2017-05-13T10:07:32-05:00 2016-06-30 990 2015-07-01 630288861 Providence Hospital PROV 2516331080 6801 Airport Boulevard Mobile AL 36608 C SUSAN CORNEJO CFO 2017-05-13 2015 2021-01-29 14:40:06Z TODD KENNEDY 6801 Airport Boulevard Mobile AL 36608 232783022 false 0928 X WWW.PROVIDENCEHOSPITAL.ORG X 1858 AL PROVIDENCE HOSPITAL IS A FULL SERVICE 349 BED MEDICAL/SURGICAL FACILITY. 10 6 2092 200 684775 0 162164 478249 226837642 227832905 6945209 -112608 4810912 4445168 238755927 232643714 0 0 0 0 89151264 90880124 0 0 0 130101770 131434609 219253034 222314733 19502893 10328981 447113177 345091659 169677457 122366102 277435720 222725557 ROOTED IN THE LOVING MINISTRY OF JESUS AS A HEALER, WE COMMIT OURSELVES TO SERVING ALL PERSONS WITH SPECIAL ATTENTION TO THOSE WHO ARE POOR AND VULNERABLE. OUR CATHOLIC HEALTH MINISTRY IS DEDICATED TO SPIRITUALLY CENTERED, HOLISTIC CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF INDIVIDUALS AND COMMUNITIES. WE ARE ADVOCATES OF A COMPASSIONATE AND JUST SOCIETY THROUGH OUR ACTIONS AND OUR WORDS. false false 184176596 227205193 PROVIDENCE HOSPITAL PROVIDES A LARGE PORTION OF ITS SERVICES TO THE ELDERLY AND POOR. DURING THE FISCAL YEAR ENDING JUNE 30, 2016, APPROXIMATELY 53% OF ADMISSIONS WERE ELDERLY PATIENTS ENROLLED IN THE MEDICARE PROGRAM. APPOXIMATELY $15 MILLION IN SERVICES WERE PROVIDED TO PERSONS WHO WERE POOR OR VULNERABLE UNDER STATE, COUNTY, OR PROVIDENCE HOSPITAL GUIDELINES. 184176596 true true false true false false false false false false true false true true true false false true false false false false false false false false true true false false true false false false false false false false false false false false false false true true true true false true 90 0 true 2092 true true true false false false false false false false false false X 10 6 false false true false true true true true true false false true true true true true true false true true true X C SUSAN CORNEJO 2516331670 6801 Airport Boulevard MOBILE AL 36608 CLARK P CHRISTIANSON PRESIDENT & CEO (ENDED 9/4/15) 32.0 8.0 X X 2190715 0 49911 C SUSAN CORNEJO CFO 10.0 31.0 X X 148972 595888 48496 G TIMOTHY GASTON CHAIR (START 1/2016) 1.0 3.0 X X 0 0 0 TODD STEVEN KENNEDY PRESIDENT 40.0 5.0 X X 419288 0 34893 HENRY J KOCH MD SECRETARY/TREASURER 1.0 1.0 X X 0 0 0 L PAGE STALCUP CHAIR (END 12/2015) 1.0 4.0 X X 0 0 0 CHRISTOPHER S BROWN MD BOARD MEMBER 1.0 2.0 X 0 0 0 LAWRENCE RUSS G FORD JR Board Member 1.0 3.0 X 0 0 0 CAROL M HARRISON EDD RN BOARD MEMBER 1.0 1.0 X 0 0 0 R MICHAEL HUDDLE MD BOARD MEMBER 40.0 1.0 X 126514 0 15131 CONNIE L HUDSON RN BOARD MEMBER 1.0 1.0 X 0 0 0 ROBERT W ISRAEL MD BOARD MEMBER 1.0 39.0 X 0 479876 32033 BETH L ROUSE RN BOARD MEMBER (END 12/2015) 1.0 1.0 X 0 0 0 WILLIAM M LIGHTFOOT MD VP MEDICAL STAFF 11.5 28.5 X 159823 396082 48366 PETER JOSEPH LINDQUIST CHIEF NURSING OFFICER 40.0 0 X 264268 0 20883 JOHN E STONE JR MD VP MEDICAL INFORMATICS 40.0 0 X 257061 0 44854 DANIEL C HARRISON MD PHYSICIAN 40.0 0 X 416838 0 35464 PRESTON T SPEAKMAN MD PHYSICIAN 40.0 0 X 419288 0 31043 JAMES J STEINHAUER MD PHYSICIAN 40.0 0 X 416626 0 30548 ASTON G ARCHIBALD MD PHYSICIAN 40.0 0 X 416135 0 36206 DAVID C BRASWELL MD PHYSICIAN 40.0 0 X 428945 0 38005 5664473 1471846 465832 75 false true false MOBILE BAY LITHOTRIPSY LLC 300 Townpark Dr NW Ste 260 Kennesaw GA 30144 Medical Services 826000 WL GORE & ASSOCIATES INC PO Box 2400 Flagstaff AZ 86003 Medical Services 793224 SYNTHES USA SALES LLC 1101 Synthese Ave Monument CO 80132 Medical Services 611885 ZAVATION LLC 400 Liberty Park Dr Flowood MS 39232 Medical Services 341545 ARUP LABORATORIES 500 S Chipeta Wat Salt Lake City UT 84108 Laboratory Services 265617 11 284477 9854 183918 478249 Net Patient Service Revenue 621990 94126383 94126383 Medicare/Medicaid 921990 133070722 133070722 Reference Laboratory 621500 627712 627712 Community Education 611710 8088 8088 0 0 0 0 227832905 57063 57063 0 57063 57063 26700 95983 43325 -95983 -16625 -112608 -112608 Cafeteria/Vending 722210 1192347 1192347 Medical Record 621990 11679 11679 Miscellaneous Revenue 621990 3184079 3184079 0 0 0 0 4388105 232643714 227205193 684775 4275497 3758150 3758150 74359525 68575026 5784499 -1285310 -1051432 -233878 8767890 7804630 963260 5279869 4646285 633584 65241 65241 592401 592401 423167 423167 4050787 3564693 486094 0 250752 250752 888226 888226 15902470 13994174 1908296 3875203 3410179 465024 261918 230488 31430 146012 128491 17521 2142036 1884992 257044 11869386 10445060 1424326 2842766 2842766 Purchased Services 23563283 20735689 2827594 Patient Related Supplies 51289337 45134617 6154720 Provider Tax 11191011 11191011 Equipment Lease 973281 856487 116794 1107332 974451 132881 0 222314733 184176596 38138137 0 5071 1068015 12715979 26169591 30273715 0 0 3005737 26955 5396882 5416103 1272852 565476 237896828 183471590 55662924 54425238 0 167586479 142887528 3871120 9253656 183079577 89521938 447113177 345091659 55711674 13108583 1634224 2048896 112331559 107208623 169677457 122366102 X 277049979 222267316 385741 458241 277435720 222725557 447113177 345091659 X 10328981 -5297186 -59741958 X false true X true false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false false false false true 1902 1902 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Providence Hospital does not participate in or intervene in (including the publishing or distributing or statements), any political campaign on behalf of (or in opposition to) any candidate for public office. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Providence Hospital does not participate in or intervene in (including the publishing or distributing or statements), any political campaign on behalf of (or in opposition to) any candidate for public office. 8400308 8400308 56635351 45503835 11131516 166093 136905 29188 160279855 132240016 28039839 12415221 5590834 6824387 54425238 CONTROL POOL INVESTMENT 142887528 C 142887528 DEFERRED COMPENSATION 9087874 DUE FROM AFFILIATES 72818962 DONOR RESTRICTED 458241 OTHER MISC RECEIVABLES 3651462 ESTIMATED SETTLEMTNS FROM THIRD PARTY PAYORS 3219935 OTHER CURRENT ASSETS -10575 PHYSICIAN GUARANTEES 296039 ACCRETIVE RECEIVABLE 89521938 ESTIMATED SETTLEMENTS TO THIRD PARTY PAYORS 1342619 PENSION AND OTHER POST RETIREMENT BENEFITS 509824 DEFERRED COMPENSATION 9087874 SELF INSURANCE LIABILITY 2381132 INTERCOMPANY DEBT TO ASCENSION HEALTH ALLIANCE 68319439 DUE TO AFFILIATES 22998185 AH SAVINGS PLAN 973183 OTHER MISC LIABILITIES 805657 RECEIVABLES SOLD WITH RECOURSE 790710 valuation allowance 107208623 Schedule D, Part XI, Line 2 FIN 48 (ASC 740) FOOTNOTE FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE ("THE SYSTEM") (WHICH INCLUDE THE ACTIVITY OF PROVIDENCE HOSPITAL): THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITION BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2016. true true X true X true X true true false true true 8754233 0 8754233 0.0394 5418839 0 5418839 0.0244 0 0 0 0 0 0.0 0 0 14173072 0 14173072 0.0638 37 3352 1030308 19175 1011133 0.0045 7 12 818076 0 818076 0.0037 0 0 0 0 0 0.0 0 0 0 0 0 0.0 38 789 144756 1400 143356 0.0006 82 4153 1993140 20575 1972565 0.0089 82 4153 16166212 20575 16145637 0.0726 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 1 2223 0 2223 0.0000 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 3 18 23801 0 23801 0.0001 0 0 0 0 0 0.0 4 19 26024 0 26024 0.0001 false 9074077 6035342 111106608 111260836 -154228 X true true 1 1 PROVIDENCE HOSPITAL 6801 AIRPORT BLVD MOBILE AL 36608 https://www.providencehospital.org/?S=FIANANCIAL%20ASSISTANCE%20APPLICATION H4905 X X X PROVIDENCE HOSPITAL 1 false false true X X X X X X X X 15 true false false true X https://www.providencehospital.org/about/community-outreach/ X true 15 true https://www.providencehospital.org/about/community-outreach/ false false true X 200.0 300.0 X X X X X true true X X X X true X https://www.providencehospital.org/financial-assistance-policy-2/ X https://www.providencehospital.org/patient-information/financial-assistance/ X https://www.providencehospital.org/financial-assistance-summary/ 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 - Providence Hospital. From September 2015 through March 2016, Providence Hospital ("Providence"), in collaboration with other community organizations and agencies, conducted a community health needs assessment ("assessment") for Mobile County. This needs assessment is for Mobile County, Alabama, the county of residence for approximately 83 percent of Providence inpatients. Input from the community included persons with a broad knowledge of the community, health and human services providers, stakeholders and representatives of the public. Special attention was given to obtaining input from the medically underserved and vulnerable populations. Key informants included individuals with public health expertise, state and local officials, community leaders and healthcare consumers. Quantitative data were obtained from county, state, and national sources in order to develop a social, economic, and health assessment of Mobile County. The indicators included public health surveillance data, such as deaths and births. Sixty-six health indicators for Mobile County were compared and contrasted to those for the state and surrounding counties. In addition, local data were compared to previous years' data from Mobile County, highlighting improvements and statistical trends. To identify the issues of greatest priority for the community, the indicator results were evaluated using the County Health Rankings Model created by the University of Wisconsin Population Health Institute and the Robert Wood Johnson Foundation. The model emphasizes factors that, when improved, can help improve the overall health of a community. This model has three major components: Health Outcomes, Health Factors, Programs and Policies. Of the 66 health status indicators, Mobile County was worse than the state average on 44 indicators. Prioritization of the community health issues was a multi-step process that included: Review and discussion of all of the top health concerns and associated indicator data. Identification and discussion of consequences of not addressing the issue. Consideration of key criteria for impacting change. Through the assessment process described in further detail in this report, the top priority health issues identified for Mobile County are: Access to Care Weight Mental Health and Substance Abuse Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Providence Hospital. THE PROVIDENCE HOSPITAL FY2015-2016 IMPLEMENTATION STRATEGY SPECIFICALLY ADDRESSES THE FOLLOWING THREE SYSTEM WIDE HEALTH IMPROVEMENT PRIORITIES: From the most recent CHNA (2015-2016), the top issues considered to be of greatest need in the community were as follows: 1. Access to Care 2. Weight 3. Mental Health/Substance Abuse. USING THE CHNA COMPLETED IN FISCAL YEAR 2012, THE HOSPITAL DEVELOPED AN IMPLEMENTATION STRATEGY TO ADDRESS PRIORITY COMMUNITY HEALTH NEEDS. THESE STRATEGIES INCLUDE: Strategies adopted to address the needs outlined in the previous CHNA (2012) included the establishment of a community garden; the development of a disease management program for indigent, diabetic clients; the development of the CARE program to assist individuals with accessing and enrolling in healthcare coverage; support for cardiac health education services; and increased support and education related to mental illness. Harvests from the Garden have been given to the Penelope House, which provides services for victims of domestic violence. Staff from the Diabetes Center have given 2 lectures at annual programs and packed and distributed 400 boxes of food to low income communities. Financial Counselors worked with 189 referrals from the CARE line with enrollment in medication assistance, Medicaid applications, insurance coverage and community resources. This ministry has also offered community wide tobacco cessation and preventions programs at a reduced rate and offered congestive heart failure education to community members. Social workers and ED managers have been sent to a train the trainer course regarding the mentally ill. NEEDS THAT WILL NOT BE ADDRESSED: The hospital will be addressing all needs that were identified. 1 Guadalupe Center 3810 Wulff Road E Semmes AL 365755256 Medical Clinic Schedule H, Part I, Line 6a Community Benefit Report This report illustrates the significant degree to which Providence Hospital contributes to the positive health status of the people and communities it serves. As a member of Ascension Health, the nation's largest Catholic healthcare system, Providence Hospital continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of Providence Hospital is to perpetuate the healing mission of the Church. Providence Hospital advances this goal through the delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community, and medical research. Our concern for all human life and the dignity of each person leads the organization to provide medical and social services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. Providence Hospital has engaged in many activities to ensure that our mission is accomplished some of which are highlighted in this report. Unreimbursed Services Provided to the Elderly and the Poor: Providence Hospital provides a large portion of its services to the elderly and poor. During the fiscal year ending June 30, 2015, approximately 52% of admissions were elderly patients enrolled in the Medicare program, and approximately $10.8 million in services were provided to persons who were poor or vulnerable under state, county, or Providence Hospital guidelines. In the spirit of principles adopted by Ascension Health, Providence Hospital has taken proactive steps to address those issues that will affect accessibility, the financing and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the under served. Patient Services: During the fiscal year ending June 30, 2015, Providence Hospital treated 15,503 inpatient adults and children in the community for a total of 777,555 patient days of service. Our health ministry also provided services for 146,244 outpatient visits, including 10,202 outpatient surgery visits, and 51,448 emergency department visits. For over 160 years the Daughters of Charity and Providence Hospital have cared for the medically needy in Mobile and the surrounding area. Over time, the needs of our community and the way we meet those needs have changed, but our compassion for those in need has never wavered. We remain committed to sharing our mission, our vision, our values and our gifts with our community. As caregivers we see the devastating impact acute and chronic illnesses have on our patients, our family members and our community. Coordinating and participating in local and national fundraisers is one of the ways we contribute towards research and financial assistance for those suffering from these illnesses. In the past year Providence has supported the ALS "Ice Bucket Challenge, the Kidney Foundation Walk, the American Cancer Society Vintage Affair, Colors for a Cause, Ozanam Charitable Pharmacy and others. Our Diabetes Center staff collaborated with Bay Area Food Bank to offer the "Diabesity Conference" to patients and professionals in addition to providing free screenings and education classes on an ongoing basis. They are also offering a "Living Well" series to help community members learn to live with Diabetes. Our Vision: We envision a strong, vibrant Catholic health ministry in the United States which will lead to the transformation of healthcare. We will ensure service that is committed to health and well-being for our communities and that responds to the needs of individuals throughout the life cycle. We will expand the role of laity, in both leadership and sponsorship, to ensure a Catholic health ministry of the future. Our Values: - Service of the Poor: Generosity of spirit, especially for persons most in need - Reverence: Respect and compassion for the dignity and diversity of life - Integrity: Inspiring trust through personal leadership - Wisdom: Integrating excellence and stewardship - Creativity: Courageous innovation - Dedication: Affirming the hope and joy of our ministry Our People & Our Gifts: Providence Hospital, like the Daughters of Charity, is committed to serving the needs of the poor and vulnerable in our community. The Guadalupe Center and the Senior Center continue to serve the needs of low income Hispanics and seniors and we have expanded our outreach program in south Mobile County to include a full-time client navigator who assists residents with both social and health related needs. Staff members from the USDA, Gulf Coast PPO, Franklin Clinic, and a local disability attorney use the office free of charge so that clients in this rural area can better access their services. The Pastoral Care Department collaborated with Goodwill Easter Seals to offer clothes to patients in need through the Sister Mary Louise Clothes Closet. When Providence employees donate to Goodwill, the resulting credit allows the Pastoral Care staff to purchase clothes for the closet. This program also allows the hospital to give vouchers to needy patients and clients who use these vouchers to obtain clothes and household items. Assessment of Community Needs: Providence Hospital is in the process of conducting an assessment of the health needs of our community. Community leaders from the Mobile County Health Department, area hospitals, and local civic and social service organizations were invited to participate in the process as were staff members, participants in local health screenings, and other community residents. As it was in 2013, the information collected will be presented to the Providence Hospital Board for their review and for the development of future goals and implementation strategies. The top five issues considered to be of greatest need in the community were as follows: 1. Good Nutrition/Obesity Prevention 2. Diabetes Education and Support 3. Free/Subsidized Healthcare Services 4. Cardiac Health Education and Support 5. Mental Health Access and Support Strategies adopted to address these needs included the establishment of a community garden; the development of a disease management program for indigent, diabetic clients; the development of the CARE program to assist individuals with accessing and enrolling in healthcare coverage; support for cardiac health education services; and increased support and education related to mental illness. We believe that healing is ultimately the work of God and that our involvement in health care is a participation in the healing ministry of Christ, a mission that we share with all those who assist in this work. Schedule H, Part II community building activities To enhance our mission to service the poor and vulnerable, Providence Hospital established an Outreach Services department in 1999. Since its inception, the department has provided services to the poor and uninsured in our area including diabetes education and medically related advocacy services. Providence Outreach team members collaborate with many local agencies to provide care to the residents of our community. This collaboration has increased awareness of our mission to serve the poor and vulnerable and also led to the development of programs that include the provision of free cataract surgery to a select number of Vocational Rehabilitation clients. Providence also works with our medical staff and a local medical mission, Bayside Medical Mission, to provide life-changing surgeries for children and young adults with deformities. Members of our Outreach team in south Mobile County and the Guadalupe Center work with Osman Charitable Pharmacy to identify and qualify low income individuals for assistance with prescription medications and the Diabetes Center collaborates with Victory Clinic to educate their working, uninsured clients regarding diabetes. Outcome measures used to monitor the program have shown consistent improvement in the Victory clients' A1C, a blood test commonly used to measure blood glucose levels. Recognizing that cancer impacts every facet of life, Providence has developed several programs to support cancer patients both physically and emotionally. Annually, Providence Hospital partners with the Telephone Pioneers to offer Camp Bluebird, a supportive camp for community members who have been diagnosed with cancer. The hospital also has a patient navigator program for our patients with breast cancer. The navigator coordinates the "Breast Friends" support group; helps patients locate resources to assist with the financially-draining aspects of the disease, and collaborates with community groups to hold fundraisers for patients and offer educational programs for patients and their caregivers. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance THE COST OF PROVIDING CHARITY CARE, MEANS TESTED GOVERNMENT PROGRAMS, AND COMMUNITY BENEFIT PROGRAMS IS ESTIMATED USING INTERNAL COST DATA, AND IS CALCULATED IN COMPLIANCE WITH CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES. THE ORGANIZATION USES A COSTING ACCOUNTING SYSTEM THAT ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE: INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED, OR SELF PAY). THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. FOR THE INFORMATION IN THE TABLE A COST-TO-CHARGE RATIO WERE CALCULATED AND APPLIED. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount BAD DEBT ACCOUNTS ARE THOSE ACCOUNTS DETERMINED TO BE DELINQUENT AFTER ALL COLLECTION PROCEDURES HAVE BEEN CONCLUDED WITHOUT PAYMENT OR RESPONSE FROM THE GUARANTOR, THE ACCOUNTS ARE TRANSFERRED TO A COLLECTION AGENCY OR ATTORNEY FOR FURTHER COLLECTION PROCEDURES. EXAMPLES OF BAD DEBT ACCOUNTS: - NON-POOR UNINSURED NOT PAYING BILL - NON-POOR INSURED NOT PAYING COPAY OR DEDUCTIBLE - DEBTORS WITH THE ABILITY TO PAY, BUT ARE UNWILLING TO DO SO Schedule H, Part III, Line 3 Bad Debt Expense Methodology THE AMOUNT REPORTED ON SCHEDULE H, PART III, LINE 3 IS A PERCENTAGE OF BAD DEBT GIVEN BY THE BUSINESS OFFICER OF PATIENTS ELIGIBLE FOR FINANCIAL ASSISTANCE. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote FROM THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF ASCENSION HEALTH ALLIANCE (WHICH INCLUDES THE ACTIVITY OF PROVIDENCE HOSPITAL): THE PROVISION FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL EXPERIENCE, ECONOMIC CONDITIONS, TRENDS IN HEALTHCARE COVERAGE, AND OTHER COLLECTION INDICATORS. PERIODICALLY THROUGHOUT THE YEAR, MANAGEMENT ASSESSES THE ADEQUACY OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY, INCLUDING THOSE AMOUNTS NOT COVERED BY INSURANCE. THE RESULTS OF THIS REVIEW ARE THEN USED TO MAKE ANY MODIFICATIONS TO THE PROVISION FOR DOUBTFUL ACCOUNTS TO ESTABLISH AN APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE AND REASONABLE EFFORTS TO COLLECT FROM THE PATIENT HAVE BEEN EXHAUSTED, THE SYSTEM FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PAST-DUE PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY THE SYSTEM. ACCOUNTS RECEIVABLE ARE WRITTEN OFF AFTER COLLECTION EFFORTS HAVE BEEN FOLLOWED IN ACCORDANCE WITH THE SYSTEM'S POLICIES. THE METHODOLOGY FOR DETERMINING THE ALLOWANCE FOR DOUBTFUL ACCOUNTS AND RELATED WRITE-OFFS ON UNINSURED PATIENT ACCOUNTS HAS REMAINED CONSISTENT WITH THE PRIOR YEAR. Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs ASCENSION HEALTH AND RELATED HEALTH MINISTRIES FOLLOW THE CATHOLIC HEALTH ASSOCIATION ("CHA") GUIDELINES FOR DETERMINING COMMUNITY BENEFIT. CHA COMMUNITY BENEFIT REPORTING GUIDELINES SUGGEST THAT MEDICARE SHORTFALL IS NOT TREATED AS COMMUNITY BENEFIT. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance THE ORGANIZATION HAS A WRITTEN DEBT COLLECTION POLICY THAT ALSO INCLUDES A PROVISION ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR CHARITY CARE OR FINANCIAL ASSISTANCE. IF A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE CERTAIN COLLECTION PRACTICES DO NOT APPLY. Schedule H, Part V, Section B, Line 16a FAP website - PROVIDENCE HOSPITAL: Line 16a URL: https://www.providencehospital.org/financial-assistance-policy-2/; Schedule H, Part V, Section B, Line 16b FAP Application website - PROVIDENCE HOSPITAL: Line 16b URL: https://www.providencehospital.org/patient-information/financial-assistance/; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - PROVIDENCE HOSPITAL: Line 16c URL: https://www.providencehospital.org/financial-assistance-summary/; Schedule H, Part VI, Line 2 Needs assessment AN INTERNAL HOSPITAL COMMITTEE COMPRISING OF ASSOCIATES FROM OUTREACH SERVICES, PLANNING AND MARKETING, CASE MANAGEMENT, AND MISSION SERVICES COLLABORATED WITH THE ALABAMA QUALITY ASSURANCE FOUNDATION TO CONDUCT A COMMUNITY NEEDS ASSESSMENT. THE PROCESS BEGAN IN 2015 AND WITH REVIEW, INPUT AND APPROVAL BY THE HOSPITAL BOARD IN MAY 2016. LEADERS FROM LOCAL COMMUNITY AGENCIES WERE INTERVIEWED AND ASKED TO IDENTIFY THE TOP FIVE ISSUES IN OUR COMMUNITY. THE RANKINGS ILLUSTRATED BOTH THE GROUPS PERCEIVED LEVEL OF IMPORTANCE OF EACH ITEM AND THE FREQUENCY AT WHICH EACH ATTENDEE THOUGHT A TOPIC WARRANTED OUTREACH EFFORTS. THE TOP ISSUES CONSIDERED TO BE OF GREATEST NEED IN THE COMMUNTITY WERE AS FOLLOWS: ACCESS TO CARE WEIGHT MENTAL HEALTH/SUBSTANCE ABUSE IMPLEMENTATION STRATEGIES TO ADDRESS THESE NEEDS WERE APPROVED BY THE BOARD IN MAY 2016. PROVIDENCE HOSPITAL WILL COLLABORATE WITH COMMUNITY PARTNERS TO BUILD SUPPORT FOR THESE STRATEGIES AND IMPLEMENTATION PLANS WITHIN THE COMMUNITY AND AMONG OTHER HEALTH CARE PROVIDERS. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance PATIENTS OR PERSONS WHO MAY BE BILLED FOR PATIENT CARE ARE INFORMED AND EDUCATED ABOUT THEIR POTENTIAL ELIGIBILITY FOR FEDERAL STATE LOCAL OR HOSPITAL ASSISTANCE IN THE FOLLOWING MANNER: - AN EXPLANATION OF THE HOSPITAL'S BILLING PROCESS AND CONTACT INFORMATION FOR FINANCIAL COUNSELORS IS POSTED ON THE HOSPITAL'S WEB SITE AND IN ALL INPATIENT AND OUTPATIENT REGISTRATION AREAS. A SUMMARY OF THE HOSPITAL'S BILLING AND PAYMENT PHILOSOPHY IS INCLUDED IN EVERY PATIENT'S REGISTRATION PACKET. THE INFORMATION IS PROVIDED IN ENGLISH AND SPANISH AND INTERPRETER SERVICES FOR OTHER LANGUAGES ARE AVAILABLE AS NEEDED. - FINANCIAL COUNSELORS VISIT EVERY UNINSURED PATIENT ON THE DAY AFTER THEIR ADMISSION TO EXPLAIN AVAILABLE RESOURCES AND WHEN APPROPRIATE, INITIATE THE APPLICATION PROCESS FOR ASSISTANCE. FINANCIAL COUNSELORS HAVE COMPLETED SPECIFIC TRAINING FOR MEDICAID, CHIPS, SOBRA, AND ALL-KIDS AND WILL RECEIVE ADDITIONAL TRAINING AS THE NEED IS IDENTIFIED. IF THE FINANCIAL COUNSELORS IDENTIFY ADDITIONAL FINANCIAL OR SOCIAL NEEDS THEY WILL REFER THE PATIENT TO A HOSPITAL SOCIAL WORKER. - A LISTING OF COMMUNITY RESOURCES IS INCLUDED IN EACH PATIENT'S DISCHARGE MATERIALS. - WITHIN 24 HOURS OF ADMISSION THE CASE MANAGEMENT DEPARTMENT CONDUCTS A SCREENING FOR POTENTIAL DISCHARGE NEEDS ON EVERY PATIENT. THOSE PATIENTS IDENTIFIED AS NEEDING ASSISTANCE WITH THEIR HOSPITAL BILL OR APPLYING FOR STATE AND FEDERAL ASSISTANCE ARE REFERRED TO THE FINANCIAL COUNSELORS BY THE HOSPITAL SOCIAL WORKERS. Schedule H, Part VI, Line 4 Community information MOBILE COUNTY IS LOCATED ON THE ALABAMA GULF COAST AND BORDERED BY MISSISSIPPI TO THE WEST AND FLORIDA TO THE EAST. ECONOMIC GROWTH, MILD CLIMATE AND COASTAL APPEAL ENTICE RESIDENTS TO LIVE IN THIS COMMUNITY. IN SUMMER 2013, CONSTRUCTION BEGAN ON A $350 MILLION JETLINER ASSEMBLY PLANT WHICH WILL BRING THOUSANDS OF JOBS TO THE AREA. THE LAND AREA OF THE COUNTY IS 1,233.09 (75%) SQUARE MILES WITH 410.93 (25%) SQUARE MILES OF WATER. ACCORDING TO THE US CENSUS 2010 RESULTS THE POPULATION OF MOBILE COUNTY IS APPROXIMATELY 412,992 PEOPLE FROM 2000 TO 2010, THE MOBILE COUNTY POPULATION GROWTH PERCENTAGE WAS 3.3%. THE COUNTY SHOWS A SLIGHTLY HIGHER PERCENTAGE OF WOMEN AS OPPOSED TO MEN; THIS IS CONSISTENT WITH STATE AND NATIONAL DATA. THE PERCENTAGE OF PERSONS 65 YEAR AND OLDER IS 13.0%, SLIGHTLY LOWER THAN THE STATE'S 14%. THE DOMINANT LANGUAGE IS ENGLISH, WITH 4.8% SPEAKING ANOTHER LANGUAGE IN THE HOME. IN MOBILE, THERE ARE 35,538 VETERANS THE COMMUNITY. THE, POPULATION OF COUNTY IS 60.8% WHITE, 34.9% BLACK, AND 2.9% OTHER WITH 1.4% REPORTING TWO OR MORE RACES. PROVIDENCE HOSPITAL COMMUNITY IS DEFINED BY THE ZIP CODE OF 75% OF THE HOSPITAL'S DISCHARGES AND INCLUDES THE FOLLOWING: 36522 36575 36606 36618 36541 36582 36608 36619 36544 36587 36609 36693 36571 36605 36613 36695 39452. Schedule H, Part VI, Line 5 Promotion of community health PROVIDENCE HOSPITAL IS LOCATED AT 6801 AIRPORT BLVD MOBILE, AL 36608. SINCE ITS FOUNDING IN 1854 PROVIDENCE HAS BEEN,HOSPITAL SERVING, CARING FOR AND HEALING THE PEOPLE OF MOBILE COUNTY AND SURROUNDING AREAS. SPONSORED BY ASCENSION HEALTH THE NATION'S LARGEST CATHOLIC NOT FOR PROFIT HEALTHCARE SYSTEM, THE HOSPITAL'S MISSION IS TO EXTEND THE HEALING MINISTRY OF JESUS CHRIST TO SOUTH ALABAMA AND SOUTHEAST MISSISSIPPI, WITH A SPECIAL CONCERN FOR PERSONS WHO ARE POOR AND VULNERABLE. THE HOSPITAL'S 500-PLUS MEMBER MEDICAL STAFF INCLUDES REPRESENTATIVES FROM EVERY MAJOR MEDICAL SPECIALTY. Schedule H, Part VI, Line 6 Affiliated health care system PROVIDENCE HOSPITAL IS A MEMBER OF ASCENSION HEALTH ALLIANCE ("THE SYSTEM"). ASCENSION HEALTH ALLIANCE, D/B/A ASCENSION (ASCENSION), IS A MISSOURI NONPROFIT CORPORATION FORMED ON SEPTEMBER 13 2011. ASCENSION IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE LOCAL HEALTHCARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 23 STATES AND THE DISTRICT OF COLUMBIA. ASCENSION HEALTH ALLIANCE SERVES AS THE MEMBER OR SHAREHOLDER OF VARIOUS SUBSIDIARIES. ASCENSION HEALTH ALLIANCE AND ITS MEMBER ORGANIZATIONS ARE HEREAFTER REFERRED TO COLLECTIVELY AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL, ST. LOUISE PROVINCE; THE CONGREGATION OF ST. JOSEPH; THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET; THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE, INC. - AMERICAN PROVINCE; AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI - US/CARIBBEAN PROVINCE. THE HOSPITAL, LOCATED IN MOBILE ALABAMA IS A NONPROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF MOBILE. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. THE HOSPITAL IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. THE ENTITIES COMPRISING THE HEALTH MINISTRY ARE UNDER COMMON MANAGEMENT AND CONTROL BY ASCENSION HEALTH AND SERVE THE SAME COMMUNITY. THE COMBINED FINANCIAL STATEMENTS INCLUDE THE ACCOUNTS OF THE HOSPITAL, PROVIDENCE AND PROVIDENCE'S MEMBER ENTITIES. ALL SIGNIFICANT INTERCOMPANY ACCOUNTS HAVE BEEN ELIMINATED. MEMBER ENTITIES OF PROVIDENCE INCLUDE: - PROVIDENCE FOUNDATION OF MOBILE (THE FOUNDATION) - ESTABLISHED TO RECEIVE MAINTAIN AND ADMINISTER FUNDS TO BE USED FOR THE DEVELOPMENT AND EXPANSION OF THE HOSPITAL OR ITS RELATED ORGANIZATIONS AND TO SUPPORT THE CORPORATE PURPOSES OF ASCENSION HEALTH. THE FOUNDATION IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. - PROVIDENCE BUILDING CORPORATION OF MOBILE - ESTABLISHED TO HOLD TITLE TO PROPERTY AND TO COLLECT INCOME THEREFROM AND TO SUPPORT THE CORPORATE PURPOSES OF ASCENSION HEALTH. PROVIDENCE BUILDING CORPORATION OF MOBILE IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(2) OF THE INTERNAL REVENUE CODE. - PROVIDENCE HEALTHCARE SERVICES OF MOBILE - ESTABLISHED TO OPERATE AND SUPPORT HEALTHCARE INSTITUTIONS WHICH ARE SPONSORED BY OR AFFILIATED WITH ASCENSION HEALTH. PROVIDENCE HEALTHCARE SERVICES OF MOBILE IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. - PROVIDENCE PARK, INC. - ESTABLISHED TO MAINTAIN AND DEVELOP PROPERTY ADJACENT TO THE HOSPITAL FOR PURPOSES OF ASCENSION HEALTH. PROVIDENCE PARK INC. IS TAXABLE UNDER THE INTERNAL REVENUE CODE. - SETON MEDICAL MANAGEMENT - ESTABLISHED TO OWN AND OPERATE PHYSICIAN PRACTICES. SETON MEDICAL MANAGEMENT IS A TAX-EXEMPT ORGANIZATION UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. - ANESTHESIA SOLUTIONS - ESTABLISHED TO PROVIDE ANESTHESIA SERVICES FOR THE HOSPITAL ANESTHESIA SOLUTIONS IS A TAXABLE ORGANIZATION THE INTERNAL REVENUE CODE. - ALABAMA PROVIDENCE HEALTHCARE SERVICES HAS BEEN FORMED TO EMPLOY PHYSICIANS, MID-LEVEL PROVIDERS, AND PHYSICIAN PRACTICE STAFF AND TO COORDINATE THE PROVISION OF INPATIENT AND OUTPATIENT PHYSICIAN AND RELATED MEDICAL CARE FOR THE PATIENTS AND COMMUNITY MEMBERS SERVED BY ORGANIZATIONS AFFILIATED WITH PROVIDENCE HEALTH SYSTEM IN ALABAMA. THE ENTITY'S APPLICATION FOR TAX-EXEMPT STATUS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE IS PENDING. - MISSISSIPPI PROVIDENCE HEALTHCARE SERVICES HAS BEEN FORMED TO EMPLOY pHYSICIANS, MID-LEVEL PROVIDERS, AND PHYSICIAN PRACTICE STAFF AND TO COORDINATE THE PROVISION OF INPATIENT AND OUTPATIENT PHYSICIAN AND RELATED MEDICAL CARE FOR THE PATIENTS AND COMMUNITY MEMBERS SERVED BY ORGANIZATIONS AFFILIATED WITH PROVIDENCE HEALTH SYSTEM IN MISSISSIPPI. MISSION THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING, AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES UTILIZED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTHCARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED. - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE, REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS. - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE THE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE COMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME. - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR THE PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS, AND MEDICAL RESEARCH. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT ROGRAMS. THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF EACH ENTITY'S TOTAL OPERATING EXPENSES TO THE ENTITY'S BILLED CHARGES FOR PATIENT CARE. X true true X X X X true true false false false false false false false CLARK P CHRISTIANSON PRESIDENT & CEO (ENDED 9/4/15) 282388 0 643906 0 1264421 0 23225 0 26686 0 2240625 0 0 0 C SUSAN CORNEJO CFO 99750 399001 37126 148503 12096 48384 3644 14575 6055 24222 158671 634685 0 0 TODD STEVEN KENNEDY PRESIDENT 396300 0 22011 0 977 0 15900 0 18993 0 454181 0 0 0 ROBERT W ISRAEL MD BOARD MEMBER 0 371282 0 106012 0 2582 0 17225 0 14808 0 511909 0 0 WILLIAM M LIGHTFOOT MD VP MEDICAL STAFF 148469 367944 5699 14124 5655 14014 6973 9510 9166 22717 175962 428309 0 0 PETER JOSEPH LINDQUIST CHIEF NURSING OFFICER 203304 0 47000 0 13964 0 8165 0 12718 0 285151 0 0 0 JOHN E STONE JR MD VP MEDICAL INFORMATICS 204554 0 31212 0 21295 0 29982 0 14871 0 301915 0 0 0 DANIEL C HARRISON MD PHYSICIAN 393017 0 22011 0 1811 0 13250 0 22214 0 452302 0 0 0 PRESTON T SPEAKMAN MD PHYSICIAN 396300 0 22011 0 977 0 12050 0 18993 0 450331 0 0 0 JAMES J STEINHAUER MD PHYSICIAN 390920 0 22011 0 3696 0 13250 0 17298 0 447174 0 0 0 ASTON G ARCHIBALD MD PHYSICIAN 392313 0 22011 0 1811 0 13250 0 22956 0 452341 0 0 0 DAVID C BRASWELL MD PHYSICIAN 405921 0 22011 0 1013 0 13250 0 24755 0 466950 0 0 0 Schedule J, Part I, Line 1a Travel for companions AN OFFICER RECEIVE PAYMENTS FOR TRAVEL FOR COMPANIONS. IRS TAX REQUIREMENTS (WHERE APPLICABLE) WERE FOLLOWED. Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation ASCENSION HEALTH, A RELATED ORGANIZATION OF PROVIDENCE HOSPITAL, USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO: - COMPENSATION COMMITTEE, - INDEPENDENT COMPENSATION CONSULTANT, - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. Schedule J, Part I, Line 4a Severance or change-of-control payment The following individual(s) received severance payments from the organization or a related organization: Clark P. Christianson - $120,791 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan ELIGIBLE EXECUTIVES PARTICIPATE IN A PROGRAM THAT PROVIDES FOR SUPPLEMENTAL RETIREMENT BENEFITS. THE PAYMENT OF BENEFITS UNDER THE PROGRAM, IF ANY, IS ENTIRELY DEPENDENT UPON THE FACTS AND CIRCUMSTANCES UNDER WHICH THE EXECUTIVE TERMINATES EMPLOYMENT WITH THE ORGANIZATION. BENEFITS UNDER THE PROGRAM ARE UNFUNDED AND NON-VESTED. DUE TO THE SUBSTANTIAL RISK OF FORFEITURE PROVISION, THERE IS NO GUARANTEE THAT THESE EXECUTIVES WILL EVER RECEIVE ANY BENEFIT UNDER THE PROGRAM. ANY AMOUNT ULTIMATELY PAID UNDER THE PROGRAM TO THE EXECUTIVE IS REPORTED AS COMPENSATION ON FORM 990, SCHEDULE J, PART II, COLUMN B IN THE YEAR PAID. NO DISTRIBUTIONS FROM THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN WERE MADE IN THE CURRENT YEAR. Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICAL IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S CEO THE PROCESS, PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF PROVIDENCE HOSPITAL, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE CEO WAS COMPARED TO INDIVIDUALS AT OTHER HOSPITALS IN THE AREA THAT HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN COMPENSATION WAS DECIDED. Form 990, Part VI, Line 4 Significant changes to organizational documents Effective 07/01/2015, the sole corporate member of Providence Hospital changed from Ascension Health to Gulf Coast Health System. Form 990, Part VI, Line 6 Classes of members or stockholders PROVIDENCE HOSPITAL HAS A SINGLE CORPORATE MEMBER, Gulf Coast Health System. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body PROVIDENCE HOSPITAL HAS A SINGLE CORPORATE MEMBER, Gulf Coast Health System, WHO HAS THE ABILITY TO ELECT MEMBERS TO THE GOVERNING BODY OF PROVIDENCE HOSPITAL. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders ASCENSION HEALTH HAS DESIGNED A SYSTEM AUTHORITY MATRIX WHICH ASSIGNS AUTHORITY FOR KEY DECISIONS THAT ARE NECESSARY IN THE OPERATION OF THE SYSTEM. SPECIFIC AREAS THAT ARE IDENTIFIED IN THE AUTHORITY MATRIX ARE: NEW ORGANIZATIONS & MAJOR TRANSACTIONS; GOVERNING DOCUMENTS; APPOINTMENTS/REMOVALS; EVALUATION; DEBT LIMITS; STRATEGIC & FINANCIAL PLANS; ASSETS; SYSTEM POLICIES & PROCEDURES. THESE AREAS ARE SUBJECT TO CERTAIN LEVELS OF APPROVAL BY ASCENSION PER THE SYSTEM AUTHORITY. Form 990, Part VI, Line 11b Review of form 990 by governing body MANAGEMENT, INCLUDING CERTAIN OFFICERS WORKS DILIGENTLY TO COMPLETE THE FORM 990 AND ATTACHED SCHEDULES IN A THOROUGH MANNER. PRIOR TO FILING THE RETURN ALL BOARD MEMBERS ARE PROVIDED THE FORM 990 AND MANAGEMENT TEAM MEMBERS ARE AVAILABLE TO ANSWER ANY BOARD MEMBERS QUESTIONS. Form 990, Part VI, Line 12c Conflict of interest policy THE ORGANIZATION REGULARLY AND CONSISTENTLY MONITORS AND ENFORCES COMPLIANCE WITH THE CONFLICT OF INTEREST POLICY IN THAT ANY DIRECTOR PRINCIPAL OFFICER OR MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS, WHO HAS A DIRECT OR INDIRECT FINANCIAL INTEREST MUST DISCLOSE THE EXISTENCE OF THE FINANCIAL INTEREST AND BE GIVEN THE OPPORTUNITY TO DISCLOSE ALL MATERIAL FACTS TO THE DIRECTORS AND MEMBERS OF THE COMMITTEES WITH GOVERNING BOARD DELEGATED POWERS CONSIDERING THE PROPOSED TRANSACTION OR ARRANGEMENT. THE REMAINING INDIVIDUALS ON THE GOVERNING BOARD OR COMMITTEE MEETING WILL DECIDE IF CONFLICTS OF INTEREST EXIST. EACH DIRECTOR PRINCIPAL OFFICER AND MEMBER OF A COMMITTEE WITH GOVERNING BOARD DELEGATED POWERS ANNUALLY SIGNS A STATEMENT WHICH AFFIRMS SUCH PERSON HAS RECEIVED A COPY OF THE CONFLICT OF INTEREST POLICY, HAS READ AND UNDERSTANDS THE POLICY, HAS AGREED TO COMPLY WITH THE POLICY, AND UNDERSTANDS THAT THE ORGANIZATION IS CHARITABLE AND IN ORDER TO MAINTAIN ITS FEDERAL TAX EXEMPTION IT MUST ENGAGE PRIMARILY IN ACTIVITIES WHICH ACCOMPLISH ITS TAX-EXEMPT PURPOSE. Form 990, Part VI, Line 15b Process to establish compensation of other employees THE BOARD OF DIRECTORS SHALL EXERCISE ALL POWER OF THE CORPORATION NOT OTHERWISE RESERVED TO ASCENSION HEALTH OR TO THE SPONSORS. Todd Kennedy IS AN EX-OFFICIO MEMBER OF THE BOARD WITH VOTING PRIVILEGES. HE SERVES ON ALL BOARDS WITHIN THE HEALTH MINISTRY AND IS PRESIDENT AND CEO OF PROVIDENCE HOSPITAL. IN DETERMINING COMPENSATION OF THE OTHER OFFICERS OF THE ORGANIZATION, THE PROCESS PERFORMED BY GULF COAST HEALTH SYSTEM, A RELATED ORGANIZATION OF ALABAMA PROVIDENCE HEALTHCARE SERVICES, INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS OF THE ORGANIZATION WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION WILL PROVIDE ANY DOCUMENTS OPEN TO PUBLIC INSPECTION UPON REQUEST. Form 990, Part XI, Line 9 Other changes in net assets or fund balances Transfer to/from Affiliates - -48426576; Deferred Pension - -11315382; ASCENSION HEALTH ALLIANCE PO BOX 45998 ST LOUIS MO 63145 453358926 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I NA false ASCENSION HEALTH PO BOX 45998 ST LOUIS MO 63145 311662309 NATIONAL HEALTH SYSTEM MO 501(c)(3 Type I ASCENSION HEALTH ALLIANCE false GULF COAST HEALTH SYSTEM 6801 AIRPORT BLVD MOBILE AL 36608 630934712 SUPPORT PROVIDENCE HOSPITAL AL 501(c)(3 Type III-FI ASCENSION HEALTH false PROVIDENCE FOUNDATION 6801 AIRPORT BLVD MOBILE AL 36608 630915493 SUPPORT PROVIDENCE HOSPITAL AL 501(c)(3 7 GULF COAST HEALTH SYSTEM true SETON MEDICAL MANAGEMENT 6801 AIRPORT BLVD MOBILE AL 36608 630937704 SUPPORT PROVIDENCE HOSPITAL AL 501(c)(3 Type II GULF COAST HEALTH SYSTEM true PROVIDENCE BUILDING CORPORATION 6801 AIRPORT BLVD MOBILE AL 36608 630914564 SUPPORT PROVIDENCE HOSPITAL AL 501(c)(2 GULF COAST HEALTH SYSTEM true SACRED HEART HEALTH SYSTEM INC 5151 N 9TH AVENUE PENSACOLA FL 32504 590634434 HOSPITAL - HEALTHCARE FL 501(c)(3 3 GULF COAST HEALTH SYSTEM true HAVEN OF OUR LADY OF PEACE INC 5151 N 9TH AVENUE PENSACOLA FL 32504 593620346 NURSING HOME FL 501(c)(3 9 SACRED HEART HEALTH SYSTEM true SACRED HEART HEALTH VENTURES INC 5151 N 9TH AVENUE PENSACOLA FL 32504 571183283 INVESTMENT FL 501(c)(3 Type I SACRED HEART HEALTH SYSTEM true SACRED HEART FOUNDATION INC 5151 N 9TH AVENUE PENSACOLA FL 32504 592436597 FOUNDATION FL 501(c)(3 7 SACRED HEART HEALTH SYSTEM true ALABAMA PROVIDENCE HEALTHCARE SERVICES 6801 AIRPORT BLVD MOBILE AL 36608 462847744 SUPPORT PROVIDENCE HOSPITAL AL 501(c)(3 Type III-FI GULF COAST HEALTH SYSTEM true PROVIDENCE HEALTHCARE SERVICES 6801 AIRPORT BLVD MOBILE AL 36608 630937705 SUPPORT PROVIDENCE HOSPITAL AL 501(c)(3 Type III-FI GULF COAST HEALTH SYSTEM true INTERVENTIONAL REHABILITATION CENTER LLC 1549 AIRPORT BOULEVARD STE 420 PENSACOLA FL 32503 593673361 MEDICAL SERVICES FL NA N/A PET LLC 5149 NORTH 9TH AVENUE SUITE 124 PENSACOLA FL 32504 593788701 MEDICAL SERVICES FL NA N/A ENDOSCOPY GROUP LLC 4810 NORTH DAVIS HIGHWAY PENSACOLA FL 32503 593519881 MEDICAL SERVICES FL NA N/A SOUTH COAST REAL ESTATE VENTURE LLC 5907 HIGHWAY 90 MOSS POINT MS 39563 455599047 OWN REAL ESTATE FOR A PHYSICIAN OFFICE BUILDING MS NA N/A EMERALD COAST RADIATION ONCOLOGY CENTER LLC 5151 NORTH 9TH AVENUE PENSACOLA FL 32504 680507481 DORMANT FL Na Related GULF REGION RADIATION ONCOLOGY MSO LLC 5147 N 9TH AVE PENSACOLA FL 32504 261353083 Medical Mngt Services FL Na Related PROVIDENCE PARK PO BOX 850429 MOBILE AL 36685 630886846 REAL ESTATE AL NA C Corporation true MISSISSIPPI PROVIDENCE HEALTHCARE SERVICES INC 6801 AIRPORT BLVD MOBILE AL 36608 461130426 HEALTHCARE SERVICES MS NA C Corporation true GULF COAST DIVERSIFIED INC 5154 NORTH 9TH AVENUE PENSACOLA FL 32507 592432798 INVESTMENT FL NA C Corporation true ANESTHESIA SOLUTIONS OF MOBILE INC 6701 AIRPORT BLVD SUITE D-430B MOBILE AL 36608 820547505 ANESTHESIA SERVICES AL NA C Corporation true true false false false false false false false false true false false false false true true false true false Providence Building Corp K 659396 FMV Alabama Providence Healthcare Services Q 969681 FMV Seton Medical Management Q 283103 FMV Providence Foundation C 284477 FMV Providence Healthcare Services R 653603 FMV