2017-05-15T11:51:02-05:00 2016-06-30 ERNST & YOUNG US LLP 18101 VON KARMAN AVENUE SUITE 1700 IRVINE CA 92612 990 2015-07-01 752426010 METHODIST HOSPITAL PLAINVIEW % BOB COPELAND METH 8062965531 2601 DIMMITT ROAD PLAINVIEW TX 790721833 BOB COPELAND INTERIM CEO 8062965531 2017-05-13 true KARA ADAMS P00023315 9497942300 2015 2021-01-29 14:40:06Z COVENANT HOSPITAL PLAINVIEW BOB COPELAND 2601 DIMMITT ROAD PLAINVIEW TX 790721833 45165943 false X WWW.COVENANTPLAINVIEW.ORG X 1998 TX SEE SCHEDULE O 14 11 422 34 0 0 0 0 40221309 45117746 45529 48197 0 0 40266838 45165943 27950 0 0 0 17356538 17913545 0 0 0 21319362 24019022 38703850 41932567 1562988 3233376 38014701 36894243 17160436 5760493 20854265 31133750 X WE ARE COMMITTED TO EXTENDING THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. 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ASC 740 ALSO PROVIDES GUIDANCE ON DERECOGNITION, MEASUREMENT, CLASSIFICATION, INTEREST AND PENALTIES, DISCLOSURE AND TRANSITION. THE GUIDANCE IS APPLICABLE TO PASS-THROUGH ENTITIES AND TAX-EXEMPT ORGANIZATIONS. NO SIGNIFICANT TAX LIABILITY FOR TAX BENEFITS, INTEREST OR PENALTIES WAS ACCRUED AT JUNE 30, 2016 OR 2015. true true X true X 175. true X true true true false true true 3475469 3475469 0.08290 5805175 4293937 1511238 0.03600 362573 121490 241083 0.00580 9643217 4415427 5227790 0.12470 18959 18959 0.00050 20183 20183 0.00050 39142 39142 0.00100 9682359 4415427 5266932 0.12570 false 4969289 0 14458178 17517293 -3059115 X true true 1 1 METHODIST HOSPITAL PLAINVIEW 2601 DIMMITT ROAD PLAINVIEW TX 790721833 www.covenanthealth.org 146 X X X METHODIST HOSPITAL PLAINVIEW false false true X X X X X X X X X 13 true false false true X SEE SCHEDULE H, PART V, SECTION C X true 13 true SEE SCHEDULE H, PART V, SECTION C false true X 175. 300. X X X X X true true X X X X true X SEE SECTION C X SEE SECTION C X SEE SECTION C X X X X X true X false X X X X true X false false SCHEDULE H, PART V, SECTION B, LINE 5 COMMUNITY INPUT COMMUNITY INPUT WAS GATHERED THROUGH FOCUS GROUPS, INTERVIEWS AND AN ON-LINE SURVEY CONDUCTED DURING JANUARY 2014. INPUT WAS GATHERED BASED ON THE HEALTH NEEDS THAT SURFACED IN THE 2012 PRC HEALTH NEEDS ASSESSMENT (FULL PDF REPORT AVAILABLE UPON REQUEST) PREPARED FOR COVENANT HEALTH. THE PRC NEEDS ASSESSMENT ANALYZED BOTH PRIMARY AND SECONDARY DATA FOR COVENANT HEALTH INCLUDING PHONE SURVEYS OF COMMUNITY RESIDENTS. FOCUS GROUPS, INTERVIEWS AND SURVEYS WERE CONDUCTED. PERSONS REPRESENTING BROAD INTERESTS OF THE COMMUNITY AND WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH WERE ASKED TO PARTICIPATE IN ONE OF MORE OF THE DATA GATHERING SESSIONS. INPUT WAS GATHERED FROM GOVERNMENTAL HEALTH AGENCIES, PERSONS REPRESENTING MEDICALLY UNDERSERVED AND LOW INCOME POPULATIONS, AS WELL AS INDIVIDUALS REPRESENTING MINORITY HEALTH NEEDS AND REPRESENTATIVES FROM PUBLIC HEALTH OR OTHER DEPARTMENTS OR AGENCIES. COMMUNITY REPRESENTATIVES WERE INVITED TO A SERIES OF COMMUNITY MEETINGS THAT INCLUDED 8 TO 10 REPRESENTATIVES PER GROUP. COMMUNITY LEADERS INCLUDED COUNTY ELECTED OFFICIALS, CITY ELECTED OFFICIALS, CITY AND COUNTY ADMINISTRATIVE OFFICERS, PHYSICIANS AND HEALTH INDUSTRY REPRESENTATIVES, COMMUNITY BUSINESS REPRESENTATIVES, LEADERS OF THE FAITH COMMUNITY, PUBLIC HEALTH REPRESENTATIVES, MANAGED CARE REPRESENTATIVES, LEADERS FROM VARIOUS RACIAL/ETHNIC MINORITY GROUPS, LOW-INCOME AND MEDICALLY UNDERSERVED RESIDENTS, SCHOOL OFFICIALS, REPRESENTATIVES FROM THE LOCAL CHAMBER OF COMMERCE, AND OTHER COMMUNITY LEADERS WHO COULD INFORM DIALOGUE ON IDENTIFYING COMMUNITY HEALTH NEEDS. THE MEETINGS WERE SCHEDULED FOR APPROXIMATELY 45 MINUTES TO ONE HOUR. SOME SUPPLEMENTAL MEETINGS WITH THE HOSPITAL BOARD AND INDIVIDUALS WHO COULD NOT PARTICIPATE IN THE GROUP MEETINGS WERE SCHEDULED BY PHONE. SINCE THE FEDERAL REGULATIONS REQUIRE THE INVOLVEMENT OF SPECIFIC INDIVIDUALS, SUCH AS A PUBLIC HEALTH REPRESENTATIVE, AND THESE INDIVIDUALS DO NOT GENERALLY RESIDE IN SMALL COMMUNITIES, THESE INTERVIEWS WERE SCHEDULED BY TELEPHONE. THESE REPRESENTATIVES WERE SELECTED BECAUSE THEY WERE FAMILIAR WITH THE LOCAL COMMUNITY, BUT RESIDE OUTSIDE THE COMMUNITY. NO WRITTEN COMMENTS HAVE BEEN RECEIVED ON THE PUBLICALLY PUBLISHED REPORTS. THE REPORTS AND THE EMAIL TO SEND COMMENTS TO ARE BOTH POSTED ON THE WEBSITE AT: HTTP://WWW.COVENANTHEALTH.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT.ASPX SCHEDULE H, PART V, SECTION B, LINE 7A CHNA WEBSITE ADDRESS HTTP://WWW.COVENANTHEALTH.ORG/DOCUMENTS/PLAINVIEW-CHNA-UPDATED-2014.PDF SCHEDULE H, PART V, SECTION B, LINE 10A IMPLEMENTATION STRATEGY WEBSITE ADDRESS HTTP://WWW.COVENANTHEALTH.ORG/DOCUMENTS/COVENANTPLAINVIEWFY15-17IMPLEMENTA TION_PLAN.PDF SCHEDULE H, PART V, SECTION B, LINE 11 THE TWO PRIORITIES SELECTED TO ADDRESS THE UNMET NEEDS OF RESIDENTS IN COVENANT HEALTH PLAINVIEW'S (CHP) SERVICE AREA DURING FY15 - 17 ARE DIABETES AND CHILDHOOD OBESITY. THESE NEEDS WILL BE ADDRESSED THROUGH THE FOLLOWING COMMUNITY BENEFIT INITIATIVES: DIABETES EDUCATION Healthy Kids 2020 (CHILDHOOD OBESITY) ADDRESSING THE NEEDS OF THE COMMUNITY: FY15 - 17 KEY COMMUNITY BENEFIT INITIATIVES AND EVALUATION PLAN DIABETES AWARENESS, TRAINING AND SUPPORT DESCRIPTION: COVENANT CENTER FOR OUTPATIENT DIABETES EDUCATION IN PLAINVIEW OFFERS COMPREHENSIVE, SELF-MANAGEMENT CLASSES DESIGNED TO HELP TRAIN, SUPPORT AND EMPOWER PEOPLE WITH DIABETES TO LIVE A HEALTHIER LIFE. CLASSES ARE OFFERED MONTHLY AND FAMILY PARTICIPATION IS ENCOURAGED. TOPICS INCLUDE DISEASE PROCESS AND TREATMENT OPTIONS, MEDICATION, MONITORING, NUTRITIONAL MANAGEMENT, PHYSICAL ACTIVITY, PREVENTING COMPLICATIONS, AND BEHAVIOR CHANGE. ADDITIONALLY, DIABETES AWARENESS PROGRAMS, SUPPORT GROUPS, GLUCOSE SCREENINGS AND HEALTH FAIRS ARE OFFERED FREQUENTLY THROUGHOUT THE YEAR. GOAL (ANTICIPATED OUTCOME): IMPROVE DIABETES MANAGEMENT IN THE COMMUNITY AND SURROUNDING AREAS. COMMUNITY PARTNERS: COVENANT CENTER FOR OUTPATIENT DIABETES EDUCATION, HK2020, COVENANT CORPORATE WELLNESS, COVENANT MEDICAL GROUP PHYSICIANS, WEST TEXAS FAMILY MEDICINE PHYSICIANS, REGENCE HEALTH NETWORK, PLAINVIEW/HALE COUNTY HEALTH DEPARTMENT, PLAINVIEW ISD, AMERICAN DIABETES ASSOCIATION, LOCAL RETAIL PHARMACIES AND MEDICAL SUPPLY COMPANIES. OUTCOME MEASURE: AVERAGE CHANGE IN THE CONCENTRATION OF BLOOD GLUCOSE (HEMOGLOBIN A1C) WITHIN 3 MONTHS OF INITIAL VISIT TO THE DIABETES PROGRAM SCOPE: PATIENTS ENROLLED IN DIABETES SELF-MANAGEMENT TRAINING CLASSES AND MONTHLY DIABETES FORUM. STRATEGIES: 1. ENGAGE PATIENTS IN AN INTERACTIONAL GROUP LEARNING ENVIRONMENT 2. PROVIDE PATIENTS WITH KNOWLEDGE, COMMUNITY RESOURCES AND THE TOOLS NEEDED TO SUCCEED 3. DEVELOP WRITTEN BEHAVIORAL GOAL CHANGES AND ENCOURAGE COMPLIANCE THROUGH MONTHLY DIABETES FORUM AND FOLLOW-UP SESSIONS STRATEGY MEASURES: 1. PERCENT OF PATIENTS COMPLETING DIABETES SELF-MANAGEMENT TRAINING 2. NUMBER OF PATIENTS RETURNING FOR FOLLOW-UP VISIT 3. PERCENT OF PATIENTS WHO COMPLY WITH BEHAVIORAL GOAL CHANGE PLAN CHILDHOOD OBESITY - HK2020 (HEALTHY KIDS 2020) DESCRIPTION: HK2020 IS A KIDS CLUB (ORGANIZED IN 2008) CREATED TO PROMOTE A HEALTHY LIFESTYLE AMONG THE NEXT GENERATION OF CHILDREN IN OUR COMMUNITY. COVENANT HEALTH PLAINVIEW, IN COLLABORATION WITH NUMEROUS COMMUNITY ENTITIES, HAVE PARTNERED TOGETHER TO PROVIDE FREE ACTIVITIES TO THE MEMBERS AND THEIR FAMILIES THAT ADDRESS A HEALTHY BODY, MIND AND SPIRIT (I.E. FISHING, SWIMMING, HIKING, BOWLING, ROLLER SKATING, COOKING, BICYCLING, FOOD SAFETY, AND READING). GOAL (ANTICIPATED OUTCOME): REDUCE CHILDHOOD OBESITY AMONG 3 TO 12 YEAR OLDS LIVING IN HALE COUNTY COMMUNITY PARTNERS: FBC UPWARD BASKETBALL AND CHEER CAMP, YMCA, PLAINVIEW BOWLING CENTER, PLAINVIEW SKATING RINK, WAYLAND BAPTIST UNIVERSITY, LLANO ESTACADO MUSEUM, WALMART DISTRIBUTION, PLAINVIEW DAILY HERALD, RSVP, DAIRY FOUNTAIN FARMS, CITY OF PLAINVIEW FIRE DEPARTMENT, PLAINVIEW HALE COUNTY HEALTH DEPARTMENT, PLAINVIEW ISD, ROBERT'S TREE HOUSE, TEXAS DEPARTMENT OF FISH AND WILDLIFE, CAPROCK CANYON STATE PARK, UNGER MEMORIAL LIBRARY, SONIC DRIVE INN, WEST TEXAS WOODFIRE GRILL, ROTARY CLUB, LIONS CLUB, JR SERVICE LEAGUE, 4H, AND GARRISON INSTITUTE ON AGING FOR A HEALTHY WEST TEXAS. OUTCOME MEASURE: PERCENT OF CHILDREN WHO MAINTAIN OR IMPROVE THEIR WEIGHT STATUS SCOPE: CHILDREN AGES 3-12 YEARS AND THEIR FAMILIES LIVING IN HALE COUNTY STRATEGIES: 1. ENGAGE COMMUNITY MEMBERS IN EVENTS FOCUSED ON HEALTHY EATING AND PHYSICAL ACTIVITY. 2. PROVIDE EDUCATIONAL ACTIVITIES TO CHILDREN AND THEIR FAMILIES THAT PROMOTE A HEALTHY BODY, MIND AND SPIRIT 3. BUILD COMMUNITY CAPACITY TO SUPPORT HEALTHY EATING AND PHYSICAL ACTIVITY STRATEGY MEASURES: 1. PERCENT OF FAMILIES REPORTING AT LEAST THREE IMPROVED LIFESTYLE CHANGES 2. PERCENT OF PARTICIPANTS REPORTING 10 OR MORE HEALTHY ACTIVITIES PER MONTH RELATED TO THE BODY, MIND AND SPIRIT 3. NUMBER OF PROGRAM ACTIVITIES IMPLEMENTED BY COMMUNITY PARTNERS NEEDS BEYOND THE HOSPITAL'S SERVICE PROGRAM ALTHOUGH COVENANT HEALTH PLAINVIEW CANNOT ADDRESS ALL COMMUNITY HEALTH NEEDS IDENTIFIED IN THE COVENANT HEALTH PLAINVIEW CHNA, MAKING THE CHNA REPORT FINDINGS PUBLICLY AVAILABLE WILL BE THE FIRST STEP TO ENCOURAGE LOCAL COORDINATION OF SERVICES AND RESOURCES AND INFORM FUTURE PROGRAM DEVELOPMENT AND CARE COORDINATION OF COVENANT HEALTH PLAINVIEW COMMUNITY BENEFIT EFFORTS. REASONS FOR NOT ADDRESSING ALL NEEDS INCLUDE RESOURCE CONSTRAINTS, CURRENT STAFFING AND AREAS OF EXPERTISE LIMITATIONS THAT PREVENT COVENANT HEALTH PLAINVIEW FROM ADDRESSING ALL THE COMMUNITY HEALTH NEEDS IDENTIFIED. BELOW WE OUTLINE REASONS PER IDENTIFIED NEED. DENTAL HEALTH AND DENTAL CARE WILL BE EXPLORED AS A FUTURE INITIATIVE, WHEN PARTNERSHIPS ARE ESTABLISHED WITH OTHER AGENCIES PROVIDING DENTAL CARE AND STAFFING ARRANGEMENTS CAN BE MADE. TEEN PREGNANCY, TOBACCO USE, AND LACK OF TRANSPORTATION TO HEALTH AND HUMAN SERVICES WILL NOT BE ADDRESSED DIRECTLY THROUGH A PROGRAM DUE TO RESOURCE CONSTRAINTS. HOWEVER, COVENANT HEALTH PLAINVIEW IS A DESIGNATED TOBACCO-FREE CAMPUS. ACCESS TO MEDICAL CARE AND ACCESS TO SPECIALTY CARE WILL NOT BE FORMALLY ADDRESSED IN THIS Community Benefit PLAN/IMPLEMENTATION STRATEGY REPORT; HOWEVER, THE FINDINGS WILL INFORM COVENANT HEALTH PLAINVIEW PHYSICIAN RECRUITMENT EFFORTS. PREMATURE DEATH AND MORTALITY RATE WILL NOT BE FORMALLY ADDRESSED THROUGH A COMMUNITY BENEFIT PROGRAM, HOWEVER, CHNA FINDINGS WILL BE DISSEMINATED TO THE PUBLIC AND OPPORTUNITIES CAN ARISE FOR COMMUNITY ENGAGEMENT AROUND FUTURE PREVENTION EFFORTS. ALTHOUGH ACCESS TO HEALTH INSURANCE WILL NOT BE FORMALLY ADDRESSED BY COVENANT HEALTH PLAINVIEW, IN LIGHT OF HEALTH CARE REFORM, COVENANT HEALTH PLAINVIEW WILL EXPLORE THE OPPORTUNITY TO ENGAGE AND PARTNER WITH HEALTH INSURANCE EXCHANGE EDUCATION CAMPAIGN TO EXPAND UNDERSTANDING OF THE NEW LAW AND OPPORTUNITY FOR HEALTH INSURANCE ENROLLMENT IN SERVICE AREA. MENTAL HEALTH IS ALREADY ADDRESSED BY THE MENTAL HEALTH AND MENTAL RETARDATION CENTER (MHMRC). COVENANT HEALTH PLAINVIEW IS EXPLORING THE OPPORTUNITY TO PARTNER WITH THE MHMRC TO COORDINATE MENTAL HEALTH CARE FOR PERSONS WHO PRESENT AT THE COVENANT HEALTH PLAINVIEW EMERGENCY DEPARTMENT FOR MENTAL HEALTH CARE. PRELIMINARY DISCUSSIONS INCLUDE EXPLORING PREVENTION EFFORTS THAT INCLUDE CARE COORDINATION TO ENSURE APPROPRIATE CARE AND TREATMENT OF COMMUNITY RESIDENTS WITH MENTAL HEALTH ISSUES. AS IN ANY COMMUNITY, THERE ARE MANY UNMET HEALTH NEEDS. CHP WILL CONTINUE TO PARTNER WITH OTHER COMMUNITY OUTREACH PROGRAMS TO SUPPORT THEIR EFFORTS IN ADDRESSING COMMUNITY NEEDS. SCHEDULE H, PART V, SECTION B, LINE 13H THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USES AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT ARE INITIALLY CLASSIFIED AS BAD DEBT. SCHEDULE H, PART V, SECTION B, LINE 16A THE FAP IS MADE WIDELY AVAILABLE AT: http://www.covenanthealth.org/documents/Patient-Financial-Assistance/Finan cial-Assistance-Policy-ENGLISH_4.20.16.pdf SCHEDULE H, PART V, SECTION B, LINE 16B THE FAP APPLICATION FORM IS MADE WIDELY AVAILABLE AT: http://www.covenanthealth.org/documents/Patient-Financial-Assistance/Finan cial-Assistance-Application-ENGLISH_2.24.16.pdf SCHEDULE H, PART V, SECTION B, LINE 16C THE FAP PLAIN LANGUAGE SUMMARY IS MADE WIDELY AVAILABLE AT: http://www.covenanthealth.org/documents/Patient-Financial-Assistance/Coven ant_FABrochure_2016.pdf SCHEDULE H, PART V, SECTION B, LINE 16I THE ORGANIZATION POSTS ITS SUMMARIZED FINANCIAL ASSISTANCE NOTICE IN ALL ADMITTING AREAS IN BOTH ENGLISH AND SPANISH AND PROVIDES THE FULL POLICY UPON REQUEST. SUMMARIZED NOTICES OF THE POLICY ARE AVAILABLE ON ITS WEBSITE ALONG WITH CONTACT INFORMATION IN THE EVENT OF ADDITIONAL INQUIRIES. NOTICES OF FINANCIAL ASSISTANCE ARE INCLUDED WITH BILLINGS FOR UNINSURED PATIENTS. BILINGUAL PATIENT ACCOUNT REPRESENTATIVES ARE AVAILABLE TO ADDRESS QUESTIONS AND ASSIST IN THE COMPLETION OF A FINANCIAL ASSISTANCE APPLICATION IN ENGLISH OR SPANISH. SCHEDULE H, PART V, SECTION B, LINE 22D FOR PATIENTS WITH A FAMILY INCOME BETWEEN 176% AND 300% OF FEDERAL POVERTY GUIDELINES (FPG), THE HOSPITAL FACILITY USED MEDICARE RATES WHEN CALCULATING THE MAXIMUM AMOUNTS THAT CAN BE CHARGED. FOR CATASTROPHIC CASES WITH A PATIENT RESPONSIBILITY GREATER THAN $75,000, THE HOSPITAL FACILITY USED MEDICARE RATES TO DETERMINE THE MAXIMUM AMOUNT THAT CAN BE CHARGED. 4 COVENANT HEALTHCARE CENTER PLAINVIEW 2222 W 24TH STREET PLAINVIEW TX 79072 MEDICAL CLINIC COVENANT HEALTHCARE CENTER PLAINVIEW 2502 XENIA PLAINVIEW TX 79072 MEDICAL CLINIC MARSHALL FORMBY UNIT - PRISON CLINIC 998 COUNTY RD AA PLAINVIEW TX 79072 MEDICAL CLINIC J B WHEELER UNIT - PRISON CLINIC 986 COUNTY ROAD AA PLAINVIEW TX 79072 MEDICAL CLINIC SCHEDULE H, PART I, LINE 3C IN DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE, THE ORGANIZATION ALSO CONSIDERED CERTAIN ASSETS OF A PATIENT. IN ADDITION, A PATIENT'S SPECIAL CIRCUMSTANCES, INCLUDING BUT NOT LIMITED TO DISABILITY AND HOMELESSNESS ARE CONSIDERED WHEN DETERMINING ELIGIBILITY. SCHEDULE H, PART I, LINE 6A COVENANT HEALTH PREPARES AN ANNUAL REPORT AS A SYSTEM WHICH INCLUDES COVENANT MEDICAL CENTER, COVENANT CHILDREN'S HOSPITAL AND COVENANT SPECIALTY HOSPITAL (JOINT VENTURE), AND IT IS PUBLICLY AVAILABLE AT http://www.covenanthealth.org/For-Community/Community-Benefit.aspx SCHEDULE H, PART I, LINE 7 THE AMOUNTS REPORTED IN THE TABLE WERE CALCULATED USING THE ORGANIZATION'S COST ACCOUNTING SYSTEM. THE ORGANIZATION'S COST ACCOUNTING SYSTEM ADDRESSED ALL PATIENT SEGMENTS. SCHEDULE H, PART III, LINE 2 METHODOLOGY FOR CALCULATING BAD DEBT THE ORGANIZATION ANALYZES ITS HISTORICAL EXPERIENCE AND TRENDS TO ESTIMATE THE APPROPRIATE BAD DEBT EXPENSE. DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS ARE RECORDED PRIOR TO CALCULATING BAD DEBT EXPENSE. SCHEDULE H, PART III, LINE 3 THE ORGANIZATION RECOGNIZES THAT A PORTION OF THE UNINSURED OR UNDERINSURED PATIENT POPULATION MAY NOT ENGAGE IN THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS. THEREFORE, THE ORGANIZATION ALSO USED AN AUTOMATED PREDICTIVE SCORING TOOL TO IDENTIFY AND QUALIFY PATIENTS FOR FINANCIAL ASSISTANCE FOR ACCOUNTS THAT WERE INITIALLY CLASSIFIED AS BAD DEBT. COLLECTION ACTIONS WERE NOT PURSUED ON THESE ACCOUNTS ONCE THEY WERE RECLASSIFIED BECAUSE RECLASSIFIED ACCOUNTS RECEIVED A 100 PERCENT WRITE-OFF OF THE BALANCE DUE. AFTER THE RECLASSIFICATION THERE WAS NO REMAINING AMOUNT OF BAD DEBT EXPENSE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER OUR FINANCIAL ASSISTANCE POLICY. SCHEDULE H, PART III, LINE 4 FINANCIAL STATEMENT FOOTNOTE DESCRIBING BAD DEBT THE ORGANIZATION RECEIVES PAYMENT FOR SERVICES RENDERED TO PATIENTS FROM FEDERAL AND STATE GOVERNMENTS UNDER THE MEDICARE AND MEDICAID PROGRAMS, PRIVATELY SPONSORED MANAGED CARE PROGRAMS FOR WHICH PAYMENT IS MADE BASED ON TERMS DEFINED UNDER FORMAL CONTRACTS, AND OTHER PAYORS. THE ORGANIZATION BELIEVES THERE ARE NO SIGNIFICANT CREDIT RISKS ASSOCIATED WITH RECEIVABLES FROM GOVERNMENT PROGRAMS. RECEIVABLES FROM CONTRACTED PAYORS ARE FROM VARIOUS PAYORS WHO ARE SUBJECT TO DIFFERING ECONOMIC CONDITIONS AND DO NOT REPRESENT ANY CONCENTRATED RISKS TO THE ORGANIZATION. IN EVALUATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE, THE ORGANIZATION REGULARLY ANALYZES ITS HISTORICAL EXPERIENCE AND IDENTIFIES TRENDS FOR EACH OF ITS MAJOR PAYOR SOURCES TO ESTIMATE THE APPROPRIATE ALLOWANCE FOR DOUBTFUL ACCOUNTS. SCHEDULE H, PART III, LINE 8 BASIS FOR CALCULATING AMOUNTS CHARGED TO PATIENTS THE ORGANIZATION DOES NOT REPORT MEDICARE REVENUES AND EXPENSES AS COMMUNITY BENEFIT. MEDICARE COSTS ARE DETERMINED FROM THE MEDICARE COST REPORT USING CMS STANDARD COSTING METHODS. THIS INCLUDES STEP-DOWN ALLOCATION PROCESSES WHICH ARE APPLIED TO CALCULATE ALLOWABLE MEDICARE COSTS. SCHEDULE H, PART III, LINE 9B PATIENT ACCOUNTS WERE NOT FORWARDED TO COLLECTION STATUS WHEN THE PATIENT MADE A GOOD FAITH EFFORT TO RESOLVE OUTSTANDING ACCOUNT BALANCES. SUCH EFFORTS INCLUDE APPLYING FOR FINANCIAL ASSISTANCE, NEGOTIATING A PAYMENT PLAN, OR APPLYING FOR MEDICAID COVERAGE. PRIOR TO ADVANCING ANY ACCOUNT FOR EXTERNAL COLLECTION, THE ORGANIZATION PERFORMED AN EVALUATION TO IDENTIFY IF THE ACCOUNT QUALIFIED FOR FINANCIAL ASSISTANCE. ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR FREE CARE WERE WRITTEN OFF AND COLLECTION EFFORTS WERE NOT PURSUED. THE ORGANIZATION'S COLLECTION POLICY ALSO APPLIED TO ACCOUNTS FOR PATIENTS WHO QUALIFIED FOR DISCOUNTED CARE. SCHEDULE H, PART VI, LINE 2 NEEDS ASSESSMENT THE COVENANT HOSPITAL PLAINVIEW COMMUNITY HEALTH NEEDS ASSESSMENT WAS DEVELOPED TO IDENTIFY LOCAL HEALTH NEEDS. THE COMMUNITY HEALTH NEEDS ASSESSMENT HAD TWO MAJOR COMPONENTS. THE FIRST WAS A PRIMARY DATA COLLECTION PHASE IN THE COMMUNITY CONDUCTED THROUGH INTERVIEWS WITH A CROSS-SECTION OF COMMUNITY REPRESENTATIVES AND LEADERS TO DETERMINE LOCAL ISSUES AND CONCERNS THAT AFFECTED HEALTH AND THE HEALTH OF THE COMMUNITY. THE SECOND PHASE WAS THE COLLECTION AND COMPILATION OF SECONDARY DATA FROM PUBLIC SOURCES THAT COULD BE USED TO DEFINE THE STATUS OF THE COMMUNITY'S HEALTH AND WELL-BEING. THESE TWO DATA SOURCES WERE COMBINED INTO A SUMMARY THAT COULD BE USED TO DETERMINE PRIORITIES AND DEVELOP PLANS AND STRATEGIES TO IMPROVE COMMUNITY HEALTH. SCHEDULE H, PART VI, LINE 3 PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE THE ORGANIZATION POSTED NOTICES INFORMING THE PUBLIC OF THE FINANCIAL ASSISTANCE PROGRAM. NOTICES WERE POSTED IN HIGH VOLUME INPATIENT AND OUTPATIENT SERVICE AREAS. NOTICES WERE ALSO POSTED AT LOCATIONS WHERE A PATIENT COULD PAY THEIR BILL. NOTICES INCLUDED CONTACT INFORMATION ON HOW A PATIENT COULD OBTAIN MORE INFORMATION ON FINANCIAL ASSISTANCE AS WELL AS WHERE TO APPLY FOR ASSISTANCE. THESE NOTICES WERE POSTED IN ENGLISH AND SPANISH AND ANY OTHER LANGUAGES THAT WERE REPRESENTATIVE OF 5% OR GREATER OF PATIENTS IN THE HOSPITAL'S SERVICE AREA. ALL PATIENTS WHO DEMONSTRATED LACK OF FINANCIAL COVERAGE BY THIRD PARTY INSURERS WERE OFFERED AN OPPORTUNITY TO COMPLETE THE FINANCIAL ASSISTANCE APPLICATION AND WERE OFFERED INFORMATION, ASSISTANCE, AND REFERRAL AS APPROPRIATE TO GOVERNMENT SPONSORED PROGRAMS FOR WHICH THEY MAY HAVE BEEN ELIGIBLE. SCHEDULE H, PART VI, LINE 4 COMMUNITY INFORMATION PLAINVIEW IS LOCATED ON THE HIGH PLAINS OF TEXAS AND SERVES THE INDUSTRIAL, COMMERCIAL AND AGRICULTURAL NEEDS OF A FOUR-COUNTY AREA (HALE, CASTRO, FLOYD, AND SWISHER COUNTIES). ALTHOUGH PLAINVIEW AND THE SERVICE AREA COUNTIES ARE LOCATED BETWEEN AMARILLO, TEXAS AND LUBBOCK, TEXAS, VIRTUALLY ALL PATIENT OUTMIGRATION GOES TO LUBBOCK, TEXAS. EACH SERVICE AREA COUNTY HAS ITS OWN HOSPITAL THAT PROVIDES PRIMARY AND SECONDARY CARE. POVERTY LEVEL: ABOUT HALF OR MORE OF THE COVENANT HOSPITAL PLAINVIEW SERVICE AREA POPULATION ARE LIVING UNDER 200% OF THE FPL. THIS INDICATOR FOR THE STATE OF TEXAS IS ABOUT 38% AND 32% FOR THE U.S. OVER ONE THIRD OF THE CHILDREN IN THE COUNTIES OF CASTRO (35%) AND FLOYD (33%) ARE LIVING BELOW FPL, WHICH IS SIGNIFICANTLY HIGHER THAN THE NATION AND THE STATE OF TEXAS. ON THE OTHER HAND, POVERTY AMONG CHILDREN IS LOWER THAN THE STATE OR NATION IN SWISHER COUNTY (14%). ALL COVENANT HOSPITAL PLAINVIEW SERVICE AREA COUNTIES HAVE A HIGH PARTICIPATION (OVER 59%) OF YOUTH PARTICIPATING IN THE FREE OR REDUCED LUNCH PROGRAM. OTHER HOSPITALS: OTHER HOSPITALS IN COUNTIES SERVED BY COVENANT HOSPITAL PLAINVIEW INCLUDE: MANGOLD MEMORIAL HOSPITAL, SWISHER MEMORIAL HOSPITAL, AND PLAINS MEMORIAL HOSPITAL. FOR A LIST OF OTHER HEALTH CARE FACILITIES WITHIN HALE COUNTY, CASTRO COUNTY, FLOYD COUNTY AND SWISHER COUNTY PLEASE REFER TO APPENDIX 3 OF THE PLAINVIEW COVENANT CHNA AT HTTP://WWW.COVENANTHEALTH.ORG/FOR-COMMUNITY/COMMUNITY-BENEFIT.ASPX SCHEDULE H, PART VI, LINE 5 PROMOTION OF COMMUNITY HEALTH AS PART OF THE LARGEST HEALTH SYSTEM IN WEST TEXAS, COVENANT HOSPITAL PLAINVIEW OFFERS MORE MEDICAL SPECIALTIES AND HEALTH SERVICES THAN ANY OTHER PROVIDER IN OUR SERVICE AREA. WE ARE COMMITTED TO PROVIDING THE PEOPLE OF OUR COMMUNITY WITH THE BEST POSSIBLE HEALTH CARE FROM BIRTH TO ADULTHOOD AND THROUGH THE END OF LIFE. COVENANT PLAINVIEW PROVIDES VITAL HOSPITAL AND COMMUNITY SERVICES AND ADDRESSES THE NEEDS OF THE UNINSURED AND UNDERINSURED THROUGH ITS FINANCIAL ASSISTANCE PROGRAM PROVIDING FREE (TRADITIONAL CHARITY CARE) AND DISCOUNTED CARE. COVENANT HEALTH IS COMMITTED TO PROMOTING THE HEALTH AND QUALITY OF LIFE OF ITS SURROUNDING COMMUNITY. THIS IS DEMONSTRATED THROUGH THE FOLLOWING MECHANISMS: 1) THERE IS A COMMUNITY BENEFIT STAFF COMMITTEE 2) AN OPEN MEDICAL STAFF AND 3) COMMUNITY BENEFIT PROGRAMS THAT ARE IN PART FUNDED BY CARE FOR THE POOR DOLLARS. COVENANT HOSPITAL PLAINVIEW LEADS THE WAY TO THE FUTURE OF HEALTH CARE, FROM OBSTETRICS AND SURGERY TO REHABILITATION. SERVICES PROVIDED INCLUDE: DIABETES EDUCATION, EMERGENCY SERVICES, ENDOSCOPY, GASTROENTEROLOGY, CHILDHOOD OBESITY PREVENTION, INTENSIVE CARE, LABORATORY SERVICES, LITHOTRIPSY, NUTRITIONAL CONSULTS, OBSTETRICS AND GYNECOLOGY, OPHTHALMOLOGY, PEDIATRICS, PHYSICAL AND SPEECH THERAPY, RADIOLOGY SERVICES, SLEEP CENTER, SPIRITUAL CARE, SURGICAL SERVICES, UROLOGY, AND WOUND CARE. SCHEDULE H, PART VI, LINE 6 AFFILIATED HEALTH CARE SYSTEM HOSPITAL PLAINVIEW IS A HEALING MINISTRY OF ST. JOSEPH HEALTH SYSTEM, AN INTEGRATED HEALTHCARE DELIVERY SYSTEM SPONSORED BY THE ST. JOSEPH HEALTH MINISTRY. ST. JOSEPH HEALTH SYSTEM IS ORGANIZED INTO THREE REGIONS: NORTHERN CALIFORNIA, SOUTHERN CALIFORNIA, AND WEST TEXAS/EASTERN NEW MEXICO. THE SYSTEM INCLUDES 14 ACUTE CARE HOSPITALS, HOME HEALTH AGENCIES, HOSPICE CARE, OUTPATIENT SERVICES, COMMUNITY CLINICS, AND PHYSICIAN ORGANIZATIONS. EACH ASSOCIATED MINISTRY WORKS TO LIVE OUT ITS MISSION TO EXTEND THE HEALING MINISTRY OF JESUS IN THE TRADITION OF THE SISTERS OF ST. JOSEPH OF ORANGE BY CONTINUALLY IMPROVING THE HEALTH AND QUALITY OF LIFE OF THE COMMUNITIES IT SERVES. IN 1986, ST. JOSEPH HEALTH SYSTEM CREATED A PLAN AND BEGAN AN EFFORT TO FURTHER ITS COMMITMENT TO NEIGHBORS IN NEED. WITH A VISION OF REACHING BEYOND THE WALLS OF ITS HEALTHCARE FACILITIES AND TRANSCENDING TRADITIONAL EFFORTS OF PROVIDING FINANCIAL ASSISTANCE FOR THOSE IN NEED OF ACUTE SERVICES, ST. JOSEPH HEALTH SYSTEM CREATED THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO IMPROVE THE HEALTH OF LOW-INCOME INDIVIDUALS RESIDING IN LOCAL COMMUNITIES. OUR FOUNDATIONAL DOCUMENT, A VISION OF VALUES, FORMALIZES A POLICY THROUGH WHICH THE HOSPITAL MINISTRIES RETURN TEN PERCENT OF THEIR NET INCOME TO THE ST. JOSEPH HEALTH SYSTEM FOUNDATION TO SUPPORT OUTREACH EFFORTS FOR THE MATERIALLY POOR. THE FOUNDATION THEN FUNDS PROGRAMS IN COMMUNITIES SERVED BY ST. JOSEPH HEALTH HOSPITALS THAT EXEMPLIFY THE FOUR CORE VALUES OF ST. JOSEPH HEALTH SYSTEM: SERVICE, EXCELLENCE, DIGNITY, AND JUSTICE. SCHEDULE H, PART VI, LINE 7 STATE FILING OF COMMUNITY BENEFIT REPORT TEXAS false true false false false false false true false Michael Benjamin Farr DO Board Member 0 490613 0 184620 0 76481 0 0 0 19826 0 771540 0 0 Kevin Jones Board Member 0 228148 0 50000 0 10789 0 2667 0 7297 0 298901 0 0 Clay Taylor BD MBR/CEO COVNT PLNVW (PT YR) 170316 0 64672 0 18419 0 8448 0 7423 0 269278 0 0 0 Leslie Hackett executive director, Nursing 119794 0 32882 0 2415 0 11488 0 20777 0 187356 0 0 0 Kimberly Erpelding Sr Echocardiogram Technologist 156115 0 3089 0 705 0 8080 0 7394 0 175383 0 0 0 Cassie Mogg Executive Director, Finance 79656 0 22065 0 1677 0 37220 0 17005 0 157623 0 0 0 Cynthia Hanby Pharmacist In Charge 142754 0 0 0 795 0 5849 0 7255 0 156653 0 0 0 SCHEDULE J, PART I, LINE 3 THE COMPENSATION OF THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS DETERMINED BY ITS CORPORATE MEMBER, COVENANT HEALTH SYSTEM. SEE SCHEDULE O OF FORM 990, PART VI, LINE 15A. SCHEDULE J, PART I, LINE 4B BEGINNING IN JULY 2015, NEW EXECUTIVES PARTICIPATE IN A NON-QUALIFIED SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN. THE PLAN PROVIDES FOR EMPLOYER CONTRIBUTIONS BASED ON A PERCENTAGE OF EXECUTIVE BASE SALARY AND ARE SUBJECT TO A FIVE YEAR OR AGE 65 VESTING SCHEDULE. SCHEDULE J, PART I, LINE 7 A PORTION OF EXECUTIVES SALARIES ARE PLACED "AT-RISKARE NOT AWARDED UNLESS SPECIFIC STRATEGIC OBJECTIVE TARGETS ARE MET OR EXCEEDED. THE AT-RISK EXECUTIVE PLAN IS DESIGNED TO MOTIVATE AND REWARD EXECUTIVES FOR TEAM PERFORMANCE THAT SUPPORTS THE STRATEGIC GOALS AND SUCCESSFUL PERFORMANCE OF ST. JOSEPH HEALTH SYSTEM. AT-RISK PAY IS AWARDED TO ASSISTANT VICE PRESIDENTS, VICE PRESIDENTS, SENIOR VICE PRESIDENTS, EXECUTIVE VICE PRESIDENTS, AND THE CHIEF EXECUTIVE OFFICER BASED ON ACHIEVING OR SURPASSING SPECIFIC GOALS THAT ARE PREDETERMINED BY THE BOARD OF TRUSTEES PRIOR TO THE BEGINNING OF THE FISCAL YEAR. THE GOALS INCLUDE OUR STRATEGIC OBJECTIVES OF PERFECT CARE, SACRED ENCOUNTERS, AND HEALTHIEST COMMUNITIES AS WELL AS FISCAL STEWARDSHIP. EACH OF THESE FACTORS IS TAKEN INTO CONSIDERATION WHEN DETERMINING THE PERCENTAGE OF AT-RISK PAY. FORM 990, PART I, LINE 1 ORGANIZATION'S MISSION COVENANT HOSPITAL PLAINVIEW IS COMMITTED TO EXTENDING CHRISTIAN MINISTRY BY CARING FOR THE WHOLE PERSON-BODY, MIND AND SPIRIT-AND BY WORKING WITH OTHERS TO IMPROVE HEALTH AND QUALITY OF LIFE IN OUR COMMUNITIES. FORM 990, PART III, LINE 4A PROGRAM SERVICE ACCOMPLISHMENTS COVENANT HOSPITAL PLAINVIEW IS DEDICATED TO PROVIDING THE COMMUNITY OF PLAINVIEW, TEXAS AND HALE COUNTY, WORLD-CLASS HEALTH CARE, CLOSE TO HOME. OUR 100-BED FACILITY IS HOME TO OVER 300 MEDICAL PROFESSIONALS WHOSE MISSION IS TO GIVE OUR PATIENTS THE BEST POSSIBLE CARE AT EACH AND EVERY VISIT. COVENANT HEALTH AND COVENANT HOSPITAL PLAINVIEW ARE FAITH-BASED, NOT-FOR-PROFIT HEALTHCARE INSTITUTIONS, STRIVING EVERY DAY TO PROVIDE HALE COUNTY RESIDENTS WITH THE REGION'S TOP PROVIDERS INCLUDING SURGEONS AND SPECIALISTS. SERVICES INCLUDE: CORPORATE WELLNESS, EMERGENCY SERVICES, ENDOSCOPY, GASTROENTEROLOGY, INTENSIVE CARE, LABORATORY SERVICES, LITHOTRIPSY, NUTRITIONAL CONSULTS, OBSTETRICS AND GYNECOLOGY, OPHTHALMOLOGY, PEDIATRICS, PHYSICAL AND SPEECH THERAPY, RADIOLOGY SERVICES, SLEEP CENTER, SPIRITUAL CARE, SURGICAL SERVICES, UROLOGY, AND WOUND CARE. THREE MISSION OUTCOMES STRATEGICALLY GUIDE OUR MINISTRY WORK COVENANT HOSPITAL PLAINVIEW IS COMMITED TO THREE SYSTEMWIDE MISSION OUTCOMES: 1) SACRED ENCOUNTERS, 2) PERFECT CARE AND 3) HEALTHIEST COMMUNITIES. EVERY INTERACTION WILL BE EXPERIENCED AS A SACRED ENCOUNTER. THE GOAL OF SACRED ENCOUNTER HAS A DIRECT CONNECTION TO THE OVERALL MISSION. OUR VALUE OF DIGNITY CALLS FOR US TO RESPECT EACH PERSON AS AN INHERENTLY VALUABLE MEMBER OF THE HUMAN COMMUNITY AND AS A UNIQUE EXPRESSION OF LIFE. WE STRIVE TO DO THIS BY KEEPING AT THE FOREFRONT OF OUR MINDS THE UNDERSTANDING OF THE IMPACT WE CAN HAVE ON ONE ANOTHER WITH EVERY ACTION WE TAKE. ALL PATIENTS WILL RECEIVE PERFECT CARE. IT IS OUR ATTENTION TO DETAIL AND THE SMALLEST IMPERFECTIONS OF EACH PATIENT'S EXPERIENCE THAT DRIVES A DEEPER UNDERSTANDING AND ULTIMATELY A SUSTAINABLE APPROACH TO THE ACHIEVEMENT OF PERFECT CARE. THE COMMUNITIES WE SERVE WILL BE AMONG THE HEALTHIEST IN OUR NATION. WE SEEK TO DEVELOP COMMUNITY HEALTH INITIATIVES THAT IMPACT LONG-TERM HEALTH ACROSS THE ENTIRE COMMUNITY. FINANCIAL ASSISTANCE PROGRAM WE BELIEVE THAT NO ONE SHOULD DELAY SEEKING NEEDED MEDICAL CARE BECAUSE THEY LACK HEALTH INSURANCE. THAT IS WHY COVENANT HOSPITAL PLAINVIEW HAS A PATIENT FINANCIAL ASSISTANCE PROGRAM THAT PROVIDES FREE AND/OR DISCOUNTED SERVICES TO ELIGIBLE PATIENTS. HEALTHY BODY, MIND, AND SPIRIT THROUGH HK2020 COVENANT HOSPITAL PLAINVIEW'S HK2020 CHILDREN'S PROGRAM IN CREATING A HEALTHIER NEXT GENERATION. HK2020 WAS CREATED AS A COMMUNITY PARTNERSHIP TO ENCOURAGE PHYSICAL ACTIVITY AND INITIALLY FUNDED THROUGH INITIATIVES OF THE ST. JOSEPH HEALTH SYSTEM. IT IS A FREE PROGRAM WITH MONTHLY HEALTHY FAMILY ACTIVITIES AND MOTIVATIONAL TOOLS TO ENCOURAGE FAMILIES TO LEAD HEALTHIER LIVES - BODY, MIND, AND SPIRIT. FOR MORE INFORMATION ABOUT COVENANT HOSPITAL PLAINVIEW PLEASE VISIT HTTP://WWW.COVENANTPLAINVIEW.ORG/ FOR MORE INFORMATION ABOUT COVENANT HEALTH, GO TO: HTTP://WWW.COVENANTHEALTH.ORG FOR MORE INFORMATION ABOUT ST. JOSEPH HEALTH SYSTEM, PLEASE VISIT WWW.STJHS.ORG FORM 990, PART V, LINE 1A ST. JOSEPH HEALTH SYSTEM (SJHS) PAYS ALL VENDORS FOR SJH ENTITIES UNDER SJH AP SHARED SERVICES. THEREFORE, SJHS ISSUES FORM 1099-MISC UNDER ITS TAX ID. SJHS complies with backup withholding rules for reportable payments to vendors. FORM 990, PART VI, LINE 6 DESCRIPTION OF CLASSES OF MEMBERS OR STOCKHOLDERS COVENANT HEALTH SYSTEM IS THE SOLE CORPORATE MEMBER OF COVENANT HOSPITAL PLAINVIEW. FORM 990, PART VI, LINE 7A DESCRIPTION OF CLASSES OF PERSONS AND THE NATURE OF THEIR RIGHTS COVENANT HOSPITAL PLAINVIEW HAS A TIERED GOVERNANCE IN WHICH THE CORPORATE MEMBERS RESERVE THE RIGHT TO APPOINT TRUSTEES TO THE COVENANT HOSPITAL PLAINVIEW BOARD. ALL TRUSTEE APPOINTMENTS THAT COME FROM THE COVENANT HOSPITAL PLAINVIEW BOARD AS NOMINATIONS MUST BE APPROVED BY COVENANT HEALTH SYSTEM, AS THE CORPORATE MEMBER, AND THE ST. JOSEPH HEALTH SYSTEM, AS THE ORGANIZATIONAL SPONSOR. FORM 990, PART VI, LINE 7B DESCR CLASSES OF PERSONS, DECISIONS REQ APPR & TYPE OF VOTING RIGHTS THE RESERVED RIGHTS IN OUR TIERED GOVERNANCE STRUCTURE CONTEMPLATE APPROVAL BY THE ST. JOSEPH HEALTH SYSTEM MEMBER OF FINANCING, BUDGETS, UNBUDGETED EXPENDITURES OF DEFINED AMOUNTS, STRATEGIC PLAN, APPOINTMENT OF AUDITORS, CREATION OR INVESTMENT IN A LEGALLY RECOGNIZED ENTITY, JOINT VENTURES, PURPOSES, SALE OR DISPOSITION OF REAL PROPERTY, MERGER OR SALE OF SUBSTANTIALLY ALL ASSETS, APPOINTMENT AND REMOVAL OF TRUSTEES, ADOPTION OR AMENDMENT OF ARTICLES OR BYLAWS. FORM 990, PART VI, LINE 11B DESCR THE PROCESS USED BY MANAGEMENT &/OR GOVERNING BODY TO REVIEW 990 THE FORM 990 WAS PREPARED BY THE FINANCE DEPARTMENT BASED ON INFORMATION RECEIVED FROM VARIOUS DEPARTMENTS OF THE ORGANIZATION AND WAS REVIEWED BY AN OFFICER OF THE ORGANIZATION. A COPY OF THE FORM 990 WAS DISTRIBUTED TO ALL VOTING MEMBERS OF THE BOARD AT THE APRIL 2017 MEETING. DURING THE FINANCE COMMITTEE MEETING, MANAGEMENT PRESENTED AND DISCUSSED CERTAIN DISCLOSURES AND INFORMATION INCLUDED IN THE FORM 990. THE FINANCE COMMITTEE CHAIR THEN PROVIDED A SUMMARY AT THE FULL BOARD MEETING. FORM 990, PART VI, LINE 12C CONFLICT OF INTEREST POLICY OFFICERS, TRUSTEES AND KEY EMPLOYEES ARE REQUIRED TO DISCLOSE THE EXISTENCE AND NATURE OF ANY ACTUAL, APPARENT, OR POTENTIAL CONFLICTS OF INTEREST HE/SHE MAY HAVE THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT IN CONNECTION WITH THAT INDIVIDUAL SATISFYING THEIR FIDUCIARY OBLIGATIONS TO THE ORGANIZATION. DISCLOSURES SHALL BE MADE PROMPTLY ANY TIME AN ACTUAL, APPARENT OR POTENTIAL CONFLICT OF INTEREST ARISES AND BEFORE THE CONSUMMATION OF ANY CONTRACT, TRANSACTION OR ARRANGEMENT THAT IS THE SUBJECT OF THE POTENTIAL CONFLICT OF INTEREST. WITH GUIDANCE FROM THE ST. JOSEPH HEALTH SYSTEM CHIEF COMPLIANCE OFFICER (CCO), THE CHIEF EXECUTIVE AND/OR THE GOVERNING BOARD CHAIRPERSON, AS APPROPRIATE, CONSIDERS THE MATTER INITIALLY. IF THE MATTER CANNOT BE RESOLVED AT THAT LEVEL, THE MATTER IS ESCALATED TO THE CCO. THE CCO, IN CONSULTATION WITH THE ST. JOSEPH HEALTH SYSTEM GENERAL COUNSEL, REVIEWS THE MATTER AND PRESENTS RECOMMENDATIONS TO THE GOVERNING BOARD AND/OR BOARD COMMITTEE, AS APPROPRIATE, FOR DISCUSSION AND VOTE. THE INDIVIDUAL WHOSE POTENTIAL CONFLICT IS BEING REVIEWED MAY BE REQUESTED TO BE PRESENT DURING ANY MEETING IN WHICH THE BOARD OR BOARD COMMITTEE CONDUCTS ITS EVALUATION BUT SHALL BE EXCUSED FOR ANY DISCUSSION OR VOTE. ONCE ALL NECESSARY INFORMATION HAS BEEN OBTAINED, THE COMMITTEE CONDUCTS ITS EVALUATION AND FORWARDS ITS FINDINGS AND RECOMMENDATIONS TO THE SJHS CHIEF COMPLIANCE OFFICER. IF THE COMMITTEE DETERMINES AN UNRESOLVED CONFLICT OF INTEREST EXISTS, THE COMMITTEE WILL EVALUATE AND RECOMMEND CONFLICT MITIGATION STRATEGIES. THE SJHS CHIEF COMPLIANCE OFFICER, IN CONSULTATION WITH SJHS GENERAL COUNSEL, WILL REVIEW THE COMMITTEE FINDINGS, RECOMMENDATIONS, AND MITIGATION STRATEGIES, AND PRESENT RECOMMENDATIONS TO THE BOARD FOR DISCUSSION AND VOTE. FORM 990, PART VI, LINES 15A & 15B THE ORGANIZATION'S CHIEF EXECUTIVE OFFICER IS PAID BY COVENANT HOSPITAL PLAINVIEW. EXECUTIVE COMPENSATION IS APPROVED BY THE COVENANT HEALTH SYSTEM CONFLICTS AND COMPENSATION COMMITTEE, WHICH IS COMPRISED OF INDEPENDENT PERSONS. THE COMMITTEE REVIEWS COMPARABILITY DATA PREPARED FOR AND COMPILED BY THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE, A COMMITTEE OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES COMPRISED OF INDEPENDENT MEMBERS. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE ACTS IN ACCORDANCE WITH A COMMITTEE CHARTER APPROVED BY THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES AND AN EXECUTIVE COMPENSATION PHILOSOPHY. THE CHARTER DIRECTS THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE TO ADMINISTER THE EXECUTIVE COMPENSATION PROGRAM AND TO APPROVE PROGRAM CHANGES, AS NECESSARY, TO ENSURE ALIGNMENT WITH THE STATED PHILOSOPHY AND ENSURE CONTINUED COMPLIANCE WITH FEDERAL AND STATE REGULATIONS ON BEHALF OF THE ST. JOSEPH HEALTH SYSTEM BOARD OF TRUSTEES. OVERALL, THE PHILOSOPHY IS INTENDED TO REWARD A BROAD SPECTRUM OF HIGH ORGANIZATIONAL AND INDIVIDUAL PERFORMANCE EXPECTATIONS, AS WELL AS RETENTION OF KEY MANAGEMENT TALENT. THE EXECUTIVE COMPENSATION PHILOSOPHY DEFINES THE MARKET FOR ADMINISTERING COMPENSATION AS A COMPARABLE SET OF FOR PROFIT AND NOT-FOR-PROFIT HEALTH CARE DELIVERY SYSTEMS. ST. JOSEPH HEALTH SYSTEM PROVIDES COMPENSATION TO ITS EXECUTIVES IN THE FORM OF BASE SALARY, AN ANNUAL INCENTIVE PROGRAM, AND BENEFITS. TO ENSURE COMPENSATION PHILOSOPHY ADHERENCE AND GENERAL FAIR MARKET VALUE COMPENSATION, THE COMMITTEE REGULARLY REVIEWS INFORMATION FROM MULTIPLE SOURCES OF MARKET DATA AND ENGAGES LEGAL COUNSEL AND CONSULTING SUPPORT, AS NEEDED. THEY USE THIS INFORMATION TO SUPPORT ONGOING EFFECTIVENESS AND ADMINISTRATION OF THE PROGRAM. THE ST. JOSEPH HEALTH SYSTEM WORKLIFE COMMITTEE MEETS AT LEAST 3 TIMES A YEAR AND TAKES ACTION IN EXECUTIVE SESSION. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES AND APPROVED IN SUBSEQUENT MEETINGS. A FULL COMPENSATION REVIEW IS CONDUCTED ON A BIENNIAL BASIS AND THE LAST REVIEW WAS PERFORMED IN JUNE 2016. DURING THE YEAR, THE COVENANT HEALTH SYSTEM CONFLICTS AND COMPENSATION COMMITTEE REVIEWED AND APPROVED ANY CHANGES IN COMPENSATION FOR KEY EXECUTIVES PREDICATED ON THE ANALYSIS AND RECOMMENDATION BY AN INDEPENDENT THIRD PARTY CONSULTNG FIRM WITH EXPERTISE IN HEALTHCARE EXECUTIVE COMPENSATION. IN ADDITION, ANNUAL INCENTIVE AWARDS ARE REVIEWED AND APPROVED PRIOR TO PAYMENT CONSISTENT WITH THE MOST RECENT COMPENSATION BIENNIAL REVIEW AND IN ACCORDANCE WITH THE PLAN DOCUMENT. THESE ACTIONS ARE DOCUMENTED IN DETAILED MINUTES WHICH ARE SUBSEQUENTLY APPROVED AT THE COMMITTEE MEETING. FORM 990, PART VI, LINE 19 AVAIL OF GOV DOCS, CONFLICT OF INTEREST POLICY & FIN STMTS TO GEN PUBLIC THE ORGANIZATION MAKES ITS GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY, AND FINANCIAL STATEMENTS AVAILABLE TO THE PUBLIC UPON REQUEST. THE SJHS COMMUNITY BENEFIT REPORTS, FINANCIAL REPORTS, AND PHILANTHROPY REPORTS ARE ALSO AVAILABLE ON THE SJHS INTERNET SITE. AUDITED FINANCIAL STATEMENTS ARE ATTACHED TO FORM 990. FORM 990, PART XI, LINE 9 CHANGES IN NET ASSETS OR FUND BALANCE INTERCOMPANY EQUITY TRANSFERS $7,046,109 ----------- TOTAL $7,046,109 FORM 990 PART IX LINE 11G DESCRIPTION:PURCHASED MEDICAL SERVICES TOTAL FEES:8302315 COVENANT HEALTH NETWORK INC 3345 MICHELSON DRIVE STE 100 IRVINE CA 92612 461259908 HEALTHCARE CA 501(C)(3) 11,III SJHS true COVENANT ACO 3615 19TH STREET LUBBOCK TX 79410 611573313 HEALTHCARE TX 501(C)(3) 11,I CHS true COVENANT HEALTH SYSTEM 3615 19TH STREET LUBBOCK TX 79410 752765566 HEALTHCARE TX 501(C)(3) 3 SJHS true COVENANT HEALTH SYSTEM FOUNDATION 3623 22ND PLACE LUBBOCK TX 79410 752897026 HEALTHCARE TX 501(C)(3) 7 CHS true COVENANT MEDICAL GROUP 3420 22ND PLACE LUBBOCK TX 79410 752743883 HEALTHCARE TX 501(C)(3) 3 CHS true COVENANT HEALTH PARTNERS 3615 19TH STREET LUBBOCK TX 79410 463516417 HEALTHCARE TX 501(C)(3) 11,I CHS true HMTS INC 1 HOAG DRIVE NEWPORT BEACH CA 92658 453583707 HEALTHCARE CA 501(C)(3) 11,I HMHP true HOAG CHARITY SPORTS 330 PLACENTIA AVE NEWPORT BEACH CA 92663 452982422 SUPPORT CA 501(C)(3) 7 HHF true HOAG HOSPITAL FOUNDATION 330 PLACENTIA AVE NEWPORT BEACH CA 92663 953222343 FUNDRAISING CA 501(C)(3) 7 HMHP true HOAG MEMORIAL HOSPITAL PRESBYTERIAN 1 HOAG ROAD BOX 6100 NEWPORT BEACH CA 92663 951643327 HEALTHCARE CA 501(C)(3) 3 CHN true HOME CARE PARTNERS 1165 MONTGOMERY DR SANTA ROSA CA 95405 680318656 INACTIVE CA 501(C)(3) 3 SRMH true HOSPICE OF LUBBOCK 3702 21ST STREET LUBBOCK TX 79410 752133781 HEALTHCARE TX 501(C)(3) 9 CHS true LUBBOCK METHODIST HOSPITAL FOUNDATION 3615 19TH STREET LUBBOCK TX 79410 752220963 HEALTHCARE TX 501(C)(3) 7 CHS true METHODIST CHILDREN'S HOSPITAL 4015 22nd Place LUBBOCK TX 79410 752428911 HEALTHCARE TX 501(C)(3) 3 CHS true METHODIST HOSPITAL LEVELLAND 1900 COLLEGE AVENUE LEVELLAND TX 79336 752246348 HEALTHCARE TX 501(C)(3) 3 CHS true MISSION HOSPITAL REGIONAL MEDICAL CTR 27700 MEDICAL CENTER ROAD MISSION VIEJO CA 92691 951643360 HEALTHCARE CA 501(C)(3) 3 CHN true QUEEN OF THE VALLEY MEDICAL CENTER 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