION BIENNIAL REVIEW AND IN ACCORDANCE WITH THE PLAN DOCUMENT. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES WHICH ARE SUBSEQUENTLY APPROVED AT THE COMMITTEE MEETING. FORM 990, PART VI, QUESTION 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY, & FIN STMTS TO PUBLIC THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. THE AUDITED FINANCIAL STATEMENTS ARE ALSO ATTACHED TO THE FORM 990. FORM 990, PART XI, LINE 9 OTHER CHANGES IN NET ASSETS OR FUND BALANCE EQUITY TRANSFERS TO AFFILIATES ($220,822) ---------- TOTAL ($220,822) FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:3251596 COVENANT HEALTH NETWORK INC 3345 MICHELSON DRIVE STE 100 IRVINE CA 92612 461259908 HEALTHCARE CA 501(C)(3) 11,III SJHS true COVENANT ACO 3615 19TH STREET LUBBOCK TX 79410 611573313 HEALTHCARE TX 501(C)(3) 11,I CHS true COVENANT HEALTH SYSTEM 3615 19TH STREET LUBBOCK TX 79410 752765566 HEALTHCARE TX 501(C)(3) 3 SJHS true COVENANT HEALTH SYSTEM FOUNDATION 3623 22ND PLACE LUBBOCK TX 79410 752897026 HEALTHCARE TX 501(C)(3) 7 CHS true COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK TX 79410 752743883 HEALTHCARE TX 501(C)(3) 3 CHS true COVENANT HEALTH PARTNERS 3615 19TH STREET LUBBOCK TX 79410 463516417 HEALTHCARE TX 501(C)(3) 11,I CHS true HMTS INC 1 HOAG DRIVE NEWPORT BEACH CA 92658 453583707 HEALTHCARE CA 501(C)(3) 11,I HMHP true HOAG CHARITY SPORTS 330 PLACENTIA AVE NEWPORT BEACH CA 92663 452982422 SUPPORT CA 501(C)(3) 7 HHF true HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH CA 92663 953222343 FUNDRAISING CA 501(C)(3) 7 HMHP true HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG ROAD BOX 6100 NEWPORT BEACH CA 92663 951643327 HEALTHCARE CA 501(C)(3) 3 CHN true HOME CARE PARTNERS 1165 MONTGOMERY DR SANTA ROSA CA 95405 680318656 INACTIVE CA 501(C)(3) 3 SRMH true HOSPICE OF LUBBOCK 3702 21ST STREET LUBBOCK TX 79410 752133781 HEALTHCARE TX 501(C)(3) 9 CHS true LUBBOCK METHODIST HOSPITAL FOUNDATION 3615 19TH STREET LUBBOCK TX 79410 752220963 HEALTHCARE TX 501(C)(3) 7 CHS true METHODIST CHILDREN'S HOSPITAL 4015 22ND PLACE LUBBOCK TX 79410 752428911 HEALTHCARE TX 501(C)(3) 3 CHS true METHODIST HOSPITAL PLAINVIEW 2601 DIMMITT ROAD PLAINVIEW TX 79072 752426010 HEALTHCARE TX 501(C)(3) 3 CHS true MISSION HOSPITAL REGIONAL MEDICAL CTR 27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691 951643360 HEALTHCARE CA 501(C)(3) 3 CHN true QUEEN OF THE VALLEY MEDICAL CENTER 1000 TRANCAS STREET NAPA CA 94558 941243669 HEALTHCARE CA 501(C)(3) 3 SJHS true REDWOOD MEMORIAL FOUNDATION 3300 RENNER DRIVE FORTUNA CA 95540 942779313 HEALTHCARE CA 501(C)(3) 7 RMH true REDWOOD MEMORIAL HOSPITAL 3300 RENNER DRIVE FORTUNA CA 95540 941384665 HEALTHCARE CA 501(C)(3) 3 SJHS true SANTA ROSA MEMORIAL HOSPITAL 1165 MONTGOMERY DR SANTA ROSA CA 95405 941231005 HEALTHCARE CA 501(C)(3) 3 SJHS true SISTERS OF ST JOSEPH OF ORANGE 480 S BATAVIA ORANGE CA 92868 951643383 RELIGIOUS ORG CA 501(C)(3) 1 NA false SRM ALLIANCE HOSPITAL SERVICES (PVH) 400 NORTH MCDOWELL BLVD PETALUMA CA 94954 680395200 HEALTHCARE CA 501(C)(3) 3 SRMH true ST JOSEPH HEALTH MINISTRY 3345 MICHELSON DRIVE STE 100 IRVINE CA 92612 271666576 RELIGIOUS ORG CA 501(C)(3) 1 SSJO false ST JOSEPH HEALTH SYSTEM 3345 MICHELSON DRIVE STE 100 IRVINE CA 92612 953589356 HEALTHCARE CA 501(C)(3) 11, I SJHM false ST JOSEPH HEALTH SYSTEM FOUNDATION 3345 MICHELSON DRIVE STE 100 IRVINE CA 92612 330143024 HEALTHCARE CA 501(C)(3) 7 SJHS true ST JOSEPH HOME CARE NETWORK 1111 SONOMA STE 308 SANTA ROSA CA 95405 680331084 HEALTHCARE CA 501(C)(3) 9 SJHS true ST JOSEPH HOSPITAL OF EUREKA 2700 DOLBEER STREET EUREKA CA 95501 941156596 HEALTHCARE CA 501(C)(3) 3 SJHS true ST JOSEPH HOSPITAL OF ORANGE 1100 WEST STEWART DRIVE ORANGE CA 92868 951643359 HEALTHCARE CA 501(C)(3) 3 CHN true ST JUDE HOSPITAL YORBA LINDA 200 WEST CENTER ST PROMENADE ANAHEIM CA 92805 330185031 HEALTHCARE CA 501(C)(3) 3 SJHS true ST JUDE HOSPITAL INC 101 EAST VALENCIA MESA DRIVE FULLERTON CA 92635 951643324 HEALTHCARE CA 501(C)(3) 3 CHN true ST MARY MEDICAL CENTER 18300 HIGHWAY 18 APPLE VALLEY CA 92307 951914489 HEALTHCARE CA 501(C)(3) 3 CHN true ST MARY OF THE PLAINS HOSPITAL FDN 4000 24TH STREET LUBBOCK TX 79410 751653181 HEALTHCARE TX 501(C)(3) 7 CHS true TALLER SAN JOSE 801 NORTH BROADWAY SANTA ANA CA 92701 593816355 WORK DEVELOPM CA 501(C)(3) 2 SSJO true COVENANT LONG-TERM CARE LP SEE PART VII ORANGE CA 92868 264591502 HEALTHCARE TX NA N/A HERITAGE INVESTMENT GROUP SEE PART VII LA PALMA CA 906231052 462611662 INVESTMENTS CA NA N/A HOAG ORTHOPEDIC INSTITUTE SEE PART VII LA PALMA CA 906231052 465497794 HEALTHCARE CA NA N/A LUBBOCK SURGERY CENTER LTD SEE PART VII ORANGE CA 92868 271000061 HEALTHCARE TX NA N/A METHODIST DIAGNOSTIC IMAGING SEE PART VII LUBBOCK TX 79410 752177401 HEALTHCARE TX NA N/A MISSION AMBULATORY SURGICENTER SEE PART VII ORANGE CA 92868 954813223 HEALTHCARE CA NA N/A NEWPORT IMAGING CENTER SEE PART VII LUBBOCK TX 79410 752343261 HEALTHCARE CA NA N/A SHA LLC SEE PART VII MISSION VIEJO CA 92691 203132592 HEALTHCARE TX NA N/A ST JOSEPH PHYSICIAN VENTURES SEE PART VII ORANGE CA 92868 454521884 REAL ESTATE CA NA N/A ST JOSEPH HLTH SYS HOME CARE SEE PART VII NEWPORT BEACH CA 92660 330841806 HOME HEALTH CA NA N/A ST JOSEPH HLTH SYS HOME HLTH SEE PART VII AUSTIN TX 78750 752569094 HOME HEALTH CA NA N/A THE INNOVATION INSTITUTE SEE PART VII ORANGE CA 92868 454521884 HEALTHCARE DE NA N/A NORTH BAY ENDOSCOPY CENTER SEE PART VII LA PALMA CA 906231052 900745066 HEALTHCARE CA NA N/A MISSION VIEJO PHYSICIAN PARTNERS I LLC 27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691 471559873 HEALTHCARE CA NA N/A ADVANCED SURGERY INSTITUTE LLC 1739 4TH STREET SANTA ROSA CA 95404 262299255 HEALTHCARE CA NA N/A AMERICAN UNITY GROUP LTD 90 PITTS BAY ROAD PEMBROKE BD HM08 CAPTIVE INSURANCE BD NA C-CORP COASTAL MANAGEMENT SERVICES ORGANIZATION 1 HOAG DRIVE BOX 6100 NEWPORT BEACH CA 92658 330676831 HEALTHCARE CA NA C-CORP DATU HEALTH INC 16150 MAIN CIRCLE DR SUITE 250 CHESTERFIELD MO 63017 463070062 IT SVCS DE NA C-CORP HOAG MANAGEMENT SERVICES INC 1 HOAG DRIVE BOX 6100 NEWPORT BEACH CA 92658 330731587 HEALTHCARE CA NA C-CORP LUBBOCK METHODIST HOSP PRACTICE MGMT 2107 OXFORD STREET STE 300 LUBBOCK TX 79410 752578995 INACTIVE TX NA C-CORP LUBBOCK METHODIST HOSPITAL SVCS PO BOX 1201 LUBBOCK TX 79410 752118585 HEALTHCARE TX NA C-CORP MISSION VIEJO MEDICAL VENTURES 27800 MEDICAL CENTER RD 354 MISSION VIEJO CA 92691 330212905 HEALTHCARE CA NA C-CORP ST JOSEPH HEALTH 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 462340232 HOLDING COMPANY CA NA C-CORP ST JOSEPH HEALTH SOURCE INC 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 461900168 HEALTHCARE CA NA C-CORP ST JOSEPH PROF SVCS ENTERPRISES INC 3345 MICHELSON DRIVE SUITE 100 IRVINE CA 92612 330155323 HEALTHCARE CA NA C-CORP false false false false false false false false false false false true false false true false true true false COVENANT HEALTH SYSTEM q 3372678 ACCRUAL COVENANT HEALTH SYSTEM o 2134328 ACCRUAL COVENANT HEALTH SYSTEM r 306701 ACCRUAL SCHEDULE R, PART III IDENTIFICATION OF RELATED ORGANIZATIONS TAXABLE AS A PARTNERSHIP COVENANT LONG-TERM CARE, LP EIN: 20-5033419 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 HERITAGE INVESTMENT GROUP I, LLC EIN: 27-1000061 ADDRESS: 500 S. MAIN STREET, STE 1000, ORANGE, CA 92868 HOAG ORTHOPEDIC INSTITUTE EIN: 61-1588294 ADDRESS: 1 HOAG DRIVE, BOX 6100, NEWPORT BEACH, CA 92658 LUBBOCK SURGERY CENTER, LTD. EIN: 75-2177401 ADDRESS: 4000 24TH STREET, LUBBOCK, TX 79410 METHODIST DIAGNOSTIC IMAGING EIN: 75-2343261 ADDRESS: 4005 24TH STREET, LUBBOCK, TX 79410 MISSION AMBULATORY SURGICENTER, LTD EIN: 33-0355575 ADDRESS: 27800 MEDICAL CENTER ROAD, STE 362, MISSION VIEJO, CA 92691 NEWPORT IMAGING CENTER EIN: 33-0191776 ADDRESS: 360 SAN MIGUEL, NEWPORT BEACH, CA 92660 SHA, LLC EIN: 75-2569094 ADDRESS: 12940 NORTH HIGHWAY 183, AUSTIN, TX 78750 ST. JOSEPH PHYSICIAN VENTURES I, LLC EIN: 45-4521884 ADDRESS: 1100 WEST STEWART DRIVE, ORANGE, CA 92868 ST. JOSEPH HEALTH SYSTEM HOME CARE SERVICES EIN: 33-0307672 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE 100, ORANGE, CA 92868-2012 ST. JOSEPH HEALTH SYSTEM HOME HEALTH AGENCY EIN: 33-0282945 ADDRESS: 1845 W. ORANGEWOOD AVENUE, STE 200 ORANGE, CA 92868-2012 THE INNOVATION INSTITUTE EIN: 90-0745066 ADDRESS: 1 CENTERPOINTE DRIVE SUITE 200, LA PALMA, CA 90623-1052 NORTH BAY ENDOSCOPY CENTER, LLC EIN: 61-1559876 ADDRESS: 1383 N. MCDOWELL BLVD SUITE 110, PETALUMA, CA 94954 MISSION VIEJO PHYSICIAN PARTNERS I LLC EIN: 47-1559873 ADDRESS: 27700 MEDICAL CENTER ROAD, MISSION VIEJO, CA 92691 ADVANCED SURGERY INSTITUTE LLC EIN: 26-2299255 ADDRESS: 1739 4TH STREET, SANTA ROSA, CA 95404