2015-05-15T09:14:10-05:00 2014-06-30 861065772 Deloitte Tax LLP 250 East Fifth Street Suite 1900 Cincinnati OH 45202 990 2013-07-01 910349750 Our Lady of Lourdes Hospital at Pasco OURL 5095477704 520 North 4th Avenue Pasco WA 993012568 Frank R Becker VP Finance/CFO 5095462282 2015-05-12 1 Cody Cain P00902498 5137847100 2015-05-06 2013 2016-04-25 22:37:26Z Lourdes Health Network John Serle 520 North 4th Avenue Pasco WA 993012568 101363560 0 0928 X www.lourdeshealth.net X 1920 WA Respond to the healthcare needs of the Mid-Columbia area in a Christian spirit. 14 14 875 111 -102813 -228691 256709 1676061 102106610 99159865 868805 719509 137999 -310698 103370123 101244737 254749 345986 0 0 57787513 52934855 0 0 0 44445494 48480170 102487756 101761011 882367 -516274 72806536 69600854 28970017 27203575 43836519 42397279 X Our Mission is an extension of the healing ministry of Jesus. We are called to serve our community, our patients, their loved ones and our coworkers with respect, compassion, and care. We respond to the healthcare needs of the community in a Christian spirit. We strive for excellence in all we do. 0 0 44815260 50693790 Our Lady of Lourdes Hospital at Pasco provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2014, approximately 31% of the value of services rendered were to elderly patients under the Medicare program, and approximately 20% of services were provided to patients who were deemed indigent under state, county, or Hospital Guidelines. In the spirit of principles adopted by Ascension Health, Our Lady of Lourdes Hospital at Pasco has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons especially the uninsured, the underinsured, and the underserved. During the fiscal year ending June 30, 2014, the estimated cost of services provided to the elderly, uninsured, and the underinsured totaled $7,191,764, including $1,892,189 cost for charity care and $1,710,666 in bad debts attributable to the uninsured and underinsured, $184,500 in services to the general community, and $3,404,409 in unpaid cost of public programs. 9567039 345986 10737924 Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. In efforts to promote healthy living, Our Lady of Lourdes Hospital at Pasco has made available the following programs to the community: physical fitness activities, community health programs, medical education, cancer screening programs, support groups and educational classes, CPR and first aid classes, health screening, flu shot clinic, nutrition and weight loss management. 33749962 37880534 Our Lady of Lourdes Hospital at Pasco provides the following inpatient and outpatient medical services to the community: emergency care services, flight care, laboratory services, orthopedic services, pain management, primary care physicians, radiology services, rehabilitation services, sleep studies, physical therapy, occupational therapy, speech therapy, respiratory therapy, surgery, pediatrics, imaging, inpatient and outpatient alcohol and substance abuse, and inpatient and outpatient behavioral health services. Some of these services, such as rehab therapies, primary care physicians and behavioral health operate at a loss in order to ensure that all services are available to meet community health care needs. During the fiscal year ending June 30, 2014, Our Lady of Lourdes Hospital at Pasco treated 2,387 inpatient adults and children in the community for a total of 12,338 patient days of service. Our Lady of Lourdes Hospital at Pasco also provided services to 267,600 outpatients, including 1,956 outpatient surgical patients, 19,679 emergency room visits, 77,264 behavioral health visits, 133,331 clinic and urgent care visits, and 35,370 other visits. 88132261 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 104 0 1 875 1 1 1 0 0 0 0 0 0 0 0 0 X 14 14 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 1 1 X Roberta Wittorf 5095423044 520 North 4th Avenue Pasco WA 993012568 X Bart Gallant Chairman 1.00 0.00 X X 0 0 0 Charles Graves Vice Chairman 1.00 0.00 X X 0 0 0 Julie Killian Vice President 1.00 0.00 X X 0 0 0 Sr Mary Catherine Siminski Secretary 1.00 0.00 X X 0 0 0 Greg Garcia Treasurer 1.00 0.00 X X 0 0 0 Dr Laurie Evans Member 1.00 0.00 X 0 0 0 Webster Jackson Member 1.00 0.00 X 0 0 0 Sr Ann Patricia O'Connor Member 1.00 0.00 X 0 0 0 Sr Adrienne Clare Pereira Member 1.00 0.00 X 0 0 0 Jeff Petersen Member 1.00 0.00 X 0 0 0 Sr Pat Rosholt Member 1.00 0.00 X 0 0 0 Dr Venkataraman Sambasivan Member 1.00 0.00 X 0 0 0 Randy Shoop Member 1.00 0.00 X 0 0 0 Kevin Williams Member 1.00 0.00 X 0 0 0 John Serle President/CEO 48.00 2.00 X 794615 0 37924 Frank R Becker VP Finance/CFO 48.00 2.00 X 373813 0 84613 Sister Esther Polacci Sch O VP Mission 50.00 0.00 X 0 0 0 Barbara Blood Executive Director HR 50.00 0.00 X 180115 0 14525 Denise Clapp Executive Director of Nursing/CNO 50.00 0.00 X 177990 0 15727 Barbara Mead VP Behavioral Health & Clinics 50.00 0.00 X 273254 0 27817 John Michael Roach MD Physician 50.00 0.00 X 396085 0 35115 Benjamin D Pe MD Physician 50.00 0.00 X 380500 0 36415 Gary Belcaster MD Physician 50.00 0.00 X 331768 0 13618 Ravinder Samra MD Physician 50.00 0.00 X 339869 0 35115 James T Go MD Physician 50.00 0.00 X 438646 0 24696 3686655 0 325565 85 0 1 0 Northwest Emergency Physicians Inc PO Box 634850 Cincinnati OH 452634850 Emergency Physicians 2245815 Premeire Anesthesia 888 Swift Boulevard Richland WA 99352 Anesthesia Services 1203147 TriMedx LLC PO Box 636129 Cincinnati OH 452636129 Equipment Servicing 663051 Tri Cities Laboratory LLC 110 West Cliff Avenue Spokane WA 99204 Laboratory Services 531828 Nuance Communications 1 Wayside Road Burlington MA 01803 Technology Services 490312 17 170897 1441251 63913 2073 1676061 Net Patient Services 621990 46037468 46037468 Medicare Patient Rev. 621990 30508685 30508685 Medicaid Patient Rev. 621990 19064686 19064686 Pharmacy 446110 320564 472947 -152383 3228462 3228462 99159865 746585 746585 67277 0 67277 67277 67277 74550 101626 -27076 -27076 -27076 85830 17197 68633 68633 Cafeteria and Vending 722212 200864 200864 Inv in Uncon. Entities 523000 -647472 49570 -697042 -446608 101244737 99312248 -102813 359241 345986 345986 1799787 608143 1191644 39428542 35574339 3854203 2319127 2026453 292674 6539243 5651320 887923 2848156 2525343 322813 607587 468553 139034 43415 26016 17399 183232 4049 179183 21017 21017 6073493 4920012 1153481 769196 9260 759936 634279 527977 106302 5044105 5044105 2800133 2626590 173543 406110 342472 63638 386555 337772 48783 2808692 2713876 94816 396881 389804 7077 Medical & Food Supplies 13473892 13304126 169766 Professional Fees 5552342 4980793 571549 Ascension Fees 1053847 1053847 Other Minor Equipment 224706 204793 19913 8000688 5500479 2500209 101761011 88132261 13628750 0 69257 506576 1143216 13796186 13755665 1543678 2042880 1479935 438084 29470918 9159578 18708745 20311340 1940889 2635967 35267846 28767126 72806536 69600854 11604904 9696750 577658 627155 16787455 16879670 28970017 27203575 X 43765978 41202146 70541 1195133 43836519 42397279 72806536 69600854 X -516274 1343181 -2266147 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 21107 21107 0 Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to national and state hospital associations that are specially allocable to lobbying. Our Lady of Lourdes Hospital at Pasco does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office. 1334397 1334397 17187051 5434094 11752957 1070670 419667 651003 8564557 3305817 5258740 1314243 1314243 20311340 Interest in Investment held by Ascension Health Alliance 16829564 Investments in Tri-Cities Cancer Center 4577393 Other Miscellaneous Receivables 2235070 Investments in Tri-Cities Lab. 2125777 Deferred Compensation Asset 2038008 Third Party Receivables 536935 MAKO asset held for sale 226946 Investement in BLT, LLC 114289 Intercompany Receivable from Ascension Health Alliance 67834 Intracompany Receivable from Foundation, Net 15310 28767126 Intercompany Debt to Ascension Health Alliance 12015079 Deferred Compensation Liability 2038008 Other Long-Term Liabilities 1106894 Estimated Settlement to Third Party Payors 883325 Self Insurance Liability 429359 Intercompany Payable to Ascension Health Alliance 289129 Other Current Liabilities 113646 Taxes Payable - Current Portion 4230 16879670 X Part X, Line 2: From the consolidated audited financial statements of Our Lady of Lourdes Hospital at Pasco: The member health care entities of the Health Network are primarily tax-exempt organizations under Internal Revenue Code Section 501(c)(3) or 501(c)(2), and their related income is exempt from federal income tax under Section 501(a). The Health Network accounts for uncertainty in income tax positions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. 1 1 X 1 X 1 X 1 1 1 0 1 1 1892189 1892189 0.01890 22469094 19064686 3404408 0.03400 24361283 19064686 5296597 0.05290 27431 27431 0.00030 124825 124825 0.00120 233786 233786 0.00230 77387 77387 0.00080 463429 463429 0.00460 24824712 19064686 5760026 0.05750 28340 28340 0.00030 3905 3905 0.00000 32245 32245 0.00030 0 1710666 0 17821190 19570991 -1749801 X 1 1 2 1 Lourdes Medical Center 520 North 4th Avenue Pasco WA 99301 www.loudeshealth.net 022 X X X X A 2 Lourdes Counseling Center 1175 Carondelet Drive Richland WA 99352 www.loudeshealth.net 915 X Behavioral Health Services A Facility Reporting Group - A 1 X X X X X X X X X 12 1 1 1 X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X 1 0 X X X X 1 X 0 0 Part V, Section B Facility Reporting Group A Facility Reporting Group A consists of: - Facility 1: Lourdes Medical Center, - Facility 2: Lourdes Counseling Center Facility 1 -- Lourdes Medical Center Part V, Section B, line 3: Throughout the assessment process members of the steering committee provided specific presentations in their field of expertise. The steering committee learned about previous assessments, current health statistics, the economy, spirituality, and many other topics relevant to understanding the sub-populations and health trends of the community. In addition, WSU-Tri-Cities students assisted the steering committee by presenting assessments on six population groups: uninsured elementary students, middle school adolescents, young adults with mental illness, agricultural workers, the Hanford workforce, and seniors aged 65+. Two Masters of Public Health (MPH) students helped with compiling data and statistical analysis. Students from Columbia Basin College helped conduct a community oral health survey. Facility 1 -- Lourdes Medical Center Part V, Section B, line 4: The assessment and report were compiled through collaboration between the Benton-Franklin Community Health Alliance, Kadlec Regional Medical Center, Kennewick General Hospital, Lourdes Health Network, PMH Medical Center, Group Health Cooperative, the Benton-Franklin Health District, and many other key partners and time contributors. For a complete list of entities included in the Community Health Needs Assessment see:http://www.lourdeshealth.net/assets-lhn/pdf/brochures/CHNA-2013-Executive- Summary.pdf Facility 1 -- Lourdes Medical Center Part V, Section B, line 7: Lourdes Medical Center does not intend to address the following community health needs identifited in the Community Health Needs Assessment: - Affordability - while we continue to contain costs and maintain our generous charity care policy, we will not specifically address this need as the issue is much larger and difficult to address. - Lack of Insurance - we will not directly address this issue as many of those without health insurance will have health insurance with the Affordable Care Act. - Inappropriate Use of the Emergency Department Lourdes Health Network actively participates in the Community Health Alliance (CHA). The CHA has a committee with several Lourdes associated involvement that is working on a community-wide solution to this issue. The Health Alliance is comprised of members from all local hospitals, the health department, local physicians, the United Way, and many other organizations. We believe this community approach will be the most successful and effective way to address inappropriate use of emergency departments. - Obesity Through Lourdes BodyWorks program, Diabetic and Nutritional Education activities, Wellness Benefit Plan, the Ideal Protein Wight loss Program, and our participation, involvement and promotion of healthy activities, we will actively address our community health need of obesity. We will approach this need with the following tactics: - Lourdes Foundation's grant-funded BodyWorks program. This free program teaches families with obese children new skills and habits to effect change. The program is extremely successful as it allows for one-on-one coaching over a longer period of time. Children's progress is tracked and reported. - Diabetic & Nutritional Education Lourdes registered dieticians will teach children and caregivers options for healthy snacks at a minimum of one elementary school, and one day care provider. Material will be sent home to parents encouraging them to stock their home with healthy snacks to complete the education loop. - Lourdes Wellness Plan Lourdes will continue our wellness plan which encourages and rewards Lourdes associates for healthy behavior and weight loss (as appropriate). We will continue to plan until the change-over to SmartHealth with Symphony. - Ideal Protein Weight Loss Lourdes will continue to offer the Ideal Protein solution for our community. In FY 14, Lourdes will lose a minimum of 10,000 pounds for our community. - Healthy Activities Lourdes will sponsor and promote the following health activities: Good Health is Good Business; Run or Dye Fun Run; Rodeo Run Fun Run; Bike to Work; YMCA Girls on the Run; Heart Chase Tri-Cities; Run for the Ribbons; Relay for Life; Cable Bridge Run; St. Pat's Fun Run; St. Joe's Fun Run; Ruth Livingston Elementary Jog-A-Thon - Mental Illness as the leader in treating mental illness in our community we will continue to work to meet those needs. In FY14, Lourdes will assess and evaluate a new, residential service for those struggling with mental illness. Facility 1 -- Lourdes Medical Center Part V, Section B, line 14g: Signs are posted in emergency rooms, in waiting rooms, and at the admissions offices to notify patients that the hospital has a financial assistance policy. In addition, every billing statement and the Hospital's website include information regarding the financial assistance policy. The policy is provided at the request of the patient. Facility 1 -- Lourdes Medical Center Part V, Section B, line 18e: Facility 2 -- Lourdes Counseling Center Part V, Section B, line 3: WSU-Tri-Cities students assisted the steering committee by presenting assessments on six population groups: uninsured elementary students, middle school adolescents, young adults with mental illness, agricultural workers, the Hanford workforce, and seniors aged 65+. Two Masters of Public Health (MPH) students helped with compiling data and statistical analysis. Students from Columbia Basin College helped conduct a community oral health survey. Facility 2 -- Lourdes Counseling Center Part V, Section B, line 4: Other facilities participating in creating the CHNA include Trios Health (formerly Kennewick General Hospital), Lourdes Health Network, PMH Medical Center, Group Health Cooperative, the Benton-Franklin Health District, and many other key partners and time contributors. For a complete list of entities included in the Community Health Needs Assessment see:http://www.lourdeshealth.net/assets-lhn/pdf/brochures/CHNA-2013-Executive- Summary.pdf Facility 2 -- Lourdes Counseling Center Part V, Section B, line 7: Lourdes Counseling Center does not intend to address the following community health needs identifited in the Community Health Needs Assessment: - Affordability - while we continue to contain costs and maintain our generous charity care policy, we will not specifically address this need as the issue is much larger and difficult to address. - Lack of Insurance - we will not directly address this issue as many of those without health insurance will have health insurance with the Affordable Care Act. - Inappropriate Use of the Emergency Department Lourdes Health Network actively participates in the Community Health Alliance (CHA). The CHA has a committee with several Lourdes associated involvement that is working on a community-wide solution to this issue. The Health Alliance is comprised of members from all local hospitals, the health department, local physicians, the United Way, and many other organizations. We believe this community approach will be the most successful and effective way to address inappropriate use of emergency departments. - Obesity Through Lourdes BodyWorks program, Diabetic and Nutritional Education activities, Wellness Benefit Plan, the Ideal Protein Wight loss Program, and our participation, involvement and promotion of healthy activities, we will actively address our community health need of obesity. We will approach this need with the following tactics: - Lourdes Foundation's grant-funded BodyWorks program. This free program teaches families with obese children new skills and habits to effect change. The program is extremely successful as it allows for one-on-one coaching over a longer period of time. Children's progress is tracked and reported. - Diabetic & Nutritional Education Lourdes registered dieticians will teach children and caregivers options for healthy snacks at a minimum of one elementary school, and one day care provider. Material will be sent home to parents encouraging them to stock their home with healthy snacks to complete the education loop. - Lourdes Wellness Plan Lourdes will continue our wellness plan which encourages and rewards Lourdes associates for healthy behavior and weight loss (as appropriate). We will continue to plan until the change-over to SmartHealth with Symphony. - Ideal Protein Weight Loss Lourdes will continue to offer the Ideal Protein solution for our community. In FY 14, Lourdes will lose a minimum of 10,000 pounds for our community. - Healthy Activities Lourdes will sponsor and promote the following health activities: Good Health is Good Business; Run or Dye Fun Run; Rodeo Run Fun Run; Bike to Work; YMCA Girls on the Run; Heart Chase Tri-Cities; Run for the Ribbons; Relay for Life; Cable Bridge Run; St. Pat's Fun Run; St. Joe's Fun Run; Ruth Livingston Elementary Jog-A-Thon - Mental Illness as the leader in treating mental illness in our community we will continue to work to meet those needs. In FY14, Lourdes will assess and evaluate a new, residential service for those struggling with mental illness. Facility 2 -- Lourdes Counseling Center Part V, Section B, line 14g: Signs are posted in emergency rooms, in waiting rooms, and at the admissions offices to notify patients that the hospital has a financial assistance policy. In addition, every billing statement and the Hospital's website include information regarding the financial assistance policy. The policy is provided at the request of the patient. Facility 2 -- Lourdes Counseling Center Part V, Section B, line 18e: Borgess Lee Memorial Hospital: Part V, Section B, Line 5a: http://www.lourdeshealth.net/assets- lhn/pdf/brochures/CHNA-2013-Executive-Summary.pdf 6 Lourdes Columbia Point 112 Columbia Point Drive Suite 103 Richland WA 99352 Physician Clinic Lourdes West Pasco 7425 Wringley Drive Pasco WA 99301 Women's Hlth, Family Med., Pediatrics, Gastroenterology, Diagnostic Imaging Lourdes at 14th Avenue 1200 North 14th Avenue Pasco WA 99301 Ear, Nose and Throat Care (ENT), Internal Medicine, Family Medicine, and Uro Loudes Occupational Health & Physical Me 9915 Sandifur Parkway Pasco WA 99301 Occupational Health and Physical Medicine Lourdes Urgent Care 5304 North Road 68 Pasco WA 99301 Urgent Care Clinic Lourdes Cullum House 208 Cullum Avenue Richland WA 99352 Behavioral Health Residential Support Part I, Line 7: The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost-to-charge ratio that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self-pay). The cost to charge ratio is calculated by taking each business unit's bad debt expense and multiplying it by the business unit's cost to charge ratio. These figures are then consolidated for Lourdes Health Network as a whole. The best available data was used to calculate the amounts reported in the table. Part I, Line 7g: The organization has not included costs attributable to a physician clinic as part of subsidized health services. Part II, Community Building Activities: Lourdes Health Network ("Lourdes") provided the following community building activities:- CHILDHOOD OBESITY - To support healthy activities and prevention of childhood obesity, Lourdes sponsored three fun runs in local schools, provided "healthy snack" education to three local schools, and sponsored America on the Move through the YMCA. Without the support of Lourdes, the schools and organizations would not have been able to offer these activities that are designed to help young children learn healthy habits. Lourdes also supports many youth sports activities, such as Kennewick Youth Baseball, little league basketball teams and soccer teams to further our work to encourage children to be active.- PRENATAL OUTREACH - Lourdes provides free prenatal classes to anyone in the community, regardless of hospital of delivery. Classes include: Prenatal education in English and Spanish, Infant CPR classes, and refresher courses. In addition, a postpartum clinic is available free of charge for any new mother and baby post discharge. A positive educational program is also provided to high-risk teen mothers via the New Horizons High School and the Pasco School District. This program provides self esteem, parenting skills, and pre and post natal education.- COMMUNITY EDUCATION - Lourdes has been active providing community education throughout the region. A few examples: - Lourdes Health Network Nutritional Counselors are guest speakers at nursing homes, assisted living facilities, schools, volunteer groups and churches presenting healthy eating and diabetes prevention information provided by Lourdes, but at no cost to attendees. - Lourdes Health Network's Infection Control nurse actively educated children in schools and the community at many community events about proper hand washing and flu prevention at no cost to attendees and funded by Lourdes. In addition, Lourdes spearheaded an internal and external hand washing campaign and provided the largest community event - the Benton Franklin Fair and Rodeo - with posters, hand wipes, and hand sanitizers. - Dr. Benjamin Pe, Lourdes board certified child psychiatrist, provides educational sessions to local elementary schools about signs and symptoms of childhood mental illness provided by Lourdes at no cost to the school district. - Blood Drives - Lourdes works in close partnership with the Red Cross and promotes and hosts blood drives in many of our facilities. Having an adequate community blood supply is essential to our community's health. Lourdes is proud to offer these blood drives at no cost to participants or to the Red Cross. - Scholarships - Lourdes Auxiliary provides outstanding local students wanting to enter the healthcare field with $1,500 scholarships to pursue their education. This is one way that we can contribute to fighting the healthcare worker shortage and further the education of our community's brightest students. Part III, Line 2: The provision for doubtful accounts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payer category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. Part III, Line 3: The provision for doubtful accounts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payer category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the System follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the System. Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies. Part III, Line 4: The organization is a part of the Our Lady of Lourdes Hospital at Pasco consolidated audit. The footnote that references bad debt expense in the June 30, 2014 consolidated audit is as follows: The provision for doubtful accounts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in health care coverage and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payer category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Health Network follows established guidelines for placing certain past-due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Health Network's policies.The methodology for determining the allowance for doubtful accounts and related write-offs on uninsured patient accounts has remained consistent with the prior year. The Health Network has not experienced material changes in write-off trends and has not materially changed its charity care policy in the current fiscal year. Part III, Line 8: Ascension Health and related health ministries follow the Catholic Health Association ("CHA") guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit. Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. Part VI, Line 2: Lourdes Health Network ("Lourdes") is a collaborative community partner. During year ended June 30, 2014, Lourdes collaborated with Benton-Franklin Community Health Alliance, Kadlec Regional Medical Center, Kennewick General Hospital, PMH Medical Center, Group Health Cooperative, the Benton-Franklin Health District, and many other key partners and time contributors to complete the Community Health Needs Assessment for Benton and Franklin Counties ("CHNA"). Through data and community perception, a CHNA is a systematic examination of the health status within a given population to help identify key problems and assets in a community. The CHNA highlights the findings through a culmination of our health status, community themes and strengths, forces of change, and local public health systems. A complete copy of the organizations CHNA can be accessed at http://www.bfcha.org/. Part VI, Line 3: Financial counselors are trained to discuss our financial assistance policy and assist those needing assistance with the application. In addition, they have knowledge of other assistance programs that patients may qualify for and assist patients in finding that information. During the pre-registration, registration, admission and discharge processes, Lourdes attempts to identify patients who may be eligible for charity or discounted care via the charity care policy. A financial counselor is provided to all patients. Lourdes charity care policy is posted in all admitting areas, the emergency room and the information desk with information about our financial assistance program and how to access it if needed. On the website is the full application available for download as well as information about the policy. A written summary and contact information is provided in all communications with patients regarding bills and account status. Part VI, Line 4: Lourdes Health Network ("Lourdes") primarily serves those residing in Franklin and Benton Counties. Lourdes offers the only acute hospital in Franklin County and provides a clinic in North Franklin County. Lourdes also offers the region's only inpatient mental health hospital in Benton & Franklin Counties. In fiscal year ending June 30, 2014, Lourdes Health Network provided more than $5.5 million calculated using CHA guidelines in charity and uncompensated care to members of our community. The demographic makeup of the community we serves is as follows:FRANKLIN COUNTY - Total Population (Est. as of July 2012) - 85,845- 69.6% are high school educated or above - Median Household Income - $51,770- 21.5% of individuals below poverty level - 51.0% Hispanic or LatinoBENTON COUNTY- Total Population (Est. as of July 2012) - 182,398- 88.9% are high school educated or above- Median Household Income - $60,300- 12.9% of individuals below poverty level- 18.5% Hispanic or LatinoThe Health Status of the Mid-Columbia region trends with the health of the nation. However, our area has a higher prevalence of childhood obesity and diabetes, which then adds to other issues, such as heart disease and stroke. Other areas rated unfavorable compared to peer counties include:- Births to women under 18- Births to unmarried women- No care in first trimester- Mortality- Homicide- Lung Cancer- Stroke- Suicide- Colon CancerLourdes Health Network works diligently to provide healthy lifestyle education to the community in multiple ways such as a community newsletter, a web-based health information library, community events and educational forums and formalized relationships with schools. Part VI, Line 5: Our Lady of Lourdes Hospital at Pasco ("Lourdes") seeks to improve the physical, mental, social, and spiritual health status of its surrounding community. In addition to providing health care services to all individuals who require medical attention, Our Lady of Lourdes Hospital at Pasco has developed programs to help achieve its mission. Lourdes has provided significant support in the form of job shadow hours for classes at a local college, an employment service, and other organizations with the purpose of creating new employment opportunities for members of the community. Lourdes has also participated in other community-building coalitions in an effort to address health and safety concerns in the community.Lourdes allows educated staff with specific expertise to provide community education. For instance, the Infection Control nurse provides hand hygiene education to schools, at community events, and to teachers. Lourdes' board-certified child psychiatrist provides education to local teachers about signs and symptoms of children's common mental health issues. Certified dieticians provide education to school children and through the YMCA about healthy after-school snacks and overall healthy eating habits. It is estimated that over 2,000 school children and staff have attended sessions in the last year. Partnership with City of Pasco for Pasco Safety Improvements - Lourdes Medical Center is located on 4th Avenue in Pasco. 4th Avenue is a major arterial with 4 lanes of traffic. There have been several deaths and many injuries as people attempt to cross 4th Avenue to enter the hospital. As a proactive community leader, Lourdes has partnered with the City on a safety assessment and plan to improve 4th Avenue. This partnership included a monetary donation to the City for the assessment. The safety of our community and our patients is of utmost concern for Lourdes. - Other Non-profits: American Cancer Society, American Diabetes Association, American Red Cross, Boys and Girls Clubs, YMCA. Part VI, Line 6: Our Lady of Lourdes Hospital at Pasco, d/b/a Lourdes Health Network ("Health Network") is a member of Ascension Health. In December 2011, Ascension Health Alliance became the sole corporate member and parent organization of Ascension Health, a Catholic, national health system consisting primarily of not-for-profit corporations that own and operate local health care facilities, or Health Ministries, located in 23 of the United States and the District of Columbia. In addition to serving as the sole corporate member of Ascension Health, Ascension Health Alliance serves as the member or shareholder of various other subsidiaries. Ascension Health Alliance, its subsidiaries, and the Health Ministries are referred to collectively from time to time hereafter as the System.Ascension Health Alliance is sponsored by Ascension Health Ministries, a Public Juridic Person. The Participating Entities of Ascension Health Ministries are the Daughters of Charity of St. Vincent de Paul in the United States, St. Louise Province, the Congregation of St. Joseph, the Congregation of the Sisters of St. Joseph of Carondelet, the Congregation of Alexian Brothers of the Immaculate Conception Province - American Province and the Sisters of Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province.Our Lady of Lourdes Hospital at Pasco d/b/a Lourdes Health Network, located in Pasco Washington, is a not-for-profit acute care hospital. The Health Network consists of two separately licensed not-for-profit health care providers and a foundation: Lourdes Medical Center ("Medical Center") located in Pasco, Washington; Lourdes Counseling Center ("Counseling Center") in Richland, Washington; and Lourdes Foundation ("Foundation"). The Medical Center and Counseling Center provide inpatient, outpatient and emergency care services for the residents of Pasco and its surrounding communities. Admitting physicians are primarily practitioners in the local area. The Foundation supports the Medical Center and the Counseling Center. The Health Network is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of Ascension Health are related to providing health care services.The System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs:- Traditional charity care includes the cost of services provided to persons who cannot afford health care because of inadequate resources and/or who are uninsured or underinsured.- Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons.- Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse and persons with acquired immune deficiency syndrome.- Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and community benefit programs. The cost of providing care to persons living in poverty and community benefit programs is estimated using internal cost data and is calculated in compliance with guidelines established by both the Catholic Health Association (CHA) and the Internal Revenue Service (IRS).The amount of traditional charity care provided, determined on the basis of cost, was approximately $1,892 million and $2,091 million for the years ended June 30, 2014 and 2013, respectively. The amount of unpaid cost of public programs, cost of other programs for persons living in poverty and other vulnerable persons, and community benefit cost are reported in the accompanying other information. Part VI, Line 7, Reports Filed With States WA OUR LADY OF LOURDES HOSPITAL AT PASCO COMMUNITY BENEFIT REPORTFOR THE YEAR ENDED JUNE 30, 2014This report illustrates the significant degree to which Our Lady of Lourdes Hospital at Pasco (dba and referred to throughout this document as Lourdes Health Network) contributes to the positive health status and population health management of the communities it serves. As a member of Ascension, the nation's largest not-for-profit healthcare system, Lourdes Health Network continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of Lourdes Health Network is to perpetuate the healing mission of Jesus. Lourdes Health Network furthers this goal through delivery of patient services throughout life with care to the elderly and indigent, patient education and health awareness programs for the community. Our concern for all human life and dignity of each person leads the organization to provide medical, mental health services and health education to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay in a compassionate spirit. In order to portray the full breadth of our contribution, our community benefit information is described below: ORGANIZATIONAL COMMITMENT TO PROVIDING COMMUNITY BENEFITLourdes Health Network consists of Lourdes Medical Center, a 25-bed Acute Critical Access Hospital with an additional 10 bed inpatient rehabilitation unit and Lourdes Counseling Center, a stand alone 32-bed Psychiatric Hospital offering both inpatient and outpatient behavioral health services along with a network of physician clinics caring for families in Southeastern Washington.In June of 2013, Lourdes Health Network's Volunteer Board of Directors approved a multi-year Community Health Improvement Plan based on community needs as identified in the Community Health Needs Assessment. Areas of focus for Lourdes Health Network include, but are not limited to obesity and behavioral health. Lourdes Health Network primarily serves the Benton & Franklin Counties of Washington State an area with a population of nearly 250,000 total population. Lourdes Health Network seeks to improve the physical, mental, social and spiritual health status of its surrounding community. In addition to providing health care services to all individuals who require medical attention, Lourdes Health Network has developed the following programs to help achieve its mission:EXPANDING AWARENESS, EDUCATION, AND HEALTH PROMOTIONLourdes Health Network believes that it is essential to educate people regarding the types of behavior that improve their chances of living a healthy life. Lourdes Health Network has invested significantly in unique, top quality health education and materials relating to first aid, health and wellness and more in order to accomplish its goals.BodyWorks Lourdes Health Network provides, at no charge, children struggling with obesity a course called BodyWorks. This five week, five session program is designed to help children and their entire families make healthier nutrition choices. Registered dieticians work directly with them and also provide coaching for grocery shopping. Lourdes Health Network also offers a series called, "Lunch and Learn" free and open to anyone on various health care topics monthly. Lourdes Health Network added in-person assisters and navigators in fiscal year 2014 to help those needing assistance with the Affordable Care Act Exchanges. These individuals have helped countless people sign up for much needed health insurance. In addition, Lourdes added assisters to our jail program and are actively signing up those incarcerated so they will have coverage when they are released. Studies show a direct correlation between coverage and re-offending. Medical Education - Lourdes Health Network believes in order to provide the best health care to the community, its clinical personnel must receive ongoing medical education. Healthcare professionals are therefore encouraged to attend the Lunch and Learn sessions provided onsite. In addition, Lourdes Health Network provides healthcare professionals education in the following job specific areas on a routine basis:- BLS = Basic Life Support (i.e. cardiopulmonary resuscitation CPR)- ACLS = Advance Cardiac Life Support- TNCC = Trauma Nurse Core Curriculum- PALS = Pediatric Advanced Life Support- STABLE = Advanced Neonatal Resuscitation- Advanced Rehab Documentation and FIM scoring- Advanced solution wound care- CPT Coding E/M Documentation guidelines- Emergency Severity index: 5 level triage- PICC Line Insertion class- Prophylaxis and Management of Asthma- Radiation Safety Training- SBAR Communication- Providing Holistic, Reverent CareIn the spirit of principles adopted by Ascension Health, Lourdes Health Network has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 30, 2014, the estimated unreimbursed cost of services provided to the elderly, uninsured, and underinsured totaled $7,191,764 with $1,892,189 in charity care delivered.Lourdes Medical Center provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2014, approximately 54% of the values of services rendered were to elderly patients under the Medicare program, and approximately 7% of the services were provided to patients who were deemed indigent under state guidelines (Medicaid).Lourdes Physician Practices provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2014, approximately 27% of the values of services rendered were to elderly patients under the Medicare program, and approximately 17% of the services were provided to patients who were deemed indigent under state guidelines (Medicaid).Lourdes Counseling Center also provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2014, approximately 31% of the values of its services rendered were to elderly patients under the Medicare program, and approximately 48% of the services were provided to patients who were deemed indigent under state guidelines (Medicaid).LOURDES MEDICAL CENTER- Operates an emergency room that is open to all persons regardless of ability to pay; - Has an open medical staff with privileges available to all qualified physicians in the area; - Has a volunteer-based governing body in which independent persons representative of the community comprise a majority;- Engages in the training and education of health care professionals; and- Participates in Medicaid, Medicare, CHAMPUS, Tricare, and/or other government-sponsored health care programs.PATIENT SERVICESLourdes Health Network provides the following in-patient and out-patient medical services to the community:- ICU- Acute Care- Chemical Dependency and Rehabilitation- Physical Rehabilitation- Surgery- Same-Day Surgery- Gastroenterology Lab- Laboratory- Urology- Neurology- Pulmonology- Diagnostic Imaging- Diagnostic Therapeutic- Adult and Child Psychiatry- Hematology and Oncology- Renal- Emergency- Clinic Services (Occupational Health, Primary Care, Pediatrics, Gastroenterology, Urgent Care, Pediatric Urgent Care, OB/GYN, ENT, Urology, Neurology, Pediatrics, Pulmonology General Surgery and Internal Medicine)- Ambulatory- Sleep Lab- Ear, Nose and Throat- Cosmetic and Plastic Surgery- Therapies (Physical, Occupational, and Speech)- Diabetic & Nutritional Education and Counseling- Inpatient Adult Psychiatric- Outpatient Counseling and Behavioral Health Treatment- Intensive Outpatient Behavioral Health- Supported Living Programs for Behavioral Health- PATH Program for the Homeless PopulationSome of the services listed above operate at a loss in order to ensure that all services are available to meet community health care needs, such as the PATH Program.During the fiscal year ending June 30, 2014, Lourdes Health Network 1 Lourdes Foundation 520 North 4th Avenue Pasco WA 99301 911528577 Section 501(c)(3) 287180 General Support Washington State University Foundation 255 E Main St Suite 301 Pullman WA 991641925 911075542 Section 501(c)(3) 30000 Tri Cities Nursing Partnership Support Benton Franklin Community Health Alliance 7102 Okanogan Place Kennewick WA 99336 030452352 Section 501(c)(3) 10614 General Support 3 0 Part I, Line 2: Our Lady of Lourdes Hospital at Pasco provided donations to Lourdes Foundation to assist in daily operations. Lourdes Foundation's operations are closely monitored through shared leadership and goverance to ensure monies given are used as intended. In addition, Our Lady of Lourdes Hospital at Pasco donated to Benton Franklin Community Health Alliance in support of its access to care goals in the local community. The use of these funds is monitored through access to care successes and break throughs in the community. X X X 1 1 0 1 0 0 0 0 0 0 0 John Serle President/CEO 306278 0 415108 0 73229 0 12850 0 25074 0 832539 0 0 0 Frank R Becker VP Finance/CFO 190699 0 74990 0 108124 0 59171 0 25442 0 458426 0 28272 0 Barbara Blood Executive Director HR 162692 0 13500 0 3923 0 6031 0 8494 0 194640 0 0 0 Denise Clapp Executive Director of Nursing/CNO 156834 0 13078 0 8078 0 6111 0 9616 0 193717 0 0 0 Barbara Mead VP Behavioral Health & Clinics 191950 0 18276 0 63028 0 16542 0 11275 0 301071 0 9567 0 John Michael Roach MD Physician 5846 0 372654 0 17585 0 12750 0 22365 0 431200 0 0 0 Benjamin D Pe MD Physician 212572 0 143894 0 24034 0 12750 0 23665 0 416915 0 0 0 Gary Belcaster MD Physician 328673 0 1828 0 1267 0 0 0 13618 0 345386 0 0 0 Ravinder Samra MD Physician 272541 0 20904 0 46424 0 12750 0 22365 0 374984 0 0 0 James T Go MD Physician 20224 0 417962 0 460 0 0 0 24696 0 463342 0 0 0 Part I, Line 1a An officer is allowed to receive companion travel reimbursement for one companion on two business trips. The companion fees are reimbursable according to the standard travel reimbursement policy. These reimbursements are considered taxable income to the officer and are included in taxable wages. Gross up payments are made to all employees of Our Lady of Lourdes Hospital at Pasco for gifts received from the employer such as Christmas gift cards and special recognition awards. An officer receives payments for tax preparation services. These reimbursements are considered taxable income to the officer and are included in taxable wages. Part I, Line 3 Ascension Health, a related organization of Our Lady of Lourdes Hospital at Pasco, uses the following to establish the compensation of the organization's CEO: - Compensation Committee, - Independent Compensation Consultant, - Compensation Survey or Study, and - Approval by the Board or Compensation Committee. Part I, Line 4b Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, are entirely dependent on the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision there is not guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals received payments from the supplemental nonqualified retirement plan in the amounts as noted: Frank Becker - $28,272 Barbara Mead - $9,567 Form 990, Part VI, Section A, line 2 Many of the persons listed on Part VII have a "business relationship" with each other by virtue of sitting on related Lourdes entity boards. Form 990, Part VI, Section A, line 6 Our Lady of Lourdes Hospital at Pasco has a single corporate member, Ascension Health. Form 990, Part VI, Section A, line 7a Our Lady of Lourdes Hospital at Pasco has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of Our Lady of Lourdes Hospital at Pasco. Form 990, Part VI, Section A, line 7b Ascension Health has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions. Form 990, Part VI, Section B, line 12c The organization regulary and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflict of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determining the compensation of the organization's CEO, the process, performed by Ascension Health, a related organization of Our Lady of Lourdes Hospital at Pasco, included a review and approval by independent persons, comparability data and contemporaneous substantiation of the deliberation and decision. The Compensation Committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the committee minutes. The individual was not present when his compensation was decided. In determining compensation of the officers whose comp is determined by Ascension Health of the organization, the process, performed by Ascension Health, a related organization of Our Lady of Lourdes Hospital at Pasco, included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the other officers or key employees of the organization were compared to individuals at other organizations in the area who hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the committee minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part VII, Section A: Sister Esther Polacci is paid directly from LA Province of the Sisters of St. Joseph Carondelet. Form 990, Part XI, line 9: Transfer to Sponsor - Sisters Sponsorship -53,709. Transfer to Affiliates - Ascension -2,212,438. Ascension Health Alliance PO Box 45998 St Louis MO 631455998 453358926 National Health System MO Section 501(c)(3) Schedule A, Line 11a N/A 0 Ascension Health PO Box 45998 St Louis MO 63145 311662309 National Health System MO Section 501(c)(3) Schedule A, Line 11a Ascension Health Alliance 0 Lourdes Foundation 520 North 4th Avenue Pasco WA 99301 911528577 Fundraising WA Section 501(c)(3) Schedule A, Line 11a Our Lady of Lourdes Hospital at Pasco 1 Physicians of Pasco Condominiums Assoc 520 North 4th Avenue Pasco WA 99301 453691641 Property Management WA Lourdes Health Network C 77210 4267 0.78540 1 0 1 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 Lourdes Foundation B 287180 Actual Amount Paid Lourdes Foundation C 170897 Actual Amount Paid Ascension Health P 39051997 Actual Amount Paid Lourdes Foundation Q 78276 Actual Amount Paid Ascension Health R 3319994 Actual Amount Paid Ascension Health S 244519 Actual Amount Paid