2015-05-13T08:34:59-05:00 2014-06-30 861065772 Deloitte Tax LLP 250 East Fifth St Suite 1900 Cincinnati OH 45202 990 2013-07-01 480543778 Via Christi Hospital Pittsburg Inc VIAC 6202316100 1 Mt Carmel Way Pittsburg KS 66762 Carol Karp Chief Financial Officer 6202316100 2015-05-13 1 Rebecca Lyons P01487105 5137847100 2013 2016-04-25 22:37:26Z Randall Cason 1 Mt Carmel Way Pittsburg KS 66762 85948506 0 0928 X www.via-christi.org/pittsburg X 1903 KS We serve as a healing presence with special concern for our neighbors who are vulnerable. 14 12 898 126 241769 105637 95317 107193 58169076 82559522 3745918 1849196 1447375 1297573 63457686 85813484 0 0 0 0 33850718 42334566 0 0 0 29523861 40578445 63374579 82913011 83107 2900473 109132529 120249552 26558274 32429110 82574255 87820442 As part of Via Christi Health, Inc. we share this mission: "Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable." 0 0 66101759 83100139 Via Christi Hospital Pittsburg, Inc. (VCH-P) and its affiliates enrich the communities in which they operate as well as the broader community, improving medicine through research, educating nurses/nursing students and other health care providers, and providing care and support to people in need. VCH-P further supports this mission with a community board, open medical staff, and an emergency room available to patients regardless of ability to pay. 66101759 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 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 53 0 1 898 1 1 1 0 0 0 0 0 0 0 0 0 0 X 14 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 X Judy Davis 3168584931 8200 E Thorn Drive Wichita KS 67226 X Wendell Wilkinson Chair 1.00 0.00 X X 0 0 0 Marty Beezley Vice Chair 1.00 0.00 X X 0 0 0 Randall Cason Sr Administrator/President 50.00 0.00 X X 0 282854 55324 Tammy Battaglia MD end 913 Trustee 1.00 0.00 X 0 0 0 Sister Susanne Daniels Sch O Trustee 1.00 0.00 X 0 0 0 David Gambino end 1213 Trustee 1.00 50.00 X 0 429376 96728 Mindi Garner end 1213 Medical Staff President 1.00 0.00 X 0 0 0 Sherry Hausmann start 114 Trustee 1.00 49.00 X 0 384995 79685 Chuck Hosman Trustee 1.00 0.00 X 0 0 0 Sister Marie Veronica Janousek (Sch O) Trustee 1.00 19.00 X 0 0 0 Jason Marietta Trustee 1.00 0.00 X 0 0 0 John Mitchelson Trustee 1.00 0.00 X 0 0 0 Richard Oler Trustee 1.00 0.00 X 0 0 0 Jacqueline Orender start 114 Medical Staff President 1.00 0.00 X 0 0 0 Kathleen Sandness start 1013 Trustee 1.00 0.00 X 0 0 0 Steve Scott Trustee 1.00 0.00 X 0 0 0 Elias Tawil Trustee 1.00 0.00 X 0 0 0 Drew Talbott Administrator Operations/Secretary 50.00 0.00 X 149247 0 44011 Roberta Johnson Assistant Secretary 1.00 49.00 X 0 228937 48336 Mike Joy Adm Finance/Treasurer 45.00 5.00 X 108204 9751 26766 David Hadley end 114 Assistant Treasurer 1.00 49.00 X 0 468299 119352 Jeff Seirer start 214 Assistant Treasurer 1.00 49.00 X 0 263573 68834 Bill Aquino end 1113 Admin-Planning 50.00 0.00 X 207378 0 42063 Ali Hammad Physician 50.00 0.00 X 938828 0 52268 Boban N Mathew Physician 50.00 0.00 X 508045 0 51774 Bashar Marji Physician 50.00 0.00 X 895142 0 52554 Mary K Reed Physician 50.00 0.00 X 456299 0 38429 Danny Reveal Physician 50.00 0.00 X 517040 0 41551 Debra Cartwright end 213 Former CFO 0.00 0.00 X 28949 0 5172 3809132 2067785 822847 36 1 1 0 TriMedx LLC PO Box 636129 Cincinnati OH 452636129 Patient Related 1180200 RehabCare Group Inc PO Box 502096 St Louis MO 631502096 Patient Related 773111 Pittsburg Emergency Physicians LLC 8717 W 110th St Ste 500 Overland Park KS 66210 Patient Related 509993 Regional Medical Laboratory Department 2821 Tulsa OK 74182 Laboratory 414191 HMN Architects Inc 7400 W 110th Ste 200 Overland Park KS 66210 Construction Services 305642 15 7650 99351 192 107193 Net Patient Svc. Rev. 621110 78873535 78873535 340b Pharmacy Revenue 621110 1988633 1988633 Meaningful Use Revenue 621110 1389343 1389343 Laboratory Services 621500 308011 256576 51435 82559522 1849536 71067 1778469 204188 134682 69506 69506 69506 340 -340 -340 -340 Cafeteria 900099 420469 420469 Catering 722320 132928 36649 96279 Durable Medical Equip. 621610 72852 72852 601818 592052 9766 1228067 85813484 83100139 241769 2364383 X 340690 340690 243800 243800 33706096 30529992 3176104 -796363 -592170 -204193 6453887 5515251 938636 2386456 1989649 396807 1257000 1257000 27849 27849 7590 7590 14410113 5766638 8643475 374348 2390 371958 17589432 17408197 181235 18341 17151 1190 1310275 1294779 15496 182984 141550 41434 33985 25085 8900 341832 341832 3558602 3097680 460922 379473 116643 262830 Medicaid State Assess. 565454 565454 0 0 Membership Dues 341639 88646 252993 0 Social Events 118080 21562 96518 0 61448 113262 -51814 82913011 66101759 16811252 0 3361564 4093040 221361 220847 0 10521961 11106001 2378269 2648300 319004 249694 52551924 4402894 36377966 48149030 55952404 53782640 109132529 120249552 8058196 14561124 18500078 17867986 26558274 32429110 X 82574255 87820442 0 0 82574255 87820442 109132529 120249552 X 2900473 2838928 -493214 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 9147 9147 0 Part II-B, Line 1: Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. Via Christi Hospital Pittsburg, Inc. 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. 2100000 2100000 16598323 1033228 15565095 14431811 3318277 11113534 19421790 51389 19370401 48149030 Related Party Receivables 6918144 Interest in Investments Held by Ascension Health Alliance 42186575 Prepaid Pension 2096803 Medicare/Medicaid Settlement 1275360 Other Current Assets 1118240 Investment in RML of SEK 161389 Investment in Pinnacle Care 26129 53782640 VCHS Note Payable 17742683 Asset Retirement Obligation 125303 17867986 X Part X, Line 2: From the consolidated audited financial statements of Ascension Health Alliance and its member organizations ("The System") which include the activity of Via Christi Hospital Pittsburg, Inc.: The System accounts for uncertainty in income tax provisions by applying a recognition threshold and measurement attribute for financial statement recognition and measurement of a tax position taken or expected to be taken in a tax return. The System has determined that no material unrecognized tax benefits or liabilities exist as of June 30, 2014. 1 1 X 1 X 1 X 1 1 1 0 1 1 4119825 0 4119825 0.04970 11565026 8839560 2725466 0.03290 15684851 8839560 6845291 0.08260 310323 22518 287805 0.00350 190212 0 190212 0.00230 74804 0 74804 0.00090 69187 0 69187 0.00080 644526 22518 622008 0.00750 16329377 8862078 7467299 0.09010 1572 1572 0.00000 5597 5597 0.00010 86 86 0.00000 1849 1849 0.00000 52 52 0.00000 1157 1157 0.00000 10313 10313 0.00010 0 10157562 831366 27702085 26361334 1340751 X 1 1 1 1 Via Christi Hospital Pittsburg Inc 1 Mt Carmel Way Pittsburg KS 66762 http://www.viachristi.org/locations/ho Kansas H-01 X X X Level III Trauma Center, Cancer Center and Heart Via Christi Hospital Pittsburg Inc 1 1 X X X X X X X X X 12 1 1 1 X See Schedule H, Part V, Section B X X X X X X X 0 0 1 1 200.000000000000 1 400.000000000000 1 X X X X X X X 1 1 X 1 0 X X X X 1 X 0 0 Via Christi Hospital Pittsburg, Inc. Part V, Section B, Line 3: As part of the 2012 Aging Assessment, interviews with a wide range of stakeholders within Via Christi Hospital Pittsburg primary service areas were conducted between April and December 2011. In total, 224 interviews were completed state-wide with individuals representing businesses, healthcare providers, government agencies, faith communities, other area not-for-profits, caregivers and last, but not least, 80 elderly residents who are currently residing in an independent or assisted living facility. In the Pittsburg market, 17 one-on-one interviews were conducted. Also, a focus group of 11 residents of Via Christi Village - Pittsburg was held to gather information. All people participating in the Pittsburg portion of the 2012 Aging Assessment are listed in the Attachment A included with the Assessment. For the protection of those who are vulnerable, the 11 residents of Via Christi Village - Pittsburg are not named in the Attachment. The Aging Assessment can be accessed at the following web site URL: https://www.viachristi.org/sites/default/files/pdf/about_us/Aging-Assessment-VCV-Markets.pdf. The Attachment A is located on pages 82-85. Via Christi Hospital Pittsburg, Inc. Part V, Section B, Line 4: The Aging Assessment was a state-wide effort and hospitals participating included: Via Christi Hospital Wichita, Via Christi Hospital St. Teresa, Via Christi Rehabilitation Hospital, Via Christi Hospital Pittsburg, Mercy Regional Health Center and Wamego City Hospital. Via Christi Hospital Pittsburg, Inc. Part V, Section B, Line 7: The Hospital facility did not address all of the significant needs identified in its most recently conducted CHNA. See below for specifics:CHNA FindingTransportation for health appointments - Transportation for low income and elderly is already available through VCH-P's CareVan Program, and the City of Pittsburg does have a door-to-door program available to those in need. It doesn't run 24/7, but they are reviewing their current services to see if additional changes can be made to offer more services while maintaining cost effectiveness.Via Christi HOPE program needs to be expanded - Via Christi Village is already pursuing this need and is discussing the feasibility of this expansion with the State of Kansas. It is unknown how far the reach would be at this time. In partnership with the State of Kansas, the HOPE program is being expanded in the NE part of the state first. Other parts of KS may fall-in later depending on funding.Fewer physicians accepting Medicare/Medicaid patients - Via Christi Clinic physicians are already working on this issue with Via Christi related primary care physicians as this is an expectation of all Via Christi Health (VCH) associated physicians. More money is needed for home improvement projects for elderly as State has cut the budget for these kind of expenses. Via Christi Hospital Pittsburg (VCH-P) is already working with area agencies when elderly patients are discharged from the hospitals and needing some minor safety improvements, but going beyond that is not really our area of expertise (e.g. building wheelchair ramps, installing air conditioning units in Summer, etc.). The public would like to see an Elder Abuse Coalition (modeled after Independence, KS Ombuddy Program) to bring awareness to bank, police, clergy on the topics of exploited and abused elderly - this issue to be raised in a local Mental Health Task Force meeting to see if the group believes this is a high priority focus area for the area.Oral Health - The FQHC is expanding its outreach to neighboring communities. This clinic has also increased its oral health staff adding an additional dentist and dental assistants.Lack of shared medical records - State of Kansas is working on a plan and VCH is involved on the state level as are other hospital providers.Recruitment of specialists that are in high need - Via Christi Clinics have teamed up with University of Kansas School of Medicine Wichita to work together in recruiting primary care givers, as well as other specialists in need to relocate to Kansas. This is going to be an on-going initiative. In addition, VCH-P is working with the local FQHC to attract specialists willing to offer a few hours a week in the clinic setting so patients don't have to travel outside of Pittsburg. Via Christi Hospital Pittsburg, Inc. Part V, Section B, Line 14g: Patients are notified in writing that the hospital facility has a Financial Assistance Policy and trained financial counselors are available to assist patients. Part V, Section B, Line 5a Hospital Facility's Web Site URL: http://www.viachristi.org/sites/default/files/pdf/about_us/Aging-Assessment-VCV-Markets.pdf 15 Physical Therapy 1 Medical Center Circle Ste B Pittsburg KS 66762 Outpatient Physical Therapy, Speech Therapy, Sports Therapy, Occupational Sleep Lab 3 Medical Center Circle Pittsburg KS 66762 Sleep Lab Services Women's Health 2711 S Rouse Ste B Pittsburg KS 66762 Outpatient Women's Health & OB/GYN Services Home Health 3 Medical Center Circle Pittsburg KS 66762 Home Health Services Cardiology 1011 Mt Carmel Place Pittsburg KS 66762 Outpatient Cardiology Services Cardiology 2711 S Rouse Ste C/D Pittsburg KS 66762 Outpatient Cardiology Services Behavioral Health 200 E Centennial Ste 13 Pittsburg KS 66762 Outpatient Behavioral Health Clinic Home Medical 202 E Centennial Ste 15 Pittsburg KS 66762 Outpatient Durable Medical Equipment Surgery Clinic 2701 S Rouse Ste A Pittsburg KS 66762 Outpatient Surgical Services Pain Management 1 Medical Center Circle Ste A Pittsburg KS 66762 Outpatient Pain Management Services Orthopedics Clinic 1 Medical Center Circle Ste A Pittsburg KS 66762 Outpatient Orthopedic Services Pulmonology Clinic 2711 S Rouse Ste A Pittsburg KS 66762 Outpatient Pulmonary Services Women's Health 2701 S Rouse Ste A Pittsburg KS 66762 Outpatient Women's Health & OB/GYN Services Cancer Center - Parsons 1509 Main Parsons KS 67357 Outpatient Oncology Clinic Cancer Center - Fort Scott 1621 S Main Fort Scott KS 66701 Outpatient Oncology Clinic Part I, Line 6a: A community benefit update that includes data from Via Christi Hospital Pittsburg (VCH-P) is printed in Via Christi Health's annual report. This annual report is released in various formats to the public and is available at the Via Christi Health website at www.viachristi.org/about-us or upon request. In addition, VCH-P makes public presentations when invited on the findings of the latest health needs assessment.Community Benefit Report:Via Christi Hospital Pittsburg, Inc. (VCH-P) is a member of Via Christi Health (VCH). As a Catholic health system, VCH-P has its origins in faith-based responses to health needs of our communities, with a particular concern for those living in poverty and who are vulnerable.The obligation to reach out to those in need and improve community health flows directly from our identity as a faith-based healing ministry. As a mission-driven organization, we provide community benefit because we are committed to our core values of:-Service of the Poor Generosity of spirit, especially for persons most in need-Reverence Respect and compassion for the dignity and diversity of life-Integrity Inspiring trust through personal leadership-Wisdom - Integrating excellence and stewardship-Creativity Courageous innovation-Dedication Affirming the hope and joy of our ministryAccording to the VCH mission statement, "As a part of Via Christi Health, we share this mission: Inspired by the Gospel and our Catholic tradition, we serve as a healing presence with special concern for our neighbors who are vulnerable."The financial information in this report was prepared in accordance with the Catholic Health Association's (CHA) A Guide for Planning and Reporting Community Benefit (2012). Per these guidelines, we report the net expense for community benefit services (e.g. the total community benefit expense minus any associated revenue from patients, residents, payers and other external sources).The CHA guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health for all. Part I, Line 6a continued: The following are VCH-P definitions for quantifiable community benefits reports.Charity Care free or discounted health services provided to persons who cannot afford to pay and who meet VCH's criteria for financial assistance. Charity care is reported in terms of costs, not charges. Charity care does not include bad debt.Government Sponsored Means-Tested Health Care includes unpaid costs of public programs for low-income persons. The shortfall created when VCH receives payments that are less than the cost of caring for public program beneficiaries. This payment shortfall is not the same as a contractual allowance, which is the full difference between charges and government payments.Health Professions Education helping to prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit. This category includes programs and financial assistance for physicians and medical students, nurses and nursing students, interns and other health professionals.For Fiscal Year Ended June 30,2014Community Benefit (VCH-P and Subsidiaries):1.Charity Care, at cost $4,119,8252.Government Sponsored Health Care, net expenseUnpaid cost of public indigent care programs(Includes Medicaid, SCHIP and other safety net programs; does notInclude Medicare shortfall) $2,725,4663. Community Benefit programs, net expense $622,0084. Total Quantifiable Community Benefit $7,467,299Listed below are just a few of the community benefit programs offered by VCH-P. This is not a complete listing but a sampling of how the hospital gives back to the community while meeting current needs. VCH-P and its affiliates enrich the communities in which they operate as well as the broader community, improving medicine through research, educating nurses/nursing students and other health care providers, and providing care and support to people in need. VCH-P further supports this mission with a community board, open medical staff, and an emergency room available to patients regardless of ability to pay.Community representation on the governing body the Board of Trustees is the governing body of VCH-P. The majority of its members are external members comprised of persons who reside in or around Crawford County. The Board has overall responsibility for the charitable mission of the organization as set forth in its articles of incorporation and bylaws. Trustees are selected based on their expertise, experience, and other criteria established by the nominating committee of the board of trustees. Areas of expertise and experience include such areas as health care, finance, education, and local government. The Board actively debates and sets policy and strategic direction for the ministry but does not get involved in issues related to daily operations. The Board takes a balanced approach when addressing community and business/financial concerns. The Board is also the primary group for determining the use of surplus funds generated by the organization, which are reinvested in the ministry in order to allow the ministry to sustain its mission and prepare for the future.Targeted population health fairs and screenings are conducted annually for children, seniors and the broader community. Screenings include: blood pressure checks, eye exams, hearing tests, feet exams, sport physicals, bone density, BMI, pre-concussion testing, and recommendations for establishing a medical home. During FY2014, VCH-P staff participated in health fairs given at local businesses, area churches, Pittsburg State University Family Day, area grade schools, middle schools and high schools, senior villages and at the Aging Expo. In addition, the Cancer Center staff held a skin cancer screening and was involved in circulating hemocult kits for colorectal cancer screenings. The Sports Medicine staff provided high school wellness/sports physicals at a discounted rate of $10 per student.Community boards/committees/coalitions VCH-P staff serve on various not-for-profit boards, committees and coalitions to keep informed about community needs and to share resources and expertise with various groups as they work to achieve their mission.In FY 2014, VCH-P served with the following community boards/committees/coalitions VCH-P served on various not-for-profit boards, committees and coalitions to keep informed about community needs and to share resources and expertise with various groups as they work to achieve their missions: Chamber of Commerce Board of Directors and Executive Committee; Crawford County Habitat for Humanity Board; Crawford County Visitors Bureau; Kansas Leadership Center's KONZA Leadership Group; Pittsburg Area Young Professional's Board; Southeast Kansas Health Care Coalition; Crawford County Community Coalition; Health and Wellness Committee Live Well; Project 17 Health Subcommittee; United Way Board; Four States Heart Walk Committee; Southeast Kansas healthcare Coalition; Pittsburg Ministerial Alliance Association; Project Warmth Planning Committee and others.CareVan, a popular transportation program owned and operated by VCH-P, provides non-emergency medical transportation assistance to elderly and handicap individuals. In FY 2014, VCH-P's CareVan provided 7,387 trips at a cost of $188,864.Health profession education of area nurses, physician assistants, nursing students and other health care professionals who are either looking for continuing education credits, wanting more hands-on training, or are in need of field practicum placements, etc. are welcomed at VCH-P for additional training opportunities. Over 750 health profession students spent time at VCH-P getting hands-on experience in a learning environment during FY2014 at a cost of $160,742.In-kind donations through staff assistance of other not-for-profit organizations in meeting their missions and/or sharing of hospital space to conduct health related not-for profit business are other ways that VCH-P gives back to the community. In FY2014, VCH-P participated with a number of groups in the following activities:VCH-P joined in with others in the community to host an Aging Expo in Parson, KS and provided bone density screenings to those in attendance. Information on osteoporosis and bone protection was also distributed and discussed.In Pittsburg, KS, VCH-P participated in the Biz Expo where staff educated those in attendance on hypertension, obesity, skin cancer and the effects of smoking. They also perform blood pressure screenings and had pig lungs available to demonstrate the effects of smoking on lungs. BMIs and Derma Scans were also available and performed.Additional health fairs were held for different employee groups, the broader community at Pittsburg State University and in Baxter, KS at the public library. Blood pressures, BMI's, educational material on blood pressure, exercise, reading food labels, colon/rectal cancer kits and bone density were distributed and questions answered.Prostate cancer, cervical cancer, colorectal cancer and skin cancer screenings were all held during FY2014 at various locations throughout the area.Concussion education for youth football coaching staff and parents, and concussion screenings were held in multiple locations (middle school, high school and college) throughout the year.Civic groups are also invited in to VCH-P to use conference rooms for their meetings to allow their limited resources to be used for programs that enhance the quality of life in the community.VCH-P staff assisted with fundraising efforts for other not-for-profit organizations (e.g. American Heart Walk, Move and Shake for Multiple Sclerosis, Our Lady of Lourdes Student Mission Trip, Salvation Army, Christmas Angels, Safehouse Drive, Lions Chili Feed, Project Warmth, etc.).VCH-P staff also assisted with coordinating and participating in periodic American Red Cross blood drives.VCH-P provides a monthly meal subsidy for the Family Resource Center to ensure children get healthy meals while at the daycare center.VCH-P also provides free medication for indigent patients who are in need of financial assistance.Staff from VCH-P also provide assistance with infant/child car seats installation and in some cases provide car seats for parents who may not be able to afford one for their child.VCH-P hosts monthly support groups for those with breast cancer and those who may have other types of cancer as well.VCH-P has additional support groups and/or educational classes for those who have had strokes or diagnosed with arthritis.VCH-P also operates a transport CareVan for those without transportation to get to and from their health care appointments. The van not only covers the City of Pittsburg but also goes into the rural areas of the county.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) guide Part II, Community Building Activities: The Hospital hosted an annual Chamber of Commerce coffee in which to update Chamber members on the Affordable Care Act and the changing landscape of healthcare which is of major interest to the business community. This helps business owners plan for their employees health care coverage and allows them to discuss issues they have dealt with over the last year in how best to handle them moving forward as business leaders.VCH-P leadership serves on the Crawford County Habitat for Humanity's board and this networking allows this agency to hear about the special needs being presented in the hospital setting for some patients who may need new homes or who may need minor tweaks in current homes in order to maintain their independence (e.g. wheel chair ramps).The CEO participates on both the Chamber Board and Executive Committee so he can stay attuned to health care needs of employees and employers as they continue to build on a healthy environment for the community. Hospital senior leadership serves on the County's Youth Leadership Program for middle school students, which focuses on leadership training and hosts discussions on bullying, nutrition, exercise and wellness. The program also presents information on various careers to sophomore students at Pittsburg High School with the intent of educating sophomores on the various careers available in the health care industry. The program also works with the schools when they are hosting mock interviews for students who will be job hunting. Our involvement focuses on students who want to pursue health careers. The outreach focus is trying to ensure we are growing our own health care professionals who will stay in the area to practice resulting in better health for all.Hospital senior leader serves on the Kansas Leadership Center's KONZA Leadership Group to share community experiences, review KLC competencies and hone adaptive leadership skills through group interactions.VCH-P allows its conference room to be used for local civic groups, Rotary and Kiwanis clubs to ensure extra resources go toward programming that results in a better community. Part III, Line 2: VCH-P reports bad debt in accordance with generally accepted accounting principles (GAAP). Healthcare Financial Management Statement No. 15 is followed to the extent that it aligns with the guidelines set forth by GAAP. Bad debt expense at cost is determined using the same cost-to-charge ratio that is used for charity care and Medicaid shortfall. VCH-P follows the guidance from CHA and does not consider bad debt as a community benefit. Part III, Line 3: The organization estimated the bad debt expense that would be attributable to patients eligible under the organization's charity care policy by taking gross bad debt expense and multiplying it by a charity write-off percentage. This percentage is calculated taking the full charity write-offs for a defined period divided by the total amount of bad debt allowance for the period preceding. This organization does not consider bad debt as a community benefit. Part III, Line 4: From the audited financial statements of Ascension Health Alliance (which include the activity of VCH-P):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 theadequacy of the allowance for doubtful accounts based upon historicalwrite-off experience by payor category, including those amounts notcovered by insurance. The results of this review are then used to make anymodifications to the provision for doubtful accounts to establish anappropriate allowance for doubtful accounts. After satisfaction of amountsdue from insurance and reasonable efforts to collect from the patient havebeen exhausted, the System follows established guidelines for placingcertain past-due patient balances with collection agencies, subject to theterms of certain restrictions on collection efforts as determined by theSystem.Accounts receivable are written off after collection efforts have been followed in accordance with the System's policies.VCH-P's bad debt deduction was $10,157,562 at charges and $3,194,914 at cost (after the cost to charge ratio was applied to the amount of charges). Part III, Line 8: VCH-P follows the CHA guidelines regarding Medicare and does not include it as community benefit. However, the methodology described in the instructions to Schedule H, Part III, Section B, Line 7 for reporting Medicare shortfall does not take into account all costs incurred by VCH-P and does not represent the total Medicare shortfall. The Medicare shortfall reported on Schedule H, Part III, Section B, Line 7 was determined using information from the organization's Medicare cost report (using the Medicare cost report step-down methodology of allocating costs). However, utilizing an internal cost accounting system actually results in a Medicare shortfall of $3,301,869. The most common reason for a difference between the Medicare shortfall reported on schedule h and the actual shortfall reported above include - inclusion of Medicare advantage revenue and expenses; inclusion of Medicare Part B revenue and expenses; inclusion of other fee schedule revenue, other timing issues, and costs that are considered unallowable on the Medicare cost report that are, in fact, related to Medicare Patient care. Part III, Line 9b: It is the policy of VCH-P to promote socially just practices for billing and collections for all patients receiving care. The policy is intended to further the VCH-P mission by requiring ethical conduct in billing and collecting self-pay balances from patients/guarantors regardless of ability to pay. The policy ensures that prior to turning an account over to a third party collection agent (agent) for collection activity, VCH-P will perform a reasonable review of each account to verify that the patient/guarantor is not potentially eligible for any government assistance program (e.g. Medicaid, Medicare, etc.) and would likely not qualify for charity care. VCH-P will direct its staff and agents to periodically assess each patient/guarantor's ability to pay or to determine eligibility for charity care. The review and assessment should include but may not be limited to the following:A. Ensure the patient/guarantor has been notified of VCH's financial assistance policy;B. Ensure the patient/guarantor was offered a financial assistance application;C. Ensure documentation of any known extraordinary financial circumstances of the patient/guarantor or if they are medically indigent. Part VI, Line 2: In addition to the Aging Assessment conducted in 2012, other area assessments were taken into account (primarily, Pittsburg Market 2011 Assessment). Up-to-date downloads from the Census Bureau as well as the Kansas University's Institute for Policy and Social Research and Kansas Hospital Association help to guide us in gathering data for our geographical areas and one-on-one interviews were held. Part VI, Line 3: The VCH-P financial assistance staff is trained on how to qualify patients for Medicaid, SCHIP, and other such income-based programs. During the patient's registration, admissions, and discharge processes, VCH-P staff attempt to identify patients who may be eligible for charity or discounted care through the charity care policy. In addition, VCH-P uses a percentage of the federal poverty guidelines (FPG) to determine free and discounted care. Part VI, Line 4: The primary counties for Pittsburg ministries include Crawford and Cherokee Counties. Crawford County has a land area of 590 square miles and Cherokee County has a land area of 588 square miles. Crawford County has an estimated 2013 population of 39,278 compared to Cherokee County's 20,978. The population demographics for Crawford County include: 92.4% white, 2.2% Black, 1.1% American Indian, 1.5% Asian, and 4.9% persons of Hispanic or Latino origin. Cherokee County demographics include: 90.7% white, 0.7% Black, 4.0% American Indian, 0.4% Asian, and 5.0% persons of Hispanic or Latino origin.Approximately 5.7% of the Crawford County residents and 2.2% of the Cherokee County residents reported using a language other than English in their homes. High school graduation rates, for the years 2008-2012, were 88.6% in Crawford County and 86.1% in Cherokee County. A bachelor's degree or higher was reported by 26.3% of Crawford County residents and 13.8% for Cherokee County residents.Median household income for Crawford County residents for the years 2008-2012 was $36,927 compared to $41,877 for Cherokee County. Median value of owner-occupied housing units for the same time period was $83,400 for Crawford County and $71,900 for Cherokee County.According to Quick Facts from the US Census, 20.4% of Crawford County lived below the poverty level between the years 2008-2012. This is higher than the 13.2% identified for the State of Kansas. Cherokee County is also above the State of Kansas level as 17.8% of their residents suggest that they live below the poverty level. VCH-P is the only hospital facility in the City of Pittsburg. Other hospitals are in neighboring communities but offer fewer services. In order to find a similar medical facility, patients would need to travel to Joplin, Missouri or Tulsa, Oklahoma for emergency care.Kansas reported in 2013 that 14.0% of all residents were persons 65 years of age and older. This compares to 14.5% for Crawford and 17.3% for Cherokee Counties. Thus services for a growing aging population need to be monitored in future assessments. Part VI, Line 5: VCH-P and its affiliates enrich the communities in which they operate as well as the broader community, improving medicine through educating physicians and other healthcare providers, and providing care and support to people in need. VCH-P further supports this mission with a community board, open medical staff, and an emergency room available to patients regardless of ability to pay.Community representation on the Governing Body- The Board of Directors is the governing body of VCH-P. The majority of its members are external members comprised of persons who reside in or around Crawford County and have overall responsibility for the charitable mission of the organization as set forth in its Articles of Incorporation and Bylaws. These directors are selected based on their expertise, experience, and other criteria established by the nominating committee of the Board of Directors. Areas of expertise and experience include such areas as healthcare, finance, education, and local government. The Board actively debates and sets policy and strategic direction for the ministry but does not get involved in issues related to daily operations. The Board takes a balanced approach when addressing community and business/financial concerns. The Board is also the primary group for determining the use of surplus funds generated by the organization which are reinvested in the ministry in order to allow the ministry to sustain its mission and prepare for the future.-The medical staff of VCH-P is open and is composed of physicians licensed to practice medicine in the State of Kansas. -VCH-P staff participates on boards of not-for-profit organizations, government entities, area colleges and university committees, state-wide coalitions, and more (e.g. Chamber, Konza Leadership, Habitat for Humanity and others).-VCH joined in with others in the community to host an Aging Expo in Parson, KS and provided bone density screenings to those in attendance. Information on osteoporosis and bone protection was also distributed and discussed.-In Pittsburg, KS, VCH-P participated in the Biz Expo where staff educated those in attendance on hypertension, obesity, skin cancer and the effects of smoking. They also perform blood pressure screenings and had pig lungs available to demonstrate the effects of smoking on lungs. BMIs and Derma Scans were also available and performed.-Additional health fairs were held for different employee groups, the broader community at Pittsburg State University and in Baxter, KS at the public library. Blood pressures, BMI's, educational material on blood pressure, exercise, reading food labels, colon/rectal cancer kits and bone density were distributed and questions answered.-Prostate cancer, cervical cancer, colorectal cancer and skin cancer screenings were all held during FY2014 at various locations throughout the area. -Concussion education for youth football coaching staff and parents, and concussion screenings were held in multiple locations (middle school, high school and college) throughout the year.-Civic groups are also invited in to VCH-P to use conference rooms for their meetings to allow their limited resources to be used for programs that enhance the quality of life in the community.-Staff assist with fundraising efforts for other not-for-profit organizations (e.g. American Heart Walk, Move and Shake for Multiple Sclerosis, Our Lady of Lourdes Student Mission Trip, Salvation Army, Christmas Angels, Safehouse Drive, Lions Chili Feed, Project Warmth, etc.).-Staff also assist with coordinating and participating in periodic American Red Cross blood drives.-VCH-P provides a monthly meal subsidy for the Family Resource Center to ensure children get healthy meals while at the daycare center.-VCH-P also provides free medication for indigent patients who are in need of financial assistance.-Staff from VCH-P also provide assistance with infant/child car seats installation and in some cases provide car seats for parents who may not be able to afford one for their child.-VCH-P hosts monthly support groups for those with breast cancer and those who may have other types of cancer as well.-VCH-P has additional support groups and/or educational classes for those who have had strokes or diagnosed with arthritis. -VCH-P also operates a transport CareVan for those without transportation to get to and from their health care appointments. The van not only covers the City of Pittsburg but also goes into the rural areas of the county. Part VI, Line 6: VCH-P is an affiliate of Via Christi Health, Inc. (VCH) and Ascension Health. VCH's affiliates are large multi-faceted, integrated, not-for-profit ministries including Hospital and Non-Hospital ministries (physician group practices, hospital organizations, research, home health, durable medical equipment, and senior facilities). These ministries work together to care for patients, joined by common systems and a philosophy of serving as a healing presence with special concern for our neighbors especially those who are vulnerable. This community benefit happens through its focus on patient care, education, and research. The organizations work together to serve their communities at the local, regional, and state level. Ascension Health Alliance, d/b/a Ascension (Ascension), is a Missouri nonprofit corporation formed on September 13, 2011. Ascension is the sole corporate member and parent organization of Ascension Health, a Catholic national health system consisting primarily of nonprofit corporation that own and operate local healthcare facilities, or Health Ministries, located in 23 of the United States and the District of Columbia.Ascension is sponsored by Ascension Sponsor, a Public Juridic Person. The Participating Entities of Ascension Sponsor are the Daughters of Charity of St. Vincent de Paul, St. Louise Province; the Congregation of St. Joseph; the Congregation of the Sisters of St. Joseph of Carondelet; theCongregation of Alexian Brothers of the Immaculate Conception Province, Inc. - American Province; and the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province. As more fully described in the Organizational Changes note, Marian Health System,which was previously sponsored by the Sisters of the Sorrowful Mother of the Third Order of St. Francis of Assisi - US/Caribbean Province, became part of Ascension Health on April 1, 2013.Mission:The System directs its governance and management activities toward strong, vibrant, Catholic Health Ministries united in service and healing, and dedicates its resources to spiritually centered care which sustains and improves the health of the individuals and communities it serves. In accordance with the System's mission of service to those persons living in poverty and other vulnerable persons, each Health Ministry accepts patients regardless of their ability to pay. The System uses four categories to identify the resources utilized for the care of persons living in poverty and community benefit programs: -Traditional charity care includes the cost of services provided to persons who cannot afford healthcare because of inadequate resources and/or who are uninsured or underinsured.-Unpaid cost of public programs, excluding Medicare, represents the unpaid cost of services provided to persons covered by public programs for persons living in poverty and other vulnerable persons.-Cost of other programs for persons living in poverty and other vulnerable persons includes unreimbursed costs of programs intentionally designed to serve the persons living in poverty and other vulnerable persons of the community, including substance abusers, the homeless, victims of child abuse, and persons with acquired immune deficiency syndrome.-Community benefit consists of the unreimbursed costs of community benefit programs and services for the general community, not solely for the persons living in poverty, including health promotion and education, health clinics and screenings, and medical research.Discounts are provided to all uninsured patients, including those with the means to pay. Discounts provided to those patients who did not qualify for assistance under charity care guidelines are not included in the cost of providing care of persons living in poverty and other community benefit programs. The cost of providing care to persons living in poverty and other community benefit programs is estimated by reducing charges forgone by a factor derived from the ratio of each entity's total operating expenses to the entity's billed charges for patient care.Certain costs such as graduate medical education and certain other activities are excluded from total operating expenses for purposes of this computation. Part VI, Line 7: The State of Kansas does not require hospitals to file community benefit reports; but VCH distributes our community benefit totals and activities annually in press releases as well as in our annual report. X 0 1 0 1 0 0 0 0 0 0 0 Randall Cason Sr Administrator/President 0 266578 0 11411 0 4865 0 38458 0 16866 0 338178 0 0 David Gambino end 1213 Trustee 0 395610 0 22500 0 11266 0 81140 0 15588 0 526104 0 0 Sherry Hausmann start 114 Trustee 0 365787 0 14567 0 4641 0 63090 0 16595 0 464680 0 0 Drew Talbott Administrator Operations/Secretary 141486 0 5056 0 2705 0 23281 0 20730 0 193258 0 0 0 Roberta Johnson Assistant Secretary 0 213515 0 7055 0 8367 0 41052 0 7284 0 277273 0 2444 David Hadley end 114 Assistant Treasurer 0 444000 0 14650 0 9649 0 96501 0 22851 0 587651 0 0 Jeff Seirer start 214 Assistant Treasurer 0 251983 0 6922 0 4668 0 50220 0 18614 0 332407 0 0 Bill Aquino end 1113 Admin-Planning 198966 0 5028 0 3384 0 27609 0 14454 0 249441 0 0 0 Ali Hammad Physician 767108 0 167710 0 4010 0 29763 0 22505 0 991096 0 0 0 Boban N Mathew Physician 505346 0 0 0 2699 0 27844 0 23930 0 559819 0 0 0 Bashar Marji Physician 656682 0 236935 0 1525 0 33500 0 19054 0 947696 0 0 0 Mary K Reed Physician 445279 0 6608 0 4412 0 16575 0 21854 0 494728 0 0 0 Danny Reveal Physician 501862 0 0 0 15178 0 17850 0 23701 0 558591 0 0 0 Debra Cartwright end 213 Former CFO 27045 0 0 0 1904 0 2359 0 2813 0 34121 0 0 0 Part I, Line 3 Via Christi Health, Inc., a related organization of Via Christi Hospital Pittsburg, Inc. uses the following to establish the compensation of the organization's President: - Compensation Committee - Independent Compensation Consultant - Compensation Survey or Study - 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, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are funded annually based on participation and are not vested until the 5 year service requirement is reached. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. The amount funded annually under the program to the executives is reported as compensation on Form 990 Schedule J, Part II, Column B in the year funded. The amount ultimately paid under the program to executives is reported on Form 990 Schedule J, Part II, Column F. There were no distributions from a supplemental nonqualified retirement plan during the year. Keysop plan-frozen: Eligible executives participated in a frozen supplemental option benefit program that provides for supplimental retirement benefits that was limited to Via Christi Hospital St. Francis, Preferred Medical Associates Physicians, Mount Carmel Regional Medical Center, and Via Christi Health System executives. The payment of benefits under the program, if any, was linked to the exercise date for the options or to earned dividends on the options. Executives were vested in full when the options were granted. The amount ultimately paid under the program to executives receiving net option value is reported on Form 990, Schedule J, Part II, Column F. The following individual received a distribution from the Keysop plan in the amount listed below: Roberta Johnson- $2,444 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 employment by related Via Christi Health, Inc. related entities. Form 990, Part VI, Section A, line 6 Via Christi Hospital Pittsburg, Inc. has a single corporate member, Via Christi Health, Inc. Form 990, Part VI, Section A, line 7a Via Christi Hospital Pittsburg, Inc. has a single corporate member, Via Christi Health, Inc., who may approve and remove individuals on the board of trustees. Form 990, Part VI, Section A, line 7b All decisions that have a material impact to Via Christi Hospital Pittsburg, Inc. Financial information or corporation as a whole are subject to approval by its sole corporate member, Via Christi Health, Inc. Form 990, Part VI, Section B, line 11 Management, including certain officers, work 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's Conflict of Interest Policy is monitored/enforced as part of the system-wide procedures of Via Christi Health, Inc. and not at the organizational level. The policy is monitored and enforced as follows: 1. At time of appointment and annually thereafter, all interested persons, including board and committee members, complete a disclosure statement which addresses actual or potential conflicts of interest; 2. The disclosure statement is done electronically and the return of the completed statement is a condition of continued appointment, employment, or participation with the organization; 3. All actual or potential conflicts are reviewed, investigated, and resolved by the chief governance officer and the corporate responsibility officer, with the results shared with the chief executive of the organization; and 4. Periodic reviews are conducted by governance, compliance, and internal audit to ensure the organization is operating consistent with the policy and enforcing the policy's terms. Form 990, Part VI, Section B, line 15b Via Christi Hospital Pittsburg, Inc. uses the policies established by Via Christi Health, Inc. (VCH). VCH has established a common philosophy, strategy, and processes for executive compensation. Through the oversight of the VCH Executive Compensation Committee, executive compensation is competitively positioned at its stated market position when compared to the compensation paid by relevant organizations (comparably-sized health systems, hospitals, and long-term care providers). VCH recognizes its responsibility to ensure that its executive compensation program is appropriate in view of its mission and tax-exempt status and that its compensation levels and expenditures are reasonable and not excessive. To ensure these ends, the VCH Executive Compensation Committee has established and approved the executive compensation philosophy for VCH and all related entities. It will also approve all changes in the compensation package for VCH executives in advance. On an annual basis, the Committee conducts a comprehensive review of total compensation for all executives. It also reviews and approves "off-cycle" compensation transactions as needed. In their review, the Committee considers the following factors: - Market data from independent compensation surveys and sources that reflect comparable positions in organizations of similar size and scope; - Difficulties in recruiting and retaining executives; - Skills, experience and performance history of individual executives; - Critical business or strategic issues that the organization may face; and - Market position for total compensation. The adequacy, competitiveness, and cost of the VCH total executive compensation program are reviewed on an ongoing basis and changes are made as the Committee determines appropriate. The executive compensation program will be maintained such that it will fall within the safe harbor guidelines established by the intermediate sanctions regulations. The Committee also employs the services of an independent compensation consultant to prepare market analysis to aid and support the Committee's actions, provide documentation of market trends for budget setting purposes, review annual compensation changes to ensure "reasonableness" and provide attestation, and provide consultation on all executive compensation issues. The Committee also relies on third-party validation of performance measures used in the determination of compensation. Form 990, Part VI, Section C, line 19 Via Christi Hospital Pittsburg, Inc.'s governing documents and Conflict of Interest Policy are available to the public upon request. Form 990, Part VII, Section A: Sister Marie Veronica Janousek receives compensation from Via Christi Hospital Wichita, Inc. Her compensation is not paid directly to her but is paid to her religious order in accordance with her vow of poverty. Sister Suzanne Daniel receives compensation from Via Christi Hospital Wichita, Inc. Her compensation is not paid directly to her but is paid to her religious order in accordance with her vow of poverty. Form 990, Part IX, line 11g Purchased Services: Program service expenses 4,006,942. Management and general expenses 482,482. Fundraising expenses 0. Total expenses 4,489,424. Service Center: Program service expenses -157,479. Management and general expenses 7,915,694. Fundraising expenses 0. Total expenses 7,758,215. Other: Program service expenses 1,917,175. Management and general expenses 245,299. Fundraising expenses 0. Total expenses 2,162,474. Form 990, Part XI, line 9: Other Comp Income - Pension 1,423,412. Fair Market Value Adjustment -1,916,626. Ascension Health Alliance 4600 Edmundson Rd St Louis MO 63134 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 Via Christi Health Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 481172107 Health System Parent KS Section 501(c)(3) Schedule A, Line 11c Ascension Health 0 Via Christi Villages Inc 2622 W Central Suite 100 Wichita KS 67203 480559086 Management Company KS Section 501(c)(3) Schedule A, Line 11c Via Christi Health Inc 1 Cornerstone Assisted Living Inc 2622 W Central Suite 100 Wichita KS 67203 481241079 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Hays Inc 2225 Canterbury Drive Hays KS 67601 202828680 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Care at Home Inc 2622 W Central Suite 100 Wichita KS 67203 271889960 Health Agency KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Healthcare Outreach Program for Elders Inc 2622 W Central Suite 101 Wichita KS 67203 481236589 PACE Community Program KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Georgetown Inc 1655 S Georgetown Wichita KS 67218 481129325 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Manhattan Inc 2800 Willow Grove Road Manhattan KS 66502 481078862 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village McLean Inc 777 N McLean Blvd Wichita KS 67203 481247723 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Pittsburg Inc 1502 E Centennial Drive Pittsburg KS 66762 743070971 Retirement Home KS Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Via Christi Village Ponca City Inc 1601 Academy Road Ponca City OK 74604 731153337 Retirement Home OK Section 501(c)(3) Schedule A, Line 9 Via Christi Villages Inc 1 Mount Carmel Foundation Inc 1 Mt Carmel Way Pittsburg KS 66762 480961283 Foundation KS Section 501(c)(3) Schedule A, Line 11a Via Christi Hospital Pittsburg Inc 1 Via Christi Health Alliance in Accountable Care Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 462872857 ACO KS Via Christi Health Inc 1 Via Christi Hospital Wichita St Teresa Inc 14800 W St Teresa Wichita KS 67235 271965272 Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Health Inc 1 Via Christi Hospitals Wichita Inc 929 N Saint Francis Wichita KS 67214 481172106 Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Health Inc 1 Gerard House Inc 3144 N Hood Wichita KS 67204 481049532 Hospital Support KS Section 501(c)(3) Schedule A, Line 9 Via Christi Hospitals Wichita Inc 1 Via Christi Rehabilitation Hospital Inc 1151 N Rock Road Wichita KS 67206 481158274 Rehabilitation Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Hospitals Wichita Inc 1 Via Christi Property Services Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 480948571 Property Management KS Section 501(c)(4) N/A Via Christi Hospitals Wichita Inc 1 Via Christi Health Partners Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 480958974 Management Company KS Section 501(c)(3) Schedule A, Line 9 Via Christi Health Inc 1 Mercy Regional Health Center Inc 1823 College Avenue Manhattan KS 66502 481186704 Hospital KS Section 501(c)(3) Schedule A, Line 3 Via Christi Health Inc 1 Mercy Community Health Foundation Inc PO Box 13 Manhattan KS 66502 481152279 Foundation KS Section 501(c)(3) Schedule A, Line 9 Mercy Regional Health Center Inc 1 Wamego Hospital Association Inc 711 Genn Drive Wamego KS 66547 721526400 Hospital KS Section 501(c)(3) Schedule A, Line 3 Mercy Regional Health Center Inc 1 Mercy Regional Home Medical Services LLC 2439 Claflin Road Manhattan KS 66502 432024491 Medical Equipment KS Section 501(c)(3) Schedule A, Line 9 Mercy Regional Health Center Inc 1 Salina Regional Home Medical Services LLC 520 South Santa Fe Ave Salina KS 67401 431948057 Medical Equipment KS Section 501(c)(3) Schedule A, Line 9 Salina Regional Health Center Inc 0 Ambulatory Surgery Center LP 8200 E Thorn Drive Suite 300 Wichita KS 67226 481114690 Surgery Center KS N/A AMS Diagnostics LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481223653 Radiology Services KS N/A Kansas Surgery and Recovery Center LLC 2770 North Webb Road Wichita KS 67226 481148580 Surgery Center KS N/A MR Imaging Center LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481000538 Imaging Center KS N/A St Joseph MRI LLC 8200 E Thorn Drive Suite 300 Wichita KS 67226 481007220 Imaging Center KS N/A Mercy Imaging LLC 1823 College Avenue Manhattan KS 66502 481251984 Radiology Services KS N/A Affiliated Medical Services Laboratory Inc 2916 E Central Wichita KS 67214 481239522 Medical Laboratory KS N/A C 0 Integrated Healthcare Systems Inc 3311 East Murdock Wichita KS 67208 480941549 Clinic Services KS N/A C 0 VCH Iowa PC Trust 8200 E Thorn Drive Suite 300 Wichita KS 67226 276937322 Beneficiary Trust IA N/A T 0 VCH Iowa PC 8200 E Thorn Drive Suite 300 Wichita KS 67226 273983977 Professional Association IA N/A C 0 Via Christi Clinic PA 3311 East Murdock Wichita KS 67208 480993446 Professional Association KS N/A C 0 Sunflower Assurance Ltd PO Box 1085 Grand Cayman CJ KY1-1102 980223159 Insurance Company CJ N/A C 0 Via Christi Clinic Services Inc 8200 E Thorn Drive Suite 300 Wichita KS 67226 273984287 Clinic Services KS N/A C 0 0 0 1 1 0 0 0 1 0 0 0 1 1 0 1 1 1 1 1 Via Christi Health Inc D 6851510 Actual Amount Transferred Via Christi Health Inc H 305902 Actual Amount Transferred Via Christi Health Inc L 60782 Actual Amount Transferred Via Christi Health Inc O 80130 Actual Amount Transferred Via Christi Health Inc P 3671724 Actual Amount Transferred Via Christi Health Inc Q 27980092 Actual Amount Transferred Via Christi Health Inc S 10397681 Actual Amount Transferred Via Christi Hospitals Wichita Inc M 78230 Actual Amount Transferred Via Christi Hospitals Wichita Inc P 278383 Actual Amount Transferred Via Christi Hospitals Wichita Inc S 327496 Actual Amount Transferred Mt Carmel Foundation Inc Q 85722 Actual Amount Transferred