2017-05-15T14:10:14-05:00 2016-06-30 470617373 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2015-07-01 450226711 St Alexius Medical Center STAL 7015307000 900 EAST BROADWAY AVENUE BISMARCK ND 585014520 Kurt Schley CEO 2017-05-15 true Mark Stocki P00642127 3032989100 2015 2021-01-29 14:40:06Z CHI St Alexius Health Kurt Schley 900 EAST BROADWAY AVENUE BISMARCK ND 585014520 326464057 false 0928 X WWW.ST.ALEXIUS.ORG X 1905 ND PROVIDING HEALTHCARE. 10 8 2901 184 4581938 681920 845158 867878 308363471 313602656 3150687 -2442183 9952440 11159671 322311756 323188022 3026486 1367116 0 132064299 129117209 0 251993 179889655 202805926 314980440 333290251 7331316 -10102229 288258761 299127589 126317270 126276107 161941491 172851482 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. (CONTINUED ON SCHEDULE O) false false 278262801 1367116 319166297 St. Alexius Medical Center began as a 20-bed hospital 130 years ago. Over the years it has evolved into a 306-bed, full-service, certified Level II Trauma Acute Care Center that provides advanced healthcare services. St. Alexius served 10,555 inpatients during the fiscal year ended June 30th 2016. With 1,570 births in FY 2016, mothers in the region choose to have their baby at St. Alexius Medical Center. Our family-focused care provides a wide range of services for mother and baby, and our specially trained nurses and physicians are prepared to handle every birthing experience with care. St. Alexius' 4-bed Level III NICU has served the region for more than 26 years, which is staffed by neonatal nurses, therapists, board-certified neonatologists, a pediatric neurologist and the region's only pediatric cardiologist. St. Alexius' Heart & Vascular Center provides comprehensive care to patients with cardiovascular, lung, and peripheral artery disease. 278262801 true true false true false false false false false true true true false true true true false true false false false false false false true true true true true true true false false false false false false false false true false false false true true true false false false true 217 0 true 2901 true true true false false false false true true false false false true false X 10 8 false false false false true true true true true false false true true true true true true false true true true X Kurt Schley 7015307610 900 EAST BROADWAY AVE BISMARCK ND 585014520 KURT SCHLEY CEO 50.0 42.0 X X 0 464621 63141 SR NANCY MILLER OSB PRESIDENT 3.0 2.0 X X 0 0 0 JOHN GIESE Chair 3.0 3.0 X X 5550 0 0 SR THOMAS WELDER Vice President 3.0 2.0 X X 0 0 0 SR GERARD WALD Secretary (Partial Year) 3.0 1.0 X X 0 0 0 SR ROSANNE ZASTOUPIL Treasurer (Partial Year) 3.0 1.0 X X 0 0 0 JEFFREY DROP Director 1.0 62.0 X 0 1216002 27308 MIKE LEFOR Director 1.0 5.0 X 0 0 0 PATRICK SOGARD Director 1.0 3.0 X 0 0 0 VERNON DOSCH Director 3.0 2.0 X 2775 0 0 ROBERT GAYTON Director (PARTIAL YEAR) 3.0 1.0 X 3375 0 0 PAMELA SCHMIDT Director (Partial Year) 3.0 1.0 X 3175 0 0 SR JOANN KREBSBACH Director (Partial Year) 3.0 1.0 X 0 0 0 LESLIE OLIVER Director 3.0 2.0 X 3475 0 0 TIMOTHY BOPP MD Director 3.0 2.0 X 1300 0 0 Dr Guy Tangedahl Director (Partial Year) 3.0 1.0 X 1625 0 0 JOSEPH MESSMER Interim President/CEO (PARTIAL YEAR) 50.0 51.0 X 0 392534 0 Priscilla Needham CFO (Partial Year) 40.0 0 X 0 186458 22057 DEB MOHESKY CFO (Partial Year) 40.0 0 X 0 0 0 Shiraz Hyder VP Medical Affairs 40.0 0 X 622320 0 31588 Rosanne Schmidt VP & Chief Nursing Officer 40.0 0 X 283000 0 30486 Duwayne Schlittenhard VP Professional Services 40.0 0 X 326440 0 39052 Amy Hornbacher VP Corporate Responsibility 40.0 0 X 158554 0 15513 Julie Jeske VP Community Services 40.0 0 X 151092 0 7879 JEFFREY BEAUCHAMP VP Materials & Facilities Resources 40.0 0 X 168493 0 18891 Dr Michael Brown Cardiovascular Surgeon 40.0 1.0 X 739497 0 33190 Dr Eric Belanger Neurosurgeon 40.0 0 X 1955924 0 45998 Dr Steven Kraljic Neurosurgeon 40.0 0 X 1937573 0 47098 Dr Allen Booth Cardiovascular & Thoracic Surgeon 40.0 0 X 726455 0 48602 Boyd Marts Cardiovascular Surgeon 40.0 0 X 720897 0 49057 Susan Sisk Former VP Accounting & Finance 40.0 0 X 292822 0 39437 Gary Miller Former President/ CEO 50.0 1.0 X 748469 0 15857 8852810 2259615 535154 224 true true false Medical Solutions 1010 N 102nd St Suite 300 Omaha NE 68114 NURSE STAFFING SERVICES 6607091 Bismarck Radiology Associates 810 E Rosser Ave Ste 201 Bismarck ND 58501 Radiology Services 5328828 Northern Plains Lab PO Box 2036 Bismarck ND 58502 Pathology Services 5201400 DMS Health Technologies Inc 2101 N University Dr Fargo ND 58102 Radiology Services 901688 Northland Nuclear Medicine LLC 2124 E Thayer Ave Bismarck ND 58501 Radiology Services 789090 20 X 0 0 259821 0 150785 457272 272244 867878 Patient Services 900099 312305672 312305672 0 0 Cafeteria 722100 1078593 1078593 0 0 Tuition 611600 218391 218391 0 0 0 0 0 0 0 0 0 0 0 0 0 313602656 486519 0 -1023 487542 0 0 0 0 0 0 0 0 1096888 0 189299 0 907589 0 907589 0 -60293 967882 1128837 1799865 -1128837 -1799865 -2928702 0 0 -2928702 178271 259821 134609 43662 0 43662 24950 23425 1525 0 0 1525 0 0 0 0 0 0 Pharmacy Services 446110 6457545 5483019 974526 0 Laboratory Services 621500 1247437 80622 1166815 0 Services Sold 900099 760599 0 760599 0 1741314 0 1741314 0 10206895 323188022 319166297 4581938 -1428091 X 180269 180269 1186847 1186847 1689567 0 1689567 0 14976 14976 102062558 90125945 11794934 141679 3902929 3487407 410525 4997 12948141 11366473 1564340 17328 8499038 7447278 1041843 9917 564749 564749 64656510 43824657 20831853 0 2235688 1117844 1117844 4825378 3356791 1391894 76693 5014164 2507082 2507082 4474912 3918165 556747 2507723 2197524 308820 1379 2644 1322 1322 4217967 4217967 14035603 13995192 40411 316397 313782 2615 Medical Supplies 61780087 61780087 Purchased Services 6472000 6472000 Bad debts 5582964 5582964 Repairs and maintenance 4247271 4247271 21871869 10935934 10935935 0 333290251 278262801 54775457 251993 0 26381796 -2279147 0 39505664 55872393 3452358 0 0 340438 9464611 10523677 947673 991699 142877066 22800490 135740263 120076576 9971110 9619980 61023862 18771919 0 0 1771424 85210054 288258761 299127589 28055590 17101196 22710237 91071113 0 6530119 86445740 0 660448 18934 126317270 126276107 X 159017746 170022378 2527780 1552004 395965 1277100 161941491 172851482 288258761 299127589 X -10102229 846024 20166196 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 8927 false false true 8927 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Line 1f- THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION- $2,719 CATHOLIC HEALTH ASSOCIATION- $1,653 NORTH DAKOTA HOSPITAL ASSOCIATION- $4,555 Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Line 1f- THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION- $2,719 CATHOLIC HEALTH ASSOCIATION- $1,653 NORTH DAKOTA HOSPITAL ASSOCIATION- $4,555 5511626 155866 18 623219 12625 5031666 5092887 1167300 148073 877031 19603 5511626 4168921 1294587 243129 596057 17693 5092887 3654924 958033 120568 548054 16550 4168921 3639568 494559 137978 601477 15704 3654924 1.0 0.0 0.0 false false 18061206 18061206 63639189 14206555 49432634 0 0 0 56704365 8455091 48249274 4472306 138844 4333462 120076576 CHI OIP 18771919 F CANCER CENTER CANCER CENTER FOUNDATION CASH & CASH EQUIVALENTS MANDAN PHARMACY CENTRAL DAKOTA LAUNDRY COOP NCHCA PRIMECARE NORTHERN PLAINS LAB SA HEALTH SERVICES INC 18771919 Deposits 52196 Intercompany Receivables 85157858 85210054 Other Liabilities 13005 Unclaimed Property 5929 18934 X Schedule D, Part V, Line 4 Intended uses of endowment funds The endowment is utilized to provide funding to continue to enhance patient care at St. Alexius Medical Center set forth in our mission, "Let all be received as Christ." Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote St. Alexius Medical Center's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 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." Night for the Stars 383329 214983 168346 6940 28854 2800 94062 SAKT 54763 44838 9925 339 344 148 1122 0 438092 259821 178271 339 7284 29002 2800 95184 134609 43662 24950 23175 250 true 0.9 24950 23175 250 ND true false true false 0.0 1.0 KILEE HARMON 900 E BROADWAY AVE BISMARCK ND 58501 false KILEE HARMON 0 DEVELOPMENT DIRECTOR X true 32529 Schedule G, Part III, Line 17 Distributions required under state law STATE=NORTH DAKOTA,MANDATORY DISTRIBUTION AMOUNT=32529; true true X false false true true true false true true 606723 606723 0.0019 12159153 9702292 2456861 0.0075 0 0.0 0 0 12765876 9702292 3063584 0.0094 139382 139382 0.0004 1927124 1927124 0.0059 12005513 2415665 9589848 0.0294 286617 159832 126785 0.0004 91108 91108 0.0003 0 0 14449744 2575497 11874247 0.0364 0 0 27215620 12277789 14937831 0.0458 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0.0 0 0 0 0 0 0.0 false 5582964 669956 87265139 124523891 -37258752 X true true NORTHERN PLAINS LAB LABORATORY SERVICES 0.5 0.5 1 1 St Alexius Medical Center 900 East Broadway Bismarck ND 585065510 www.st.alexius.org 5004 X X X X St Alexius Medical Center 1 false false true X X X X X X X X X 15 true false false true X https://www.st.alexius.org/about/community-health-assessment X true 15 true https://www.st.alexius.org/about/community-health-assessment false false true X X X X X true true X X X true X https://www.st.alexius.org/visitors/financial-assistance X https://www.st.alexius.org/visitors/financial-assistance X https://www.st.alexius.org/visitors/financial-assistance X X X 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 - St. Alexius Medical Center. Input for CHI St. Alexius Health's Community Health Needs Assessment was derived from several resources including a generalizable survey, non-generalizable survey, stakeholders' meeting, Project Service Connect Survey and Veteran's Stand Down Survey. In March of 2015, CSR conducted a mail survey (generalizable) to a representative sample of community residents of the Bismarck-Mandan metro area via the United States Postal Service. On April 1, members of the community were invited to participate in an online (non-generalizable) survey. The survey instrument was available on each Community Health Collaborative partner's website and was also distributed via e-mail to various agencies. Data collection occurred throughout the month of April 2015 and a total of 502 respondents participated in the online survey. The online survey instrument used was based largely on questions included in the paper survey format. However, some questions in the paper survey were modified for the online version of the survey and therefore are not comparable, particularly those questions relating to Advanced Care Directives and alcohol use and prescription or non-prescription drug abuse. To gain input from persons who represent the broad interests of the communities served by our facilities, including those with special knowledge of or expertise in public health, a community stakeholders meeting was held in June. The Project Service Connect Survey was conducted by Bismarck Burleigh Public Health. Summary of the feedback provided by the community stakeholders was placed in a survey tool and distributed to stakeholders to determine a prioritization of needs for the communities. An additional survey title Veteran's Stand Down, was conducted to reach vulnerable populations in the Burleigh-Morton county area. Vulnerable populations include the economically disadvantaged, racial and ethnic minorities, the uninsured, low-income children, the elderly, the homeless, those with human immunodeficiency virus (HIV), and those with other chronic health conditions, including severe mental illness identified as at-risk for health disparities. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - St. Alexius Medical Center. The 2016 Community Health Needs Assessment identified the following three critical needs in the community: Chronic Diseases/Mental Health/Diabetes with a focus on diabetics The implementation strategy for the Chronic Diseases/Mental Health/Diabetes committee includes recognizing and referring at risk individuals. This will be accomplished through education to providers as well as the general population. Awareness will be created through a series of public service announcements, digital media and printed collateral pieces. Violence Prevention/Violence Against Women Part of the violence prevention strategy is focused on our partnerships with area schools. School programs will be presented to middle school students in an age-appropriate manner to raise awareness and provide information on how gender roles and expectations, as well as our culture, influence dating violence and sexual assault. Students will learn about resources, risk reduction strategies and bystander intervention. The committee will also develop a strategy to involve local law enforcement officers. Obesity/Childhood Obesity Many social and environmental factors have negatively influenced the physical activity and eating behaviors of US children and adolescents. Financial and time pressures force many families to minimize food costs and meal preparation time, resulting in increased consumption of prepackaged convenience foods that are high in calories and fat. To move the needle when it comes to childhood obesity, the committee will add to our Kohl's Care for Kids sponsored activities. Each of these activities is designed to educate children and their parents/guardians about the importance of proper weight, good nutrition and exercise. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - St. Alexius Medical Center. When Catholic Health Initiatives (the ultimate parent organization to St. Alexius Medical Center 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 18 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. St. Alexius Medical Center 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 V, Section B, Line 22 Facility , 1 Facility , 1 - St. ALexius Medical Center. THE ORGANIZATION WILL NOT CHARGE INDIVIDUALS WHO ARE ELIGIBLE FOR FINANCIAL ASSISTANCE MORE THAN AMOUNTS GENERALLY BILLED TO THOSE WHO HAVE INSURANCE 6 St Alexius Heart & Lung Clinic 310 North 10th Street Bismarck ND 58501 Heart, lung & peripheral vascular disease clinic Great Plains Rehabilitation Services 1212 East Main Bismarck ND 58501 Provide home medical products to general public St Alexius Minot Clinic 2700 8TH ST NW Minot ND 58701 Family medicine clinic St Alexius Mandan Clinic North 2500 Sunset Dr NW Mandan ND 58554 Family medicine clinic St Alexius Mandan Clinic-South 403 Burlington Street SE Mandan ND 58554 Family medicine clinic Mandan Clinic-East 2008 Twin City Drive Mandan ND 58554 Family medicine clinic Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care When Catholic Health Initiatives (the ultimate parent organization to St. Alexius Medical Center 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 18 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. St. Alexius Medical Center 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 7g Subsidized Health Services Subsidized health services does not include any costs attributable to physician clinics. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 5582964 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The charity care included in Part I, Line 7a is based on the average cost to gross charges calculated from our audited financial. The unreimbursed Medicaid in Part I, Line 7b is based on gross charges and claims from our Accounts Receivable system. The community health services, education and contributions in Part I, Lines 7e, f and i are based on actual expenses. The subsidized health services in Part I, Line 7g are based on estimated costs from the internal cost accounting general ledger systems. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount THE AMOUNT REPORTED AS BAD DEBT EXPENSE REPRESENTS TOTAL CHARGES WRITTEN OFF TO BAD DEBT. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. Schedule H, Part III, Line 3 Bad Debt Expense Methodology The estimated amount of the organization's bad debt expense that is attributable to patients eligible under the organization's charity care policy is approximately $669,956. This was based off the most recent community needs assessment reported, which indicated that 12% of the population is below the Federal Poverty Guidelines. The 12% was applied to the amount of bad debt expense. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote St. Alexius Medical Center does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of Catholic Health Initiatives. The consolidated footnote reads as follows: "The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration historical business and economic conditions, trends in health care coverage, and other collection indicators. Management routinely assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category. The results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. After satisfaction of amounts due from insurance, CHI follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. The provision for bad debts is presented on the consolidated statements 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 Using essentially the same Medicare cost report principles as to the allocation of general services costs and "apportionment" methods, the "CHI Workbook" calculates a payers' gross allowable costs by service (so as to facilitate a corresponding comparison between gross allowable costs and ultimate payments received). The term "gross allowable costs" means costs before any deductibles or co-insurance are subtracted. St. Alexius Medical Center's ultimate reimbursement will be reduced by any applicable copayment/ deductible. Where Medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from Medicare allowable costs because the amounts are typically immaterial. St. Alexius Medical Center believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as "subsidized health services." Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance St. Alexius Medical Center's debt collection policy provides that St. Alexius Medical Center 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-payment, to assure that the patient and patient guarantor are not eligible for any assistance program (e.g. Medicaid) and do not qualify for coverage through St. Alexius Medical Center's community assistance policy. After having been turned over to a third-party collection agent, any patient account that is subsequently determined to meet the St. Alexius Medical Center community assistance policy is required to be returned immediately by the third-party collection agent to St. Alexius Medical Center for appropriate follow-up. St. Alexius Medical Center 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: * Neither CHI hospitals nor their collection agencies will request bench or arrest warrants as a result of non-payment; * Neither CHI hospitals nor their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and * No Catholic Health Initiatives' collection agency may seek court action without hospital approval. Finally, collection agencies are trained on the Catholic Health Initiatives 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 - St. Alexius Medical Center: Line 16a URL: https://www.st.alexius.org/visitors/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - St. Alexius Medical Center: Line 16b URL: https://www.st.alexius.org/visitors/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - St. Alexius Medical Center: Line 16c URL: https://www.st.alexius.org/visitors/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment The Organization completed a community health needs assessment during fiscal year 2016. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance St. Alexius Medical Center includes information concerning its financial assistance policy on its website. In addition, St. Alexius Medical Center prominently displays its financial assistance policy in both English and Spanish in obvious locations throughout the hospitals, including the emergency rooms and other patient intake areas, as well as in St. Alexius Medical Center outpatient facilities. In addition, St. Alexius Medical Center registration clerks are trained to provide consultation to those who have no insurance or potentially inadequate insurance concerning their financial options including application for Medicaid and for financial assistance under St. Alexius Medical Center's financial assistance policy. Upon registration (and once all EMTALA requirements are met), patients who are identified as uninsured (and not covered by Medicare or Medicaid) are provided with a packet of information that addresses the financial assistance policy and procedures including an application for assistance. St. Alexius Medical Center registration clerks read the organization's medical assistance policy to those who appear to be incapable of reading, and provide translators for non-English-speaking individuals. St. Alexius Medical Center's staff will also assist the patient/guarantor with applying for other available coverage (such as Medicaid), if necessary. Counselors assist Medicare eligible patients in enrollment by providing referrals to the appropriate government agencies. Schedule H, Part VI, Line 4 Community information St. Alexius provides outreach services across its service area of central and western North Dakota. St. Alexius operates the Garrison Memorial Hospital in Garrison, North Dakota and manages the Community Memorial Hospital in Turtle Lake. St. Alexius owns and operates clinics in Mandan, Minot, Garrison, and Washburn. North Dakota's population is 739,482 of which 68,896 reside in the city of Bismarck. The population is 89.1% white, 4.5% Native American, and the remaining 6.4% being African American, Asian, and Hispanic. By the year 2020, 45 of the 53 counties will have more than 22% of their population age 65 or older. From 2000-2005 our state had a 15% decrease in the number of youth and a 13.8% increase in the minority population which was primarily Native American Reservations. North Dakota has 12% of their population living in poverty. The leading causes of death in Burleigh county ranked in order are Diseases of the Heart, Alzheimers, Respiratory Cancer, Accidental, Cerebrovascular Disease, COPD, Diabetes, Breast Cancer, and Colorectal Cancer. Health related behaviors influence cardiovascular diseases such as smoking, physical inactivity, poor nutrition, and unhealthy weight status. Hypertension is a chronic disease associated with aging that has a high risk factor for heart disease and stroke. In North Dakota, 26% adults have high blood pressure. North Dakota adults are a part of the national trend towards increased obesity. 63% of the adults here have an unhealthy weight/BMI. Some of the health screenings that St. Alexius is conducting throughout the service region are vascular, wellness, memory, sleep apnea, and chronic obstructive pulmonary disease. Those individuals that are being screened at no or minimal cost are being alerted of health risks that might go undetected. Through screenings, it is our hope that these individuals seek further treatment and are empowered to make healthier lifestyle choices. Schedule H, Part VI, Line 5 Promotion of community health The governing body is comprised of people in the community who are knowledgeable to advise the organization and are compensated for their expertise and time (see Part VII of Form 990). The organization extends medical staff privileges to Primecare physicians. The organization applies surplus funds, if available, to their reinvestment in equipment and facilities to improve patient care. The Hospital provides several services at reduced or no costs. Those included are as follows: 1. INTERACTIVE NETWORK - Consists of twenty five communities located in Montana, South and North Dakota covering 70,000 square miles are serviced by the St. Alexius Medical Center network. INTERACTIVE NETWORK provides electrocardiogram management, interactive cardiac management, remote cardiac monitoring, electroencephalogram monitoring, fetal monitoring, biomedical services, dialysis and infant pneumocardiograms to patients in western and central North Dakota. These services might not be provided if not for the Hospital servicing these areas. 2. OTHER ACTIVITES INCLUDED ON PART 1, LINE 7E: - In keeping with the Hospital's commitment to serve all members of its community St. Alexius Medical Center: -participated in health fairs -provided patient educational materials and classes -provided patient support groups for different diseases -conducted health screenings -sponsored "Wellness" type programs ranging from Lamaze instruction and parenting to babysitting to diet and weight control to social issues. -operated a Hospice Program -has telemedicine capabilities set-up in several rural communities -provides PAC's (radiology) services and radiology reading to many rural communities -tumor registry 3. St. Alexius operates a Telemedicine network, known as The Telecare Network. It is a service St. Alexius Medical Center and affiliated physicians offer in cooperation with 27 healthcare providers throughout the Dakotas. The service features telemedicine consultations between rural physicians and specialists in Bismarck using real time video and audio telepresence equipment. Consultations of both urgent and routine nature are available. 4. St. Alexius provides support to many other rural communities in terms of Critical Access Hospital management, primary care physician coverage, and visiting specialists. Schedule H, Part VI, Line 6 Affiliated health care system St. Alexius Medical Center, 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. St. Alexius Medical Center operates with its wholly owned affiliates and community partners, to serve the health care needs of the North Dakota communities. Schedule H, Part VI, Line 7 State filing of community benefit report ND true Cystic Fibrosis Foundation 921 S 9th St 115 Bismarck ND 585045858 131930701 501(c)(3) 16328 Cysitc Fibrosis clinic ND Department of Health 600 E Boulevard Ave Bismarck ND 585050200 ND Dept of Health 150785 Program Support for Multiple Medical Programs North Dakota Community Foundation PO Box 387 Bismarck ND 58502 450336015 501(c)(3) 10000 COMMUNITY SUPPORT 3 0 CHARITY CARE 733 1186847 Schedule I, Part III Charity Care St. Alexius 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. St. Alexius makes donations to entities with charitable missions to ensure that our donations are used for the purposes intended. true true false false false false false true false Gary Miller Former President/ CEO 192801 0 149127 0 406541 0 8001 0 7856 0 764326 0 0 0 KURT SCHLEY CEO 0 308346 0 75581 0 80694 0 52675 0 10466 0 527762 0 0 JEFFREY DROP Director 0 509375 0 472560 0 234067 0 15428 0 11880 0 1243310 0 42295 JOSEPH MESSMER Interim President/CEO (PARTIAL YEAR) 0 392534 0 0 0 0 0 0 0 0 0 392534 0 0 Priscilla Needham CFO (Partial Year) 0 173571 0 12756 0 131 0 10078 0 11979 0 208515 0 0 Susan Sisk Former VP Accounting & Finance 93423 0 63076 0 136323 0 25503 0 13934 0 332259 0 0 0 Shiraz Hyder VP Medical Affairs 391222 0 226196 0 4902 0 10600 0 20988 0 653907 0 0 0 Rosanne Schmidt VP & Chief Nursing Officer 209740 0 68563 0 4697 0 10600 0 19886 0 313485 0 0 0 Duwayne Schlittenhard VP Professional Services 252798 0 68022 0 5619 0 28600 0 10452 0 365492 0 0 0 Amy Hornbacher VP Corporate Responsibility 133369 0 24538 0 646 0 6435 0 9079 0 174067 0 0 0 Julie Jeske VP Community Services 113735 0 36548 0 809 0 6030 0 1849 0 158971 0 0 0 JEFFREY BEAUCHAMP VP Materials & Facilities Resources 124337 0 43245 0 911 0 6794 0 12097 0 187384 0 0 0 Dr Michael Brown Cardiovascular Surgeon 739497 0 0 0 0 0 28150 0 5040 0 772687 0 0 0 Dr Eric Belanger Neurosurgeon 1559922 0 394291 0 1710 0 27500 0 18498 0 2001922 0 0 0 Dr Steven Kraljic Neurosurgeon 1309192 0 627241 0 1140 0 28600 0 18498 0 1984671 0 0 0 Dr Allen Booth Cardiovascular & Thoracic Surgeon 704591 0 14340 0 7524 0 27604 0 20998 0 775057 0 0 0 Boyd Marts Cardiovascular Surgeon 720897 0 0 0 0 0 28124 0 20933 0 769954 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 4a Severance or change-of-control payment The following reportable individuals received severance payments during the 2015 calendar year, and these severance payments were included in the individual's W-2 income and reportable compensation on Schedule J: Gary Miller $367,200 Susan Sisk $108,022 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 MBO CEOs/Presidents and other CHI employees at the level of Senior Vice President and above. The following reportable individuals were eligible to participate in that plan: Jeffrey Drop Kurt Schley During 2015 the following contributions were made by CHI to the deferred compensation plan: Kurt Schley- $ 36,900 During 2015 the following distributions were made by CHI from the deferred compensation plan: JEFFREY DROP - $ 42,295 Due to the "super" vesting rules under the CHI deferred compensation plan, participants who have met certain requirements such as age, years of service or more than 5 years of plan participation are eligible to receive their 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: Jeffrey Drop - $ 79,113 Schedule J, Part I, Line 7 Non-fixed payments At the beginning of each fiscal year, the Compensation Committee establishes a financial threshold which must be met before any awards are paid and establishes guidelines defining the size of any awards available to participants. At the end of the plan year, the Committee decides whether to make any awards to participants and how large any award shall be, in accordance with the guidelines established at the beginning of the plan year. Incentive compensation is earned as a percent of base salary. Base salary is defined as the annualized rate of pay (summation of monthly base salary for the plan year). X 209690 Market value X 2 30974 Market value X 1 5019 Market value X 1 102 Market value X Custom Built Wine Cabinet 1 6500 Market value X GIft Cards 1 937 Market value X Vacation Package 3 18430 Market value X American Girl Doll 1 592 Market value 0 false false false Schedule M, Part I Explanations of reporting method for number of contributions Cars and other vehicles - Number of Items Received Food inventory - Number of Contributions Other - Custom Built Wine Cabinet Number of Items Received Other - GIft Cards Number of contributors Other - Vacation Package Number of Contributions Received Other - American Girl Doll Number of items contributed Securities - Publicly traded - Number of contributions Form 990, Part III, Line 1 ORGANIZATION'S MISSION The Corporation, sponsored by a lay-religious partnership, calls other Catholic sponsors and systems to unite to ensure the future of Catholic health care. To fulfill this mission, the Corporation, as a values-based organization, will assure the integrity of the ministry in both current and developing organizations and activities; research and develop new ministries that integrate health, education, pastoral, and social services; promote leadership development and formation for ministry throughout the entire organization; advocate for systemic changes with specific concern for persons who are poor, alienated, and underserved; and steward resources by general oversight of the entire organization. Form 990, Part III, Line 4a Program Service Accomplishment Continuation We are comprised of an interventional radiologist, cardiologists, heart and vascular surgeons as well as other highly trained support personnel. Specialty Clinics: Our specialty clinics are a unique multi-specialty group practice located mainly inside St. Alexius Medical Center. Over 26 providers in 14 different specialties work together to care for patients. Specialists must complete sever or more years of medical school and post-graduate training and then complete fellowships in their chosen specialties. All physicians are board eligible or board certified in one or more specialties. We provide clinic services in many off site satellite clinics and bring specialty services to the region. The specialty clinics include Medical Plaza Mandan, Medical Plaza Minot, Infectious Disease, Children's Services, Infusion Center, Nephrology, Neurosurgery, Pain, Neurology, Adult Physical Medicine, Rheumatology, and Urology. St. Alexius operates an outpatient family service program called Archway Mental Health Services. This program offers sensitive and responsive services for individual, marital and family problems. This program is keeping with St. Alexius Medical Center's philosophy of being a leader in progressive and quality services to the people of North Dakota. Archway services are also provided in Hazen, Garrison, and Linton, ND. Great Plains Rehabilitation Services is a division of St. Alexius Medical Center that provides Home Medical Equipment, Orthotic & Prosthetic, Home Respiratory Care, ADA Environmental and Rehabilitation Technology services. Great Plains provides needed medical equipment and supplies to help individual lead active and independent lives. Great Plains services all of North Dakota, Center and Eastern Montana, and Northern South Dakota. Other: St. Alexius Medical Center served 10,555 inpatients 126,620 outpatients, 28,965 emergency patients, and 2,364 Home Health Care patients during fiscal year ended June 30, 2016. St. Alexius Medical Center provided community activities and services at reduced or no cost. Those included: 1. Employee Assistance Program (EAP)- St. Alexius services over 200 employer contracts through its EAP with more than 35,000 employees by providing problem assessment, short term counseling and referral to appropriate resources for follow-up care. EAP services are only open to employees of a participating company. The service is free if your employer pays to participate. 2. Employee Activities - In keeping with the Medical center commitment to its employees: a. Actively participated in the United Way fund campaign. b. Journey Beyond Excellence Program - we have several teams that assist with our journey-rewards and recognition, patient satisfaction, physician satisfaction. These teams work together with our leadership to resolve challenges and engage all in our mission. c. The vacation donation program assisted employees who have an illness or an illness in the family allowing other employees to donate vacation hours to allow the affected employee time to heal or time with a family member during their healing process. d. The Employee Emergency Fund is for any St. Alexius employee who experiences a crisis or is directly affected by a crisis involving a family member. The funds are available to employees who are facing personal tragedies or hardships for reason such as a loss of a spouse or child, catastrophic illness, loss of home by fire or flood, or other calamities. 3. Acute Care Facility - St. Alexius is a partner with another acute care facility in Bismarck for the operation of a radiation therapy facility known as the Bismarck Cancer Center. The Bismarck Cancer Center helps to ensure that patients with cancer receive quality care and management of their disease without having to drive a long distance to receive necessary care. 4.Awards and Accomplishments: For the third consecutive year, CHI St. Alexius Health was recognized as The Best Hospital in North Dakota by U.S. News & World Report. The annual U.S. News Best Hospitals rankings, recognize hospitals that excel in treating the most challenging patients. Less than three percent of the nearly 5,000 hospitals that were analyzed for Best Hospitals 2015-16 were nationally ranked in even one specialty. CHI St. Alexius Health ranked high performing in gastroenterology and GI surgery, geriatrics, orthopedics and pulmonology. Cleverley and Associates Community rated CHI St. Alexius Health a Value Five-Star Hospital. Each year, Cleverley and Associates publishes a ranking of the best hospitals in the nation in terms of the value that they provide to their community. The current rankings were recently published in The State of the Hospital Industry - 2015 Edition In September 2015, CHI St. Alexius Health was notified by Women's Choice Award that it was considered a Best Hospital I American for Bariatric Surgery. The recognition is determined as the result of meeting Women's Choice Award's high standards, including current MBSAQIP accreditation, and high patient safety and patient recommendation scores. CHI St. Alexius Health was among a select group of hospitals nationwide and the only hospital in western North Dakota recognized by the U.S. Department of Health and Human Services (HHS) for reaching the gold level of achievement for conducting activities that encouraged enrollment in state organ donor registries. CHI St. Alexius Health was part of a national hospital campaign, sponsored by HHS's Health Resources and Services Administration (HRSA), which added 580,000 donor enrollments to state registries nationwide since 2011, exceeding the goal of 300,000. CHI St. Alexius Health was recognized by Women's Choice Award as one of America's Best Hospitals for Heart Care, based on our cardiac and vascular experience and our record with regard to 30-day mortality and readmission rates for heart attacks, heart failure with additional consideration given for patient satisfaction scores. CHI St. Alexius Health was recognized as The Joint Commission Top Performing Hospital For Key Quality Measures as part of The Joint Commission's 2015 annual report "America's Hospitals: Improving Quality and Safety," for attaining and sustaining excellence in accountability measure performance for heart attack, heart failure, pneumonia, surgical care, stroke and perinatal care. CHI St. Alexius Health is the only hospital in Bismarck and one of only 1,043 hospitals out of more than 3,300 eligible hospitals in the United States to achieve the 2014 Top Performer distinction. In CareChex 2015 Quality Recognition, CHI St. Alexius Health was ranked # 1 in the state for medical excellence - scoring 94.1 in overall hospital care and a 94.1 in overall medical care. CHI St. Alexius Health was also ranked #1 in the state for medical excellence award summary for overall hospital care, overall medical care, cancer care, gastrointestinal hemorrhage, neurological care, pulmonary care and women's health. Women's Choice Award ranked CHI St. Alexius Health the Best Hospital for Cancer Care based on our advanced cancer program accreditation as well as additional cancer services, clinical performance and patient recommendations. CHI St. Alexius Health received The Joint Commission's Certification of Distinction for advanced certification as a primary stroke center. Comparion Medical Analytics ranked CHI St. Alexius Health #1 in state for Overall Hospital Care - Patient Safety; #1 in Overall Medical Care - Patient Safety. The 2016 Quality Recognition for Medical Excellence in one or more clinical categories based on Comparion's CareChex Hospital Quality Ratings. CHI St. Alexius Health was recognized as a Blue Cross Blue Shield Distinction Center+ for Maternity Care. CHI St. Alexius Health was designated as one of the first hospitals to receive the Blue Distinction Center+ for Maternity Care designation, a new designation under the Blue Distinction Specialty Care program. The Leapfrog Group gave CHI St. Alexius Health the highest rating possible - Hospital Safety Score "A" Grade. CHI St. Alexius Health was one of only two hospitals in ND to receive this score. And the only hospital in central and western North Dakota. CHI St. Alexius Health received Comparion Medical Analytics 2016 CareChex Quality Award and was ranked #1 in the State of Overall Hospital Care as well as its 2016 Quality Recognition for being Ranked #1 in the State for Medical Excellence in one or more clinical categories based on Comparion's CareChex Hospital Quality Ratings. CHI St. Alexius Health was ranked #1 in the state for Overall Hospital Care and Overall Medical Care. CHI St. Alexius Health was rated the Best Hospital in North Dakota by HealthGrove. Our top rating is based on several attributes including US and World Report Best Hospital, Truven Health Analytics, Medicare Performance Score and others. Form 990, Part VI, Line 1a Delegate broad authority to a committee PURSUANT TO SECTION 8.6 OF THE BYLAWS OF ST. ALEXIUS MEDICAL CENTER, THE EXECUTIVE COMMITTEE IS COMPOSED OF ONLY DIRECTORS OF THE CORPORATION AND SHALL BE COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, AND THE PRESIDENT, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE (1) YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. Form 990, Part VI, Line 6 Classes of members or stockholders ACCORDING TO THE BYLAWS OF St. Alexius Medical Center, THE ENTITY'S SOLE MEMBER IS CATHOLIC HEALTH INITIATIVES, A COLORADO NONPROFIT CORPORATION. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body 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 Catholic Health Initiatives. Pursuant to Section 5.4 of the organization's bylaws, Catholic Health Initiatives shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: * Approve members of the organization's board * Amendment of the corporate documents of the organization * Adoption of long range and strategic plans for the organization * Substantial change in the mission or philosophy of the organization * Removal of a member of the governing body of the organization * Approval of issuance of debt by organization * Approval of participation of organization in a joint venture * Approval of formation of a new corporation by organization * Approval of a merger involving the organization * Approval of the sale of all or substantially all of the assets of the organization * To require the transfer of assets by the organization to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. Pursuant to Section 5.5 of the organization's bylaws, 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 Once the return is prepared, the return is reviewed by the Chief Financial Officer. The Chief Financial Officer sends an electronic copy of the return to each board member by email for their review Form 990, Part VI, Line 12c Conflict of interest policy Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy in place to maintain the integrity of all of its activities. The policy applies to CHI Board of Stewardship Trustees and members of its committees; all board and board committee members of CHI Entities; all CHI employees; all CHI physicians (both employed and non-employed) and all physician administrators and leaders; advanced practice clinicians (both employed and non-employed); and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure 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 15b Process to establish compensation of other employees Compensation is reviewed annually by an independent group using comparability data and recommendations are presented to the President/CEO and/or Board of Directors for approval. Form 990, Part VI, Line 19 Required documents available to the public The organization's financial statements, conflict of interest policy and governing documents are available to the public upon request. The organization's financial statements are included in Catholic Health Initiatives' consolidated audited financial statements that are available at http://www.catholichealthinitiatives.org/ or at www.DACBOND.org. Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 1741314, Related or Exempt Function Revenue: , Unrelated Business Revenue: 1741314, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part IX, Line 11g Other Fees Other Fees for Services - Total Expense: 33502887, Program Service Expense: 12906223, Management and General Expenses: 20596664, Fundraising Expenses: ; Physician Fees - Total Expense: 31153623, Program Service Expense: 30918434, Management and General Expenses: 235189, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Net Asset Transfer - 21082930; Capital Resource Pool Contribution - -916734; St Alexius Heart & Lung Clinic LLC 900 East Broadway Avenue Bismarck ND 58501 861123162 Speciality Clinic-Cardiology, etc. ND 39188366 14194 St Alexius Medical Center 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 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CENTER KY JHSMH Related 11207 803899 false 0 true Alegent HealthCreighton St Joseph Managed Care Services Inc 12809 West Dodge Rd Omaha NE 68154 470802396 Managed Care NE CHI Nebraska C Corporation 8129445 5108822 1 true All Saints Insurance Company SPC Ltd PO BOX 10073 APO Georgetown GRAND CAYMAN CJ KY11001 980556913 Insurance CJ CHI C Corporation 0 0 1 true ALLIANCE HEALTH PROVIDERS OF BRAZOS Valley Inc 2801 FRACNISCAN DRIVE BRYAN TX 77802 742466914 Healthcare TX SJSC C Corporation 204115 535165 1 true Alternative Insurance Management Service Inc 3900 OLYMPIC BLVD STE 400 Erlanger KY 41018 841112049 Management Services CO CHI C Corporation 0 6056338 1 true AMERICAN NURSING CARE Inc 1700 EDISON DR MILFORD OH 45150 311085414 HOME HEALTH OH CHS C Corporation 91903143 55758044 1 true AMERIMED INC 1700 EDISON DR MILFORD OH 45150 311158699 HOME HEALTH OH ANC C Corporation 21464273 12744198 1 true BC HOLDING COMPANY INC 1850 BLUEGRASS AVE LOUISVILLE KY 40215 311542851 Fitness Club KY JHSMH 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WA FHS C Corporation 0 0 1 true QCA Health Plan Inc 12615 Chenal Parkway STE 300 Little Rock AR 72211 710794605 Insurance AR QCHI C Corporation 104106960 86204029 1 true QualChoice Advantage 32129 WEYERHAEUSER WAY S STE 201 FEDERAL WAY WA 98001 473433912 Insurance WA QCPS C Corporation 2767 3502767 1 true QualChoice Health Plan Services Inc (fka CollabHealth Plan Services Inc) 198 INVERNESS DRIVE WEST Englewood CO 80112 461224037 Admin Services CO QCHI C Corporation 17917443 64152898 1 true QualChoice Health Inc (fka CollabHealth Managed Solutions Inc) 198 INVERNESS DRIVE WEST Englewood CO 80112 461222808 Holding Co CO CHI C Corporation 2010400 -2237656 1 true QualChoice Holdings Inc 12615 Chenal Parkway STE 300 Little Rock AR 72211 274075520 Holding Co AR PHPS C Corporation 0 10190 1 true QualChoice Life and Health Insurance Company Inc 12615 Chenal Parkway STE 300 Little Rock AR 72211 710386640 Insurance AR QCH C Corporation 19949469 19444633 1 true QualChoice of Nebraska 2401 S 73rd St Omaha NE 68124 810738827 Insurance NE QCH C Corporation 0 0 1 true RiverLink Health 198 INVERNESS DRIVE WEST Englewood CO 80112 464380824 Insurance OH PHPS C Corporation 2069874 3679879 1 true RiverLink Health of Kentucky Inc 198 INVERNESS DRIVE WEST Englewood CO 80112 464828332 Insurance KY PHPS C Corporation 1590037 5958786 1 true Ross Park Pharmacy Inc 380 SUMMIT AVE STEUBENVILLE OH 43952 341832654 Pharmacy OH THS C Corporation 1104611 2024431 1 true Saint Clare's Primary Care Inc 66 FORD RD Denville NJ 07834 222441202 Billing Services NJ SCCC C Corporation 499042 1183247 1 true SAMARITAN FAMILY CARE INC 40 W FOURTH ST STE 1700 Dayton OH 45402 311299450 Healthcare OH SHP C Corporation 0 0 1 true SJH Services Corporation 198 INVERNESS DRIVE WEST Englewood CO 80112 232307408 Healthcare CO FSI C Corporation 2007370 2441286 1 true SJL PHYSICIAN MANAGEMENT SERVICES INC 424 LEWIS HARGETT CR STE 160 Lexington KY 40503 270164198 Mgmt KY SJHS C Corporation 41 0 1 true SLMT Parking Inc 6624 Fannin STE 800 Houston TX 77030 760637140 Parking TX SLHS C Corporation 3345698 205200 1 true SoundPath Health Inc 32129 Weyerhaeuser Way S STE 201 Federal Way WA 98001 421720801 Insurance WA PHPS C Corporation 138106211 32840909 1 true St Alexius Health Services Inc 900 East Broadway Avenue Bismarck ND 58501 450402812 Healthcare ND SAMC C Corporation 0 0 1 true St Anthony Development Company 1415 Southgate Pendleton OR 97801 931216943 Athletic Club OR SAH C Corporation 1541465 2192287 1 true St Joseph Development Company Inc 1717 SOUTH J ST Tacoma WA 98405 911480569 Rental WA FSI C Corporation 3758845 12828493 1 true ST JOSEPH OFFICE PARK ASSOCIATION 1401 HARRODSBURG RD BLDG B70 Lexington KY 40504 611079899 Mgmt KY SJHS C Corporation 200108 1137660 0.85 true St Luke's 6620 Main Condominium Association 6624 Fannin STE 1100 Houston TX 77030 300355517 Condo Assoc TX SLPC C Corporation 0 0 1 true St Luke's Anesthesiology Associates 6624 Fannin STE 1100 Houston TX 77030 461517163 Medical Clinic TX CHI-SLH C Corporation 0 0 1 true St Luke's Episcopal Hospital Physician Hospital Organization Inc 6720 Bertner MC4-262 Houston TX 77030 760377932 PHO TX CHI-SLH C Corporation 0 0 0.6 true St Luke's Health System Holdings Inc 6624 Fannin STE 800 Houston TX 77030 760637138 Holding Co TX SLHS C Corporation 2163924 4389084 1 true St Luke's Medical Arts Center I Condominium Association 6624 Fannin STE 1100 Houston TX 77030 300355518 Condo Assoc TX SLPC C Corporation 0 0 1 true St Luke's Medical Tower Condominium Association 6624 Fannin STE 1100 Houston TX 77030 760298751 Condo Assoc TX SLMTC C Corporation 0 0 1 true St Vincent Community Health Services Inc TWO ST VINCENT CIRCLE Little Rock AR 72205 710710785 Healthcare AR SVIMC C Corporation 4033444 16764150 1 true StableView Health Inc 198 INVERNESS DRIVE WEST Englewood CO 80112 464373713 Insurance KY PHPS C Corporation 301615 5787296 1 true Sugar Land Doctor Group 1317 Lake Point Parkway Sugar Land TX 77478 454270163 Medical Clinic TX SLCDC-SL C Corporation 0 0 1 true The Texas Heart Institute at St Luke's Episcopal Hospital Denton A Cooley B uilding Comdominium Association 6624 Fannin STE 1100 Houston TX 77030 900064009 Condo Assoc TX CHI-SLH C Corporation 0 0 1 true Towson Management Inc 7601 OSLER DR Towson MD 21204 521710750 Mgmt Services MD FSI C Corporation 0 0 1 true TRINITY MANAGEMENT SERVICES ORGANIZATION 380 SUMMIT AVE STEUBENVILLE OH 43952 341471026 Mgmt Services OH THS C Corporation -76969 259991 1 true Vintage Doctor Group 6624 Fannin STE 1100 Houston TX 77030 Medical Clinic TX CHI-SLH C Corporation 0 0 1 true false false false false false false false false false false false true false false true false false false true