2013-05-10T11:00:13-05:00 2012-06-30 470617373 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2011-07-01 470443636 ST MARY'S COMMUNITY HOSPITAL STMA 4028733321 1314 3rd Avenue Nebraska City NE 68410 SHAWN CLOSNER 2013-05-09 true PAMELA KROHN P01210500 3032989100 2011 2016-02-25 16:41:14Z DANIEL KELLY 1314 3rd Avenue Nebraska City NE 68410 17972244 false 0928 X WWW.STMARYSHOSPITALNECITY.COM X 1927 NE ST. MARY'S IS A NOT FOR PROFIT CRITICAL ACCESS HOSPITAL THAT PROVIDES ACUTE CARE FOR THE BENEFIT OF ALL REGARDLESS OF ABILITY TO PAY AND PROMOTES HEALTH THROUGH COMMUNITY OUTREACH INITIATIVES AND PARTNERSHIPS. 13 9 175 15 8844 7844 71174 123866 16780295 17356377 623610 314496 94931 143236 17570010 17937975 6927 738825 0 0 7215703 7740978 0 0 0 8638593 8557277 15861223 17037080 1708787 900895 19027049 19461918 1778708 1552341 17248341 17909577 THE ORGANIZATION'S MISSION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY. FIDELITY TO THE GOSPEL URGES US TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE MOVE TOWARD THE CREATION OF HEALTHIER COMMUNITIES. false false 12428064 738825 17356377 SEE SCHEDULE H 12428064 true true false true false false false false false true true false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 0 0 175 true true true false false false false false false false false false X 13 9 false false true false true true true true true false false true true true true true true false true false X Sharon Crunk 4028738929 1314 3rd Avenue Nebraska City NE 68410 X DANIEL KELLY 40.00 X X 0 246983 50352 JONATHAN STELLING 2.00 X X 0 267532 41974 KATHRYN NELSON 1.00 X X 0 0 0 SCOTT VANDERVEEN 4.00 X X 0 0 0 BRETT GAY 1.00 X 0 0 0 DAVID J PARTSCH 1.00 X 0 0 0 JOSEPH J JOHNSON 1.00 X 0 0 0 LIDIA BORER 1.00 X 0 0 0 MELISSA TURNER 1.00 X 0 0 0 MICHAEL MCCABE 1.00 X 0 0 0 MR ERWIN FRIESEN 1.00 X 0 0 0 ROBERT LANIK 1.00 X 0 882209 46446 SHARON M CRUNK 1.00 X 0 0 0 STACY BLUM 1.00 X 0 249893 42006 SHAWN CLOSNER 40.00 X 109095 0 27938 JOAN BECCARD 40.00 X 112087 0 31654 SHARI LOCK 40.00 X 113020 0 7537 334202 1646617 247907 3 false true false KETTER & ASSOCIATES 1819 F STREET AUBURN NE 68305 THERAPY SERVICES 570125 SLEEP TIGHT ANESTHESIA PC 2640 WHITAKER ROAD NEBRASKA CITY NE 68410 ANESTHESIA SERVICES 502400 2 103866 20000 123866 PATIENT SERVICES 900099 17327351 17327351 INTERCOMPANY REIMBURSEMENTS 900099 29026 29026 0 0 0 0 17356377 230637 283 230354 0 0 28364 26934 1430 0 1430 1430 84292 433 84292 -433 83859 83859 0 0 8743 6902 1841 1841 CAFETERIA 722100 44756 44756 MEALS ON WHEELS 624210 19560 19560 LABORATORY SERVICES 621500 35566 8561 27005 40083 0 0 40083 139965 17937975 17356377 8844 448888 738075 738075 750 750 0 0 112074 112074 0 5864697 4402965 1461732 308285 232755 75530 1039759 785018 254741 416163 314203 101960 0 0 0 0 0 0 3335939 2145770 1190169 43096 43096 783178 475724 307454 465 465 0 342254 234813 107441 55400 25739 29661 0 29502 22621 6881 49303 49303 494172 494172 653594 333781 319813 24829 24829 MEDICAL SUPPLIES 1586013 1586013 BAD DEBTS 510230 510230 REPAIRS AND MAINTENANCE 422035 309172 112863 UNRELATED BUSINESS TAXES 9702 9702 217565 149058 68507 0 17037080 12428064 4609016 0 0 300 300 2876548 1825273 2360710 3137395 208506 285842 40588 49086 13563620 9893660 4066624 3669960 0 9402394 10422683 0 0 71379 71379 19027049 19461918 686453 559623 0 1092255 992718 1778708 1552341 X 17245088 17906321 3253 3256 17248341 17909577 19027049 19461918 X 900895 -239659 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 428 false false false 428 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $297, CATHOLIC HEALTH ASSOCIATION - $131 31012 31012 322014 8103637 5621624 2804027 0 4883771 4168337 715434 223186 103699 119487 3669960 0 0 CHI OIP - FIXED INCOME 5232482 F CHI OIP - EQUITY SECURITIES 5190201 F 10422683 0 CHI DEBT PROGRAM 991772 UNCLAIMED PROPERTY 946 992718 FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 ST. MARY'S COMMUNITY HOSPITAL'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI'S FIN 48 (ASC 740) FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2012 READS AS FOLLOWS: "CHI IS A TAX-EXEMPT COLORADO CORPORATION AND HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CHI OWNS CERTAIN TAXABLE SUBSIDIARIES AND ENGAGES IN CERTAIN ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE AND THEREFORE SUBJECT TO INCOME TAX. MANAGEMENT REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS." true true X false false true true false true true 160 209227 0 209227 0.01270 0 0 0 0 0.00000 0 0 0 0 0.00000 0 160 209227 0 209227 0.01270 8 367 93271 90 93181 0.00560 2 18 10835 0 10835 0.00070 0 0 0 0 0 0.00000 0 0 0 0 0 0.00000 11 921 74809 17022 57787 0.00350 21 1306 178915 17112 161803 0.00980 21 1466 388142 17112 371030 0.02250 0 0 0 0 0 0.00000 1 0 574 0 574 0.00000 1 0 29415 0 29415 0.00170 1 246 2798 0 2798 0.00020 0 0 0 0 0 0.00000 1 0 6064 0 6064 0.00040 0 0 0 0 0 0.00000 2 5 1286 0 1286 0.00010 0 0 0 0 0 0.00000 6 251 40137 0 40137 0.00240 true 510230 0 6550667 6502247 48420 X true true 1 1 ST MARY'S COMMUNITY HOSPITAL

1314 3RD AVENUE NEBRASKA CITY NE 68410

X X X X Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO ST. MARY'S COMMUNITY HOSPITAL) ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY IT WAS DETERMINED THAT ESTABLISHING A HOUSEHOLD INCOME SCALE BASED ON THE HUD VERY LOW INCOME GUIDELINES MORE ACCURATELY REFLECTS THE SOCIOECONOMIC DISPERSIONS AMONG THE 69 URBAN AND RURAL COMMUNITIES IN 19 STATES SERVED BY CHI HOSPITALS AND HEALTH CARE FACILITIES. IN COMPARING HUD GUIDELINES TO THE FEDERAL POVERTY GUIDELINES ("FPG"), WE FIND THAT ON AVERAGE HUD GUIDELINES COMPUTE TO APPROXIMATELY 200% TO 250% (AND SOMETIMES 300%) OF FPG. ST. MARY'S COMMUNITY HOSPITAL BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. PREPARED COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A ST. MARY'S COMMUNITY HOSPITAL PREPARES ITS OWN ANNUAL WRITTEN COMMUNITY BENEFIT REPORT. ITS COMMUNITY BENEFIT REPORT IS NOT CONTAINED IN THAT OF A RELATED ORGANIZATION. Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING THE ORGANIZATION'S COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/12 WAS COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 510,230 Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 THE AMOUNT REPORTED ON THE SCHEDULE H, PART III, LINES 2 AND 3 ARE THE SAME AMOUNTS REPORTED FOR BAD DEBT IN THE AUDITED FINANCIAL STATEMENTS. PLEASE REFER TO THE FINANCIAL STATEMENT FOOTNOTE BELOW FOR INFORMATION REGARDING THE METHODOLOGY USED TO DETERMINE AND REPORT BAD DEBT EXPENSE. ST. MARY'S COMMUNITY HOSPITAL DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. ST. MARY'S COMMUNITY HOSPITAL DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS: "THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHI FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY." Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 ST. MARY'S COMMUNITY HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL ("CAH"). CAHS ARE RURAL COMMUNITY HOSPITALS THAT ARE CERTIFIED TO RECEIVE COST-BASED REIMBURSEMENT FROM MEDICARE. THE REIMBURSEMENT THAT CAHS RECEIVE IS INTENDED TO IMPROVE THEIR FINANCIAL PERFORMANCE AND THEREBY REDUCE HOSPITAL CLOSURES. CAHS ARE CERTIFIED UNDER A DIFFERENT SET OF MEDICARE CONDITIONS OF PARTICIPATION (COP). SHORTFALLS ARE CREATED WHEN A FACILITY RECEIVES PAYMENTS THAT ARE LESS THAN THE COSTS OF CARING FOR PROGRAM BENEFICIARIES. BECAUSE SHORTFALLS ARE BASED ON COSTS, NOT CHARGES, ST. MARY'S COMMUNITY HOSPITAL, DUE TO THEIR DESIGNATION AS A CAH, RECEIVED COST-BASED REIMBURSEMENT FOR MEDICARE PURPOSES, ST. MARY'S COMMUNITY HOSPITAL WILL NOT EXPERIENCE MEDICARE RELATED SHORTFALLS. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b ST. MARY'S COMMUNITY HOSPITAL, ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES ARE PART OF CATHOLIC HEALTH INITIATIVES "CHI". CHI HAS A WRITTEN POLICY (STEWARDSHIP POLICY NO. 16) GOVERNING THE PROCEDURES FOR COLLECTIONS OF PAST DUE ACCOUNTS. ALL HOSPITAL FACILITIES INCLUDED IN THE FILING ORGANIZATION HAVE ADOPTED THIS POLICY AND FOLLOW THESE PRACTICES WITH REGARDS TO COLLECTIONS: PROCEDURES CHI ENTITIES WILL FOLLOW STANDARD PROCEDURES IN COLLECTING SELF-PAY BALANCES AS FOLLOWS: PERMISSIBLE COLLECTIONS ACTIVITY EACH FACILITY MUST ADHERE TO THE FOLLOWING REQUIREMENTS IN RELATION TO THE PURSUIT OF SELF-PAY BALANCES: * FAIR PURSUIT. EACH FACILITY SHALL ENSURE THAT ALL PATIENT AND PATIENT GUARANTOR ACCOUNTS ARE PURSUED FAIRLY. * ETHICS AND INTEGRITY. EACH FACILITY SHALL ENSURE THAT ALL COLLECTION ACTIVITIES CONSISTENTLY REFLECT THE HIGHEST STANDARDS OF ETHICS AND INTEGRITY. * REASONABLE PAYMENT TERMS. EACH FACILITY SHALL OFFER REASONABLE PAYMENT SCHEDULES AND TERMS TO EACH PATIENT AND PATIENT GUARANTOR WITH SELF-PAY BALANCES. ALL COLLECTION ACTIVITIES CONDUCTED BY THE FACILITY OR ITS THIRD-PARTY COLLECTION AGENTS WILL BE IN CONFORMANCE WITH ALL FEDERAL AND STATE LAWS GOVERNING DEBT COLLECTION PRACTICES. COLLECTION ACTIVITY MAY BE IN THE FORM OF LETTERS, EMAILS, PHONE CALLS, AND/OR CREDIT REPORTING AND MAY ALSO INCLUDE WAGE GARNISHMENTS, PLACING OF LIENS ON BUILDINGS OR RESIDENCES OTHER THAN PERSONAL RESIDENCES, INITIATION OF LAWSUIT, AND/OR OTHER ACTIONS AS REQUIRED, EXCEPT AS PROHIBITED BY IMPERMISSIBLE COLLECTIONS ACTIONS BELOW. PRE-COLLECTIONS ACTIVITY * TIMING. GENERALLY, ACCOUNTS WILL NOT BE REFERRED TO COLLECTIONS UNTIL THEY ARE 120 DAYS OLD. HOWEVER, IN CIRCUMSTANCES WHERE INVOICES TO NON-MEDICARE PATIENTS ARE RETURNED UNDELIVERED WITH NO KNOWN ADDRESS, THOSE SELF-PAY BALANCES MAY BE REFERRED TO COLLECTIONS PRIOR TO EXPIRATION OF 120 DAYS. * LIMITATIONS - FINANCIAL ASSISTANCE ELIGIBILITY. THE FACILITY SHALL PERFORM A REASONABLE REVIEW OF EACH PATIENT ACCOUNT PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT (INCLUDING, BUT NOT LIMITED TO, REPORTING THE ACCOUNT TO A COLLECTION AGENCY) TO ENSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G., MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH THE FACILITY'S FINANCIAL ASSISTANCE POLICY. THAT REASONABLE REVIEW WILL INCLUDE ONE OR MORE OF THE FOLLOWING: A. NOTIFICATION TO PATIENT OF THE AVAILABILITY OF FINANCIAL ASSISTANCE ON ADMISSION, PRIOR TO DISCHARGE, AND/OR IN THE BILLING PROCESS; B. REVIEW OF FINANCIAL ASSISTANCE APPLICATION SUBMITTED BY OR ON BEHALF OF THE PATIENT; OR C. REVIEW OF THE PATIENT'S ELIGIBILITY USING PATIENT ACCOUNT STATISTICAL SCORING SOFTWARE. * COOPERATING EFFORTS. NO FACILITY SHALL SEND ANY UNPAID SELF-PAY ACCOUNT TO A THIRD-PARTY COLLECTION AGENT AS LONG AS THE PATIENT AND PATIENT GUARANTOR ARE COOPERATING WITH THE FACILITY IN EFFORTS TO SETTLE THE ACCOUNT BALANCE WITHIN A REASONABLE TIME FRAME (GENERALLY 18 MONTHS). * SUBSEQUENT ASSESSMENT. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY ACCOUNT THAT SUBSEQUENTLY IS DETERMINED TO QUALIFY FOR FINANCIAL ASSISTANCE SHALL BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO THE FACILITY FOR APPROPRIATE FOLLOW-UP. CHI SHALL DIRECT ITS STAFF AND THIRD-PARTY COLLECTION AGENTS TO CONTINUALLY ASSESS EACH PATIENT AND PATIENT GUARANTOR'S ABILITY TO PAY OR TO BE DETERMINED ELIGIBLE FOR FINANCIAL ASSISTANCE. COLLECTIONS THE FACILITY MAY USE A THIRD-PARTY COLLECTION AGENT AS A REPRESENTATIVE, ACTING IN THE NAME OF THE FACILITY AND ENGAGED ON A CONTRACTUAL BASIS, FOR THE EXPRESS PURPOSES OF FOLLOWING-UP ON AND POTENTIALLY COLLECTING ANY PATIENT ACCOUNTS RECEIVABLE BALANCES. THE FACILITY SHALL CONTRACTUALLY DEFINE THE STANDARDS AND SCOPE OF PRACTICES TO BE USED BY THIRD-PARTY COLLECTION AGENTS. THOSE STANDARDS AND SCOPE OF PRACTICES SHALL BE CONSISTENT WITH THIS POLICY AND SHALL, AT A MINIMUM, INCLUDE THE FOLLOWING: * STATEMENT MESSAGE. THE FACILITY SHALL REQUIRE ITS THIRD-PARTY COLLECTION AGENTS TO INCLUDE A MESSAGE ON ALL STATEMENTS INDICATING THAT IF A PATIENT OR PATIENT GUARANTOR MEETS CERTAIN STIPULATED INCOME REQUIREMENTS, THE PATIENT OR PATIENT GUARANTOR MAY BE ELIGIBLE FOR FACILITY OR OTHER FINANCIAL ASSISTANCE PROGRAMS. * ADVANCE SETTLEMENT APPROVALS. THE FACILITY SHALL INSTRUCT ITS THIRD-PARTY COLLECTION AGENTS TO SEEK APPROVAL FROM THE AUTHORIZED AND DESIGNATED FACILITY STAFF MEMBER BEFORE ANY SETTLEMENT, AS A RESULT OF BANKRUPTCY PROCEEDINGS, SHALL BE ACCEPTED. * STANDARDS OF CONDUCT. THE FACILITY SHALL REQUIRE THAT THE THIRD-PARTY COLLECTION AGENTS CONDUCT THEMSELVES IN COMPLIANCE WITH THE HIGHEST STANDARDS OF BUSINESS ETHICS AND INTEGRITY AND APPLICABLE LEGAL REQUIREMENTS, AS REFLECTED IN THE CHI STANDARDS OF CONDUCT, AS MAY BE AMENDED BY CHI, AVAILABLE AT THE FOLLOWING WEBSITE: HTTP://WWW.CATHOLICHEALTHINITIATIVES.ORG/CORPORATERESPONSIBILITY. * PROHIBITED COLLECTIONS ACTIONS. THE FACILITY SHALL PROHIBIT THE THIRD-PARTY COLLECTION AGENTS FROM ENGAGING IN PROHIBITED COLLECTIONS ACTIONS AS DEFINED IN IMPERMISSIBLE COLLECTIONS ACTIONS BELOW. * ANNUAL ADHERENCE AUDIT. THE FACILITY OR ITS DESIGNEE SHALL BE PERMITTED TO AUDIT ITS THIRD-PARTY COLLECTION AGENTS AT LEAST ANNUALLY FOR ADHERENCE TO THESE STANDARDS. IMPERMISSIBLE COLLECTIONS ACTIONS CHI ENTITIES SHALL DIRECT THEIR STAFF AND THIRD-PARTY COLLECTION AGENTS THAT THE FOLLOWING ACTIONS ARE ALWAYS PROHIBITED IN RELATION TO THE PURSUIT OF SELF-PAY BALANCES. * UNEMPLOYED WITHOUT SIGNIFICANT INCOME/ASSETS. NO FACILITY SHALL PURSUE ANY LEGAL ACTION FOR NON-PAYMENT OF ANY BILLS AGAINST ANY PATIENT OR PATIENT GUARANTOR WHO IS KNOWN TO BE UNEMPLOYED AND WHO HAS BEEN DETERMINED IN ACCORDANCE WITH CHI STEWARDSHIP POLICY NO. 15, HOSPITAL FINANCIAL ASSISTANCE, ON THE BASIS OF A COMPLETED FINANCIAL ASSISTANCE APPLICATION, TO BE WITHOUT SIGNIFICANT INCOME OR ASSETS. * PRINCIPAL RESIDENCE. NO FACILITY SHALL PURSUE ANY LEGAL ACTION AGAINST ANY PATIENT OR PATIENT GUARANTOR BY SEEKING A REMEDY THAT WOULD INVOLVE FORECLOSING UPON THE PRINCIPLE RESIDENCE OF A PATIENT OR PATIENT GUARANTOR, PLACING A LIEN ON THE PRINCIPAL RESIDENCE, TAKING ANY OTHER ACTION THAT COULD RESULT IN THE INVOLUNTARY SALE OR TRANSFER OF SUCH RESIDENCE, OR INFORMING ANY PATIENT OR PATIENT GUARANTOR THAT HE/SHE MAY BE SUBJECT TO ANY SUCH ACTION. * OTHER IMPERMISSIBLE COLLECTION TACTICS. A. NO FACILITY SHALL CHARGE INTEREST ON OUTSTANDING BALANCES; B. NO FACILITY SHALL REQUIRE PATIENTS OR PATIENT GUARANTORS TO INCUR DEBT OR LOANS WITH RECOURSE TO THE PATIENT'S OR GUARANTOR'S PERSONAL OR REAL PROPERTY ASSETS ("RECOURSE INDEBTEDNESS"); AND C. NO FACILITY SHALL INVOKE SO-CALLED "BODY ATTACHMENTS" (I.E., THE ARREST OR JAILING OF PATIENTS IN DEFAULT ON THEIR ACCOUNTS, SUCH AS FOR MISSED COURT APPEARANCES). IN ADDITION TO THE WRITTEN POLICY ALL OF CATHOLIC HEALTH INITIATIVES' HOSPITALS' CONTRACTS WITH THIRD PARTY COLLECTION AGENCIES INCLUDE THE FOLLOWING STANDARDS: * NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL REQUEST BENCH OR ARREST WARRANTS AS A RESULT OF NON-PAYMENT; * NEITHER CHI HOSPITALS NOR THEIR COLLECTION AGENCIES WILL SEEK LIENS THAT WOULD REQUIRE THE SALE OR FORECLOSURE OF A PRIMARY RESIDENCE; AND * NO CATHOLIC HEALTH INITIATIVES' COLLECTION AGENCY MAY SEEK COURT ACTION WITHOUT HOSPITAL APPROVAL. FINALLY, COLLECTION AGENCIES ARE TRAINED ON THE CATHOLIC HEALTH INITIATIVES MISSION, CORE VALUES AND STANDARD OF CONDUCT TO MAKE SURE ALL PATIENTS ARE TREATED WITH DIGNITY AND RESPECT. Used federal poverty guidelines (FPG) to determine eligibility Schedule H, Part V Section B, Line 9 (1) ST. MARY'S COMMUNITY HOSPITAL - USE HUD FEDERAL GUIDELINES.; Used FPG to determine eligibility for providing discounted care criteria Schedule H, Part V Section B, Line 10 (1) ST. MARY'S COMMUNITY HOSPITAL - USE HUD FEDERAL GUIDELINES.; LINES 2, 3, 4, & 5: NEEDS ASSESSMENT AND COMMUNITY INFORMATION SCHEDULE H, PART VI ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE ST. MARY'S COMMUNITY HOSPITAL ("SMCH") WAS FOUNDED TO ALLEVIATE A SHORTAGE OF HOSPITAL BEDS IN THE COMMUNITY IN 1927. AS A CATHOLIC HOSPITAL, SMCH EMBRACED THE MISSION OF THE FOUNDING RELIGIOUS CONGREGATION, WHICH HAS SINCE JOINED WITH OTHER RELIGIOUS CONGREGATIONS TO FORM CATHOLIC HEALTH INITIATIVES. THE MISSION OF SMCH IS TO DEVELOP A HEALTHY COMMUNITY AND PROVIDE CARE TO ALL IN NEED. IT HAS A BOARD OF DIRECTORS THAT IS COMPRISED OF INDEPENDENT, COMMUNITY REPRESENTATIVES. SMCH OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THAT EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. SMCH HAS AN OPEN MEDICAL STAFF, PARTICIPATES IN MEDICARE AND MEDICAID, AND HAS AN ACTIVE CHARITY CARE PROGRAM. COMMUNITY SERVICE HAS ALWAYS BEEN AT THE CORE OF SMCH'S ACTIVITIES. EACH YEAR, SERVICES AND PROGRAMS ARE EXPANDED TO PROMOTE A HEALTHY COMMUNITY. THE PROGRAMS AND SERVICES DESCRIBED THROUGHOUT THIS REPORT NOT ONLY SERVE THE COMMUNITY, BUT ALSO REDUCE THE BURDENS ON THE GOVERNMENT. FOR EXAMPLE, IF SMCH DID NOT PROVIDE CHARITY CARE, THE BURDEN OF PROVIDING CHARITY CARE WOULD FALL ON A GOVERNMENT-SUPPORTED INSTITUTION. SMCH IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. COMMUNITY BENEFIT APPROACH LOCATED IN NEBRASKA CITY, NEBRASKA, SMCH SERVES OTOE COUNTY, NEBRASKA AND THE SURROUNDING COUNTIES IN SOUTHEAST NEBRASKA, AS WELL AS SOUTHWEST IOWA. THIS ENCOMPASSES THE HOSPITAL'S HOME ZIP CODE AREA AND THE 11 NEIGHBORING ZIP CODES. OTOE COUNTY HAS A POPULATION OF 15,740. ALMOST ONE HALF OF THE COUNTY'S POPULATION RESIDE IN NEBRASKA CITY WHILE THE OTHER HALF LIVE IN AND NEAR ONE OF THE NINE OTHER COMMUNITIES. OTOE COUNTY: THE MOST RECENT 2011 ESTIMATES, BASED ON THE LAST OFFICIAL COUNT FROM 2010 FROM THE U.S. CENSUS BUREAU, REFLECT OTOE COUNTY AS AN OLDER AND MORE DIVERSE COMMUNITY. OTOE COUNTY HAS A MEDIAN AGE OF 39.1 OTOE COUNTY MEDIAN HOUSEHOLD INCOME: $46,160 OTOE COUNTY UNEMPLOYMENT RATE: 3.9% OTOE COUNTY; PERCENTAGE OF PERSONS LIVING BELOW THE POVERTY LINE: 12.2% OTOE COUNTY HISPANIC POPULATION: 5.1% MEDICALLY UNDERSERVED POPULATION: 11.2% UNINSURED THE BABY BOOMERS BORN BETWEEN 1946 AND 1964 ARE THE LARGEST GENERATION WITH MANY REACHING THE STATUS OF A SENIOR CITIZEN. CITY OF NEBRASKA CITY: LARGEST POPULATION IS WHITE: 91.5% HISPANIC POPULATION: 7.5% MEDIAN INCOME: $55,350 JOBS HAVE DECREASED BY 70 SINCE 12/31/2011 SMCH HAS BEEN COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES FOR A NUMBER OF YEARS. IN 2004, SMCH OFFICIALLY LAUNCHED THE HEALTHY COMMUNITIES COALITION PROCESS TO LOOK AT AREA HEALTH ISSUES, SET PRIORITIES AND PLAN FOR IMPROVEMENT. A WIDE VARIETY OF CITIZENS FROM THE PUBLIC AND PRIVATE SECTORS PARTICIPATED IN THIS PROCESS. SMCH CONTINUES OUR DEEP COMMITMENT AND INVOLVEMENT IN THE COMMUNITY HEALTH COLLABORATIVE TODAY. PROCESS SMCH'S COMMUNITY BENEFIT EFFORTS ARE BASED ON THE UNDERSTANDING OF COMMUNITIES' NEEDS DERIVED FROM COLLABORATIVE NEEDS ASSESSMENTS, FOCUS GROUPS, AND SURVEYS CONDUCTED WITH OUR COMMUNITY PARTNERS. IN 2007, SMCH'S HEALTHY COMMUNITIES COALITION AND OTOE COUNTY COALITION MERGED TO FORM PARTNERS FOR OTOE COUNTY (P4OC) COALITION. THE COALITION STRIVES TO MAXIMIZE RESOURCES (FINANCIAL AND HUMAN), REDUCE DUPLICATION OF WORK AND EFFECTIVELY MEET THE NEEDS AND PRIORITIES OF NEBRASKA CITY AND OTOE COUNTY. P4OC ENCOURAGES INDIVIDUALS, ORGANIZATIONS AND INSTITUTIONS TO TAKE RESPONSIBILITY FOR IMPROVING THE HEALTH AND QUALITY OF LIFE IN THEIR COMMUNITIES. P4OC HAS BEEN WORKING FOR SEVERAL YEARS TO MEASURE AND IMPROVE THE HEALTH STATUS OF THE COMMUNITY. SUMMARY OF ASSESSMENT FINDINGS SMCH, IN COLLABORATION WITH PARTNER FOR OTOE COUNTY (P4OC) COALITION, COMPLETED THE HEALTHY COMMUNITIES' ASSESSMENT PROCESS IN 2007. IN SUBSEQUENT YEARS, SMCH HAS WORKED WITH COMMUNITY PARTNERS TO CONDUCT ADDITIONAL FOCUS GROUPS AND SURVEYS TO GAUGE COMMUNITY NEEDS. THESE PROCESSES IDENTIFIED ISSUES HAVING A SIGNIFICANT IMPACT ON THE OVERALL HEALTH OF THE POPULATION OF NEBRASKA CITY AND OTOE COUNTY. FROM THESE IDENTIFIED ISSUES, P40C DEVELOPED GOALS. IN FISCAL YEAR 2012, THE GOAL AREAS WERE EVALUATED TO BETTER RESPOND TO COMMUNITY NEEDS. THE OVERARCHING COALITION GOAL IS TO BUILD A COMMUNITY WHERE EVERY FAMILY THRIVES. KEY FACTORS IDENTIFIED AS HAVING THE GREATEST IMPACT ON THE OVERALL WELLNESS OF THE AREA CURRENTLY GUIDE SMCH COMMUNITY BENEFIT EFFORTS AND INCLUDE THE FOLLOWING: * HEALTHY LIFESTYLES AND BEHAVIORS * VIOLENCE PREVENTION * CHILD AND MATERNAL HEALTH * ACCESS TO BASIC NEEDS/COMMUNITY HEALTH SERVICES * EDUCATIONAL PROGRAMS LINES 2, 3, 4, & 5: NEEDS ASSESSMENT AND COMMUNITY INFORMATION SCHEDULE H, PART VI QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT COMMUNITY OUTREACH FOR THE POOR SMCH IS DEDICATED TO SERVING ALL PEOPLE IN OUR COMMUNITY REGARDLESS OF ABILITY TO PAY. SMCH'S CHARITY CARE POLICY PROVIDES FOR UNCOMPENSATED OR DISCOUNTED MEDICAL SERVICES FOR INDIVIDUALS WHO HAVE DEMONSTRATED NEED IN EXCESS OF INSURANCE, PERSONAL RESOURCES, AND FUNDS AVAILABLE THROUGH FEDERAL, STATE, AND LOCAL MEDICAL FUNDING PROGRAMS. CHARITY CARE MAY BE PROVIDED TO PATIENTS WHO ARE UNINSURED, UNDERINSURED, OR DETERMINED TO BE MEDICALLY INDIGENT. SMCH PROVIDES SUPPORT TO LOW INCOME FAMILIES IN THE REGION THROUGH VARIOUS OUTREACH INITIATIVES. SMCH ALSO HOSTS AN ANNUAL BACK TO SCHOOL EVENT. THIS OUTREACH PROGRAM BENEFITS LOW INCOME CHILDREN AND FAMILIES IN THE REGION AND WAS DEVELOPED IN RESPONSE TO AN IDENTIFIED NEED. THIS INITIATIVE SERVED OVER 350 AREA CHILDREN AND PROVIDED SCHOOL SUPPLIES AS WELL AS EDUCATIONAL MATERIALS TO SUPPORT A HEALTHY LIFESTYLE. IN A COLLABORATIVE COMMUNITY EFFORT, SMCH WORKED TO HELP AREA FAMILIES WHO REQUESTED AND QUALIFIED FOR ASSISTANCE THROUGH THE SOUTHEAST NEBRASKA COMMUNITY ACTION AND THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY IN COLLABORATION WITH THE UNIVERSITY OF NEBRASKA MEDICAL CENTER (UNMC), SMCH SERVES AS A TELEMEDICINE HOST SITE. TELEMEDICINE IS THE USE OF MEDICAL INFORMATION EXCHANGED FROM ONE SITE TO ANOTHER VIA ELECTRONIC COMMUNICATION TO IMPROVE A PATIENT'S HEALTH STATUS. THIS IMPORTANT SERVICE PROVIDES ACCESS TO MENTAL HEALTH CARE NOT READILY AVAILABLE LOCALLY. SMCH PROVIDES STAFF AND RESOURCES TO SUPPORT THE COMMUNITY MEALS ON WHEELS PROGRAM. SMCH'S FOOD PREPARATION AND ORGANIZATION OF THE DELIVERY ROUTES KEEP THIS MUCH NEEDED SERVICE OPERATIONAL. THIS NUTRITION PROGRAM PROVIDES IN-HOME MEALS TO SENIORS AND OTHER HOME-BOUND PERSONS AND HELPS ENSURE A HEALTHIER COMMUNITY. ADDITIONAL COMMUNITY HEALTH SERVICES PROVIDED BY SMCH THAT IMPROVES COMMUNITY HEALTH AND EXTENDS BEYOND TRADITIONAL PATIENT CARE INCLUDE TELEPHONE TRIAGE SERVICES, INFANT HEARING SCREENINGS, DIABETES EDUCATION, AND SMOKING CESSATION CLASSES. COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH SMCH PROVIDED HEALTH EDUCATION TO AREA FAMILIES THROUGH IT'S COLLABORATION WITH THE SOUTHEAST DISTRICT HEALTH DEPARTMENT. GROWING GREAT KIDS IN SOUTHEAST NEBRASKA IS A HOME VISITATION PROGRAM THAT MATCHES TRAINED PROFESSIONALS WITH PREGNANT AND NEW MOMS DURING THE CRITICAL EARLY YEARS OF THEIR CHILD'S LIFE TO PROMOTE CHILD DEVELOPMENT, HEALTH, SAFETY, NUTRITION AND STRESS MANAGEMENT. THE PROGRAM SERVICES INCLUDE A ONE-TIME PARENT SURVEY VISIT TO CONNECT FAMILIES WITH COMMUNITY RESOURCES AND HOME VISITS PRENATAL UP TO THE CHILD'S THIRD BIRTHDAY. SMCH PROVIDED COORDINATION, FUNDING AND RESOURCES FOR THE PROGRAM. HEALTH PROFESSIONS EDUCATION SMCH SERVED AS A TRAINING SITE FOR VARIOUS HEALTH CARE PROFESSIONS WHICH EXPOSED HEALTH CARE WORKERS TO THE RURAL EXPERIENCE AND ATTRACTED NEW GRADUATES TO MEET FUTURE NEEDS. IN FISCAL YEAR 2012, SMCH SERVED AS A TRAINING SITE FOR THE FOLLOWING HEALTHCARE PROFESSIONS: LABORATORY, IMAGING SERVICES, PHYSICIAN/MED STUDENT, NURSING AND OCCUPATIONAL THERAPY. COMMUNITY BUILDING ACTIVITIES COMMUNITY BUILDING ACTIVITIES FOR SMCH TARGETS ROOT CAUSES OF HEALTH PROBLEMS, SUCH AS POVERTY, HOUSING ISSUES, AND ENVIRONMENTAL AND SAFETY ISSUES THROUGH ACTIVE PARTICIPATION IN COMMUNITY LIFE OF NEBRASKA CITY. ACTIVITIES INCLUDE: * HOSPITAL LEADERSHIP SERVED ON VARIOUS LOCAL BOARDS. * SMCH HAS AN ACTIVE ROLE IN PARTNERS FOR OTOE COUNTY (P40C) COALITION, A COUNTY-WIDE PARTNERSHIP OF COMMUNITY ORGANIZATIONS, BUSINESSES, AND INDIVIDUALS OF ALL AGES WORKING TOGETHER FOR POSITIVE CHANGE IN OTOE COUNTY. THE COALITION STRIVES TO MAXIMIZE RESOURCES (FINANCIAL AND HUMAN), REDUCE DUPLICATION OF WORK AND WORK EFFECTIVELY TO MEET THE NEEDS AND PRIORITIES OF NEBRASKA CITY AND OTOE COUNTY. SMCH PROVIDED DEDICATED STAFF TO SUPPORT THE WORK OF P4OC. * IN FISCAL YEAR 2012, SMCH HOSTED ITS 4TH ANNUAL BACK TO SCHOOL EVENT. THIS OUTREACH PROGRAM BENEFITED LOW INCOME CHILDREN AND FAMILIES IN THE REGION BY PROVIDING ESSENTIAL BACK TO SCHOOL SUPPLIES WHILE PROVIDING HEALTH EDUCATION TO PARTICIPATING FAMILIES. THE EVENT IS POSSIBLE THROUGH PARTNERSHIPS WITH THE COMMUNITY BUSINESSES AND ORGANIZATIONS. * SMCH IDENTIFIED THAT AREA FAMILIES WERE IN NEED OF FUNDS FOR HEAT ASSISTANCE. SMCH RESPONDED WITH A SERIES OF REACH OUT AND WARM UP SOUP LUNCHEONS. THE LUNCHEONS WERE A FREE WILL DONATION AND SMCH MATCHED THE FUNDS AND PROVIDED THEM TO SOUTHEAST NEBRASKA COMMUNITY ACTION (SENCA) FOR DISTRIBUTION TO QUALIFYING FAMILIES. BY MEETING THIS BASIC NEED, SMCH HELPED ALLEVIATE STRESS ON THESE FAMILIES AND IMPROVED THEIR OVERALL HEALTH AND WELLBEING. * DURING FISCAL YEAR 2011, AREA COMMUNITY MEMBERS COMPLETED A PLANNING PROCESS AND IDENTIFIED YOUTH VIOLENCE AS A TOP PRIORITY FOR OTOE COUNTY. BASED ON THE COMMUNITY'S INPUT, SMCH AND THEIR PARTNERS ARE WORKING TO REDUCE REPORTED INCIDENTS OF YOUTH VIOLENCE (INCLUDING BULLYING, ASSAULT, AND PHYSICAL AGGRESSION) AMONG YOUTH AGE 10-17 IN OTOE COUNTY. THE FIRST GOAL IS TO EDUCATE YOUTH, FAMILIES AND THE COMMUNITY ON SAFE HOMES, SAFE LIVES AND SAFE COMMUNITIES BY WORKING WITH FAMILIES, SCHOOLS, CHURCHES, BUSINESSES, YOUTH ORGANIZATIONS, AND OTHER ORGANIZATIONS TO REDUCE THE CONDITIONS OF VIOLENCE AND TO EQUIP YOUTH WITH KNOWLEDGE, SKILLS AND RELATIONSHIPS WHICH REDUCE VIOLENCE. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 ST. MARY'S COMMUNITY HOSPITAL INCLUDES INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, ST. MARY'S COMMUNITY HOSPITAL PROMINENTLY DISPLAYS ITS FINANCIAL ASSISTANCE POLICY IN BOTH ENGLISH AND SPANISH IN OBVIOUS LOCATIONS THROUGHOUT THE HOSPITALS, INCLUDING THE EMERGENCY ROOMS AND OTHER PATIENT INTAKE AREAS. IN ADDITION, ST. MARY'S COMMUNITY HOSPITAL'S REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR FINANCIAL ASSISTANCE UNDER ST. MARY'S COMMUNITY HOSPITAL'S FINANCIAL ASSISTANCE POLICY. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY AND PROCEDURES INCLUDING AN APPLICATION FOR ASSISTANCE. ST. MARY'S COMMUNITY HOSPITAL'S REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON-ENGLISH-SPEAKING INDIVIDUALS. ST. MARY'S COMMUNITY HOSPITAL'S STAFF WILL ALSO ASSIST THE PATIENT/GUARANTOR WITH APPLYING FOR OTHER AVAILABLE COVERAGE (SUCH AS MEDICAID), IF NECESSARY. COUNSELORS ASSIST MEDICARE ELIGIBLE PATIENTS IN ENROLLMENT BY PROVIDING REFERRALS TO THE APPROPRIATE GOVERNMENT AGENCIES. Affiliated health care system Schedule H, Part VI, Line 6 ST. MARY'S COMMUNITY HOSPITAL IN NEBRASKA CITY, NEBRASKA IS PART OF CATHOLIC HEALTH INITIATIVES. CATHOLIC HEALTH INITIATIVES (CHI) IS A NATIONAL FAITH-BASED NONPROFIT HEALTH CARE ORGANIZATION WITH HEADQUARTERS IN ENGLEWOOD, COLORADO. CHI'S EXEMPT PURPOSE IS TO SERVE AS AN INTEGRAL PART OF ITS NATIONAL SYSTEM OF HOSPITALS AND OTHER CHARITABLE ENTITIES, WHICH ARE DESCRIBED AS MARKET-BASED ORGANIZATIONS, OR MBOS. AN MBO IS A DIRECT PROVIDER OF CARE OR SERVICES WITHIN A DEFINED MARKET AREA THAT MAY BE AN INTEGRATED HEALTH SYSTEM AND/OR A STAND-ALONE HOSPITAL OR OTHER FACILITY OR SERVICE PROVIDER. CHI SERVES AS THE PARENT CORPORATION OF ITS MBOS WHICH ARE COMPRISED OF 73 HOSPITALS; 40 LONG-TERM CARE, ASSISTED- AND RESIDENTIAL-LIVING FACILITIES; TWO COMMUNITY HEALTH-SERVICES ORGANIZATIONS; TWO ACCREDITED NURSING COLLEGES; AND HOME HEALTH AGENCIES. TOGETHER, THESE FACILITIES PROVIDED $612 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN THE 2011 FISCAL YEAR, INCLUDING SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. CHI PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED "SHARED SERVICES" FOR THE MBOS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES - INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN -- PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE MBOS. THE COST SAVINGS ACHIEVED THROUGH CHI'S CENTRALIZATION ENABLE MBOS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. ST. MARY'S COMMUNITY HOPSITAL OPERATES WITH ITS WHOLLY OWNED AFFILIATES AND COMMUNITY PARTNERS, ALONG WITH IT'S FUNDRAISING ARM, ST. MARY'S COMMUNITY HOSPITAL FOUNDATION, TO SERVE THE HEALTH CARE NEEDS OF THE NEBRASKA CITY AND SURROUNDING COMMUNITIES. false CHI NEBRASKA 6940 O STREET SUITE 200 LINCOLN NE 68510 363233121 501(C)(3) 734693 PROGRAM SUPPORT 1 0 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 THE ORGANIZATION MADE A GRANT TO CHI NEBRASKA, A RELATED ORGANIZATION THAT ENGAGES IN ACTIVITIES THAT BENEFIT THE COMMUNITY AT LARGE. NO CONSIDERATION IS RECEIVED IN EXCHANGE FOR THIS CONTRIBUTION, AS IT IS CONSIDERED TO BE A GIFT TO BE USED BY THE RECIPIENT IN ACCORDANCE WITH THEIR CHARITABLE PURPOSES. AS SUCH, USE OF THE FUNDS GIVEN TO CHI NEBRASKA IS NOT MONITORED BEYOND DISTRIBUTION. false true false false false false false true false DANIEL KELLY 0 163137 0 56012 0 27834 0 38262 0 12090 0 297335 0 5926 JONATHAN STELLING 0 209167 0 57673 0 692 0 22678 0 19296 0 309506 0 0 ROBERT LANIK 0 532784 0 194611 0 154814 0 32478 0 13968 0 928655 0 81987 STACY BLUM 0 213439 0 23492 0 12962 0 22678 0 19328 0 291899 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SEVERANCE PAYMENTS SCHEDULE J, PART I, LINE 4A POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. THERE WERE NO INTERESTED PERSONS THAT RECEIVED SEVERANCE OR CHANGE-OF-CONTROL PAYMENTS DURING CALENDAR YEAR 2011. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b DURING THE 2011 CALENDAR YEAR, CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: DANIEL KELLY AND ROBERT LANIK DURING 2011, THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: DANIEL KELLY - $14,760 DURING 2011, THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: DANIEL KELLY - $5,926; ROBERT LANIK - $81,987 DUE TO THE "SUPER" VESTING RULES UNDER THE CHI DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS TERMINATION, AGE, OR YEARS OF SERVICE ARE ELIGIBLE TO RECEIVE THEIR 2011 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2011, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: ROBERT LANIK - $45,883 Non-fixed payments Schedule J, Part I, Line 7 DURING FISCAL YEAR 2012, SMCH MAINTAINED A DISCRETIONARY BONUS PROGRAM ACCRUED FOR IN FISCAL YEAR 2012, TO BE PAID OUT IN NOVEMBER, 2012 (FISCAL YEAR 2013). AWARDS OF COMPENSATION FROM THIS PLAN ARE BASED ON THE ACHIEVEMENT OF CERTAIN ORGANIZATIONAL TARGETS (GENERALLY ASSOCIATED WITH PATIENT SATISFACTION, FINANCIAL PERFORMANCE, AND QUALITY INITIATIVES) AND ARE PAYABLE AS A FIXED PERCENTAGE OF EACH PARTICIPANT'S BASE COMPENSATION IF SUCH TARGETS ARE ACHIEVED. HOWEVER, TARGETS WERE NOT ACHIEVED. Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a PURSUANT TO SECTION 8.1 OF THE BYLAWS OF ST. MARY'S COMMUNITY HOSPITAL, THE BOARD OF DIRECTORS MAY, BY RESOLUTION ADOPTED BY A MAJORITY OF THE DIRECTORS THEN IN OFFICE, ESTABLISH ONE OR MORE COMMITTEES, AS NEED OR REQUIRED TO CONDUCT AND TRANSACT THE BUSINESS OF THE CORPORATION. PURSUANT TO SECTION 8.6 OF THE BYLAWS OF ST. MARY'S COMMUNITY HOSPITAL, THE EXECUTIVE COMMITTEE SHALL BE COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, AND THE PRESIDENT AND CEO. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. Significant changes to organizational documents Form 990, Part VI, Section A, Line 4 THE ORGANIZATION'S BYLAWS WERE REVISED, EFFECTIVE AS OF MAY 1, 2012, RELATING TO A RESTRUCTURING. IN SUMMARY, THE ORGANIZATION'S BOARD OF DIRECTORS DEEMED IT IN THE BEST INTERESTS OF THE ORGANIZATION TO ADOPT THE NEBRASKA GOVERNANCE RESTRUCTRE AS PRESENTED AND RECOMMENDED BY THE GOVERNANCE COMMITTEE AND RESOLVED THAT THE BYLAWS WOULD REFLECT CHANGES BROUGHT ABOUT IN THE NEBRASKA GOVERNANCE RESTRUCTURE. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 THE SOLE MEMBER OF THE ORGANIZATION IS CHI NEBRASKA, A NEBRASKA NON-PROFIT CORPORATION. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b THE ORGANIZATION'S CORPORATE MEMBER IS CHI NEBRASKA. PURSUANT TO SECTION 5.4.1 OF THE ORGANIZATION'S BYLAWS, BOTH CHI NEBRASKA AND CATHOLIC HEALTH INITIATIVES ("CHI") (CHI NEBRASKA'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE CHI GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE CHI NEBRASKA BOARD: * APPROVE MEMBERS OF THE ST. MARY'S COMMUNITY HOSPITAL BOARD * AMENDMENT OF THE CORPORATE DOCUMENTS OF ST. MARY'S COMMUNITY HOSPITAL * APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF ST. MARY'S COMMUNITY HOSPITAL * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR ST. MARY'S COMMUNITY HOSPITAL THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF ST. MARY'S COMMUNITY HOSPITAL * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF ST. MARY'S COMMUNITY HOSPITAL * APPROVAL OF ISSUANCE OF DEBT BY ST. MARY'S COMMUNITY HOSPITAL * APPROVAL OF PARTICIPATION OF ST. MARY'S COMMUNITY HOSPITAL IN A JOINT VENTURE * APPROVAL OF FORMATION OF A NEW CORPORATION BY ST. MARY'S COMMUNITY HOSPITAL * APPROVAL OF A MERGER INVOLVING ST. MARY'S COMMUNITY HOSPITAL * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ST. MARY'S COMMUNITY HOSPITAL * TO REQUIRE THE TRANSFER OF ASSETS BY ST. MARY'S COMMUNITY HOSPITAL TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, CHI NEBRASKA OR CHI MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b ONCE THE RETURN IS PREPARED, IT IS REVIEWED BY THE VP OF FINANCE. AFTER THE VP OF FINANCE HAS REVIEWED THE RETURN, COPIES OF THE 990 ARE PROVIDED TO ALL BOARD MEMBERS. THE TAX DEPARTMENT THEN FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD UNLESS MATERIAL. Conflict of interest policy Form 990, Part VI, Section B, Line 12c ST. MARY'S COMMUNITY HOSPITAL HAS A BOARD POLICY THAT REFERENCES THE DUALITY OF INTEREST AND CONFLICT OF INTEREST POLICIES PROVIDED BY CHI NATIONAL. AT THE ANNUAL BOARD AND BOARD COMMITTEE MEETINGS ALL MEMBERS ARE REQUESTED TO SIGN CONFLICT OF INTEREST STATEMENTS. THE SIGNED STATEMENTS ARE RETAINED IN THE ADMINISTRATIVE FILES. ALL MEMBERS ARE REQUESTED TO DECLARE POTENTIAL CONFLICTS OF INTEREST AT EACH BOARD AND/OR COMMITTEE MEETING OF THE BOARD (FINANCE, AUDIT AND COMPLIANCE COMMITTEE AND THE PERFORMANCE IMPROVEMENT COMMITTEE). IF THE BOARD FINDS THAT A CONFLICT DOES EXIST REGARDING THE AGENDA ITEMS TO BE PRESENTED FOR ACTION, MEMBERS ARE REQUESTED TO ABSTAIN FROM VOTING. IN ADDITION, A QUESTIONNAIRE IS SENT ANNUALLY TO ALL BOARD MEMBERS, TOP PAID VENDORS, AND TOP PAID EMPLOYEES ASKING THEM TO DISCLOSE ANY BUSINESS OR FAMILY RELATIONSHIPS. DOCUMENT RETENTION & DESTRUCTION POLICY FORM 990, PART VI, LINE 14 THE ORGANIZATION'S BOARD FORMALLY ADOPTED A DOCUMENT RETENTION & DESTRUCTION POLICY ON MAY 22, 2012. PROCESS FOR DETERMING COMPENSATION - TOP MANAGEMENT OFFICIAL FORM 990, PART VI, LINE 15A THE ORGANIZATION'S CEO'S COMPENSATION IS PAID BY CHI. CHI HAS A DEFINED COMPENSATION PHILOSOPHY. BOTH THE EXECUTIVE AND NON-EXECUTIVE COMPENSATION STRUCTURES AND RANGES ARE REVIEWED ANNUALLY IN COMPARISON TO MARKET DATA. CHI USES THE HAY GROUP AS THE INDEPENDENT THIRD PARTY TO ASSESS EXECUTIVE COMPENSATION PROGRAMS AND TO ENSURE THE REASONABLENESS OF ACTUAL SALARIES AND TOTAL COMPENSATION PACKAGES. COMPENSATION OF THE SENIOR MOST EXECUTIVES IS REVIEWED ANNUALLY. THE HAY GROUP REVIEWS BOTH CASH AND TOTAL COMPENSATION FOR OVERALL REASONABLENESS, FOR ADHERENCE TO CHI'S COMPENSATION PHILOSOPHY, AND FOR COMPARABILITY TO THE NOT-FOR-PROFIT HEALTHCARE MARKET. THIS INDEPENDENT REVIEW IS DELIVERED BY HAY GROUP TO THE HR COMMITTEE OF THE CHI BOARD OF STEWARDSHIP TRUSTEES ANNUALLY AT THEIR SEPTEMBER MEETING AND MINUTES ARE SHARED WITH THE FULL BOARD AT THE DECEMBER MEETING. THE LAST REVIEW WAS SEPTEMBER 2012. IN ADDITION, IN DECEMBER 2009, HAY GROUP COMPLETED A COMPREHENSIVE REVIEW OF ALL POSITIONS AT THE LEVEL OF VICE PRESIDENT AND ABOVE TO DETERMINE AND VALIDATE APPROPRIATE COMPENSATION LEVELS. THESE LEVELS HAVE BEEN REVIEWED ANNUALLY SINCE AND REVISED BASED ON MARKET DATA, WHERE APPLICABLE. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b ANY EXECUTIVE COMPENSATION PAID BY ST. MARY'S COMMUNITY HOSPITAL WAS SET BY THE EXECUTIVE COMMITTEE UTILIZING COMPARABILITY STUDIES TO DETERMINE OFFICER COMPENSATION AS REQUIRED BY THE ORGANIZATION'S EXECUTIVE COMPENSATION REVIEW POLICY. THE BOARD OF DIRECTORS OVERSEES THE COMPENSATION SETTING PROCESS AND ENSURES REASONABLENESS AND COMPLIANCE WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE ORGANIZATION'S FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.ORG. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII, SECTION A COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 60 HOUR-PER-WEEK EMPLOYEES. Other changes in net assets or fund balances Form 990, Part XI, Line 5 NET UNREALIZED GAINS (LOSSES) ON INVESTMENTS - -284410; CHI CONNECT DEPRECIATION - 44751; ALEGENT HEALTH - BERGAN MERCY HEALTH SYS 7500 MERCY ROAD OMAHA NE 68124 470484764 HEALTHCARE NE 501(C)(3) 3 CHI true ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HEALTHCARE IA 501(C)(3) 3 AHBMHS true ALVERNA APARTMENTS 300 SE 8TH AVENUE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(C)(3) 9 CHI true APPLETREE COURT 601 OAK STREET BRECKENRIDGE MN 56520 411850500 SENIOR HOMES MN 501(C)(3) 9 SFH true BISHOP DRUMM RETIREMENT CENTER 1111 6TH AVENUE DES MOINES IA 50314 420725196 LTERM CARE IA 501(C)(3) 9 CHI-IA CORP true BORNEMANN HEALTHCARE CORPORATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 232187242 HEALTHCARE PA 501(C)(3) 11 - Type I CHI true CARRINGTON HEALTH CENTER 800 NORTH 4TH STREET CARRINGTON ND 58421 450227311 HEALTHCARE ND 501(C)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(C)(3) 9 NA true CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 6385 CORPORATE DRIVE COLORADO SPRINGS CO 80919 840902211 FUNDRAISING CO 501(C)(3) 7 CHIC true CATHOLIC HEALTH INITIATIVES INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(C)(3) 11 - Type I CHI true CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 6385 CORPORATE DRIVE COLORADO SPRINGS CO 80919 270930004 FUNDRAISING CO 501(C)(3) 9 CHI true CATHOLIC HEALTH INITIATIVES-COLORADO 188 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 840405257 HEALTHCARE CO 501(C)(3) 3 CHI true CENTENNIAL MEDICAL GROUP INC 2700 STEWART PARKWAY ROSEBURG OR 97470 263946191 PHYSICIANS OR 501(C)(3) 9 MMC true CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 480543724 SURGERY CNTR KS 501(C)(3) 3 CHI true CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PARKWAY FARGO ND 58104 271966847 HEALTHCARE ND 501(C)(3) 3 CHI true CHI KENTUCKY INC 3900 OLYMPIC BLVD SUITE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(C)(3) 11 - Type I CHI true CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(C)(3) 11 - Type I CHINS true CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(C)(3) 9 CHI true CHI NEBRASKA 6940 O STREET SUITE 200 LINCOLN NE 68510 363233121 HEALTHCARE NE 501(C)(3) 11 - Type I CHI true CONTINUING CARE HOSPITAL 150 NORTH EAGLE CREEK DRIVE LEXINGTON KY 40509 611400619 LTACH KY 501(C)(3) 3 SJHS true COVENANT HOME CARE 1223 POTTSVILLE PIKE SHOEMAKERSVILLE PA 19555 232018429 HOME HEALTH PA 501(C)(3) 11 - Type II NA true ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1450 BATTERSBY AVENUE ENUMCLAW WA 98022 910715805 HEALTHCARE WA 501(C)(3) 3 FHS true FLAGET HEALTHCARE DBA FLAGET MEMORIAL HOSPITAL 4305 NEW SHEPHERDSVILLE ROAD BARDSTOWN KY 40004 611345363 HEALTHCARE KY 501(C)(3) 3 KOH true FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE ROAD BARDSTOWN KY 40004 562351341 FUNDRAISING KY 501(C)(3) 11 - Type I FH true FRANCISCAN FOUNDATION 1717 SOUTH J STREET TACOMA WA 98405 911145592 FUNDRAISING WA 501(C)(3) 9 FHS true FRANCISCAN HEALTH SYSTEM FKA FRANCISCAN HEALTH SYSTEM WEST 1717 SOUTH J STREET TACOMA WA 98405 910564491 HEALTHCARE WA 501(C)(3) 3 CHI true FRANCISCAN MEDICAL GROUP 1708 SOUTH YAKIMA AVENUE TACOMA WA 98405 911939739 HEALTHCARE WA 501(C)(3) 9 FHS true FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 SOUTH CHICAGO AVENUE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(C)(3) 9 CHI true GETTYSBURG MEDICAL CENTER 606 EAST GARFIELD AVENUE GETTYSBURG SD 57442 460234354 HEALTHCARE SD 501(C)(3) 3 SMHC true GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 201536108 MINISTRIES CO 501(C)(3) 11 - Type I CHI true GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 375 DIXMYTH AVE CINCINNATI OH 45220 311778403 EDUCATION OH 501(C)(3) 2 GSH true GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK STREET ACCOUNTING-3 W CINCINNATI OH 45206 311206047 FUNDRAISING OH 501(C)(3) 11 - Type I GSH true GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST STREET KEARNEY NE 68847 470659443 FUNDRAISING NE 501(C)(3) 7 GSH true HEALTH SET 4200 WEST CONEJOS PLACE 436 DENVER CO 80204 841102943 LOW INC.CARE CO 501(C)(3) 7 CHIC true HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 760761782 FUNDRAISING MN 501(C)(3) 11 - Type I SFMC true HOSPITAL ASSOCIATION FOR ST JOSEPH HOSPITAL 7601 OSLER DRIVE TOWSON MD 21204 526050777 HEALTHCARE MD 501(C)(3) 9 SJMC true HOUSE OF MERCY 1111 6TH AVENUE DES MOINES IA 50314 421323808 SHELTER IA 501(C)(3) 7 CHI-IA CORP true JEWISH HOSPITAL AND ST MARY'S HEALTHCARE 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029768 HEALTHCARE KY 501(C)(3) 3 KOH true JEWISH PHYSICIAN GROUP INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40215 611352729 HEALTHCARE KY 501(C)(3) 9 JHSMH true KENTUCKYONE HEALTH INC FKA JH PROPERTIES INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029769 HEALTHCARE KY 501(C)(3) 9 CHI true LAKEWOOD HEALTH CENTER 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 410758434 HEALTHCARE MN 501(C)(3) 3 CHI true LINUS OAKES INC 2700 STEWART PARKWAY ROSEBURG OR 97470 930821381 SENIOR LIVING OR 501(C)(3) 9 MMC true LISBON AREA HEALTH SERVICES 905 MAIN STREET LISBON ND 58054 820558836 HEALTHCARE ND 501(C)(3) 3 CHI true MEMORIAL HEALTH CARE SYSTEM FOUNDATION 2525 DE SALES AVENUE CHATTANOOGA TN 37404 621839548 FUNDRAISING TN 501(C)(3) 7 MHCS true MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVENUE CHATTANOOGA TN 37404 620532345 HEALTHCARE TN 501(C)(3) 3 CHI true MEMORIAL HEALTH PARTNERS FOUNDATION INC 6028 SHALLOWFORD ROAD CHATTANOOGA TN 37421 030417049 HEALTHCARE TN 501(C)(3) 9 MHCS true MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVENUE DES MOINES IA 50314 426076069 AUXILIARY IA 501(C)(3) 11 - Type I CHI-IA CORP true MERCY CLINICS INC 1111 6TH AVENUE DES MOINES IA 50314 421193699 PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP true MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVENUE DES MOINES IA 50314 421511682 EDUCATION IA 501(C)(3) 2 CHI-IA CORP true MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVENUE DES MOINES IA 50314 237358794 FUNDRAISING IA 501(C)(3) 7 CHI-IA CORP true MERCY FOUNDATION INC 2700 STEWART PARKWAY ROSEBURG OR 97470 936088946 FUNDRAISING OR 501(C)(3) 7 MMC true MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 421461064 FUNDRAISING NE 501(C)(3) 11 - Type I AHMH true MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BOULEVARD VALLEY CITY ND 58072 450226553 FUNDRAISING ND 501(C)(3) 11 - Type I MHVC true MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DRIVE COUNCIL BLUFFS IA 51503 421178204 FUNDRAISING IA 501(C)(3) 11 - Type I AHBMHS true MERCY HOSPITAL OF DEVILS LAKE 1031 SEVENTH STREET NE DEVILS LAKE ND 58301 450227012 HEALTHCARE ND 501(C)(3) 3 CHI true MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BOULEVARD VALLEY CITY ND 58072 450226553 HEALTHCARE ND 501(C)(3) 3 CHI true MERCY MEDICAL CENTER 2700 STEWART PARKWAY ROSEBURG OR 97470 930386868 HEALTHCARE OR 501(C)(3) 3 CHI true MERCY MEDICAL CENTER 1301 15TH AVENUE WEST WILLISTON ND 58801 450231183 HEALTHCARE ND 501(C)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES-IOWA CORP DBA MERCY MEDICAL CENTER-DES MOINES 1111 6TH AVENUE DES MOINES IA 50314 420680448 HEALTHCARE IA 501(C)(3) 3 CHI true MERCY MEDICAL FOUNDATION 1301 15TH AVENUE WEST WILLISTON ND 58801 450381803 FUNDRAISING ND 501(C)(3) 11 - Type I MMC true MERCY PROFESSIONAL PRACTICE ASSOCIATES INC 1111 6TH AVENUE DES MOINES IA 50314 421470935 PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP true MLIFECARES 2727 MCCLELLAND BLVD JOPLIN MO 64804 431305163 PROPERTY MGMT MO 501(C)(3) 11 - Type I SJRMC true MNMCH INC 220 NORTH PENNSYLVANIA COLUMBUS KS 66725 481216238 HEALTHCARE KS 501(C)(3) 3 SJRMC true MT ST JOSEPH INC 3060 SE STARK STREET PORTLAND OR 97214 930386870 NURSING CARE OR 501(C)(3) 9 CHI true NEBRASKA HEART HOSPITAL 7500 SOUTH 91ST STREET LINCOLN NE 68526 392031968 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true OAKES COMMUNITY HOSPITAL 314 SOUTH 8TH STREET OAKES ND 58474 450231675 HEALTHCARE ND 501(C)(3) 3 CHI true OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH STREET OAKES ND 58474 710966606 FUNDRAISING ND 501(C)(3) 11 - Type I OCH true PUEBLO STEPUP 1925 EAST ORMAN AVE SUITE G52 PUEBLO CO 81004 841234295 COMMUNITY CO 501(C)(3) 7 CHIC true SET OF COLORADO SPRINGS INC 825 E PIKES PEAK AVENUE BLDG 29 COLORADO SPRINGS CO 80903 841183335 LTERM CARE CO 501(C)(3) 7 CHIC true SAINT CLARE'S COMMUNITY CARE 25 POCONO ROAD DENVILLE NJ 07834 222876836 HEALTHCARE NJ 501(C)(3) 11 - Type II SCHS true SAINT CLARE'S FOUNDATION INC 25 POCONO ROAD DENVILLE NJ 07834 222502997 FUNDRAISING NJ 501(C)(3) 7 SCHS true SAINT CLARE'S HEALTH SERVICES INC 25 POCONO ROAD DENVILLE NJ 07834 223639733 MANAGEMENT NJ 501(C)(3) 7 CHI true SAINT CLARE'S HOSPITAL 25 POCONO ROAD DENVILLE NJ 07834 223319886 HEALTHCARE NJ 501(C)(3) 3 SCHS true SAINT ELIZABETH FOUNDATION 555 SOUTH 70TH STREET LINCOLN NE 68510 470625523 FUNDRAISING NE 501(C)(3) 7 SERMC true SAINT ELIZABETH HEALTH SERVICES 555 SOUTH 70TH STREET LINCOLN NE 68510 363233120 HEALTHCARE NE 501(C)(3) 3 SERMC true SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 SOUTH 70TH STREET LINCOLN NE 68510 470379836 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER 2620 WEST FAIDLEY GRAND ISLAND NE 68803 470376601 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND NE 68802 470630267 FUNDRAISING NE 501(C)(3) 7 SFMC true SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL STREET BEREA KY 40403 260152877 FUNDRAISING KY 501(C)(3) 7 SJHS true SAINT JOSEPH HEALTH SYSTEM INC 424 LEWIS HARGETT CIRCLE 160 LEXINGTON KY 40509 611334601 HEALTHCARE KY 501(C)(3) 3 CHI true SAINT JOSEPH LONDON FOUNDATION INC 310 EAST NINTH STREET LONDON KY 40741 260438748 FUNDRAISING KY 501(C)(3) 11 - Type I SJHS true SAINT JOSEPH MEDICAL FOUNDATION INC ONE ST JOSEPH DRIVE LEXINGTON KY 40504 311539059 PHY PRACTICES KY 501(C)(3) 3 SJHS true SAINT JOSEPH MOUNT STERLING FOUNDATION INC 50 STERLING AVENUE MOUNT STERLING KY 40353 272884584 FUNDRAISING KY 501(C)(3) 7 SJHS true SAINT JOSEPH'S HOSPITAL FOUNDATION 30 WEST 7TH STREET DICKINSON ND 58601 363418207 FUNDRAISING ND 501(C)(3) 11 - Type I SJHHC true SAMARITAN BEHAVIORAL HEALTH 601 S EDWIN C MOSES BLVD DAYTON OH 45408 020633634 HEALTHCARE OH 501(C)(3) 3 SHP true SAMARITAN HEALTH FOUNDATION 2222 PHILADELPHIA DRIVE DAYTON OH 45406 237296923 FUNDRAISING OH 501(C)(3) 7 SHP true SAMARITAN HEALTH PARTNERS 2222 PHILADELPHIA DRIVE DAYTON OH 45406 311107411 HEALTHCARE OH 501(C)(3) 11 - Type I CHI true SJMGROUP 2727 MCCLELLAND BLVD JOPLIN MO 64804 431882377 PHYS PRACTICE MO 501(C)(3) 9 SJRMC true SJRMC JOPLIN MISSOURI 2727 MCCLELLAND BLVD JOPLIN MO 64804 440545809 HEALTHCARE MO 501(C)(3) 3 CHI true ST JOSEPH HEALTH MINISTRIES 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232342997 HEALTH PA 501(C)(3) 11 - Type I CHI true ST ANTHONY HOSPITAL 1601 SE COURT AVENUE PENDLETON OR 97801 930391614 HEALTHCARE OR 501(C)(3) 3 CHI true ST ANTHONY HOSPITAL FOUNDATION 1601 SE COURT AVENUE PENDLETON OR 97801 930992727 FUNDRAISING OR 501(C)(3) 11 - Type I SA HOSPITAL true ST ANTHONY'S HOSPITAL ASSOCIATION FOUR HOSPITAL DRIVE MORRILTON AR 72110 710245507 HEALTHCARE AR 501(C)(3) 3 SVIMC true ST CATHERINE HOSPITAL 401 EAST SPRUCE STREET GARDEN CITY KS 67846 480543721 HEALTHCARE KS 501(C)(3) 3 CHI true ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION 401 EAST SPRUCE STREET GARDEN CITY KS 67846 200598702 FUNDRAISING KS 501(C)(3) 11 - Type I SCH true ST DOMINIC OF ONTARIO OREGON 351 SW 9TH STREET ONTARIO OR 97914 930433692 HEALTHCARE OR 501(C)(3) 3 CHI true ST FRANCIS HOME 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 410729978 LTERM CARE MN 501(C)(3) 9 CHI true ST FRANCIS LIFE CARE CORPORATION 19 POCONO ROAD DENVILLE NJ 07834 222536017 ELDERLY CARE NJ 501(C)(3) 9 SCHS true ST FRANCIS MEDICAL CENTER 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 410695598 HEALTHCARE MN 501(C)(3) 3 CHI true ST FRANCIS OF BAKER CITY 3325 POCAHONTAS ROAD BAKER CITY OR 97814 930412495 HEALTHCARE OR 501(C)(3) 3 CHI true ST JOHN'S MERCY REGIONAL FOUNDATION 2727 MCCLELLAND BLVD JOPLIN MO 64804 431308084 FUNDRAISING MO 501(C)(3) 7 SJRMC true ST JOSEPH COMMUNITY HEALTH 300 CENTRAL AVE SW SUITE 3000 ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(C)(3) 11 - 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