2016-05-13T12:17:28-05:00 2015-06-30 990 2014-07-01 271789847 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC SAIN 5418817295 351 SW 9TH STREET ONTARIO OR 979142639 KENNETH FRY INTERIM SYSTEM CFO 5418817295 2016-05-13 2014 2016-08-17 19:52:53Z SEE SCHEDULE O KARL KEELER 351 SW 9TH STREET ONTARIO OR 979142639 70541829 0 0928 X WWW.SAINTALPHONSUS.ORG/ONTARIO X 2010 OR TO PROVIDE HEALTHCARE AND HOSPITAL SERVICES 15 13 610 73 22915 10106 99494 811970 60796575 65182012 757274 744546 3241988 3647822 64895331 70386350 160485 346908 0 0 30384298 28213871 0 0 212945 35259318 35467967 65804101 64028746 -908770 6357604 59024174 68021109 32463927 36234371 26560247 31786738 X WE, SAINT ALPHONSUS HEALTH SYSTEM AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS A MEMBER OF SAINT ALPHONSUS HEALTH SYSTEM AND TRINITY HEALTH. 0 0 52957172 346908 68175555 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. (SAMC - ONTARIO) IS A COMMUNITY HOSPITAL LOCATED IN ONTARIO, OREGON. SAMC - ONTARIO IS A 49-BED ACUTE CARE HOSPITAL SERVING ONTARIO AND THE SURROUNDING COMMUNITIES IN EASTERN OREGON AND SOUTHWESTERN IDAHO. THE HOSPITAL OFFERS A FULL RANGE OF SERVICES IN AN INPATIENT AND OUTPATIENT SETTING AS WELL AS 24 HOUR EMERGENCY CARE, SURGICAL SERVICES, CANCER CARE, MATERNITY CARE, NEUROLOGY, ORTHOPEDICS AND CRITICAL CARE, AMONG MANY OTHER SERVICES. SAMC - ONTARIO OFFERS CONVENIENT ACCESS TO HEALTHCARE SERVICES WITH TWO SEPARATE CLINIC LOCATIONS. PLEASE VISIT SCHEDULE H AND THE WEBSITE FOR ADDITIONAL INFORMATION ABOUT SERVICES, RECOGNITIONS AND AWARDS: WWW.SAINTALPHONSUS.ORG/ONTARIO 52957172 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 137 0 1 610 1 1 1 0 0 0 0 0 0 0 0 0 X 15 13 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X STEPHANIE PLISCHKE 2083674504 6301 EMERALD ST BOISE ID 83706 RODNEY REIDER TRUSTEE; PRES & CEO IDAHO-OREGON REG 1.00 54.00 X X 0 647951 41607 DARREL ANDERSON TRUSTEE; VICE CHAIR AS OF 1/15 1.00 4.00 X X 0 0 0 RONALD GRAVES TRUSTEE; CHAIR THROUGH 12/14 1.00 4.00 X X 0 0 0 MIKE REULING TRUSTEE;V CHAIR THR 12/14;CHR AT1/15 1.00 4.00 X X 0 0 0 J RICHARD O'CONNELL TRUSTEE THRU 7/14; EVP EAST GROUP 1.00 54.00 X 0 1748402 54577 SR SHARON FORD RSM TRUSTEE 1.00 4.00 X 0 0 0 GARY DYER TRUSTEE AS OF 1/15 1.00 4.00 X 0 0 0 MICHAEL FERY TRUSTEE AS OF 1/15 1.00 4.00 X 0 0 0 SALLY JEFFCOAT TRUSTEE; EVP WEST/MIDWEST GROUP 1.00 54.00 X 0 1069085 45673 GEORGE JUETTEN TRUSTEE 1.00 4.00 X 0 0 0 KAYE O'RIORDAN TRUSTEE 1.00 4.00 X 0 0 0 DON ROUMAGOUX TRUSTEE 1.00 4.00 X 0 0 0 MATTHEW SHIRTCLIFF TRUSTEE 1.00 4.00 X 0 0 0 SR SHARLET WAGNER CSC TRUSTEE 1.00 4.00 X 0 0 0 JON WAGNILD MD TRUSTEE 1.00 4.00 X 0 0 0 VICTOR YAMAMOTO TRUSTEE 1.00 4.00 X 0 0 0 STEPHANIE WESTERMEIER SECRETARY; VP & GENERAL COUNSEL 1.00 49.00 X 0 329077 33968 BLAINE PETERSEN TREASURER; SYSTEM CFO 2.00 48.00 X 0 469956 33012 JEAN BASOM REGIONAL DIRECTOR SUPPLY CHAIN 2.00 48.00 X 0 176390 27230 JAMES POLK SAHS CHIEF QUALITY OFFICER 2.00 48.00 X 0 342030 42042 KARL KEELER SAMC NAMPA & SAMC ONTARIO CEO 24.00 26.00 X 0 487044 39538 B LANNIE CHECKETTS SAMC NAMPA & SAMC ONTARIO CFO 24.00 26.00 X 0 273471 39364 PAMELA BRUCE MD SURGEON 50.00 0.00 X 401112 0 36712 FRANK SPOKAS MD SURGEON 50.00 0.00 X 327563 0 43218 JOSH LEAVITT DO PHYSICIAN 50.00 0.00 X 225041 0 26570 MICHAEL HOILIEN DO MEDICAL DIRECTOR 50.00 0.00 X 209221 0 21797 MARK CHRISTENSON MD PHYSICIAN 50.00 0.00 X 207486 0 26807 KEDRICK ADKINS FORMER KEY EMPLOYEE 0.00 0.00 X 0 1069394 1656 PAUL VACHEK FORMER KEY EMPLOYEE 0.00 0.00 X 100979 0 0 RICHARD PALAGI FORMER KEY EMPLOYEE 0.00 0.00 X 0 356193 95922 1471402 6968993 609693 26 1 1 0 REHABILITATION MGMT ASSO 901 N CURTIS 204 BOISE ID 83706 REHAB STAFFING 1726677 ONTARIO EMERGENCY SPECIALISTS 351 SW 9TH ONTARIO OR 97914 EMERGENCY ROOM PHYSICIAN STAFFING 1358971 STRATEGIC STAFFING SOLUTIONS 645 GRISWOLD STE 2900 DETROIT MI 78226 STAFFING SERVICES 613730 APOGEE MEDICAL MANAGEMENT 2525 E CAMELBACK RD STE 1100 PHOENIX AZ 85016 PHYSICIAN SERVICES 548742 EMCARE INC 7032 COLLECTION CENTER DR CHICAGO IL 60693 ER ADMINISTRATIVE SERVICE 501819 14 803831 8139 811970 NET PATIENT SERVICE REVENUE 622110 65182012 65182012 65182012 384877 384877 244530 131575 112955 112955 112955 343819 39754 0 23904 343819 15850 359669 359669 GOV'T SUBSIDY-EHR 622110 1991898 1991898 CAFETERIA REVENUE 722514 338211 338211 PHARMACY REVENUE 446110 180198 180198 1024560 1001645 22915 3534867 70386350 68175555 22915 1375910 X 335500 335500 11408 11408 553094 553094 22447269 21411707 897847 137715 555955 552107 3848 2972949 2790343 164659 17947 1684604 1486246 190209 8149 51143 51143 1937 1937 29193 29193 6474738 5923918 532622 18198 293942 4243 278670 11029 801534 345137 447593 8804 2473440 13169 2460271 1595232 1511312 83920 142124 107676 28334 6114 8520 7658 862 828710 828710 3850884 3139779 711024 81 672228 31793 640435 MEDICAL SUPPLIES 9058499 9058499 I/C PURCHASED SERVICES 4899745 1455231 3444514 BAD DEBT 2104703 2104703 UBI TAXES 23504 23504 2157891 1814529 342302 1060 64028746 52957172 10858629 212945 1184063 1546072 10543987 10882739 110769 139893 138005 1226159 1291102 154232 79880 39738473 10851638 28781972 28886835 8102503 11716032 7185238 11716032 1595358 1764412 59024174 68021109 8742558 13017813 738775 807998 22982594 22408560 32463927 36234371 X 26560247 31786738 26560247 31786738 59024174 68021109 X 6357604 -448429 -682684 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 16401 0 0 0 16401 0 PART II-B, LINE 1: SAINT ALPHONSUS MEDICAL CENTER-ONTARIO, INC. (SAMC-ONTARIO) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED SAMC-ONTARIO WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SAMC-ONTARIO MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 1158775 1158775 22789494 4732601 18056893 13080803 6119037 6961766 2709401 2709401 28886835 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 3280489 F EQUITY METHOD INVESTMENTS 4452092 C HEDGE FUNDS 3983451 F 11716032 INTERCOMPANY NOTES PAYABLE 21470082 INTERCOMPANY ACCOUNTS PAYABLE 574524 ASSET RETIREMENT OBLIGATION(FIN 47) 363954 22408560 1 1 X 1 X 1 X 1 1 0 1 1 866 1185472 1185472 0.01910 43 18234 15350824 13410508 1940316 0.03130 43 19100 16536296 13410508 3125788 0.05040 5 7733 93135 93135 0.00150 2 38 2485 2485 0.00000 1 555 80352 80352 0.00130 9 4013 254477 254477 0.00410 17 12339 430449 430449 0.00690 60 31439 16966745 13410508 3556237 0.05730 1 54 871 871 0.00000 1 12 247 247 0.00000 1 60 32128 32128 0.00050 3 126 33246 33246 0.00050 0 2104703 0 15785070 17749628 -1964558 X 1 1 1 1 ST ALPHONSUS MEDICAL CENTER - ONTARIO 351 SW 9TH ST ONTARIO OR 97914 WWW.SAINTALPHONSUS.ORG/ONTARIO LICENSE 14-1470 X X X ST ALPHONSUS MEDICAL CENTER - ONTARIO 1 0 0 1 X X X X X X X X X 13 1 0 0 1 X PART V, SECTION C X 1 13 1 PART V, SECTION C 0 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X X 1 X PART V, SECTION C X PART V, SECTION C X PART V, SECTION C X X X X X 1 X 0 X X X X 1 X 0 0 ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 5: IN 2014, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO CONDUCTED A COMMUNITY HEALTH NEEDS ASSESSMENT TO DETERMINE THE STATE OF THE COMMUNITY IT SERVES. THIS SURVEY WAS CONDUCTED DURING THE PERIOD FROM FEBRUARY OF 2014 THROUGH MAY OF 2014 AND USED A WIDE VARIETY OF PRIMARY AND SECONDARY SOURCES TO OBTAIN A BROAD OVERVIEW OF INFORMATION. PRIMARY SOURCES: DATA WAS OBTAINED THROUGH COMMUNITY SURVEYS IN OREGON AND IDAHO. IN ORDER TO PROVIDE CONTINUITY OF INFORMATION THROUGHOUT THE SAINT ALPHONSUS HEALTH SYSTEM, ONE COMMUNITY SURVEY WAS UTILIZED FOR THE COMMUNITY HEALTH NEEDS ASSESSMENTS (CHNA) CONDUCTED IN ADA, CANYON AND GEM COUNTIES BY UNITED WAY OF TREASURE VALLEY AND THE UTAH FOUNDATION, AS WELL AS THE NEEDS ASSESSMENT CONDUCTED IN MALHEUR, PAYETTE AND WASHINGTON COUNTIES FOR SAINT ALPHONSUS MEDICAL CENTER - ONTARIO. THE SURVEY WAS DEVELOPED BY THE UNITED WAY OF TREASURE VALLEY WITH COMMUNITY ADVICE ON A NUMBER OF INDICATORS TO BEST DESCRIBE THE OVERALL HEALTH OF THE COMMUNITIES BEING SURVEYED. THE INDICATORS ARE GROUPED INTO FOUR CATEGORIES: FINANCIAL STABILITY AND INDEPENDENCE, SUCCESS IN EDUCATION, LIVING HEALTHY LIVES, AND ACCESS TO BASIC SERVICES.WHILE THE INDICATORS ARE GROUPED INTO CATEGORIES, MANY OF THE INDICATORS AND BARRIERS IDENTIFIED HAVE IMPLICATIONS IN OTHER CATEGORIES. THESE OVER-ARCHING BARRIERS TEND TO BE SOCIAL DETERMINANTS OF POPULATION HEALTH SUCH AS WAGE AND JOB OPPORTUNITIES, POVERTY, EDUCATIONAL ATTAINMENT, AVAILABILITY OF HEALTHY FOODS AND EXERCISE OPPORTUNITIES, AND ACCESS TO BASIC SERVICES. PAYING INCREASED ATTENTION TO THESE SOCIAL DETERMINANTS OF HEALTH REPRESENTS A FUNDAMENTAL SHIFT IN APPROACHING IMPROVEMENTS IN THE OVERALL HEALTH OF COMMUNITIES. ADMINISTERING THE SURVEY WAS ACCOMPLISHED THROUGH A VARIETY OF METHODS AIMED AT GETTING THE MOST DIVERSE CROSS-SECTION OF RESPONDENTS WITH RESPECT TO THOSE TYPICALLY AT RISK IN OUR COMMUNITIES INCLUDING PEOPLE WHO ARE POOR, SINGLE PARENTS, THE ELDERLY, LIMITED ENGLISH PROFICIENT PEOPLE, PEOPLE WITH LOW LEVELS OF LITERACY AND EDUCATION, RACIAL MINORITIES AND PEOPLE WITH UNDOCUMENTED RESIDENCY STATUS. SURVEYS WERE ADMINISTERED THROUGH PARTNERSHIPS WITH SERVICE AGENCIES AND COMMUNITY EXPERTS SUCH AS WICAP (WESTERN IDAHO COMMUNITY ACTION PARTNERSHIP, INC.), SENIOR CENTERS, SCHOOL DISTRICTS, FOOD PANTRIES, AND HEALTH CARE PROVIDERS. THE SURVEY WAS ADMINISTERED IN ENGLISH AND SPANISH, AS WELL AS ORALLY. THE SURVEY WAS ADMINISTERED IN A VARIETY OF SETTINGS, INCLUDING HEALTH CARE WAITING ROOMS, COMMUNITY EVENTS, SCHOOL FAIRS, CLIENT-BASED SERVICE SETTINGS, AND AREAS WHERE PEOPLE FROM UNDER-SERVED POPULATIONS TEND TO VISIT SUCH AS LAUNDROMATS, SENIOR CENTERS, SERVICE AGENCIES, LIBRARIES AND FOOD KITCHENS. COMMUNITY EXPERTS AND SERVICE AGENCIES PROVIDED MUCH INPUT THROUGH SURVEY WORK, DISCUSSIONS AND REVIEW OF THE NEEDS ASSESSMENT AND FINDINGS. THIS WORK OCCURRED DURING THE TIME PERIOD OF MARCH THROUGH MAY DURING THE SURVEY PERIOD AS WELL AS IN JUNE DURING DEVELOPMENT OF THE FINAL COMMUNITY HEALTH NEEDS ASSESSMENT. ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 11: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS ADDRESSING THE NEEDS AS FOLLOWS: NUTRITION, PHYSICAL ACTIVITY AND INCREASED WEIGHT STATUS - THESE NEEDS ARE BEING ADDRESSED BY INCREASING EDUCATIONAL OPPORTUNITIES REGARDING HEALTHY FOODS THROUGH OUR FOOD OUTREACH PROGRAMS, DIABETES EDUCATION, HEALTH FAIRS AND EDUCATION OF HEALTHY PLATE IN THE SURROUNDING COMMUNITY. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO CONTINUES TO SUPPORT THE HEALTH TEACHER AND FOOD EDUCATION PROGRAMS SUCH AS HEALTHY PANTRY AND COOKING MATTERS IN PARTNERSHIP WITH THE OREGON FOOD BANK. TOGETHER, WE ARE COMMITTED TO LOOKING FOR WAYS TO MAKE FRESH FRUIT AND VEGETABLE CONSUMPTION MORE ACCESSIBLE.EDUCATION BARRIERS - LOW HIGH SCHOOL GRADUATION AND COLLEGE ENROLLMENT RATES HAVE BEEN ADDRESSED THROUGH THE POVERTY TO PROSPERITY PROGRAM WITH SEVERAL SITES INCLUDING ONTARIO HIGH SCHOOL, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO AND TREASURE VALLEY COMMUNITY COLLEGE. THE PROGRAM SELECTS STUDENTS FROM HIGH SCHOOLS TO TAKE CLASSES ON WELDING AND ALLIED HEALTH PRIOR TO GRADUATION FROM HIGH SCHOOL, AS A GATEWAY TO FURTHER EDUCATION OPPORTUNITIES OFFERED AT THE LOCAL COMMUNITY COLLEGE. ACCESS TO HEALTH SERVICES - ACCESS TO BASIC HEALTH SERVICES AND LACK OF MEDICAL COVERAGE AND UTILIZATION ARE BEING ADDRESSED THROUGH OUR COMMUNITY OUTREACH. TRANSPORTATION ASSISTANCE, IN THE FORM OF SUPPORTING ADDITIONAL BUS ROUTES TO/FROM VALE, NYSSA AND FRUITLAND, HELP MANY ACCESS SERVICES NOT AVAILABLE IN THEIR COMMUNITIES. CERTIFIED ASSISTERS WERE PROVIDED TO HELP RESIDENTS NAVIGATE THE CHALLENGE OF THE NEWLY FORMED STATE HEALTH INSURANCE EXCHANGES AND MEDICAID EXPANSION IN OREGON. THOUSANDS OF RESIDENTS WERE ENROLLED IN INSURANCE PRODUCTS; MANY HAD BEEN WITHOUT INSURANCE FOR EXTENSIVE PERIODS OF TIME. CONTINUED SUPPORT OF THE MATERNITY CARE CLINIC ENABLES EARLY PRENATAL CARE FOR UNDER-INSURED, UNINSURED AND IMPOVERISHED WOMEN WHO MIGHT OTHERWISE BE UNABLE TO QUALIFY FOR CARE. OF PARTICULAR NOTE IS A GRANT THAT WAS OBTAINED TO DEVELOP A NEW, INNOVATIVE APPROACH TO CARE FOR THE CHRONICALLY ILL AND POOREST MEMBERS OF OUR COMMUNITY. THE HEALTH RESOURCE CENTER, HOUSED WITHIN SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, HAS BEEN ENROLLING PATIENTS IN A COMPREHENSIVE PROGRAM AIMED AT ADDRESSING CHRONIC DISEASE, PREVENTIVE CARE AND LONG-TERM HEALTH MAINTENANCE. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO WILL NOT TAKE ACTION ON THE FOLLOWING IDENTIFIED NEEDS:INJURY AND VIOLENCE PREVENTION - DUE TO LIMITED RESOURCES AND LOWER PRIORITY. FURTHERMORE, THE COUNTY HEALTH DEPARTMENT AND OTHER COMMUNITY ORGANIZATIONS ARE ADDRESSING THIS SPECIFIC NEED.FINANCIAL STABILITY - SAINT ALPHONSUS MEDICAL CENTER - ONTARIO BELIEVES THAT WHILE WE CANNOT DIRECTLY IMPACT THE FINANCIAL STABILITY OF THE COMMUNITY, WE CAN FOCUS EFFORTS ON ASSISTING THE COMMUNITY WITH ACCESS TO AFFORDABLE HEALTH CARE, ASSISTANCE WITH OBTAINING INSURANCE, DEVELOPMENT OF CAREER ADVANCEMENT PROGRAMS AND TUITION ASSISTANCE. ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 22D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. ACUTE CARE PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE ACUTE CARE CONTRACTUAL ADJUSTMENT FOR MEDICARE. AMBULATORY PATIENTS WITH INCOME BETWEEN 201% AND 400% OF THE FPG RECEIVE A DISCOUNT OFF TOTAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE PHYSICIAN CONTRACTUAL ADJUSTMENT FOR MEDICARE. THE ACUTE AND PHYSICIAN AVERAGE CONTRACTUAL ADJUSTMENT AMOUNTS FOR MEDICARE ARE CALCULATED UTILIZING THE LOOK BACK METHODOLOGY OF CALCULATING THE SUM OF PAID CLAIMS DIVIDED BY THE TOTAL GROSS CHARGES FOR THOSE CLAIMS ANNUALLY USING TWELVE MONTHS OF PAID CLAIMS WITH A 30 DAY LAG FROM REPORT DATE TO THE MOST RECENT DISCHARGE DATE. PART V, SECTION B, LINE 7A: WWW.SAINTALPHONSUS.ORG/COMMUNITY-NEEDS-ASSESSMENT PART V, SECTION B, LINE 10A: WWW.SAINTALPHONSUS.ORG/COMMUNITY-NEEDS-ASSESSMENT-IMPLEMENTATION-STRATEGY PART V, SECTION B, LINE 16A: WWW.SAINTALPHONSUS.ORG/FINANCIAL-SERVICES-2133 PART V, SECTION B, LINE 16B: WWW.SAINTALPHONSUS.ORG/FINANCIAL-APPLICATION PART V, SECTION B, LINE 16C: WWW.SAINTALPHONSUS.ORG/FINANCIAL-ASSISTANCE-FAQ-2135 PART V, SECTION B, LINE 16 FINANCIAL ASSISTANCE POLICY WEBSITE AVAILABILITY ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 16A WEBSITE: PART V, SECTION C ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 16B WEBSITE: PART V, SECTION C ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 16C WEBSITE: PART V, SECTION C 5 FRUITLAND HEALTH PLAZA 910 NW 16TH STREET FRUITLAND ID 83619 FAMILY MEDICINE NEW PLYMOUTH CLINIC 213 N PLYMOUTH AVE NEW PLYMOUTH ID 83655 FAMILY MEDICINE ST ALPHONSUS MEDICAL CENTER 1219 SW 4TH AVE ONTARIO OR 97914 WOMEN'S HEALTH STAARS ONTARIO 898 SW 4TH AVE ONTARIO OR 97914 REHAB AND PHYSICAL THERAPY ONTARIO PODIATRY 840 SW 4TH AVE ONTARIO OR 97914 PODIATRY PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF OREGON. IN ADDITION, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.SAINT ALPHONSUS MEDICAL CENTER - ONTARIO ALSO INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, LN 7 COL(F): THE FOLLOWING NUMBER, $2,104,703, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II, COMMUNITY BUILDING ACTIVITIES: AS AN AREA OF DECREASED EDUCATIONAL OPPORTUNITIES, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO HAS BEEN WORKING WITH OTHER EDUCATIONAL INSTITUTIONS TO INCREASE COMMUNITY HEALTH EDUCATION, SUCCESS IN EDUCATION, AND CONTINUE WITH PHYSICIAN RECRUITING IN OUR AREA. THE POVERTY TO PROSPERITY PROGRAM, WHERE STUDENTS FROM HIGH SCHOOLS ARE SELECTED TO TAKE CLASSES ON WELDING AND ALLIED HEALTH PRIOR TO GRADUATION FROM HIGH SCHOOL, ACTS AS A GATEWAY TO FURTHER EDUCATION OPPORTUNITIES OFFERED AT THE LOCAL COMMUNITY COLLEGE. ACCESS TO EDUCATIONAL OPPORTUNITIES THROUGH POVERTY TO PROSPERITY CREATES MORE PROSPECTS FOR HIGH SCHOOL STUDENTS TO PARTICIPATE IN PROGRAMS AIMED AT INCREASING HIGH SCHOOL AND COLLEGE GRADUATION RATES. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS FINANCIALLY AND OPERATIONALLY SUPPORTING THE COMMUNITY THROUGH ALLIED HEALTH PROGRAMS INCLUDING SHADOWING AND MENTORING THROUGH POVERTY TO PROSPERITY. WE HAVE ESTABLISHED AN ALLIED HEALTH PROGRAM IN THREE HIGH SCHOOLS IN MALHEUR COUNTY AND SHADOW PROGRAM FOR HEALTHCARE CAREERS, AS WELL AS SPONSORSHIP OF SIX COMMUNITY NURSING SCHOLARSHIPS ANNUALLY AT TREASURE VALLEY COMMUNITY COLLEGE AND SIX COMMUNITY BSN SCHOLARSHIPS AT NORTHWEST NAZARENE UNIVERSITY AS A WAY TO BUILD THE COMMUNITY. PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS. PART III, LINE 3: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 15 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE." PART III, LINE 8: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - SAINT ALPHONSUS MEDICAL CENTER - ONTARIO ASSESSES THE HEALTH STATUS OF ITS COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED, IN ITS ASSESSMENT OF THE COMMUNITY'S HEALTH STATUS. WE ALSO UTILIZE THE EXPERTISE OF OUR PUBLIC HEALTH PARTNERS AND THEIR ANALYSIS OF COMMUNITY NEEDS. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO EXAMINED SEVERAL OTHER LOCAL NEEDS ASSESSMENTS AND OBTAINED INPUT FROM ORGANIZATIONS INVOLVED IN THOSE ASSESSMENTS, INCLUDING OUR EXTERNAL REVIEW COMMITTEE (FOUR RIVERS HEALTHY COMMUNITIES OREGON), THE MALHEUR COUNTY HEALTH DEPARTMENT AND THE EASTERN OREGON COORDINATED CARE ORGANIZATION TO IDENTIFY NEEDS BEING ADDRESSED BY OTHER AGENCIES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS COMMITTED TO:-PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES-CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES-ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE -BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: -PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS-MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS-OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS-IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER-IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSSAINT ALPHONSUS MEDICAL CENTER - ONTARIO COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE.FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. FINANCIAL ASSISTANCE APPLICATIONS WILL BE ACCEPTED UNTIL ONE YEAR AFTER THE FIRST BILLING STATEMENT TO THE PATIENT. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN SPANISH, REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. PART VI, LINE 4: COMMUNITY INFORMATION - SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS SITUATED IN MALHEUR COUNTY, OREGON, THE SECOND LARGEST COUNTY IN THE STATE; 9,926 SQUARE MILES IN THE SOUTHEASTERN-MOST CORNER OF THE STATE. BY DEFINITION, MALHEUR COUNTY IS CONSIDERED "FRONTIER" WITH A MERE 3.2 PERSONS PER SQUARE MILE - ALTHOUGH THE POPULATION IS FAIRLY CLUSTERED TOGETHER IN SMALL COMMUNITIES. GEOGRAPHIC ISOLATION RESULTS IN CHALLENGES ACCESSING OREGON SERVICES. WHILE IDAHO IS IN CLOSE PROXIMITY, RESIDENTS OF MALHEUR COUNTY ARE OFTEN UNABLE TO UTILIZE GOVERNMENT SERVICES ACROSS STATE LINES. THE COUNTY HAS A TOTAL OF 31,313 RESIDENTS, OVER HALF OF WHICH LIVE IN THE CITY OF ONTARIO. THE LOCAL ECONOMY IS LARGELY BASED ON AGRICULTURE AND FARMING, AND THE COUNTY IS 94% RANGELAND.MALHEUR COUNTY IS NOTABLE FOR A HIGHER THAN AVERAGE HISPANIC/LATINO POPULATION, MANY OF WHOM ARE SEASONAL, OR MIGRANT, AGRICULTURE WORKERS. THIS IS ALSO EVIDENCED BY A HIGHER THAN AVERAGE PERCENTAGE OF LANGUAGES OTHER THAN ENGLISH SPOKEN AT HOME. MALHEUR COUNTY IS ALSO NOTABLE FOR A POPULATION DENSITY OF 3.2 PERSONS PER SQUARE MILE, WHERE RESIDENTS MUST TRAVEL LONG DISTANCES FOR SERVICES. MALHEUR COUNTY HAS THE LOWEST MEDIAN HOUSEHOLD INCOME AT $35,788, COMPARED TO $50,036 AT A STATE LEVEL AND $53,046 AT THE U.S. LEVEL. THE POVERTY LEVEL, AT 22.7%, IS THE HIGHEST OF THE THREE COUNTIES, AND IS SIGNIFICANTLY ABOVE STATE AND U.S. LEVELS.THE ABILITY TO EARN A LIVABLE WAGE WAS THE HIGHEST RATED BARRIER TO FINANCIAL STABILITY WITH ALMOST EVERY SURVEY RESPONDENT LISTING THIS AS THEIR PRIMARY NEED FOR ACHIEVING FINANCIAL STABILITY. LOW WAGES ALSO CONTRIBUTE TO THE OTHER MOST FREQUENTLY IDENTIFIED BARRIERS AS WELL, WITH INABILITY TO AFFORD TRAINING AND EDUCATION, INCLUDING COLLEGE AND TECHNICAL EDUCATION, AS A KEY THEME. HIGH HOUSING COST BURDENS FURTHER EXACERBATE THE DIFFICULTIES OF THOSE WITH LOW INCOME LEVELS. PART VI, LINE 5: OTHER INFORMATION - SAINT ALPHONSUS MEDICAL CENTER - ONTARIO STRONGLY SUPPORTS HEALTHCARE WORKFORCE DEVELOPMENT EFFORTS, INCLUDING ANNUAL FINANCIAL SUPPORT TO THE TREASURE VALLEY COMMUNITY COLLEGE NURSING PROGRAM. IN ADDITION, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO SERVES AS A KEY CLINICAL TRAINING SITE FOR NURSES AND OTHER ALLIED HEALTH PROFESSIONALS.WE PROVIDE THE MAJORITY OF THE FUNDING, SPACE AND SUPPLIES TO STAFF A MATERNITY CARE CLINIC TO SERVE LOW-INCOME WOMEN WHO OTHERWISE COULD NOT AFFORD PRE-NATAL CARE.WE OFFER A VARIETY OF HEALTH EDUCATION AND SCREENING OPPORTUNITIES FREE OF CHARGE INCLUDING CARDIAC & STROKE SCREENINGS, FREE LIPID PROFILES, MAMMOGRAMS, AND MORE. WE USE THESE SCREENINGS AS AN OPPORTUNITY TO CONNECT PARTICIPANTS WITH A PRIMARY CARE PROVIDER FOR FURTHER HEALTH GUIDANCE. PART VI, LINE 6: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL REGIONAL HEALTH MINISTRIES DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. ANNUALLY, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. PART VI, LINE 7, REPORTS FILED WITH STATES OR 1 BOYS & GIRLS CLUB OF WESTERN TREASURE VALLEY PO BOX 876 ONTARIO OR 97914 208035378 501(C)3 5100 PROGRAM ACTIVITIES HANDS OF HOPE NORTHWEST INC 1201 S POWERLINE RD NAMPA ID 83686 841398889 501(C)3 100729 FMV MEDICAL SUPPLIES MEDICAL SUPPLIES TREASURE VALLEY COMMUNITY COLLEGE FOUNDATION 650 COLLEGE BLVD ONTARIO OR 97914 237052989 501(C)3 111900 GENERAL DONATION TREASURE VALLEY WOMENS CLINIC 1219 SW 4TH AVE STE 2 ONTARIO OR 97914 931161658 80000 GENERAL DONATION CITY OF ONTARIO 444 SW 4TH ST ONTARIO OR 97914 936002229 GOVERNMENT ORG. 25000 AQUATIC CENTER 4 1 MEDICATIONS 27 644 FMV PRESCRIPTION MEDICATIONS HEALTHCARE ASSISTANCE 52 2030 FMV MAMMOGRAM READINGS HEALTHCARE ASSISTANCE 46 8714 FMV MAMMOGRAM SCREENINGS PART I, LINE 2: DONATIONS MADE BY SAINT ALPHONSUS MEDICAL CENTER - ONTARIO TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. 1 1 0 0 0 0 0 0 0 RODNEY REIDER TRUSTEE; PRES & CEO IDAHO-OREGON REG 0 403612 0 169313 0 75026 0 14603 0 27004 0 689558 0 0 J RICHARD O'CONNELL TRUSTEE THRU 7/14; EVP EAST GROUP 0 791024 0 532372 0 425006 0 18200 0 36377 0 1802979 0 174337 SALLY JEFFCOAT TRUSTEE; EVP WEST/MIDWEST GROUP 0 603463 0 201629 0 263993 0 18200 0 27473 0 1114758 0 118482 STEPHANIE WESTERMEIER SECRETARY; VP & GENERAL COUNSEL 0 321522 0 6007 0 1548 0 13000 0 20968 0 363045 0 0 BLAINE PETERSEN TREASURER; SYSTEM CFO 0 385126 0 80954 0 3876 0 13000 0 20012 0 502968 0 0 JEAN BASOM REGIONAL DIRECTOR SUPPLY CHAIN 0 153515 0 19037 0 3838 0 11857 0 15373 0 203620 0 0 JAMES POLK SAHS CHIEF QUALITY OFFICER 0 267431 0 70626 0 3973 0 24775 0 17267 0 384072 0 0 KARL KEELER SAMC NAMPA & SAMC ONTARIO CEO 0 316893 0 108996 0 61155 0 14251 0 25287 0 526582 0 0 B LANNIE CHECKETTS SAMC NAMPA & SAMC ONTARIO CFO 0 235947 0 27445 0 10079 0 18200 0 21164 0 312835 0 0 PAMELA BRUCE MD SURGEON 316609 0 47500 0 37003 0 13000 0 23712 0 437824 0 0 0 FRANK SPOKAS MD SURGEON 308223 0 18000 0 1340 0 28200 0 15018 0 370781 0 0 0 JOSH LEAVITT DO PHYSICIAN 216815 0 100 0 8126 0 6875 0 19695 0 251611 0 0 0 MICHAEL HOILIEN DO MEDICAL DIRECTOR 207071 0 0 0 2150 0 10614 0 11183 0 231018 0 0 0 MARK CHRISTENSON MD PHYSICIAN 184439 0 0 0 23047 0 6160 0 20647 0 234293 0 0 0 KEDRICK ADKINS FORMER KEY EMPLOYEE 0 0 0 0 0 1069394 0 0 0 1656 0 1071050 0 1056681 PAUL VACHEK FORMER KEY EMPLOYEE 0 0 0 0 100979 0 0 0 0 0 100979 0 0 0 RICHARD PALAGI FORMER KEY EMPLOYEE 0 39288 0 55086 0 261819 0 83997 0 11925 0 452115 0 0 PART I, LINE 3 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION FOR SAINT ALPHONSUS MEDICAL CENTER - ONTARIO'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINES 4A-B THE FOLLOWING INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR 2014. THESE AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $814,924 RICHARD PALAGI - $215,992 PAUL VACHEK - $100,979 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. IN ADDITION, COLUMN C OF SCHEDULE J, PART II INCLUDES $83,997 OF SEVERANCE FOR RICHARD PALAGI WHICH WAS UNPAID AS OF 12/31/14. THIS AMOUNT WAS PAID AND INCLUDED IN RICHARD PALAGI'S TAXABLE INCOME IN 2015. THE FOLLOWING IS A PARTICIPANT IN AN INDIVIDUAL SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). HE DID NOT RECEIVE A SERP PAYOUT IN 2014. KEDRICK ADKINS THE FOLLOWING ARE PARTICIPANTS IN THE NEW TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) EFFECTIVE JANUARY 1, 2014. THE PLAN WILL PROVIDE RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. THERE WERE NO PAYOUTS IN 2014. SALLY JEFFCOAT KARL KEELER J. RICHARD O'CONNELL RICHARD PALAGI RODNEY REIDER THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH CASH BALANCE RESTORATION AND RETENTION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETENTION BENEFITS PLUS RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($260,000 FOR 2014). THE PLAN WAS FROZEN DECEMBER 31, 2013. THE FOLLOWING PAYOUTS FOR 2014 FOR THIS PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $242,986 SALLY JEFFCOAT - $126,988 J. RICHARD O'CONNELL - $185,824 COLUMN F OF SCHEDULE J, PART II INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS. THE FOLLOWING INDIVIDUAL IS A PARTICIPANT IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER SECTION 457(F). THE FOLLOWING DEFERRAL FOR 2014 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: FRANK SPOKAS - $10,000 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS SAINT ALPHONSUS HEALTH SYSTEM, INC. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A SAINT ALPHONSUS HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. SAINT ALPHONSUS HEALTH SYSTEM, INC. HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, SAINT ALPHONSUS HEALTH SYSTEM, INC. MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. SAINT ALPHONSUS HEALTH SYSTEM, INC. MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE FINANCE COMMITTEE OF SAINT ALPHONSUS HEALTH SYSTEM. (SAINT ALPHONSUS HEALTH SYSTEM IS THE SOLE MEMBER OF THE CORPORATION.) THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC., WHICH INCLUDES TRUSTEES, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE PROVIDED TO INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF TRUSTEES OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF TRUSTEES OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS ESTABLISHED AND PAID BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND SYSTEM CFO COMPENSATION, TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF THE CEO AND SYSTEM CFO OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC.'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MEDICAL SPECIALIST FEES: PROGRAM SERVICE EXPENSES 2,825,132. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,825,132. CONSULTING SERVICES: PROGRAM SERVICE EXPENSES 36,177. MANAGEMENT AND GENERAL EXPENSES 71,779. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 107,956. COLLECTION SERVICES: PROGRAM SERVICE EXPENSES 17,430. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 17,430. MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 655,049. MANAGEMENT AND GENERAL EXPENSES 460,843. FUNDRAISING EXPENSES 18,198. TOTAL EXPENSES 1,134,090. MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 405,477. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 405,477. THERAPEUTIC SERVICES: PROGRAM SERVICE EXPENSES 1,970,044. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,970,044. RECRUITMENT: PROGRAM SERVICE EXPENSES 14,609. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 14,609. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES -680,000. OTHER TRANSACTIONS -2,684. FORM 990, PART XII, LINE 2: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY15 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PAGE I, DOING BUSINESS AS NAMES: TRINITY HOLY ROSARY MEDICAL CENTER SAINT ALPHONSUS MEDICAL CENTER - ONTARIO SAINT ALPHONSUS MEDICAL GROUP - ONTARIO ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 1 ALBANY MEMORIAL HOSPITAL 600 NORTHERN BLVD ALBANY NY 12204 141338457 HEALTHCARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 NORTHEAST HEALTH INC 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT FL 501(C)(3) LINE 11A, I TRINITY HEALTH CORPORATION 1 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 HOSPICE SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 1 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 VOLUNTEER SERVICE AUXILIARY OR 501(C)(3) LINE 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 HEALTHCARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 FOUNDATION IA 501(C)(3) LINE 11A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 BRIGHTSIDE INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042182395 HEALTHCARE SERVICES MA 501(C)(3) LINE 9 SISTERS OF PROVIDENCE HEALTH SYSTEM INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA ST COHOES NY 12047 141701597 LONG TERM CARE NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 HEALTHCARE SERVICES (INACTIVE) MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 CATHOLIC HEALTH MINISTRIES 20555 VICTOR PARKWAY LIVONIA MI 48152 GOVERNANCE AND MANAGEMENT OF TRINITY HEALTH SYSTEM VT 501(C)(3) LINE 1 N/A 0 COLUMBUS ACQUISITION CORP 111 CENTRAL AVENUE NEWARK NJ 07102 262616342 INACTIVE ENTITY NJ 501(C)(3) LINE 9 SAINT MICHAEL'S MEDICAL CENTER 1 COMMUNITY HEALTH PARTNERS OF SOUTH BEND PO BOX 3998 SOUTH BEND IN 46619 263051440 HEALTHCARE SERVICES IN 501(C)(3) LINE 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 1 CRANBROOK HOSPICE CARE 1111 W LONG LAKE RD STE 102 TROY MI 48098 383320699 HOSPICE SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 1 DILEY RIDGE MEDICAL CENTER 7911 DILEY ROAD CANAL WINCHESTER OH 43110 342032340 HEALTHCARE AND HOSPITAL SERVICES OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM 1 DUBUQUE MERCY HEALTH FOUNDATION INC 250 MERCY DRIVE DUBUQUE IA 52001 262227941 FOUNDATION IA 501(C)(3) LINE 11A, I MERCY HEALTH SERVICES-IOWA CORP 1 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 FOUNDATION IA 501(C)(3) LINE 11A, I MERCY HEALTH SERVICES-IOWA CORP 1 EAST NORRITON PHYSICIAN SERVICES C/O ONE WEST ELM STREET CONSHOHOCKEN PA 19428 232515999 HEALTHCARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH SERVICES NY 501(C)(3) LINE 3 LTC (EDDY) INC 1 EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME HEALTH SERVICES NY 501(C)(3) LINE 9 HOME AIDE SERVICE OF EASTERN NEW YORK INC 1 FARREN CARE CENTER INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 042501711 LONG TERM CARE MA 501(C)(3) LINE 3 SISTERS OF PROVIDENCE HEALTH SYSTEM INC 1 FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON DE 19805 223008680 LONG TERM CARE (INACTIVE) DE 501(C)(3) LINE 9 ST FRANCIS HOSPITAL 1 GLEN EDDY INC ONE GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 GLOBAL HEALTH MINISTRY 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE PA 19073 233068656 HEALTHCARE SERVICES PA 501(C)(3) LINE 7 TRINITY HEALTH CORPORATION 1 GLOBAL HEALTH MINISTRY (FKA TRINITY HEALTH INTERNATIONAL) 20555 VICTOR PARKWAY LIVONIA MI 48152 421253527 HEALTHCARE SERVICES MI 501(C)(3) LINE 11A, I TRINITY HEALTH CORPORATION 1 GOOD SAMARITAN HOSPITAL INC 5401 LAKE OCONEE PARKWAY GREENSBORO GA 30642 261720984 HEALTHCARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 ST MARY'S HEALTH CARE SYSTEM INC 1 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK IL 60160 363332852 COMMUNITY OUTREACH IL 501(C)(3) LINE 9 GOTTLIEB MEMORIAL HOSPITAL 1 GOTTLIEB MEMORIAL FOUNDATION 701 W NORTH AVE MELROSE PARK IL 60160 743260011 FOUNDATION IL 501(C)(3) LINE 11C, III-FI N/A 0 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 60160 362379649 HEALTHCARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 GRAND RAPIDS MEDICAL EDUCATION PARTNERS INC 1000 MONROE AVENUE NW GRAND RAPIDS MI 49503 237270669 MEDICAL EDUCATION TRAINING PROGRAMS MI 501(C)(3) LINE 11A, I TRINITY HEALTH-MICHIGAN 1 HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 MUSKEGON MI 49443 382299878 SELF INSURANCE MI 501(C)(3) LINE 11B, II MERCY HEALTH PARTNERS 1 HACKLEY LIFE COUNSELING 125 E SOUTHERN AVENUE MUSKEGON MI 49442 381386362 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 MERCY HEALTH PARTNERS 1 HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH NY 12061 800102840 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE TROY NY 12180 141725101 LONG TERM CARE NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS MI 48152 521945054 LONG TERM CARE MD 501(C)(3) LINE 9 HOLY CROSS HEALTH INC 1 HOLY CROSS HEALTH FOUNDATION INC 11801 TECH ROAD SILVER SPRING MD 20904 208428450 FOUNDATION MD 501(C)(3) LINE 7 HOLY CROSS HEALTH INC 1 HOLY CROSS HEALTH INC 1500 FOREST GLEN RD SILVER SPRING MD 20910 520738041 HEALTHCARE AND HOSPITAL SERVICES MD 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 590791028 HEALTHCARE AND HOSPITAL SERVICES FL 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS MEDICAL PROPERTIES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 650666283 BUILDING MANAGEMENT SERVICES FL 501(C)(2) N/A HOLY CROSS HOSPITAL INC 1 HOLY CROSS OUTPATIENT SERVICES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 465421068 HEALTHCARE SERVICES FL 501(C)(3) LINE 9 HOLY CROSS HOSPITAL INC 1 HOME AIDE SERVICE OF EASTERN NEW YORK INC 433 RIVER ST SUITE 3000 TROY NY 12180 141514867 HOME HEALTH SERVICES NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 HOSPICE OF NORTH IOWA 232 SECOND STREET SE MASON CITY IA 50401 421173708 HOSPICE SERVICES IA 501(C)(3) LINE 9 MERCY HEALTH SERVICES-IOWA CORP 1 HOSPICE OF SIOUXLAND 4300 HAMILTON BLVD SIOUX CITY IA 51104 383320710 HOSPICE SERVICES IA 501(C)(3) LINE 11A, I N/A 0 HOSPICE OF WASHTENAW II 806 AIRPORT BLVD ANN ARBOR MI 48108 383320707 HOSPICE SERVICES MI 501(C)(3) LINE 11A, I TRINITY HEALTH-MICHIGAN 1 IHA HEALTH SERVICES CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR MI 48106 383316559 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 1 INTRACOASTAL HEALTH SYSTEMS INC 3805 WEST CHESTER PIKE SUITE 100 NEWTOWN SQUARE PA 19073 650556413 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT FL 501(C)(3) LINE 9 TRINITY HEALTH CORPORATION 1 JAMES A EDDY MEMORIAL GERIATRIC CENTER INC 2256 BURDETT AVE TROY NY 12180 222570478 LONG TERM CARE NY 501(C)(3) LINE 9 LTC (EDDY) INC 1 LANGHORNE MRI INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 232519529 HEALTHCARE SERVICES (INACTIVE) PA 501(C)(3) LINE 9 ST MARY MEDICAL CENTER 1 LANGHORNE PHYSICIAN SERVICES INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 232571699 HEALTHCARE SERVICES PA 501(C)(3) LINE 9 ST MARY MEDICAL CENTER 1 LIFE AT LOURDES INC 2475 MCCLELLAN AVENUE PENNSAUKEN NJ 08109 261854750 PACE PROGRAM NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LIFE AT ST FRANCIS HEALTHCARE INC 7TH CLAYTON STREETS WILMINGTON DE 19805 452569214 PACE PROGRAM DE 501(C)(3) LINE 9 ST FRANCIS HOSPITAL 1 LIFE ST FRANCIS CORPORATION 1435 LIBERTY STREET HAMILTON NJ 08629 222797282 PACE PROGRAM NJ 501(C)(3) LINE 11A, I ST FRANCIS MEDICAL CENTER TRENTON NJ 1 LIFE ST JOSEPH OF THE PINES INC 100 GOSSMAN DRIVE SOUTHERN PINES NC 28387 272159847 PACE PROGRAM NC 501(C)(3) LINE 3 ST JOSEPH OF THE PINES INC 1 LIFE ST MARY 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 262976184 PACE PROGRAM PA 501(C)(3) LINE 9 ST MARY MEDICAL CENTER 1 LOURDES ANCILLARY SERVICES 1600 HADDON AVENUE CAMDEN NJ 08103 222568525 VOLUNTEER SERVICE AUXILIARY NJ 501(C)(3) LINE 11B, II OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES CARDIOLOGY SERVICES PC 1600 HADDON AVENUE CAMDEN NJ 08103 274357794 HEALTHCARE SERVICES NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES DIALYSIS AT INNOVA INC 3716 CHURCH ROAD MT LAUREL NJ 08054 263237625 HEALTHCARE SERVICES (INACTIVE) NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES MEDICAL CENTER OF BURLINGTON COUNTY 218 SUNSET ROAD WILLINGBORO NJ 08046 223612265 HEALTHCARE AND HOSPITAL SERVICES NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOYOLA UNIVERSITY HEALTH SYSTEM 2160 SOUTH FIRST AVENUE MAYWOOD IL 60153 363342448 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT IL 501(C)(3) LINE 11B, II TRINITY HEALTH CORPORATION 1 LOYOLA UNIVERSITY MEDICAL CENTER 2160 SOUTH FIRST AVENUE MAYWOOD IL 60153 364015560 HEALTHCARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 LTC (EDDY) INC 2212 BURDETT AVE TROY NY 12180 222564710 MANAGEMENT SERVICES FOR LONG TERM CARE NY 501(C)(3) LINE 11B, II NORTHEAST HEALTH INC 1 MARIAN COMMUNITY HOSPITAL 3805 WEST CHESTER PIKE NO 100 NEWTOWN SQUARE PA 19073 240711230 HEALTHCARE SERVICES (INACTIVE) PA 501(C)(3) LINE 9 MAXIS HEALTH SYSTEM 1 MARIAN HOME HEALTHCARE 801 5TH STREET SIOUX CITY IA 51101 383320705 HOME HEALTH SERVICES (INACTIVE) IA 501(C)(3) LINE 11A, I MERCY HEALTH SERVICES-IOWA CORP 1 MARYCREST HEIGHTS PO BOX 9184 FARMINGTON HILLS MI 48333 270291722 SENIOR LIVING COMMUNITY MI 501(C)(3) LINE 11A, I TRINITY CONTINUING CARE SERVICES 1 MAXIS HEALTH SYSTEM 3805 WEST CHESTER PIKE NO 100 NEWTOWN SQUARE PA 19073 911940902 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT (INACTIVE) PA 501(C)(3) LINE 11A, I TRINITY HEALTH CORPORATION 1 MCAULEY CENTER INC 275 STEELE ROAD WEST HARTFORD CT 06117 061058086 SENIOR LIVING COMMUNITY CT 501(C)(3) LINE 9 MERCY COMMUNITY HEALTH INC 1 MCAULEY CLINIC CORPORATION PO BOX 992 ANN ARBOR MI 48106 382561013 HEALTHCARE SERVICES (INACTIVE) MI 501(C)(3) LINE 3 CATHERINE MCAULEY HEALTH SERVICES CORP 1 MCAULEY MINISTRIES 3333 FIFTH AVENUE PITTSBURGH PA 15213 943436142 GRANT MAKING PA 501(C)(3) LINE 11A, I PITTSBURGH MERCY HEALTH SYSTEM 1 MERCY AMICARE HOME HEALTHCARE OAKLAND 1111 W LONG LAKE RD STE 102 TROY MI 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SPRINGFIELD PA 19064 232325059 HOME HEALTH SERVICES PA 501(C)(3) LINE 9 MERCY HOME HEALTH SERVICES 1 MERCY FOUNDATION INC 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 60616 363227350 FOUNDATION IL 501(C)(3) LINE 7 MERCY HEALTH SYSTEM OF CHICAGO 1 MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE 888 TERRACE STREET MUSKEGON MI 49440 383321856 HOME HEALTH SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 1 MERCY HEALTH FOUNDATION OF SOUTHEASTERN PENNSYLVANIA C/O ONE WEST ELM STREET CONSHOHOCKEN PA 19428 232829864 FOUNDATION PA 501(C)(3) LINE 11B, II MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA 1 MERCY HEALTH NETWORK 1111 6TH AVENUE DES MOINES IA 50314 421478417 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT DE 501(C)(3) LINE 11A, I N/A 0 MERCY HEALTH PARTNERS 1415 LEAHY STREET MUSKEGON MI 49442 382589966 HEALTHCARE AND HOSPITAL SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 MERCY HEALTH PLAN C/O ONE WEST ELM STREET CONSHOHOCKEN PA 19428 222483605 MEDICAID MANAGED CARE PLAN PA 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SERVICES PA 501(C)(3) LINE 9 MERCY HOME HEALTH SERVICES 1 MERCY HOME HEALTH SERVICES 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD PA 19064 232325058 MANAGEMENT SERVICES FOR HOME HEALTH PA 501(C)(3) LINE 11B, II MERCY HEALTH SYSTEM OF SOUTHEASTERN PENNSYLVANIA 1 MERCY HOSPITAL AND MEDICAL CENTER 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 60616 362170152 HEALTHCARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 MERCY HEALTH SYSTEM OF CHICAGO 1 MERCY HOSPITAL CADILLAC FOUNDATION 400 HOBART CADILLAC MI 49601 203357131 FOUNDATION MI 501(C)(3) LINE 11A, I TRINITY HEALTH-MICHIGAN 1 MERCY HOSPITAL GIFT SHOP 2601 ELECTRIC AVE PORT HURON MI 48060 381630480 VOLUNTEER SERVICE AUXILIARY MI 501(C)(3) LINE 11A, I TRINITY HEALTH-MICHIGAN 1 MERCY HOSPITAL INC C/O SPHS 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 043398280 HEALTHCARE AND HOSPITAL SERVICES MA 501(C)(3) LINE 3 SISTERS OF PROVIDENCE HEALTH SYSTEM INC 1 MERCY HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 590791034 HEALTHCARE SERVICES 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