2013-05-13T10:00:14-05:00 2012-06-30 470617373 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2011-07-01 710245507 ST ANTHONY'S HOSPITAL ASSOCIATION STAN 5019772300 4 HOSPITAL DRIVE MORRILTON AR 72110 MARK MCGINNIS 2013-05-13 true KIMBERLY STEENHOEK P01201968 3032989100 2011 2016-02-24 21:20:13Z ST VINCENT MORRILTON TOM FITZ 2 ST VINCENT CIRCLE LITTLE ROCK AR 72205 21339302 false 0928 X WWW.STVINCENTHEALTH.COM/MORRILTON X 1925 AR PROVIDING HOLISTIC CARE ADDRESSING THE PHYSICAL, SPIRITUAL & PSYCHO-SOCIAL NEEDS OF PATIENTS. THESE ACTIVITIES TAKE PLACE IN A VARIETY OF SETTINGS, BUT ALL SPRING FROM THE SAME MISSION & FUNDAMENTAL PURPOSE. 10 8 291 45 33992 11983 1130332 1286748 20017851 19937056 307 -615 130579 101572 21279069 21324761 10009 30253 0 0 8697746 8432686 0 0 8662 11067365 11912262 19775120 20375201 1503949 949560 9679780 10851486 663812 1013633 9015968 9837853 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 17622863 30253 19937056 SEE SCHEDULE H 17622863 true true false true false false false false false true false false true true true false true false false false false false false true false true true true false true false false false false false false false false false false false false false true false false false false true 0 0 291 true true true false false false false false false false false false X 10 8 false false false false true true true true true false false true true true true true true false true false AR X MARK MCGINNIS 5015523912 2 ST VINCENT CIRCLE LITTLE ROCK AR 72205 X CHARLES PENICK 1.00 X X 0 0 0 PATTY SHIPP 1.00 X X 0 0 0 RAYMOND CHAMBERS 1.00 X X 0 0 0 TOM FITZ 1.00 X X 0 0 0 JACK LYON MD 1.00 X 0 0 0 JAMES NOLEN MD 1.00 X 162086 7200 17842 KAREN CREE 1.00 X 0 0 0 LARRY DAVIS MD 1.00 X 0 0 0 MATTHEW SZYMANSKI 1.00 X 0 0 0 PETER NOONAN 4.00 X 0 204452 33958 SR VIRGINIA DEGRAVELLE 1.00 X 0 0 0 MARK MCGINNIS 4.00 X 0 330746 35179 CHRISTINA HOCKADAY 40.00 X 178936 0 26189 ANGELA LONGING 40.00 X 101656 0 28195 JEROMY TEAGUE 40.00 X 112127 0 19070 LYDIA TEAGUE 40.00 X 173898 0 28635 728703 542398 189068 5 false true false ARKANSAS EMERGENCY GROUP LLC 5665 NEW NORTHSIDE DR STE 320 ATLANTA GA 30328 MEDICAL SERVICES 491665 CPP WOUND CARE LLC 3017 N CAUSEWAY BLVD METAIRIE LA 70002 WOUND CARE 427096 NABHOLZ CONSTRUCTION SERVICES PO BOX 2090 CONWAY AR 72033 CONSTRUCTION SERVICES 406860 IMAGING RESOURCES GROUP LLC 136 ARKOTA SHRS HOT SPRINGS AR 719138181 IMAGING SERVICES 229250 SLEEP MANAGEMENT SERVICES INC 9305 TREASURE HILL RD LITTLE ROCK AR 722276217 SLEEP STUDIES 184125 10 6035 140345 974954 165414 1286748 PATIENT SERVICES 900099 19904732 19904732 RENTAL INCOME 900099 32324 32324 0 0 0 0 19937056 569 569 0 0 0 0 0 0 0 4850 6034 0 -1184 -1184 -1184 28291 6035 8507 19784 19784 0 0 LABORATORY SERVICES 621500 33992 33992 CAFETERIA 722100 47796 47796 0 0 0 0 81788 21324761 19937056 33992 66965 30253 30253 0 0 0 333072 141286 191786 0 6047985 5601959 443060 2966 623037 623037 1012982 1012982 415610 373213 42202 195 0 6023 6023 2590 2590 0 0 0 2194368 2060698 133670 53507 52865 642 590298 584546 4953 799 0 0 315525 315525 70033 61594 8207 232 0 1054 1054 1143 1143 0 303163 303163 30353 30353 BAD DEBT 4938367 4938367 INTERCOMPANY ALLOCATIONS 1723320 1723320 REPAIRS AND MAINTENANCE 182941 182833 108 DUES AND SUBSCRIPTIONS 23309 1737 21572 1476268 1360174 112374 3720 20375201 17622863 2743676 8662 0 1140 1140 72049 66025 6731009 6863323 446353 370843 9905103 7611597 2429229 2293506 0 0 0 0 0 1256649 9679780 10851486 330919 603080 332893 410553 663812 1013633 X 8942115 9837853 73853 0 9015968 9837853 9679780 10851486 X 949560 -127675 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 1550 false false false 1550 false Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 ST. ANTHONY'S HOSPITAL ASSOCIATION PAID DUES TO THE ARKANSAS HOSPITAL ASSOCIATION AND THE AMOUNT LISTED ABOVE REPRESENTS THE PORTION OF THESE DUES THAT WERE ALLOCATED TO LOBBYING ACTIVITIES. 0 3769316 2552727 1216589 188382 188382 0 5553899 4507714 1046185 393506 362774 30732 2293506 INTERCOMPANY RECEIVABLE 1256649 1256649 0 POST EMPLOYMENT BENEFITS 398574 DEPOSITS 11979 410553 FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 ST. ANTHONY'S HOSPITAL ASSOCIATION'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." MELODIES & MEDICINE 34326 6035 28291 8507 0 0 34326 6035 28291 0 0 0 0 0 8507 8507 19784 true true X false false true true false true true 185 90242 0 90242 0.00580 0 0 0 0.00000 0 0 0 0.00000 0 185 90242 0 90242 0.00580 29293 16051 0 16051 0.00100 3 4874 0 4874 0.00030 0 0 0 0.00000 0 0 0 0.00000 0 0 0 0.00000 0 29296 20925 0 20925 0.00130 0 29481 111167 0 111167 0.00710 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0.00000 0 0 0 0 0 0.00000 true 4938367 0 7446795 7128227 318568 X true true 1 1 ST ANTHONY'S HOSPITAL ASSOCIATION

4 HOSPITAL DRIVE MORRILTON AR 72110

X X X X ST ANTHONY'S HOSPITAL ASSOCIATION 1 true false false true X X X X X X true true X X X X true false true X false false Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO ST. ANTHONY HOSPITAL ASSOCIATION) 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. ANTHONY HOSPITAL ASSOCIATION 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. 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) 4,938,367 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. ANTHONY HOSPITAL ASSOCIATION 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. ANTHONY HOSPITAL ASSOCIATION 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. ANTHONY HOSPITAL ASSOCIATION 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. ANTHONY HOSPITAL ASSOCIATION, DUE TO THEIR DESIGNATION AS A CAH, RECEIVES COST-BASED REIMBURSEMENT FOR MEDICARE PURPOSES AND WILL NOT EXPERIENCE MEDICARE RELATED SHORTFALLS. ST. ANTHONY HOSPITAL ASSOCIATION BELIEVES THAT EXCLUDING MEDICARE LOSSES FROM COMMUNITY BENEFIT MAKES THE OVERALL COMMUNITY BENEFIT REPORT MORE CREDIBLE FOR THESE REASONS: UNLIKE SUBSIDIZED AREAS SUCH AS BURN UNITS OR BEHAVIORAL-HEALTH SERVICES, MEDICARE IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS. IN FACT, FOR-PROFIT HOSPITALS FOCUS ON ATTRACTING PATIENTS WITH MEDICARE COVERAGE, ESPECIALLY IN THE CASE OF WELL-PAID SERVICES THAT INCLUDE CARDIAC AND ORTHOPEDICS. SIGNIFICANT EFFORT AND RESOURCES ARE DEVOTED TO ENSURING THAT HOSPITALS ARE REIMBURSED APPROPRIATELY BY THE MEDICARE PROGRAM. THE MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC), AN INDEPENDENT CONGRESSIONAL AGENCY, CAREFULLY STUDIES MEDICARE PAYMENT AND THE ACCESS TO CARE THAT MEDICARE BENEFICIARIES RECEIVE. THE COMMISSION RECOMMENDS PAYMENT ADJUSTMENTS TO CONGRESS ACCORDINGLY. THOUGH MEDICARE LOSSES ARE NOT INCLUDED BY CATHOLIC HOSPITALS AS COMMUNITY BENEFIT, THE CATHOLIC HEALTH ASSOCIATION GUIDELINES ALLOW HOSPITALS TO COUNT AS COMMUNITY BENEFIT SOME PROGRAMS THAT SPECIFICALLY SERVE THE MEDICARE POPULATION. FOR INSTANCE, IF HOSPITALS OPERATE PROGRAMS FOR PATIENTS WITH MEDICARE BENEFITS THAT RESPOND TO IDENTIFIED COMMUNITY NEEDS, GENERATE LOSSES FOR THE HOSPITAL, AND MEET OTHER CRITERIA, THESE PROGRAMS CAN BE INCLUDED IN THE CHA FRAMEWORK IN CATEGORY C AS "SUBSIDIZED HEALTH SERVICES." MEDICARE LOSSES ARE DIFFERENT FROM MEDICAID LOSSES, WHICH ARE COUNTED IN THE CHA COMMUNITY BENEFIT FRAMEWORK, BECAUSE MEDICAID REIMBURSEMENTS GENERALLY DO NOT RECEIVE THE LEVEL OF ATTENTION PAID TO MEDICARE REIMBURSEMENT. MEDICAID PAYMENT IS LARGELY DRIVEN BY WHAT STATES CAN AFFORD TO PAY, AND IS TYPICALLY SUBSTANTIALLY LESS THAN WHAT MEDICARE PAYS. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b ST. ANTHONY HOSPITAL ASSOCIATION ("SAHA"), 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: * NOTIFICATION TO PATIENT OF THE AVAILABILITY OF FINANCIAL ASSISTANCE ON ADMISSION, PRIOR TO DISCHARGE, AND/OR IN THE BILLING PROCESS; * REVIEW OF FINANCIAL ASSISTANCE APPLICATION SUBMITTED BY OR ON BEHALF OF THE PATIENT; OR * 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. * NO FACILITY SHALL CHARGE INTEREST ON OUTSTANDING BALANCES; * 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 * 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. LINES 2, 4, & 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION SCHEDULE H, PART IV ST. ANTHONY'S HOSPITAL ASSOCIATION D/B/A ST. VINCENT MORRILTON CELEBRATES 86 YEARS OF MINISTRY THIS YEAR. THE BENEDICTINE SISTERS OF ST. SCHOLASTICA, JOINED BY A SISTER OF CHARITY OF NAZARETH FROM ST. VINCENT INFIRMARY, MEMBERS OF SACRED HEART CATHOLIC CHURCH AND OTHER CONCERNED CITIZENS, CAME TOGETHER TO FORM THE ORIGINAL MINISTRY IN 1925. SIXTY NINE YEARS LATER IN 1994, ST. VINCENT MORRILTON BECAME PART OF THE ST. VINCENT HEALTH SYSTEM AND IN 1996 BECAME A MEMBER OF CATHOLIC HEALTH INITIATIVES. ST. VINCENT MORRILTON, A 25-BED CRITICAL ACCESS FACILITY IS THE PRIMARY SOURCE OF HEALTHCARE FOR THE RESIDENTS OF CONWAY AND PERRY COUNTIES. ST. VINCENT MORRILTON IS LED BY A 10-MEMBER ADVISORY BOARD COMPRISED OF PROFESSIONALS WHO ARE EITHER ACTIVE IN THE LOCAL COMMUNITY OR MEMBERS OF THE ST. VINCENT PRESIDENT'S COUNCIL. THE BOARD SERVES IN AN ADVISORY CAPACITY AND ITS CHAIRPERSON REPRESENTS THE LOCAL COMMUNITY AS A MEMBER OF THE ST. VINCENT HEALTH SYSTEM BOARD OF DIRECTORS. SERVICES AVAILABLE AT ST. VINCENT MORRILTON INCLUDE OUTPATIENT/SAME-DAY SURGERY, AN INTENSIVE CARE UNIT, MEDICAL/SURGICAL UNIT, 24-HOUR EMERGENCY ROOM, ORTHOPEDIC SERVICES, CARDIOLOGY SERVICES, SENIOR DAY CARE, REHABILITATION SERVICES, IMAGING SERVICES, SLEEP MEDICINE, WOUND CARE AND LABORATORY SERVICES. AN OUTPATIENT SPECIALTY CLINIC OFFERS CARDIOLOGY, ORTHOPEDICS, ONCOLOGY, NEUROLOGY, GASTROENTEROLOGY, EAR, NOSE, AND THROAT, PODIATRY AND NEPHROLOGY SPECIALTIES. ST. VINCENT MORRILTON PETIT JEAN HOME HEALTH SERVICES PROVIDE HOME HEALTH CARE FOR RESIDENTS OF THE SERVICE AREA. ST. VINCENT MEDICAL CLINIC - MORRILTON PROVIDES PATIENT ACCESS TO HEALTHCARE, SERVING AS A RURAL HEALTH CLINIC REACHING MORE THAN 5,750 PATIENTS THIS YEAR. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT COMMUNITY OUTREACH FOR THE POOR DONATION OF SUPPLIES: DURING FY 12, ST. VINCENT MORRILTON DONATED $10,000 IN SUPPLIES TO THE CONWAY COUNTY CHRISTIAN CLINIC, BAPTIST MEDICAL MISSIONS INTERNATIONAL AND A LOCAL VETERINARIAN. THE CONWAY COUNTY CHRISTIAN CLINIC OFFERS FREE HEALTHCARE TO MANY RESIDENTS OF CONWAY COUNTY AND PARTNERS WITH ST. VINCENT MORRILTON TO PROVIDE SERVICES THROUGH GRANT FUNDING OBTAINED BY THE CLINIC. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY ST. VINCENT MORRILTON SERVICE EXCELLENCE EMPLOYEE COUNCIL RAISED 130 SCHOOL SUPPLY ITEMS FOR THE LOCAL MORRILTON ELEMENTARY SCHOOL. COMMUNITY OUTREACH HEALTH FAIRS: ST. VINCENT MORRILTON PARTICIPATED IN TWO COMMUNITY OUTREACH HEALTH FAIRS FOR LOCAL BUSINESSES IN THE AREA. THE UNIVERSITY OF ARKANSAS COMMUNITY COLLEGE OF MORRILTON (UACCM) ALSO HELD A HEALTH FAIR FOR ITS EMPLOYEES. ST. VINCENT MORRILTON PROVIDED CHOLESTEROL SCREENINGS, BLOOD PRESSURE CHECKS, AND BODY MASS INDEX ANALYSIS. ON THIS OCCASION, ST. VINCENT MORRILTON WAS ABLE TO SERVE 160 EMPLOYEES WHO WORK FOR THE COLLEGE. COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH BODY, MIND & SOUL: ST. VINCENT MORRILTON, IN CONJUNCTION WITH THE WINTHROP ROCKEFELLER INSTITUTE, AN AFFILIATED OUTREACH CAMPUS OF THE UNIVERSITY OF ARKANSAS SYSTEM, HOSTS AN ANNUAL "LADIES NIGHT OUT" WHICH FEATURES HEALTH AND WELLNESS TOPICS THAT IMPACT A WOMAN'S BODY, MIND, AND SOUL. DEVELOPED BY A GROUP OF WOMEN FROM THE LOCAL COMMUNITY, THIS EVENT CONSISTS OF VARIOUS REPRESENTATIVES FROM THE COMMUNITY PROVIDING INFORMATION ON DIABETIC EDUCATION, CANCER, EXERCISE TECHNIQUES, WEIGHT MANAGEMENT, OSTEOPOROSIS, HEART HEALTH/STROKE, STRESS MANAGEMENT, MENTAL HEALTH/DEPRESSION, MENOPAUSE, SLEEP DISORDERS, AND SPIRITUALITY/REJUVENATION. DR. BRENT SCROGGINS, FAMILY PRACTICE PHYSICIAN, SPOKE AND ANSWERED QUESTIONS ON TOPICS OF INTEREST TO ALL WOMEN SUCH AS MANAGING YOUR WEIGHT, HEALTHY FOOD CHOICES, AND BALANCING YOUR DIET WITH PROPER EXERCISE. OVER 150 WOMEN ATTENDED THE EVENT. THIS ANNUAL EVENT WAS CREATED TO OFFER EDUCATIONAL PROGRAMS THAT WILL HELP ENCOURAGE HEALTHIER LIFESTYLE CHOICES FOR INDIVIDUALS AND FAMILIES ACROSS CENTRAL ARKANSAS. THE TOTAL COMMUNITY BENEFIT PROVIDED FOR THE YEAR ENDING JUNE 30, 2012 IS $111,167 WITH A PRIOR YEAR COMMUNITY BENEFIT OF $806,834. THE DECREASE IS PRIMARY DUE TO A CHANGE IN THE PRESUMPTIVE ELIGIBILITY POLICY FOR CHARITY CARE WHICH REDUCED THE NUMBER OF INDIVIDUALS QUALIFYING FOR PRESUMPTIVE ELIGIBILITY. AS A RESULT OF THIS QUALIFICATION CHANGE, A SHIFT BETWEEN CHARITY CARE AND BAD DEBT HAS OCCURRED. THE OVERALL CHARITY CARE FOR FY2012 DECREASED AND BAD DEBT HAS INCREASED, AS THE INDIVIDUALS WHO NO LONGER QUALIFY FOR CHARITY ARE NOW BEING WRITTEN OFF TO BAD DEBT. A DETAILED EXPLANATION IS PROVIDED BELOW: COST OF CHARITY CARE PROVIDED - THE TOTAL COST OF CHARITY CARE PROVIDED IN FY12 WAS $90,242 COMPARED TO THE PRIOR YEAR TOTAL OF $779,932. THE SYSTEM CONTINUES TO SEE THE AFFECTS OF THE CHANGE IN CHARITY CARE POLICY IN FY12. THE PATIENTS QUALIFYING FOR CHARITY FELL 35% WHEN COMPARING TO FY11. OTHER COMMUNITY BENEFITS - THE TOTAL COST OF OTHER COMMUNITY BENEFITS PROVIDED IN FY12 WAS $20,925 COMPARED TO THE PRIOR YEAR TOTAL OF $26,902. Used federal poverty guidelines (FPG) to determine eligibility Schedule H, Part V Section B, Line 9 (1) ST. ANTHONY'S HOSPITAL ASSOCIATION - HUD LOW INCOME GUIDELINES USED; Used FPG to determine eligibility for providing discounted care criteria Schedule H, Part V Section B, Line 10 (1) ST. ANTHONY'S HOSPITAL ASSOCIATION - HUD LOW INCOME GUIDELINES USED; Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 ST. ANTHONY HOSPITAL ASSOCIATION ("SAHA") INCLUDES INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, SAHA 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, AS WELL AS IN SAHA OUTPATIENT FACILITIES. A FINANCIAL ASSISTANCE BROCHURE IS ALSO PRESENTED TO EACH PATIENT AT REGISTRATION. IN ADDITION, SAHA 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 SAHA'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. SAHA 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. SAHA'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. ANTHONY HOSPITAL ASSOCIATION, ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES ARE 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 74 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 $715 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN THE 2012 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. State filing of community benefit report Schedule H, Part VI, Line 7 AR true X Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 EXCESS AND OBSOLETE SUPPLIES ARE DONATED TO THE LOCAL FREE CLINIC AND VETERINARIAN. ASSISTANCE PROVIDED DOES NOT GO THROUGH A FORMAL REVIEW/MONITORING PROCESS. true false false false false false false false false CHRISTINA HOCKADAY 123774 0 28097 0 27065 0 13883 0 12306 0 205125 0 0 0 JAMES NOLEN MD 153255 7200 800 0 8031 0 11248 0 6594 0 179928 7200 0 0 LYDIA TEAGUE 172977 0 0 0 921 0 15170 0 13465 0 202533 0 0 0 MARK MCGINNIS 0 272761 0 31252 0 26733 0 20228 0 14951 0 365925 0 0 PETER NOONAN 0 160270 0 42500 0 1682 0 20513 0 13445 0 238410 0 0 METHODS USED TO ESTABLISH CEO 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 or change-of-control payment 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. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM SAHA DURING THE 2011 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE COMPENSATION ON SCHEDULE J: CHRISTINA HOCKADAY $19,566 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. DURING 2011 THERE WERE NO INTERESTED PERSONS AT SAHA WHO PARTICIPATED IN THE PLAN. Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a PURSUANT TO SECTION 8.6 OF THE BYLAWS OF ST. ANTHONY'S HOSPITAL ASSOCIATION, THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION AND IS COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER AND THE SECRETARY, EACH OF WHOM SERVES AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE. 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. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT SUCH ACTIONS TAKEN SHALL BE CONSISTENT WITH AND NOT CONFLICT WITH ANY ACTIONS OR POLICIES OF THE BOARD OF DIRECTORS, THE CORPORATE MEMBER, THE PARENT CORPORATION OR WITH APPLICABLE LAW. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 ACCORDING TO THE BYLAWS OF ST. ANTHONY'S HOSPITAL ASSOCIATION, THE ENTITY'S SOLE MEMBER IS ST. VINCENT INFIRMARY MEDICAL CENTER D/B/A ST. VINCENT HEALTH SYSTEM, AN ARKANSAS NONPROFIT CORPORATION. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a THE SOLE MEMBER OF THE ORGANIZATION HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b THE ORGANIZATION'S CORPORATE MEMBER IS ST. VINCENT INFIRMARY MEDICAL CENTER D/B/A ST. VINCENT HEALTH SYSTEM ("SVHS"). PURSUANT TO ARTICLE V, SECTION 5.4.1 OF THE ORGANIZATION'S BYLAWS, BOTH SVHS AND CATHOLIC HEALTH INITIATIVES ("CHI") (SVHS' 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 SVHS BOARD: - APPROVE MEMBERS OF THE ST. ANTHONY'S HOSPITAL ASSOCIATION BOARD - AMENDMENT OF THE CORPORATE DOCUMENTS OF ST. ANTHONY'S HOSPITAL ASSOCIATION - APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF ST. ANTHONY'S HOSPITAL ASSOCIATION - ADOPTION OF LONG-RANGE AND STRATEGIC PLANS FOR ST. ANTHONY'S HOSPITAL ASSOCIATION. 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. ANTHONY'S HOSPITAL ASSOCIATION - REMOVAL OF A MEMBER OF THE GOVERNING BODY OF ST. ANTHONY'S HOSPITAL ASSOCIATION - APPROVAL OF ISSUANCE OF DEBT BY ST. ANTHONY'S HOSPITAL ASSOCIATION - APPROVAL OF PARTICIPATION OF ST. ANTHONY'S HOSPITAL ASSOCIATION IN A JOINT VENTURE - APPROVAL OF FORMATION OF A NEW CORPORATION BY ST. ANTHONY'S HOSPITAL ASSOCIATION - APPROVAL OF A MERGER INVOLVING ST. ANTHONY'S HOSPITAL ASSOCIATION - APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ST. ANTHONY'S HOSPITAL ASSOCIATION - TO REQUIRE THE TRANSFER OF ASSETS BY ST. ANTHONY'S HOSPITAL ASSOCIATION TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO ARTICLE V, SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, SVHS OR CHI, 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, THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. THE CHIEF FINANCIAL OFFICER PROVIDES A COPY OF THE RETURN TO THE FINANCE COMMITTEE AND TO THE ST. ANTHONY'S HOSPITAL ASSOCIATION BOARD EITHER AT A BOARD MEETING OR ELECTRONICALLY. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX DEPARTMENT 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. Conflict of interest policy Form 990, Part VI, Section B, Line 12c ST. ANTHONY'S HOSPITAL ASSOCIATION, DOING BUSINESS AS ST. VINCENT MORRILTON, FOLLOWS THESE GUIDELINES TO MONITOR AND ENFORCE ITS COI POLICY: EACH OF THE CORPORATION'S OFFICERS AND DIRECTORS SHALL ACT AT ALL TIMES IN A MANNER THAT FURTHERS THE CORPORATION'S CHARITABLE PURPOSE OF SERVICE TO THE COMMUNITY AND SHALL EXERCISE CARE THAT HE OR SHE DOES NOT ACT IN A MANNER THAT FURTHERS HIS OR HER PRIVATE INTERESTS TO THE DETRIMENT OF THE CORPORATION'S COMMUNITY BENEFIT PURPOSES. A CONFLICT OF INTEREST CAN BE CONSIDERED TO EXIST IN ANY INSTANCE WHERE THE ACTIONS OR ACTIVITIES OF AN INDIVIDUAL, ON BEHALF OF THE CORPORATION, ALSO INVOLVE THE OBTAINING OF A DIRECT OR INDIRECT PERSONAL GAIN OR ADVANTAGE, OR AN ADVERSE OR POTENTIALLY ADVERSE EFFECT ON THE INTEREST OF THE CORPORATION. THE CORPORATION'S OFFICERS AND DIRECTORS SHALL AVOID CONFLICTS OF INTEREST AND OTHERWISE FULLY DISCLOSE TO THE CORPORATION ANY POTENTIAL OR ACTUAL CONFLICTS OF INTEREST OF THE CORPORATION. THE CORPORATION AND ALL ITS OFFICERS AND DIRECTORS SHALL COMPLY WITH ANY POLICIES OF THE CORPORATION AND ALL ITS OFFICERS AND DIRECTORS SHALL COMPLY WITH ANY POLICIES OF THE CORPORATION AND ANY POLICIES OF THE CORPORATE MEMBER REGARDING CONFLICTS OF INTEREST, AS WELL AS ALL REQUIREMENTS OF STATE LAW REGARDING SUCH CONFLICTS, AND SHALL COMPLETE ANY AND ALL SUCH DISCLOSURE FORMS AS MAY BE DEEMED NECESSARY OR USEFUL BY THE CORPORATION FOR IDENTIFYING POTENTIAL CONFLICTS OF INTEREST. PROCESS FOR DETERMINING TOP MANAGEMENT OFFICIAL COMPENSATION FORM 990, PART VI, LINE 15A THE ORGANIZATION PAYS A CONTRACTED FIRM TO PROVIDE SERVICES TO THE ORGANIZATION. THE TOP MANAGEMENT OFFICIAL IS EMPLOYED BY THE CONTRACTED FIRM. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b ANY EXECUTIVE COMPENSATION PAID BY THE REPORTING AND RELATED ORGANIZATIONS WAS SET BY A COMPENSATION COMMITTEE UTILIZING COMPARABILITY STUDIES/SURVEYS TO DETERMINE THE REASONABLENESS OF EXECUTIVE COMPENSATION IN COMPARISON TO SIMILARLY SITUATED TAX-EXEMPT ORGANIZATIONS. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS 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. IN ADDITION, THE GOVERNING DOCUMENTS ARE AVAILABLE FROM THE ARKANSAS SECRETARY OF STATE. ESTIMATE OF HOURS 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, 40 HOUR PER WEEK EMPLOYEES. Other changes in net assets or fund balances Form 990, Part XI, Line 5 PRIOR PERIOD ADJUSTMENTS - -15293; GAAP ADJUSTMENT - -112382; 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 CHI NS 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 - 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