GOOD SAMARITAN HOSPITAL: Form 990, tax year 2011

View the entire original 990 at ProPublica ↗

Organization: GOOD SAMARITAN HOSPITAL (EIN 47-0379755)
Tax period: 2011-07-01 to 2012-06-30
Filed: 2013-05-15
IRS object ID: 201341359349304479
Schema version: 2011v1.2
Source: Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Timestamp	2013-05-15T12:00:24-05:00	Timestamp
Tax Period End Date	2012-06-30	TaxPeriodEndDate

Preparer Firm PreparerFirm

Field	Value	IRS element (for citing)
EIN	470617373	EIN

Preparer Firm Business Name PreparerFirmBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	CATHOLIC HEALTH INITIATIVES	BusinessNameLine1

Preparer Firm US Address PreparerFirmUSAddress

Field	Value	IRS element (for citing)
Address Line1	198 INVERNESS DRIVE WEST	AddressLine1
City	ENGLEWOOD	City
State	CO	State
ZIP Code	80112	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnType
Tax Period Begin Date	2011-07-01	TaxPeriodBeginDate

Filer Filer

Field	Value	IRS element (for citing)
EIN	470379755	EIN

Name Name

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
Name Control	GOOD	NameControl
Phone	3088657902	Phone

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO Box 1990	AddressLine1
City	Kearney	City
State	NE	State
ZIP Code	68848	ZIPCode

Officer Officer

Field	Value	IRS element (for citing)
Name	GEORGE HARMS	Name
Title	VP OF FINANCE	Title
Date Signed	2012-10-02	DateSigned
Authorize Third Party	true	AuthorizeThirdParty

Preparer Preparer

Field	Value	IRS element (for citing)
Name	KIMBERLY STEENHOEK	Name
PTIN	P01201968	PTIN
Phone	3032989100	Phone

Field	Value	IRS element (for citing)
Tax Year	2011	TaxYear
Build TS	2016-02-24 21:20:13Z	BuildTS

Form 990 IRS990

Name Of Principal Officer Business NameOfPrincipalOfficerBusiness

Field	Value	IRS element (for citing)
Business Name Line1	MICHAEL SCHNIEDERS PRESIDENT	BusinessNameLine1

Address Principal Officer US AddressPrincipalOfficerUS

Field	Value	IRS element (for citing)
Address Line1	10 East 31st Street	AddressLine1
City	Kearney	City
State	NE	State
ZIP Code	68848	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	226794706	GrossReceipts
Group Return For Affiliates	false	GroupReturnForAffiliates
Group Exemption Number	0928	GroupExemptionNumber
Organization501c3	X	Organization501c3
Web Site	WWW.GSHS.ORG	WebSite
Type Of Organization Corporation	X	TypeOfOrganizationCorporation
Year Formation	1924	YearFormation
State Legal Domicile	NE	StateLegalDomicile
Activity Or Mission Description	TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY, AND VIABILITY. TO PROMOTE AND PROVIDE HEALTH CARE SERVICES TO THE NEEDS OF THE COMMUNITY IN THE ABSENCE OF PRIVATE BENEFIT.	ActivityOrMissionDescription
Nbr Voting Members Governing Body	14	NbrVotingMembersGoverningBody
Nbr Independent Voting Members	11	NbrIndependentVotingMembers
Total Nbr Employees	1747	TotalNbrEmployees
Total Nbr Volunteers	792	TotalNbrVolunteers
Total Gross UBI	152408	TotalGrossUBI
Net Unrelated Business Txbl Income	106697	NetUnrelatedBusinessTxblIncome
Contributions Grants Prior Year	1083663	ContributionsGrantsPriorYear
Contributions Grants Current Year	1392485	ContributionsGrantsCurrentYear
Program Service Revenue Prior Year	214592483	ProgramServiceRevenuePriorYear
Program Service Revenue CY	214955979	ProgramServiceRevenueCY
Investment Income Prior Year	10920883	InvestmentIncomePriorYear
Investment Income Current Year	5716394	InvestmentIncomeCurrentYear
Other Revenue Prior Year	3264114	OtherRevenuePriorYear
Other Revenue Current Year	4603707	OtherRevenueCurrentYear
Total Revenue Prior Year	229861143	TotalRevenuePriorYear
Total Revenue Current Year	226668565	TotalRevenueCurrentYear
Grants And Similar Amnts Prior Year	2382159	GrantsAndSimilarAmntsPriorYear
Grants And Similar Amnts CY	14649021	GrantsAndSimilarAmntsCY
Benefits Paid To Members Prior Year	0	BenefitsPaidToMembersPriorYear
Benefits Paid To Members CY	0	BenefitsPaidToMembersCY
Salaries Etc Prior Year	79675983	SalariesEtcPriorYear
Salaries Etc Current Year	77875595	SalariesEtcCurrentYear
Total Prof Fundrsng Exp Prior Year	0	TotalProfFundrsngExpPriorYear
Total Prof Fundrsng Exp CY	0	TotalProfFundrsngExpCY
Total Fundrsng Exp Current Year	0	TotalFundrsngExpCurrentYear
Other Expense Prior Year	112817995	OtherExpensePriorYear
Other Expenses Current Year	110725401	OtherExpensesCurrentYear
Total Expenses Prior Year	194876137	TotalExpensesPriorYear
Total Expenses Current Year	203250017	TotalExpensesCurrentYear
Revenues Less Expenses Prior Year	34985006	RevenuesLessExpensesPriorYear
Revenues Less Expenses CY	23418548	RevenuesLessExpensesCY
Total Assets BOY	337318563	TotalAssetsBOY
Total Assets EOY	352550852	TotalAssetsEOY
Total Liabilities BOY	57558769	TotalLiabilitiesBOY
Total Liabilities EOY	54264723	TotalLiabilitiesEOY
Net Assets Or Fund Balances BOY	279759794	NetAssetsOrFundBalancesBOY
Net Assets Or Fund Balances EOY	298286129	NetAssetsOrFundBalancesEOY
Mission Description	THE MISSION OF GOOD SAMARITAN HOSPITAL 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.	MissionDescription
Significant New Program Services	false	SignificantNewProgramServices
Significant Change	false	SignificantChange
Expense	169799355	Expense
Grants	14649021	Grants
Revenue	214919155	Revenue
Description	SEE SCHEDULE H	Description
Total Program Service Expense	169799355	TotalProgramServiceExpense
Described In501 C3	true	DescribedIn501C3
Schedule B Required	true	ScheduleBRequired
Political Activities	false	PoliticalActivities
Lobbying Activities	true	LobbyingActivities
Donor Advised Funds	false	DonorAdvisedFunds
Conservation Easements	false	ConservationEasements
Collections Of Art	false	CollectionsOfArt
Credit Counseling	false	CreditCounseling
Term Or Permanent Endowments	false	TermOrPermanentEndowments
Report Land Bldg Equip	true	ReportLandBldgEquip
Report Invest Oth Securities	true	ReportInvestOthSecurities
Report Prog Rel Invest	false	ReportProgRelInvest
Report Other Assets	false	ReportOtherAssets
Report Other Liabilities	true	ReportOtherLiabilities
Report Fin48 Footnote	true	ReportFin48Footnote
Independent Audit Financial Stmt	false	IndependentAuditFinancialStmt
Consolidated Audit Financial Stmt	true	ConsolidatedAuditFinancialStmt
School	false	School
Foreign Office	false	ForeignOffice
Foreign Activities	false	ForeignActivities
More Than5000 K To Organizations	false	MoreThan5000KToOrganizations
More Than5000 K To Individuals	false	MoreThan5000KToIndividuals
Professional Fundraising	false	ProfessionalFundraising
Fundraising Activities	false	FundraisingActivities
Gaming	false	Gaming
Hospital	true	Hospital
Financial Stmt Attached	true	FinancialStmtAttached
Grants To Organizations	true	GrantsToOrganizations
Grants To Individuals	true	GrantsToIndividuals
Schedule J Required	true	ScheduleJRequired
Tax Exempt Bonds	false	TaxExemptBonds
Excess Benefit Transaction	false	ExcessBenefitTransaction
Prior Excess Benefit Transaction	false	PriorExcessBenefitTransaction
Loan To Officer Or DQP	false	LoanToOfficerOrDQP
Grant To Related Person	false	GrantToRelatedPerson
Bsnss Rltnshp With Organization	false	BsnssRltnshpWithOrganization
Bsnss Rltnshp Thru Family Member	false	BsnssRltnshpThruFamilyMember
Officer Entity With Bsnss Rltnshp	false	OfficerEntityWithBsnssRltnshp
Deductible Non Cash Contributions	false	DeductibleNonCashContributions
Deductible Contributions Of Art	false	DeductibleContributionsOfArt
Terminated	false	Terminated
Partial Liquidation	false	PartialLiquidation
Disregarded Entity	true	DisregardedEntity
Related Entity	true	RelatedEntity
Related Org Controlled Entity	true	RelatedOrgControlledEntity
Transaction Related Entity	true	TransactionRelatedEntity
Transfers To Exempt Non Chrtbl Org	false	TransfersToExemptNonChrtblOrg
Activities Conducted Partnership	false	ActivitiesConductedPartnership
Schedule O Required	true	ScheduleORequired
Number Forms Transmitted With1096	5	NumberFormsTransmittedWith1096
Number W2 G Included	0	NumberW2GIncluded
Compliance With Backup Witholding	true	ComplianceWithBackupWitholding
Number Of Employees	1747	NumberOfEmployees
Employment Tax Returns Filed	true	EmploymentTaxReturnsFiled
Unrelated Business Income	true	UnrelatedBusinessIncome
Form990-T Filed	true	Form990-TFiled
Foreign Financial Account	false	ForeignFinancialAccount
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTrans
Taxable Party Notification	false	TaxablePartyNotification
Non Deductible Contributions	false	NonDeductibleContributions
Quid Pro Quo Contributions	false	QuidProQuoContributions
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOf
Funds To Pay Premiums	false	FundsToPayPremiums
Premiums Paid	false	PremiumsPaid
Indoor Tanning Services	false	IndoorTanningServices
Info In Schedule O Part VI	X	InfoInScheduleOPartVI
Nbr Voting Governing Body Members	14	NbrVotingGoverningBodyMembers
Number Independent Voting Members	11	NumberIndependentVotingMembers
Family Or Business Relationship	false	FamilyOrBusinessRelationship
Delegation Of Management Duties	false	DelegationOfManagementDuties
Changes To Organizing Docs	false	ChangesToOrganizingDocs
Material Diversion Or Misuse	false	MaterialDiversionOrMisuse
Members Or Stockholders	true	MembersOrStockholders
Election Of Board Members	true	ElectionOfBoardMembers
Decisions Subject To Approval	true	DecisionsSubjectToApproval
Minutes Of Governing Body	true	MinutesOfGoverningBody
Minutes Of Committees	true	MinutesOfCommittees
Officer Mailing Address	false	OfficerMailingAddress
Local Chapters	false	LocalChapters
Form990 Provided To Governing Body	true	Form990ProvidedToGoverningBody
Conflict Of Interest Policy	true	ConflictOfInterestPolicy
Annual Disclosure Covered Persons	true	AnnualDisclosureCoveredPersons
Regular Monitoring Enforcement	true	RegularMonitoringEnforcement
Whistleblower Policy	true	WhistleblowerPolicy
Document Retention Policy	true	DocumentRetentionPolicy
Compensation Process CEO	false	CompensationProcessCEO
Compensation Process Other	false	CompensationProcessOther
Investment In Joint Venture	true	InvestmentInJointVenture
Written Policy Or Procedure	false	WrittenPolicyOrProcedure
States Where Copy Of Return Is Filed	NE	StatesWhereCopyOfReturnIsFiled
Upon Request	X	UponRequest

The Books Are In Care Of TheBooksAreInCareOf

Name Business NameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	George Harms	BusinessNameLine1

Field	Value	IRS element (for citing)
Telephone Number	3088657902	TelephoneNumber

Address US AddressUS

Field	Value	IRS element (for citing)
Address Line1	10 East 31st Street	AddressLine1
City	Kearney	City
State	NE	State
ZIP Code	68848	ZIPCode

Field	Value	IRS element (for citing)
Info In Schedule O Part VII	X	InfoInScheduleOPartVII

Form990 Part VII Section A Form990PartVIISectionA (26 entries)

TitleTitle	Average Hours Per WeekAverageHoursPerWeek	Individual Trustee Or DirectorIndividualTrusteeOrDirector	OfficerOfficer	Reportable Comp From OrganizationReportableCompFromOrganization	Reportable Comp From Related OrgsReportableCompFromRelatedOrgs	Other CompensationOtherCompensation	Key EmployeeKeyEmployee	Highest Compensated EmployeeHighestCompensatedEmployee	FormerFormer
BEN HIRSCHFELD
SECRETARY / TREASURER	3.00	X	X	0	0	0
DAN BAHENSKY
CHAIR	5.00	X	X	0	0	0
MICHAEL SCHNIEDERS
PRESIDENT GSH	60.00	X	X	0	737973	72594
THOMAS TYE II
VICE CHAIR	5.00	X	X	0	0	0
CLINT JONES MD
BOARD MEMBER	2.00	X		0	0	0
DALE POHLMANN
Board Member	3.00	X		0	0	0
DEB SCHROEDER
BOARD MEMBER	2.00	X		0	0	0
GARY STEFFENSMEIER
BOARD MEMBER	2.00	X		0	0	0
JANICE WIEBUSCH
BOARD MEMBER	2.00	X		0	0	0
KENT BARNEY
BOARD MEMBER/CHAIR GSH FOUNDATION	2.00	X		0	0	0
MICHAEL MORGAN
BOARD MEMBER	2.00	X		0	0	0
RICHARD HRANAC
BOARD MEMBER/PRESIDENT, MEDICAL STAFF	5.00	X		25196	0	29603
RICHARD PILAKOWSKI
BOARD MEMBER	4.00	X		0	0	0
ROBERT LANIK
BOARD MEMBER/CHI SVP	2.00	X		0	882209	46446
GEORGE HARMS
VICE PRESIDENT OF FINANCE	60.00		X	252817	0	42960
CAROL WAHL
VP PATIENT SERVICES	60.00			252351	0	35510	X
KENNETH SMOOT
VP MISSION INTEGRATION	45.00			150118	0	19301	X
ROBERT CUNNINGHAM
VP ANCILLARY SUPPORT	60.00			227657	0	40304	X
ELIZABETH TAYLOR-TRUJILLO
DIRECTOR BEHAVIORAL HEALTH	45.00			120785	0	31757		X
FISHEL LIBERMAN
PHYSICIAN	65.00			637677	0	42382		X
HUGO GONZALEZ NIETO
PHYSICIAN	65.00			136210	231899	36775		X
NICKI L BOHL
DIRECTOR PHARMACY	45.00			140611	0	27241		X
TODD STOVER
DIRECTOR PERFUSION	45.00			159288	0	37218		X
JOHN ALLEN
fORMER PRESIDENT/CEO GSH	0.00			0	203513	6955			X
LEIGH BERTHOLF
Former VP & CRO	0.00			0	210369	43635			X
STEPHEN LEURCK
FORMER INTERIM CAO	0.00			199502	71892	0			X

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	2302212	TotalReportableCompFromOrg
Total Reportable Comp Frm Rltd Orgs	2337855	TotalReportableCompFrmRltdOrgs
Total Other Compensation	512681	TotalOtherCompensation
Number Individuals GT100 K	34	NumberIndividualsGT100K
Formers Listed	true	FormersListed
Total Comp GT150 K	true	TotalCompGT150K
Compensation From Other Sources	false	CompensationFromOtherSources

Contractor Compensation ContractorCompensation (5 entries)

Address Line1AddressOfContractor/AddressUS/AddressLine1	CityAddressOfContractor/AddressUS/City	StateAddressOfContractor/AddressUS/State	ZIP CodeAddressOfContractor/AddressUS/ZIPCode	Description Of ServicesDescriptionOfServices	CompensationCompensation
AECOM TECHNICAL SERVICES INC
555 S FLOWER ST 4TH FL	LOS ANGELES	CA	900712201	CONSTRUCTION CONTRACTOR	16117466
ELLERBE BECKET INC
800 LASALLE AVE	MINNEAPOLIS	MN	55402	ARCHITECT/CONTRACTOR	3442603
RODGERS HELICOPTER SERVICES
4965 AIRPORT ROAD	KEARNEY	NE	688473372	AIRCARE FLIGHT SVCS	1570114
MCKAY CONSULTING
8590 BUSINESS PARK DR	SHREVEPORT	LA	71005	CONSULTANT	1537148
SENTINEL HEALTH CARE
2605 2ND AVE	KEARNEY	NE	68847	PHO	907691

Field	Value	IRS element (for citing)
Number Of Contractors GT100 K	32	NumberOfContractorsGT100K
Related Organizations	1227212	RelatedOrganizations
Government Grants	107073	GovernmentGrants
All Other Contributions	58200	AllOtherContributions
Total Contributions	1392485	TotalContributions

Program Service Revenue ProgramServiceRevenue (5 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	Related Or Exempt Function IncomeRelatedOrExemptFunctionIncome	Unrelated Business RevenueUnrelatedBusinessRevenue
PATIENT SERVICES	900099	212754122	212754122
EQUITY CHANGES OF UNCONSOLIDATED ORGS	900099	1113025	1076201	36824
RENTAL INCOME	900099	868755	868755
PROGRAM SERVICE REVENUE	900099	150162	150162
EDUCATION	611710	69915	69915

Total Oth Program Service Revenue TotalOthProgramServiceRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	0	UnrelatedBusinessRevenue
Exclusion	$0	ExclusionAmount

Field	Value	IRS element (for citing)
Total Program Service Revenue	214955979	TotalProgramServiceRevenue

Investment Income InvestmentIncome

Field	Value	IRS element (for citing)
Total Revenue Column	3611048	TotalRevenueColumn
Unrelated Business Revenue	5713	UnrelatedBusinessRevenue
Exclusion	$3,605,335	ExclusionAmount

Income From Invest Bond Proceeds IncomeFromInvestBondProceeds

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Royalties Revenue RoyaltiesRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Gross Rents GrossRents

Field	Value	IRS element (for citing)
Real	0	Real

Rental Income Or Loss RentalIncomeOrLoss

Field	Value	IRS element (for citing)
Real	0	Real
Personal	0	Personal

Net Rental Income Or Loss NetRentalIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn
Exclusion	$0	ExclusionAmount

Gross Amount Sales Assets GrossAmountSalesAssets

Field	Value	IRS element (for citing)
Securities	2216988	Securities
Other	14499	Other

Less Cost Oth Basis Sales Expenses LessCostOthBasisSalesExpenses

Field	Value	IRS element (for citing)
Other	126141	Other

Gain Or Loss GainOrLoss

Field	Value	IRS element (for citing)
Securities	2216988	Securities
Other	-111642	Other

Net Gain Or Loss Investments NetGainOrLossInvestments

Field	Value	IRS element (for citing)
Total Revenue Column	2105346	TotalRevenueColumn
Exclusion	$2,105,346	ExclusionAmount

Net Income From Fundraising Events NetIncomeFromFundraisingEvents

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income From Gaming NetIncomeFromGaming

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Net Income Or Loss NetIncomeOrLoss

Field	Value	IRS element (for citing)
Total Revenue Column	0	TotalRevenueColumn

Other Revenue Misc OtherRevenueMisc (3 entries)

DescriptionDescription	Business CodeBusinessCode	Total Revenue ColumnTotalRevenueColumn	ExclusionExclusionAmount	Unrelated Business RevenueUnrelatedBusinessRevenue
SERVICES SOLD	900099	1269757	$1,269,757
CAFETERIA	722100	941481	$938,403	3078
CHILD CARE	624410	458845	$458,845

Miscellaneous Revenue MiscellaneousRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	1933624	TotalRevenueColumn
Related Or Exempt Function Income	0	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	106793	UnrelatedBusinessRevenue
Exclusion	$1,826,831	ExclusionAmount

Field	Value	IRS element (for citing)
Total Other Revenue	4603707	TotalOtherRevenue

Total Revenue TotalRevenue

Field	Value	IRS element (for citing)
Total Revenue Column	226668565	TotalRevenueColumn
Related Or Exempt Function Income	214919155	RelatedOrExemptFunctionIncome
Unrelated Business Revenue	152408	UnrelatedBusinessRevenue
Exclusion	$10,204,517	ExclusionAmount

Grants To Domestic Orgs GrantsToDomesticOrgs

Field	Value	IRS element (for citing)
Total	14604240	Total
Program Services	14604240	ProgramServices

Grants To Domestic Individuals GrantsToDomesticIndividuals

Field	Value	IRS element (for citing)
Total	44781	Total
Program Services	44781	ProgramServices

Foreign Grants ForeignGrants

Field	Value	IRS element (for citing)
Total	0	Total

Benefits To Members BenefitsToMembers

Field	Value	IRS element (for citing)
Total	0	Total

Comp Current Officers Directors CompCurrentOfficersDirectors

Field	Value	IRS element (for citing)
Total	934952	Total
Program Services	388142	ProgramServices
Management And General	546810	ManagementAndGeneral

Comp Disqual Persons CompDisqualPersons

Field	Value	IRS element (for citing)
Total	0	Total

Other Salaries And Wages OtherSalariesAndWages

Field	Value	IRS element (for citing)
Total	57775159	Total
Program Services	50712987	ProgramServices
Management And General	7062172	ManagementAndGeneral

Pension Plan Contributions PensionPlanContributions

Field	Value	IRS element (for citing)
Total	3098778	Total
Program Services	2309175	ProgramServices
Management And General	789603	ManagementAndGeneral

Other Employee Benefits OtherEmployeeBenefits

Field	Value	IRS element (for citing)
Total	11753283	Total
Program Services	9085906	ProgramServices
Management And General	2667377	ManagementAndGeneral

Payroll Taxes PayrollTaxes

Field	Value	IRS element (for citing)
Total	4313423	Total
Program Services	3646506	ProgramServices
Management And General	666917	ManagementAndGeneral

Fees For Services Management FeesForServicesManagement

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Legal FeesForServicesLegal

Field	Value	IRS element (for citing)
Total	1793	Total
Management And General	1793	ManagementAndGeneral

Fees For Services Accounting FeesForServicesAccounting

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Lobbying FeesForServicesLobbying

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Invst Mgmnt Fees FeesForServicesInvstMgmntFees

Field	Value	IRS element (for citing)
Total	0	Total

Fees For Services Other FeesForServicesOther

Field	Value	IRS element (for citing)
Total	34236296	Total
Program Services	21801928	ProgramServices
Management And General	12434368	ManagementAndGeneral

Advertising Advertising

Field	Value	IRS element (for citing)
Total	715655	Total
Program Services	52382	ProgramServices
Management And General	663273	ManagementAndGeneral

Office Expenses OfficeExpenses

Field	Value	IRS element (for citing)
Total	6898336	Total
Program Services	4855580	ProgramServices
Management And General	2042756	ManagementAndGeneral

Information Technology InformationTechnology

Field	Value	IRS element (for citing)
Total	0	Total

Royalties Royalties

Field	Value	IRS element (for citing)
Total	0	Total

Occupancy Occupancy

Field	Value	IRS element (for citing)
Total	2702323	Total
Program Services	1981691	ProgramServices
Management And General	720632	ManagementAndGeneral

Travel Travel

Field	Value	IRS element (for citing)
Total	697224	Total
Program Services	472405	ProgramServices
Management And General	224819	ManagementAndGeneral

Travel Entrtnmnt Public Officials TravelEntrtnmntPublicOfficials

Field	Value	IRS element (for citing)
Total	0	Total

Conferences Meetings ConferencesMeetings

Field	Value	IRS element (for citing)
Total	70235	Total
Program Services	8932	ProgramServices
Management And General	61303	ManagementAndGeneral

Interest Interest

Field	Value	IRS element (for citing)
Total	0	Total

Payments To Affiliates PaymentsToAffiliates

Field	Value	IRS element (for citing)
Total	3782004	Total
Program Services	2836503	ProgramServices
Management And General	945501	ManagementAndGeneral

Depreciation Depletion DepreciationDepletion

Field	Value	IRS element (for citing)
Total	10933318	Total
Program Services	8639629	ProgramServices
Management And General	2293689	ManagementAndGeneral

Insurance Insurance

Field	Value	IRS element (for citing)
Total	594691	Total
Program Services	475753	ProgramServices
Management And General	118938	ManagementAndGeneral

Other Expenses OtherExpenses (4 entries)

DescriptionDescription	TotalTotal	Program ServicesProgramServices	Management And GeneralManagementAndGeneral
BAD DEBTS	9505493	9505493
MEDICAL SUPPLIES	35602440	35579922	22518
UNRELATED BUSINESS TAXES	23372	23372
REPAIRS AND MAINTENANCE	3016518	2342428	674090

All Other Expenses AllOtherExpenses

Field	Value	IRS element (for citing)
Total	1945703	Total
Program Services	431600	ProgramServices
Management And General	1514103	ManagementAndGeneral
Fundraising	0	Fundraising

Total Functional Expenses TotalFunctionalExpenses

Field	Value	IRS element (for citing)
Total	203250017	Total
Program Services	169799355	ProgramServices
Management And General	33450662	ManagementAndGeneral
Fundraising	0	Fundraising

Total Joint Costs TotalJointCosts

Field	Value	IRS element (for citing)
Total	0	Total

Cash Non Interest Bearing CashNonInterestBearing

Field	Value	IRS element (for citing)
BOY	4660	BOY
EOY	4551	EOY

Savings And Temp Cash Investments SavingsAndTempCashInvestments

Field	Value	IRS element (for citing)
BOY	23292498	BOY
EOY	13528737	EOY

Accounts Receivable AccountsReceivable

Field	Value	IRS element (for citing)
BOY	31321539	BOY
EOY	31570749	EOY

Other Notes Loans Receivable Net OtherNotesLoansReceivableNet

Field	Value	IRS element (for citing)
BOY	290559	BOY
EOY	1041804	EOY

Inventories For Sale Or Use InventoriesForSaleOrUse

Field	Value	IRS element (for citing)
BOY	7411778	BOY
EOY	7033096	EOY

Prepaid Expenses Deferred Charges PrepaidExpensesDeferredCharges

Field	Value	IRS element (for citing)
BOY	278463	BOY
EOY	289557	EOY

Field	Value	IRS element (for citing)
Land Buildings Equipment Basis	260441243	LandBuildingsEquipmentBasis
Land Bldg Equipment Accum Deprec	133233684	LandBldgEquipmentAccumDeprec

Land Buildings Equipment Basis Net LandBuildingsEquipmentBasisNet

Field	Value	IRS element (for citing)
BOY	96026860	BOY
EOY	127207559	EOY

Investments Pub Traded Securities InvestmentsPubTradedSecurities

Field	Value	IRS element (for citing)
BOY	1142	BOY
EOY	271	EOY

Investments Other Securities InvestmentsOtherSecurities

Field	Value	IRS element (for citing)
BOY	170545706	BOY
EOY	160905737	EOY

Investments Program Related InvestmentsProgramRelated

Field	Value	IRS element (for citing)
BOY	0	BOY
EOY	0	EOY

Intangible Assets IntangibleAssets

Field	Value	IRS element (for citing)
BOY	2301156	BOY
EOY	2301156	EOY

Other Assets Total OtherAssetsTotal

Field	Value	IRS element (for citing)
BOY	5844202	BOY
EOY	8667635	EOY

Total Assets TotalAssets

Field	Value	IRS element (for citing)
BOY	337318563	BOY
EOY	352550852	EOY

Accounts Payable Accrued Expenses AccountsPayableAccruedExpenses

Field	Value	IRS element (for citing)
BOY	27298294	BOY
EOY	23972237	EOY

Mort Notes Pybl Secured Invest Prop MortNotesPyblSecuredInvestProp

Field	Value	IRS element (for citing)
BOY	243626	BOY
EOY	20354	EOY

Other Liabilities OtherLiabilities

Field	Value	IRS element (for citing)
BOY	30016849	BOY
EOY	30272132	EOY

Total Liabilities TotalLiabilities

Field	Value	IRS element (for citing)
BOY	57558769	BOY
EOY	54264723	EOY

Field	Value	IRS element (for citing)
Follow SFAS117	X	FollowSFAS117

Unrestricted Net Assets UnrestrictedNetAssets

Field	Value	IRS element (for citing)
BOY	279759794	BOY
EOY	298286129	EOY

Temporarily Restricted Net Assets TemporarilyRestrictedNetAssets

Field	Value	IRS element (for citing)
EOY	0	EOY

Permanently Restricted Net Assets PermanentlyRestrictedNetAssets

Field	Value	IRS element (for citing)
EOY	0	EOY

Total Net Assets Fund Balances TotalNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	279759794	BOY
EOY	298286129	EOY

Total Liab Net Assets Fund Balances TotalLiabNetAssetsFundBalances

Field	Value	IRS element (for citing)
BOY	337318563	BOY
EOY	352550852	EOY

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	X	InfoInScheduleOPartXI
Reconcilation Revenue Expenses	23418548	ReconcilationRevenueExpenses
Reconcilation Other Changes	-4892213	ReconcilationOtherChanges
Method Of Accounting Accrual	X	MethodOfAccountingAccrual
Accountant Compile Or Review	false	AccountantCompileOrReview
FS Audited	true	FSAudited
Audit Committee	true	AuditCommittee
Financial Statement Consolidated	X	FinancialStatementConsolidated
Federal Grant Audit Required	false	FederalGrantAuditRequired

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital170b1 Aiii	X	Hospital170b1Aiii

Schedule B IRS990ScheduleB

Contributor Info ContributorInfo

Field	Value	IRS element (for citing)
Contributor Number	RESTRICTED	ContributorNumber

Contributor Name Business ContributorNameBusiness

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor Address US ContributorAddressUS

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Aggregate Contributions	RESTRICTED	AggregateContributions

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	Volunteers
Paid Staff Or Management	false	PaidStaffOrManagement
Media Advertisements	false	MediaAdvertisements
Mailings Members	false	MailingsMembers
Publications Or Broadcast	false	PublicationsOrBroadcast
Grants Other Organizations	true	GrantsOtherOrganizations
Grants Other Organizations	$8,713	GrantsOtherOrganizationsAmount
Direct Contact Legislators	false	DirectContactLegislators
Rallies Demonstrations	false	RalliesDemonstrations
Other Activities	false	OtherActivities
Total Lobbying Expenditures IIB	8713	TotalLobbyingExpendituresIIB
Not Described In501c3	false	NotDescribedIn501c3

Form990 Schedule C Part IV Form990ScheduleCPartIV

Field	Value	IRS element (for citing)
Identifier	Description of the activities reported on Lines 1a through 1i	Identifier
Return Reference	Schedule C, Part II-B, Line 1	ReturnReference
Explanation	LINE 1F: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS; NEBRASKA HOSPITAL ASSOCIATION $5,424, CATHOLIC HEALTH ASSOCIATION $1,009 AND AMERICAN HOSPITAL ASSOCIATION $2,280.	Explanation

Schedule D IRS990ScheduleD

Land Land

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	8098717	OtherCostOrOtherBasis
Book Value	8098717	BookValue

Buildings Buildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	71647795	OtherCostOrOtherBasis
Depreciation	36770111	Depreciation
Book Value	34877684	BookValue

Leasehold Improvements LeaseholdImprovements

Field	Value	IRS element (for citing)
Book Value	0	BookValue

Equipment Equipment

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	121199360	OtherCostOrOtherBasis
Depreciation	90571061	Depreciation
Book Value	30628299	BookValue

Other Land Buildings OtherLandBuildings

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	59495371	OtherCostOrOtherBasis
Depreciation	5892512	Depreciation
Book Value	53602859	BookValue

Field	Value	IRS element (for citing)
Total Of Book Value Land Buildings	127207559	TotalOfBookValueLandBuildings

Financial Derivatives FinancialDerivatives

Field	Value	IRS element (for citing)
Book Value	0	BookValue

Closely Held Equity Interests CloselyHeldEquityInterests

Field	Value	IRS element (for citing)
Book Value	0	BookValue

Other Securities OtherSecurities (2 entries)

DescriptionDescription	Book ValueBookValue
CHI OIP - FIXED INCOME	80222123
CHI OIP - EQUITY SECURITIES	80683614

Field	Value	IRS element (for citing)
Total Of Book Value Securities	160905737	TotalOfBookValueSecurities
Federal Income Tax Liability	0	FederalIncomeTaxLiability

Other Liabilities OtherLiabilities (3 entries)

DescriptionDescription	AmountAmount
PHYSICIAN MINIMUM REVENUE GUARANTEE	$925,718
INTERCOMPANY PAYABLES	$4,083,413
INTERCOMPANY NOTES PAYABLE	$25,263,001

Field	Value	IRS element (for citing)
Total Of Amounts	30272132	TotalOfAmounts

Form990 Schedule D Part XIV Form990ScheduleDPartXIV

Field	Value	IRS element (for citing)
Identifier	FIN 48 (ASC 740) footnote	Identifier
Return Reference	Schedule D, Part X, Line 2	ReturnReference
Explanation	GOOD SAMARITAN 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."	Explanation

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Charity Care Policy	true	CharityCarePolicy
Written Policy	true	WrittenPolicy
Policy Applied To All Hospitals	X	PolicyAppliedToAllHospitals
FPG Reference Free Care	false	FPGReferenceFreeCare
FPG Reference Discounted Care	false	FPGReferenceDiscountedCare
Free Disc Care Medically Indigent	true	FreeDiscCareMedicallyIndigent
Amounts Budgeted For Charity Care	true	AmountsBudgetedForCharityCare
Expenses Exceeded Budget	true	ExpensesExceededBudget
Unable To Provide Care	false	UnableToProvideCare
Annual Community Benefit Report	true	AnnualCommunityBenefitReport
Report Publically Available	true	ReportPublicallyAvailable

Charity Care At Cost CharityCareAtCost

Field	Value	IRS element (for citing)
Persons Served	3868	PersonsServed
Total Community Benefit Expense	6697379	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	6697379	NetCommunityBenefitExpense
Percent Of Total Expense	0.03460	PercentOfTotalExpense

Unreimbursed Medicaid UnreimbursedMedicaid

Field	Value	IRS element (for citing)
Persons Served	9906	PersonsServed
Total Community Benefit Expense	16685691	TotalCommunityBenefitExpense
Direct Offsetting Revenue	7064983	DirectOffsettingRevenue
Net Community Benefit Expense	9620708	NetCommunityBenefitExpense
Percent Of Total Expense	0.04970	PercentOfTotalExpense

Unreimbursed Costs UnreimbursedCosts

Field	Value	IRS element (for citing)
Persons Served	0	PersonsServed
Total Community Benefit Expense	0	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	0	NetCommunityBenefitExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Total Charity Care TotalCharityCare

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	13774	PersonsServed
Total Community Benefit Expense	23383070	TotalCommunityBenefitExpense
Direct Offsetting Revenue	7064983	DirectOffsettingRevenue
Net Community Benefit Expense	16318087	NetCommunityBenefitExpense
Percent Of Total Expense	0.08430	PercentOfTotalExpense

Community Health Services CommunityHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	58	NumberOfActivitiesOrPrograms
Persons Served	324910	PersonsServed
Total Community Benefit Expense	1941167	TotalCommunityBenefitExpense
Direct Offsetting Revenue	203220	DirectOffsettingRevenue
Net Community Benefit Expense	1737947	NetCommunityBenefitExpense
Percent Of Total Expense	0.00900	PercentOfTotalExpense

Health Professions Education HealthProfessionsEducation

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	34	NumberOfActivitiesOrPrograms
Persons Served	4043	PersonsServed
Total Community Benefit Expense	919784	TotalCommunityBenefitExpense
Direct Offsetting Revenue	149608	DirectOffsettingRevenue
Net Community Benefit Expense	770176	NetCommunityBenefitExpense
Percent Of Total Expense	0.00400	PercentOfTotalExpense

Subsidized Health Services SubsidizedHealthServices

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	370	PersonsServed
Total Community Benefit Expense	3304277	TotalCommunityBenefitExpense
Direct Offsetting Revenue	3048504	DirectOffsettingRevenue
Net Community Benefit Expense	255773	NetCommunityBenefitExpense
Percent Of Total Expense	0.00130	PercentOfTotalExpense

Research Research

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	3	NumberOfActivitiesOrPrograms
Persons Served	600	PersonsServed
Total Community Benefit Expense	340618	TotalCommunityBenefitExpense
Direct Offsetting Revenue	73000	DirectOffsettingRevenue
Net Community Benefit Expense	267618	NetCommunityBenefitExpense
Percent Of Total Expense	0.00140	PercentOfTotalExpense

Cash And In Kind Contributions CashAndInKindContributions

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	21	NumberOfActivitiesOrPrograms
Persons Served	45312	PersonsServed
Total Community Benefit Expense	382934	TotalCommunityBenefitExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Benefit Expense	382934	NetCommunityBenefitExpense
Percent Of Total Expense	0.00200	PercentOfTotalExpense

Total Other Benefits TotalOtherBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	117	NumberOfActivitiesOrPrograms
Persons Served	375235	PersonsServed
Total Community Benefit Expense	6888780	TotalCommunityBenefitExpense
Direct Offsetting Revenue	3474332	DirectOffsettingRevenue
Net Community Benefit Expense	3414448	NetCommunityBenefitExpense
Percent Of Total Expense	0.01770	PercentOfTotalExpense

Total Community Benefits TotalCommunityBenefits

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	117	NumberOfActivitiesOrPrograms
Persons Served	389009	PersonsServed
Total Community Benefit Expense	30271850	TotalCommunityBenefitExpense
Direct Offsetting Revenue	10539315	DirectOffsettingRevenue
Net Community Benefit Expense	19732535	NetCommunityBenefitExpense
Percent Of Total Expense	0.10200	PercentOfTotalExpense

Physical Improvements And Housing PhysicalImprovementsAndHousing

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Economic Development EconomicDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Community Support CommunitySupport

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	22232	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	22232	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Environmental Improvements EnvironmentalImprovements

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Leadership Development LeadershipDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Coalition Building CoalitionBuilding

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	0	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	0	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	0	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Health Improvement Advocacy HealthImprovementAdvocacy

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	1241	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	1241	NetCommunityBuildingExpense
Percent Of Total Expense	0.00000	PercentOfTotalExpense

Workforce Development WorkforceDevelopment

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	0	PersonsServed
Total Community Building Expense	1296265	TotalCommunityBuildingExpense
Direct Offsetting Revenue	0	DirectOffsettingRevenue
Net Community Building Expense	1296265	NetCommunityBuildingExpense
Percent Of Total Expense	0.00640	PercentOfTotalExpense

Other Other

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	1	NumberOfActivitiesOrPrograms
Persons Served	925	PersonsServed
Total Community Building Expense	29163	TotalCommunityBuildingExpense
Direct Offsetting Revenue	17255	DirectOffsettingRevenue
Net Community Building Expense	11908	NetCommunityBuildingExpense
Percent Of Total Expense	0.00010	PercentOfTotalExpense

Total Total

Field	Value	IRS element (for citing)
Number Of Activities Or Programs	4	NumberOfActivitiesOrPrograms
Persons Served	925	PersonsServed
Total Community Building Expense	1348901	TotalCommunityBuildingExpense
Direct Offsetting Revenue	17255	DirectOffsettingRevenue
Net Community Building Expense	1331646	NetCommunityBuildingExpense
Percent Of Total Expense	0.00660	PercentOfTotalExpense

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	false	BadDebtExpenseReported
Bad Debt Expense	$9,505,493	BadDebtExpenseAmount
Amount Attributable To	0	AmountAttributableTo
Amount Reimbursed By Medicare	64000884	AmountReimbursedByMedicare
Cost Of Care Reimbursed By Medicare	70749245	CostOfCareReimbursedByMedicare
Medicare Surplus Or Shortfall	-6748361	MedicareSurplusOrShortfall

Costing Methodology Used CostingMethodologyUsed

Field	Value	IRS element (for citing)
Cost To Charge Ratio	X	CostToChargeRatio

Field	Value	IRS element (for citing)
Written Debt Collection Policy	true	WrittenDebtCollectionPolicy
Provision For Charity Care	true	ProvisionForCharityCare

Form990 Schedule H Part IV Form990ScheduleHPartIV

Name Of Entity NameOfEntity

Field	Value	IRS element (for citing)
Business Name Line1	KEARNEY AMBULATORY SURGICAL CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
Description Ent Primary Activity	SURGERY	DescriptionEntPrimaryActivity
Organization Profit Or Ownership	0.2462	OrganizationProfitOrOwnership
Officers Etc Profit Or Ownership	0	OfficersEtcProfitOrOwnership
Physicans Profit Or Ownership	0.7538	PhysicansProfitOrOwnership

Field	Value	IRS element (for citing)
Number Of Hospital Facilities	3	NumberOfHospitalFacilities

Form990 Schedule H Part V Section A Form990ScheduleHPartVSectionA (3 entries)

Facility NumberFacilityNumber	Address Line1Address/AddressLine1	CityAddress/City	StateAddress/State	ZIP CodeAddress/ZIPCode	Licensed HospitalLicensedHospital	General Medical And SurgicalGeneralMedicalAndSurgical	OtherOther
GOOD SAMARITAN HOSPITAL
1	10 EAST 31ST STREET PO BOX 1990	KEARNEY	NE	68848	X	X	ACUTE HOSPITAL
RICHARD H YOUNG HOSPITAL
2	1755 PRAIRIE VIEW PL	KEARNEY	NE	68847	X		PSYCHIATRIC HOSPITAL
GOOD SAMARITAN HOSPITAL LTC
3	10 EAST 31ST STREET PO BOX 1990	KEARNEY	NE	68848	X		LONG TERM CARE

Form990 Schedule H Part VI Form990ScheduleHPartVI (22 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Eligibility criteria for free or discounted care	Schedule H, Part I, Line 3c	WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO GOOD SAMARITAN HOSPITAL) ESTABLISHED ITS CHARITY CARE 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. ELIGIBILITY FOR CHARITY CARE DISCOUNTS SHALL BE DETERMINED BASED ON 130% OF THE ANNUALLY UPDATED HUD GEOGRAPHIC VERY-LOW INCOME GUIDELINES FOR THE APPLICANT'S COUNTY OF RESIDENCE, REFERENCED LATER IN THIS DOCUMENT, AVAILABLE ASSETS AND ANY EXTENUATING CIRCUMSTANCES. THUS, THE STANDARDS OF ELIGIBILITY FOR THE APPLICATION OF CHARITY DISCOUNTS MUST CONSIDER ASSETS, AS WELL AS INCOME. IN ADDITION, THE NEED FOR FUTURE SERVICES REQUIRING FINANCIAL ASSISTANCE SHALL BE ASSESSED. SEPARATE DETERMINATIONS OF ELIGIBILITY FOR CHARITY CARE DISCOUNTS SHALL BE MADE FOR EACH DATE OF SERVICE. CONFIRMATION OF CONTINUED ELIGIBILITY SHALL BE UPDATED EVERY 90 DAYS FOR PATIENTS WHO REQUIRE ONGOING HEALTH CARE SERVICES. AN INDIVIDUAL'S OCCUPATION MAY BE INDICATIVE OF ELIGIBILITY FOR A CHARITY CARE DISCOUNT. EXAMPLES OF LOW-PAYING JOBS MIGHT INCLUDE DAY LABORER, FARM WORKER, MIGRANT WORKER AND FOOD SERVICE ASSOCIATE.
Bad Debt Expense excluded from financial assistance calculation	Schedule H, Part I, Line 7, column(f)	9,505,493
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. GOOD SAMARITAN 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 CHARITYCARE. GOOD SAMARITAN 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	USING ESSENTIALLY THE SAME MEDICARE COST REPORT PRINCIPLES AS TO THE ALLOCATION OF GENERAL SERVICES COSTS AND "APPORTIONMENT" METHODS, THE "CHI WORKBOOK" CALCULATES A PAYER'S GROSS ALLOWABLE COSTS BY SERVICE (SO AS TO FACILITATE A CORRESPONDING COMPARISON BETWEEN GROSS ALLOWABLE COSTS AND ULTIMATE PAYMENTS RECEIVED). THE TERM "GROSS ALLOWABLE COSTS" MEANS COSTS BEFORE ANY DEDUCTIBLES OR CO-INSURANCE ARE SUBTRACTED. GOOD SAMARITAN HOSPITAL'S ULTIMATE REIMBURSEMENT WILL BE REDUCED BY ANY APPLICABLE COPAYMENT/ DEDUCTIBLE. WHERE MEDICARE IS THE SECONDARY INSURER, AMOUNTS DUE FROM THE INSURED'S PRIMARY PAYER WERE NOT SUBTRACTED FROM MEDICARE ALLOWABLE COSTS BECAUSE THE AMOUNTS ARE TYPICALLY IMMATERIAL. ALTHOUGH NOT PRESENTED ON THE MEDICARE COST REPORT, IN ORDER TO FACILITATE A MORE ACCURATE UNDERSTANDING OF THE "TRUE" COST OF SERVICES (FOR "SHORTFALL" PURPOSES) THE CHI WORKBOOK ALLOWS A HEALTH CARE FACILITY NOT TO OFFSET COSTS THAT MEDICARE CONSIDERS TO BE NON-ALLOWABLE, BUT FOR WHICH THE FACILITY CAN LEGITIMATELY ARGUE ARE RELATED TO THE CARE OF THE FACILITY'S PATIENTS. IN ADDITION, ALTHOUGH NOT REPORTABLE ON THE MEDICARE COST REPORT, THE CHI WORKBOOK INCLUDES THE COST OF SERVICES THAT ARE PAID VIA A SET FEE-SCHEDULE RATHER THAN BEING REIMBURSED BASED ON COSTS (E.G. OUTPATIENT CLINICAL LABORATORY). FINALLY, THE CHI WORKBOOK ALLOWS A FACILITY TO INCLUDE OTHER HEALTH CARE SERVICES PERFORMED BY A SEPARATE FACILITY (SUCH AS A PHYSICIAN PRACTICE) THAT ARE MAINTAINED ON SEPARATE BOOKS AND RECORDS (AS OPPOSED TO THE MAIN FACILITY'S BOOKS AND RECORDS WHICH HAS ITS COSTS OF SERVICE INCLUDED WITHIN A COST REPORT). TRUE COSTS OF MEDICARE COMPUTED USING THIS METHODOLOGY: TOTAL MEDICARE REVENUE: $ 64,000,884 TOTAL MEDICARE COSTS: $ 70,749,245 SURPLUS OF SHORTFALL $(6,748,361) GOOD SAMARITAN HOSPITAL 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.A 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	GOOD SAMARITAN 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: - 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 S-ATISTICAL 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.
Used federal poverty guidelines (FPG) to determine eligibility	Schedule H, Part V Section B, Line 9	(1) GOOD SAMARITAN HOSPITAL - HUD LOW INCOME GUIDELINES USED;(2) RICHARD H YOUNG HOSPITAL - HUD LOW INCOME GUIDELINES USED;(3) GOOD SAMARITAN HOSPITAL LTC - HUD LOW INCOME GUIDELINES USED;
Used FPG to determine eligibility for providing discounted care criteria	Schedule H, Part V Section B, Line 10	(1) GOOD SAMARITAN HOSPITAL - HUD LOW INCOME GUIDELINES USED;(2) RICHARD H YOUNG HOSPITAL - HUD LOW INCOME GUIDELINES USED;(3) GOOD SAMARITAN HOSPITAL LTC - HUD LOW INCOME GUIDELINES USED;
Other ways hospital publicized Financial Assistance Policy	Schedule H, Part V Section B, Line 13g	(1) GOOD SAMARITAN HOSPITAL - INFORMATION FOR OUR FINANCIAL ASSISTANCE PROGRAM, INCLUDING THE APPLICATION PROCESS, IS PROVIDED TO PATIENTS IN VARYING FORMATS AND PROCESSES (E.G. PATIENT BROCHURES, GUEST INFORMATION GUIDE, SIGNAGE, SELF-PAY PACKETS, COMMUNITY BENEFIT TAB ON WEBSITE, ETC.). ;(2) RICHARD H YOUNG HOSPITAL - INFORMATION FOR OUR FINANCIAL ASSISTANCE PROGRAM, INCLUDING THE APPLICATION PROCESS, IS PROVIDED TO PATIENTS IN VARYING FORMATS AND PROCESSES (E.G. PATIENT BROCHURES, GUEST INFORMATION GUIDE, SIGNAGE, SELF-PAY PACKETS, COMMUNITY BENEFIT TAB ON WEBSITE, ETC.) ;(3) GOOD SAMARITAN HOSPITAL LTC - INFORMATION FOR OUR FINANCIAL ASSISTANCE PROGRAM, INCLUDING THE APPLICATION PROCESS, IS PROVIDED TO PATIENTS IN VARYING FORMATS AND PROCESSES (E.G. PATIENT BROCHURES, GUEST INFORMATION GUIDE, SIGNAGE, SELF-PAY PACKETS, COMMUNITY BENEFIT TAB ON WEBSITE, ETC.). ;
Means used to determine amounts billed	Schedule H, Part V Section B, Line 19d	(1) GOOD SAMARITAN HOSPITAL - THE AVERAGE MANAGED CARE CONTRACTUAL ALLOWANCES RATE SHALL BE DEVELOPED ANNUALLY BY GOOD SAMARITAN HOSPITAL AND APPLIED TO ALL UNINSURED PATIENTS DEEMED ELIGIBLE FOR THIS DISCOUNT. THE DISCOUNT SHALL BE CALCULATED BY EACH SEPARATE ENTITY WITHIN GOOD SAMARITAN HOSPITAL BY DIVIDING THE TOTAL AMOUNT OF MANAGED CARE CONTRACTUAL ALLOWANCES, FOR THE MOST RECENT FISCAL YEAR, BY THE TOTAL GROSS CHARGES FOR THOSE MANAGED CARE PLANS TO DETERMINE A DISCOUNT RATE THAT SHALL BE USED FOR THE CURRENT FISCAL YEAR, AS FOLLOWS: DISCOUNT PERCENTAGE =TOTAL MANAGED CARE CONTRACTUAL ALLOWANCES / TOTAL MANAGED CARE GROSS CHARGES. FEDERAL, STATE, LOCAL AND COUNTY ENTITLEMENT PROGRAMS SHALL BE EXCLUDED FROM THE ABOVE CALCULATION (I.E., DISREGARD THE DISCOUNTS AND CHARGES FROM SUCH PLANS). ;(2) RICHARD H YOUNG HOSPITAL - THE AVERAGE MANAGED CARE CONTRACTUAL ALLOWANCES RATE SHALL BE DEVELOPED ANNUALLY BY GOOD SAMARITAN HOSPITAL AND APPLIED TO ALL UNINSURED PATIENTS DEEMED ELIGIBLE FOR THIS DISCOUNT. THE DISCOUNT SHALL BE CALCULATED BY EACH SEPARATE ENTITY WITHIN GOOD SAMARITAN HOSPITAL BY DIVIDING THE TOTAL AMOUNT OF MANAGED CARE CONTRACTUAL ALLOWANCES, FOR THE MOST RECENT FISCAL YEAR, BY THE TOTAL GROSS CHARGES FOR THOSE MANAGED CARE PLANS TO DETERMINE A DISCOUNT RATE THAT SHALL BE USED FOR THE CURRENT FISCAL YEAR, AS FOLLOWS: DISCOUNT PERCENTAGE = TOTAL MANAGED CARE CONTRACTUAL ALLOWANCES / TOTAL MANAGED CARE GROSS CHARGES. FEDERAL, STATE, LOCAL AND COUNTY ENTITLEMENT PROGRAMS SHALL BE EXCLUDED FROM THE ABOVE CALCULATION (I.E., DISREGARD THE DISCOUNTS AND CHARGES FROM SUCH PLANS). ;(3) GOOD SAMARITAN HOSPITAL LTC - THE AVERAGE MANAGED CARE CONTRACTUAL ALLOWANCES RATE SHALL BE DEVELOPED ANNUALLY BY GOOD SAMARITAN HOSPITAL AND APPLIED TO ALL UNINSURED PATIENTS DEEMED ELIGIBLE FOR THIS DISCOUNT. THE DISCOUNT SHALL BE CALCULATED BY EACH SEPARATE ENTITY WITHIN GOOD SAMARITAN HOSPITAL BY DIVIDING THE TOTAL AMOUNT OF MANAGED CARE CONTRACTUAL ALLOWANCES, FOR THE MOST RECENT FISCAL YEAR, BY THE TOTAL GROSS CHARGES FOR THOSE MANAGED CARE PLANS TO DETERMINE A DISCOUNT RATE THAT SHALL BE USED FOR THE CURRENT FISCAL YEAR, AS FOLLOWS: DISCOUNT PERCENTAGE = TOTAL MANAGED CARE CONTRACTUAL ALLOWANCES / TOTAL MANAGED CARE GROSS CHARGES. FEDERAL, STATE, LOCAL AND COUNTY ENTITLEMENT PROGRAMS SHALL BE EXCLUDED FROM THE ABOVE CALCULATION (I.E., DISREGARD THE DISCOUNTS AND CHARGES FROM SUCH PLANS). ;
LINES 2, 4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE THE MISSION OF GOOD SAMARITAN HOSPITAL 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. HONORING OUR CATHOLIC HERITAGE, GOOD SAMARITAN HOSPITAL IS RECOGNIZED FOR EXCELLENCE IN REGIONAL HEALTHCARE THROUGH VALUES-BASED LEADERSHIP. THE PRIMARY TAX-EXEMPT PURPOSE IS TO SUPPORT THE COMMUNITY BY PROMOTING AND PROVIDING HEALTH CARE SERVICES IN ACCORDANCE WITH THE NEEDS OF A COMMUNITY IN THE ABSENCE OF PRIVATE BENEFIT. GOOD SAMARITAN HOSPITAL SERVES BOTH THE UNDERINSURED AND UNINSURED IN KEARNEY, NE AND THE SURROUNDING COMMUNITIES. GOOD SAMARITAN HOSPITAL OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THAT EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. GOOD SAMARITAN HOSPITAL 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 GOOD SAMARITAN HOSPITAL'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. GOOD SAMARITAN HOSPITAL IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. GOOD SAMARITAN HOSPITAL IS ALSO COMMITTED TO THE PROMOTION OF HEALTHIER COMMUNITIES. GOOD SAMARITAN HOSPITAL IS PROUD OF ITS CATHOLIC HERITAGE AND ITS ABILITY TO PROVIDE DIRECT AND INDIRECT SUPPORT TO THE COMMUNITIES IT SERVES. COMMUNITY BENEFIT APPROACH LOCATED IN KEARNEY, NEBRASKA, IN BUFFALO COUNTY, GOOD SAMARITAN HOSPITAL SERVES INDIVIDUALS ACROSS CENTRAL NEBRASKA AND BEYOND. OUR APPROACH IS TO COLLABORATIVELY ASSESS THE HEALTH NEEDS OF THE COMMUNITY AND IMPLEMENT A COMMUNITY BENEFIT PLAN THAT ADDRESSES THOSE NEEDS. UNDERSTANDING THE COMMUNITY. RURAL STATUS. THE POPULATION OF BUFFALO COUNTY ACCORDING TO THE 2010 CENSUS IS 46,102, CLASSIFYING BUFFALO COUNTY AS RURAL. ECONOMY - MAJOR INDUSTRIES/EMPLOYERS; MANUFACTURING, WHOLESALE TRADE, RETAIL TRADE INFORMATION, REAL ESTATE/RENTAL & LEASING, PROFESSIONAL/SCIENTIFIC/TECH. SERVICES , ADMINISTRATIVE/SUPPORT & WASTE MANAGEMENT, EDUCATION SERVICES, HEALTH CARE & SOCIAL ASSISTANCE, ARTS/ENTERTAINMENT/RECREATION, ACCOMMODATION & FOOD SERVICES, OTHER SERVICES (NON-GOVERNMENTAL) MAJOR NON-MANUFACTURING EMPLOYERS INCLUDE: GOOD SAMARITAN HOSPITAL 1,000+, UNIVERSITY OF NE AT KEARNEY 1000+, KEARNEY PUBLIC SCHOOLS 750-1000, THE BUCKLE 500-750, WAL-MART STORES, INC. 500-750, CABELA'S 250-500, CASH-WA 250-500, CITY OF KEARNEY 250-500. MAJOR MANUFACTURING EMPLOYERS INCLUDE: BALDWIN FILTERS OIL, AIR, FUEL FILTERS 750-1000, EATON CORPORATION AUTO VALVES & FORGED GEARS 250-500, WEST PHARM. SERVICES PHARM. STOPPERS & CLOSURES 250-500. APPENDIX 1. INCOME LEVELS; MEDIAN HOUSEHOLD INCOME IS $46,762; PER CAPITA INCOME $22,787 DEMOGRAPHICS; PERSONS UNDER 5 YEARS, PERCENT, 2011 7.1% PERSONS UNDER 18 YEARS, PERCENT, 2011 23.6% PERSONS 65 YEARS AND OVER, PERCENT, 2011 12.1% FEMALE PERSONS, PERCENT, 2011 50.4% WHITE PERSONS, PERCENT, 2011 (A) 96.1% BLACK PERSONS, PERCENT, 2011 (A) 1.0% AMERICAN INDIAN AND ALASKA NATIVE PERSONS, PERCENT, 2011 (A) 0.4% ASIAN PERSONS, PERCENT, 2011 (A) 1.3% NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER PERSONS, PERCENT, 2011 (A) .1% PERSONS REPORTING TWO OR MORE RACES, PERCENT, 2011 1.2% PERSONS OF HISPANIC OR LATINO ORIGIN, PERCENT, 2011 (B) 7.6% WHITE PERSONS NOT HISPANIC, PERCENT, 2011 89.1% LIVING IN SAME HOUSE 1 YEAR & OVER, 2006-2010 79.3% FOREIGN BORN PERSONS, PERCENT, 2006-2010 3.7% LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME, PCT AGE 5+, 2006-2010 6.5% HIGH SCHOOL GRADUATES, PERCENT OF PERSONS AGE 25+, 2006-2010 92.1% BACHELOR'S DEGREE OR HIGHER, PCT OF PERSONS AGE 25+, 2006-2010 32.0% VETERANS, 2006-2010 3,102 MEAN TRAVEL TIME TO WORK (MINUTES), WORKERS AGE 16+, 2006-2010 14.7 GOOD SAMARITAN HOSPITAL (GSH) HAS ALWAYS BEEN INTIMATELY INVOLVED IN COMMUNITY HEALTH COLLABORATION. IN THE EARLY 1990S GOOD SAMARITAN HOSPITAL PROVIDED A GRANT TO HELP ESTABLISH WHAT IS TODAY BUFFALO COUNTY COMMUNITY PARTNERS, WHOSE MISSION IS TO ASSESS, STRENGTHEN AND PROMOTE THE HEALTH OF BUFFALO COUNTY. GSH HOLDS A PERMANENT SEAT ON THE BOARD OF BUFFALO COUNTY COMMUNITY PARTNERS, PROVIDING SIGNIFICANT FINANCIAL AND IN-KIND SUPPORT, AS WELL AS HOSPITAL STAFF PARTICIPATION ON THE BOARD AND VARIOUS COALITIONS AND COMMITTEES. ASSESSMENT PROCESS. ASSESSMENTS ARE AN ESSENTIAL PART OF THE MODEL CREATED BY BUFFALO COUNTY COMMUNITY PARTNERS. BCCP FUNDING REQUIRES THAT PROGRAMS BE EVIDENCE-BASED, MEANING THEY ARE DEPENDENT ON MEASURABLE RESULTS AND OUTCOMES TO DETERMINE THEIR EFFECTIVENESS AND ARE PROVEN EFFECTIVE IN COMMUNITIES SIMILAR TO BUFFALO COUNTY. THE ASSESSMENT PROCESS IS A FLUID PROCESS THAT IS COORDINATED BY THE BOARD'S PLANNING AND MEASUREMENT COMMITTEE. THE COMMITTEE HAS OUTLINED STEPS BELOW THAT ARE FOLLOWED TO ENSURE A CONSISTENT AND LIVING ASSESSMENT PROCESS. STEP 1: IN 2008-2010, THE COMMUNITY PARTNERS CONDUCTED A COUNTYWIDE ASSESSMENT TO DETERMINE WHICH PRIORITY HEALTH GOALS SHOULD BE ATTAINED BY 2020. ASSESSMENT TOOLS USED FOR THE COUNTY WIDE ASSESSMENT INCLUDE; BEHAVIORAL RISK FACTOR SURVEYS FOR ADULTS, MINORITY AND YOUTH IN BUFFALO COUNTY. TO SECURE THE QUALITATIVE DATA THE PARTNERS CONDUCTED A FOCUS GROUP PROCESS CALLED MINI-TOWN HALL MEETINGS IN EACH BUFFALO COUNTY COMMUNITY NETWORKING WITH 300 RESIDENTS INCLUDING YOUTH AND MINORITIES. DURING THIS SAME PROCESS, THE PLANNING AND MEASUREMENT COMMITTEE OVERLAYED DATA TO DETERMINE IF BUFFALO COUNTY 2010 GOALS WERE ATTAINED. SEE APPENDIX 4 FOR A REPORT ON THE 2010 GOALS. STEP 2: THE MATRIX FOUND ON PAGE EIGHT OF THE TOWN HALL MEETING REPORT LIST THE HEALTH ISSUES PRIORITIZED BY BUFFALO COUNTY COMMUNITIES. THE QUALITATIVE DATA WAS PRIORITIZED BY MEMBERS OF EACH COMMUNITY TO BEGIN DEVELOPING THE BUFFALO COUNTY 2020 VISION. STEP 3 - BUFFALO COUNTY COMMUNITY PARTNERS PLANNING AND MEASUREMENT COMMITTEE ALIGNED THE QUALITATIVE PRIORITIES WITH QUANTITATIVE DATA TO DEFINE A LIST OF COUNTY WIDE PRIORITIES. THE COMMITTEE UTILIZED HEALTHY PEOPLE 2020 TO SET MEASURABLE TARGETS FOR EACH PRIORITY. THE LIST OF PRIORITIES WAS DEVELOPED AND PRESENTED TO THE BOARD. THE BOARD DEFINED GOALS BY ALIGNING TO THE 'DETERMINANTS OF HEALTH' AND RESOURCES ON HEALTHY PEOPLE 2020 WEBSITE. STEP 4 - THE BOARD VOTED ON THE TOP TEN ISSUES TO BE ADDRESSED IN BUFFALO COUNTY. PLANNING AND MEASUREMENT COMMITTEE PROCESSED THE ISSUES INTO A DASHBOARD OF WELL-BEING INDICATORS WITH MEASURABLE OUTCOMES. AT THIS TIME, THE BOARD DETERMINED TO ADDRESS THE WELL-BEING INDICATORS IN FIVE STRATEGIC DIRECTIONS TO BE ADOPTED BY THE COMMUNITY FOR ATTAINMENT BY 2020. STEP 5 - THE STRATEGIC DIRECTIONS WERE RELEASED TO THE COMMUNITY THROUGH THE 2010 ANNUAL REPORT TO THE COMMUNITY. THIS REPORT IS UPDATED ANNUALLY. A NEW BUFFALO COUNTY HEALTHY COMMUNITY ADVISORY BOARD WAS LAUNCHED IN JULY 2012 TO ADOPT THE FIVE STRATEGIC DIRECTIONS AND MODEL PROGRAMS IN THE COMMUNITY. THE ADVISORY BOARD WILL MEET ANNUALLY TO DISCUSS BUSINESS APPROACH TO MOVING THE FIVE STRATEGIC DIRECTIONS FOR BUFFALO COUNTY. CONT'D.
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	STEP 6 - THE COLLABORATION COUNCIL WILL BE LAUNCHED FOR MEMBERS OF THE COMMUNITY TO MEET QUARTERLY TO DISCUSS ACTION PLAN PROCESSES AND OBJECTIVES MOVING THE 5 STRATEGIC DIRECTIONS TOWARD 2020 TO MEET WELL-BEING INDICATOR TARGETS. ONGOING PROCESSES THAT WEAVE THROUGH ALL FIVE STEPS LISTED ABOVE INCLUDE PLANNING AND MEASUREMENT'S MONTHLY MEETING TO MARK COMMUNITY WIDE SURVEYING AND FOCUS GROUP PROCESSES, REPORTS TO THE COMMUNITY AND MARKING PROGRESS.
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	ANNUAL COMMUNITY BENEFIT REPORT JULY 1, 2011 - JUNE 30, 2012 GOOD SAMARITAN HOSPITAL RICHARD YOUNG BEHAVIORAL HEALTH CENTER KEARNEY, NE SECTION 1 - INTRODUCTION THE FIRST COMPONENT OF THE COMMUNITY BENEFIT REPORT IS TO MEASURE EXPENSES ASSOCIATED WITH SERVICES PROVIDED TO THE POOR AND BROADER COMMUNITY THAT ARE FREE, NON-BILLED OR UNPAID BY TRADITIONAL PUBLIC PROGRAMS SUCH AS MEDICARE AND MEDICAID. PROGRAMS FOR THE POOR AND BROADER COMMUNITY IN FISCAL YEAR 2012, GOOD SAMARITAN HOSPITAL ASSISTED THE POOR AND THE BROADER COMMUNITY THROUGH MULTIPLE PROGRAMS. THE POOR ARE DEFINED AS THOSE PERSONS WHO CANNOT AFFORD HEALTHCARE BECAUSE THEY HAVE INADEQUATE RESOURCES AND/OR ARE UNINSURED OR UNDERINSURED. THE BROADER COMMUNITY WAS SERVED THROUGH PROGRAMS FOR OTHER NEEDY POPULATIONS, WHICH ARE DEFINED AS POPULATIONS THAT MAY NOT ALWAYS QUALIFY AS "POOR" BUT WHO NEED SPECIAL SERVICES AND SUPPORT. THE BROADER COMMUNITY WAS ALSO SERVED THROUGH PROGRAMS FOR THE GENERAL POPULATION WHICH IS DEFINED AS POPULATIONS WHO BENEFIT FROM SUCH TRADITIONAL CATHOLIC FACILITY SERVICES AS HEALTH PROMOTION AND EDUCATION, HEALTH SCREENING, MEDICAL RESEARCH, TRAINING OF HEALTH PROFESSIONALS AND COMMITMENT TO A SINGLE LEVEL OF HEALTHCARE. PROGRAMS FOR THE POOR AND BROADER COMMUNITY INCLUDE: TOTAL QUANTIFIABLE COMMUNITY BENEFITS THE TOTAL QUANTIFIABLE COMMUNITY BENEFITS INCLUDING BENEFITS FOR THE POOR AND BROADER COMMUNITY BUT EXCLUDING THE UNPAID COSTS OF MEDICARE FOR GOOD SAMARITAN HOSPITAL FOR FISCAL YEAR 2012 REPRESENTS $21,064,181 IN UNSPONSORED BENEFIT EXPENSE WHICH IS 11.7 PERCENT OF GOOD SAMARITAN HOSPITAL'S TOTAL EXPENSES. TOTAL QUANTIFIABLE COMMUNITY BENEFITS INCLUDING THE UNPAID COSTS OF MEDICARE REPRESENTS $33,618,059 IN UNSPONSORED EXPENSE WHICH IS 18.7 PERCENT OF GOOD SAMARITAN HOSPITAL'S TOTAL EXPENSES. BEING A NON-PROFIT ORGANIZATION, GOOD SAMARITAN HOSPITAL CHANNELED $21,064,181 ($33,618,059) WITH UNPAID COSTS OF MEDICARE INCLUDED) OF ITS EXPENSE DOLLARS INTO PROGRAMS AND SERVICES THAT BENEFIT THE POOR AND BROADER COMMUNITY. SECTION 2 - UNCOMPENSATED CARE CHARITY CARE AS DESCRIBED IN THE CATHOLIC HEALTH ASSOCIATION'S GUIDE FOR PLANNING AND REPORTING COMMUNITY BENEFIT RELEASED IN 2006, CHARITY CARE IS FREE OR DISCOUNTED HEALTH AND HEALTH-RELATED SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD TO PAY AND WHO MEET THE ORGANIZATION'S CRITERIA FOR FINANCIAL ASSISTANCE. GENERALLY, A BILL MUST BE GENERATED AND RECORDED AND THE PATIENT MUST MEET THE ORGANIZATION'S CRITERIA FOR CHARITY CARE AND DEMONSTRATE AN INABILITY TO PAY. CHARITY CARE IS REPORTED IN TERMS OF COSTS, NOT CHARGES. CHARITY CARE DOES NOT INCLUDE BAD DEBT. AS DESCRIBED IN THE TABLE ON THE PREVIOUS PAGE, GOOD SAMARITAN HOSPITAL PROVIDES A SIGNIFICANT LEVEL OF FREE CARE EACH YEAR. IN FISCAL YEAR 2012, THE COST OF CHARITY CARE PROVIDED WAS $6.7 MILLION. GOVERNMENT-SPONSORED HEALTH CARE GOVERNMENT-SPONSORED HEALTH CARE COMMUNITY BENEFIT INCLUDES UNPAID COSTS OF PUBLIC PROGRAMS, THE "SHORTFALL" CREATED WHEN A FACILITY RECEIVES PAYMENTS THAT ARE LESS THAN COSTS FOR CARING FOR PUBLIC PROGRAM BENEFICIARIES. THIS "PAYMENT SHORTFALL" IS NOT THE SAME AS A CONTRACTUAL ALLOWANCE, WHICH IS THE FULL DIFFERENCE BETWEEN CHARGES AND GOVERNMENT PAYMENTS. IT DOES NOT INCLUDE ANY SHORTFALL THAT RESULTS FROM INEFFICIENCY OR POOR MANAGEMENT. GOOD SAMARITAN HOSPITAL INCURRED $9.6 MILLION IN UNREIMBURSED COSTS FOR SERVICES PROVIDED TO MEDICAID PATIENTS AND $12.5 MILLION IN UNREIMBURSED COSTS FOR SERVICES PROVIDED TO MEDICARE PATIENTS. MEDICAID PATIENTS REPRESENTED APPROXIMATELY 16.1 PERCENT OF THE PATIENTS SERVED BY GOOD SAMARITAN HOSPITAL IN FISCAL YEAR 2012 AND MEDICARE PATIENTS REPRESENTED APPROXIMATELY 44.5 PERCENT OF THE PATIENTS SERVED. FREQUENTLY, THE COST OF PROVIDING SERVICES TO MEDICARE AND MEDICAID PATIENTS IS GREATER THAN THE PAYMENT GOOD SAMARITAN HOSPITAL RECEIVES FROM THE GOVERNMENT. SECTION 3 - COMMUNITY OUTREACH FOR THE POOR IN FISCAL YEAR 2012, GOOD SAMARITAN HOSPITAL PARTNERED WITH OTHER COMMUNITY ORGANIZATIONS TO ENHANCE THE QUALITY OF LIFE OF THE POOR IN OUR COMMUNITY. SUCH PARTNERSHIPS AND SERVICES ARE DESCRIBED IN THIS SECTION. COMMUNITY HEALTH ACCESS TEAM (CHAT) THE COMMUNITY HEALTH ACCESS TEAM IS A TEAM OF INDIVIDUALS REPRESENTING 14 DIFFERENT ORGANIZATIONS AND AGENCIES WHOSE MISSION IS: EVERYONE WITH A POINT OF ENTRY TO SERVICE IN BUFFALO COUNTY WILL HAVE ACCESS TO, REGULARLY USE, AND BE SATISFIED WITH COMPREHENSIVE, COST EFFECTIVE, HIGH QUALITY, PRIMARY HEALTH SERVICES THAT SUPPORT OPTIMAL QUALITY OF LIFE. CHAT'S GOAL IS TO REACH 100 PERCENT ACCESS TO PRIMARY HEALTHCARE SERVICES FOR ALL WITH ZERO RACIAL AND ETHNIC DISPARITY. DIFFERENCES BETWEEN PEOPLE, SUCH AS CULTURE, CLASS, EDUCATIONAL ATTAINMENT, EMPLOYMENT STATUS AND ABILITY TO PAY, WILL NO LONGER BE ASSOCIATED WITH DIFFERENTIAL HEALTH OUTCOMES. CHAT'S PRIMARY TARGET GROUP IS THE UNINSURED AND UNDERINSURED AND THEIR DESIRED OUTCOME IS TO CREATE A NEW MODEL TO REACH 100 PERCENT HEALTH ACCESS AND ZERO HEALTH DISPARITIES. IN ADDITION TO GOOD SAMARITAN HOSPITAL, CHAT HAS REPRESENTATIVES FROM THESE LOCAL PARTNERS: COMMUNITY ACTION PARTNERSHIP OF MID-NEBRASKA, NEBRASKA HEALTH AND HUMAN SERVICES OFFICE OF MINORITY HEALTH, REGION 3 BEHAVIORAL HEALTH SERVICES, EDUCATIONAL SERVICE UNIT #10, UNITED WAY OF KEARNEY AREA, UNIVERSITY OF NEBRASKA AT KEARNEY COUNSELING & STUDENT HEALTH, UNIVERSITY OF NEBRASKA MEDICAL CENTER-COLLEGE OF NURSING-KEARNEY DIVISION, TWO RIVERS PUBLIC HEALTH DEPARTMENT, GIBBON PUBLIC SCHOOLS, KEARNEY PUBLIC SCHOOLS, NEBRASKA AIDS PROJECT, CENTRAL HEALTH SERVICES, GOODWILL INDUSTRIES, BUFFALO COUNTY HEALTH MINISTRY NETWORK, GOOD SAMARITAN HOSPITAL FOUNDATION, KEARNEY HOUSING AGENCY, KEARNEY CLINIC, SENTINEL HEALTH CARE, WALGREENS PHARMACY, AREA HEALTH AND DENTAL PROVIDERS AND A DIVERSE GROUP OF RESIDENTS OF BUFFALO COUNTY. CHAT IS A COALITION OF THE BUFFALO COUNTY COMMUNITY PARTNERS WORKING TO 'ELIMINATE HEALTH DISPARITIES' AS ONE OF THE FIVE STRATEGIC ELEMENTS OF THE BUFFALO COUNTY 2020 VISION. AS A PART OF THE 2020 VISION, CHAT WILL ELEVATE HEALTH ISSUES IN BUFFALO COUNTY, ENGAGE RESIDENTS IN ACCOUNTABILITY TO HEALTH, EMPOWER RESIDENTS TO CREATE CHANGE, AND EVALUATE PROGRESS TOWARD BUILDING A HEALTHIER BUFFALO COUNTY. DURING FISCAL YEAR 2008, CATHOLIC HEALTH INITIATIVES AWARDED A GRANT TO BUFFALO COUNTY COMMUNITY PARTNERS AND PRESENTED TO CHAT TO ADDRESS 'ACCESS ISSUES'. SINCE THAT TIME, CHAT CONDUCTED SURVEYS OF PROVIDERS, CONDUCTED MINORITY BEHAVIORAL RISK FACTOR SURVEY OF 300 RESIDENTS, AND CONDUCTED MINORITY FOCUS GROUPS IN BUFFALO COUNTY. THE QUALITATIVE AND QUANTITATIVE DATA COLLECTED IN THE PLANNING PHASE WAS USED TO DEVELOP A "COMMUNITY BASED PATHWAY" FOR HISPANIC RESIDENTS WITH DIABETES. IN FY2009, DIABETES WAS DEFINED AS NUMBER ONE ISSUE FACING THE HISPANIC COMMUNITY. CHAT HAS PLANS TO ADD ADDITIONAL PATHWAYS IN DEFINING A MEDICAL HOME, PROVIDING INTERPRETER SERVICES, REDUCING OBESITY AND A VARIETY OF OTHER SOCIAL FACTORS THAT IMPACT HEALTH. IN FISCAL YEAR 2010 AND 2011, CHAT DEVELOPED THE 'WHEELS' THAT WILL MOTORIZE THE PATHWAY INTO OPERATIONS AND SECURED ADDITIONAL FUNDING NEEDED FOR THE PROJECT. THIS WILL BE THE FIRST COMMUNITY BASED PATHWAY DEVELOPED IN THE STATE OF NEBRASKA. CHAT HOPES TO BE A NATIONAL LEADER IN CREATING NEW AND INNOVATIVE WAYS TO ADDRESS ACCESS AND DISPARITY ISSUES IN BUFFALO COUNTY AND BEYOND. FY2010, GOOD SAMARITAN HOSPITAL FOUNDATION APPLIED FOR A THREE YEAR CATHOLIC HEALTH INITIATIVES MISSION AND MINISTRY GRANT TO FUND THE COMMUNITY PATHWAY. FUNDING WAS SECURED FOR FY2011. FROM JULY 2011 TO JUNE 2012, 53 CLIENTS WERE ENROLLED INTO FIVE SEPARATE PATHWAYS. IN YEAR TWO AND THREE OF THE GRANT CHAT EXPECTS TO ADD 200 MORE CLIENTS. HEALTH EDUCATION GOOD SAMARITAN HOSPITAL PROVIDES FUNDING FOR THE PURCHASED KRAMES PATIENT EDUCATION SYSTEM FOR ITS NETWORK OF HEALTH CARE PROVIDERS. THE KRAMES PATIENT EDUCATION SYSTEM IS A WEB-BASED SYSTEM THAT PROVIDES INSTANT ACCESS TO THOUSANDS OF ILLUSTRATED PATIENT EDUCATION TOPICS THAT COVERS CONDITIONS, PROCEDURES, MEDICATIONS AND WELLNESS PROMOTION. HEALTH CARE PROVIDERS HAVE UTILIZED OVER 22,981 HEALTH SHEETS, AND 30,397 DRUG SHEETS FOR FY 2012. PROVIDED APPROXIMATELY 250 PERSONAL HEALTH MANAGERS TO PATIENTS DURING FY 2012 AND SUPPORTS THE DISTRIBUTION OF THE FILE FOR LIFE AND POLST FORMS THROUGHOUT THE COMMUNITY CONT'D
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	HOME MONITORING FOR HEART FAILURE GOOD SAMARITAN HOSPITAL PROVIDES PATIENTS WITH EQUIPMENT TO MONITOR THEIR BLOOD PRESSURE, OXYGENATION LEVEL AND WEIGHT. PATIENTS ARE MONITORED BY AN RN CLINICAL COORDINATOR AND ANY VARIANCES FROM ACCEPTABLE LEVELS ARE ASSESSED BY THE NURSE AND THEN COMMUNICATED WITH THE PATIENT'S HEALTH CARE PROVIDER IN ORDER TO REDUCE EXACERBATIONS OF THEIR CONDITION. SENTINEL HEALTH CARE PROVIDED MONITORING SERVICES TO PATIENTS OVER A WIDE GEOGRAPHIC AREA FROM NORCATOR, KS TO STAPLETON AND FROM AURORA TO BRADY. PATIENTS ALSO RECEIVE EDUCATIONAL INFORMATION ABOUT THEIR HEART FAILURE CONDITION IN THE FORM OF A HEART FAILURE CALENDAR AND GO-TO-GUIDE CREATED BY KRAMES PATIENT EDUCATION SYSTEMS. MEDICATION ACCESS PROGRAM THE MEDICATION ACCESS PROGRAM ASSISTS PATIENTS IN OBTAINING LOW-COST OR NO-COST MEDICATIONS FROM PHARMACEUTICAL COMPANIES. FOR THE 2012 FISCAL YEAR, THE PROGRAM SAVED PARTICIPATING PATIENTS OVER $3.6 MILLION IN PRESCRIPTION DRUG COSTS BY PROVIDING AID IN OBTAINING MORE THAN 4,300 PRESCRIPTIONS. THE PROGRAM PROVIDED ASSISTANCE TO APPROXIMATELY 763 PATIENTS THROUGHOUT THE YEAR. THE AVERAGE PRESCRIPTION DRUG COSTS SAVINGS PER PATIENT WAS $4,700. PROJECT SNOWFLAKE AS A MISSION OUTREACH INITIATIVE, GOOD SAMARITAN HOSPITAL COORDINATES A SPECIAL CHRISTMAS GIVING ACTIVITY EACH YEAR. IN FISCAL YEAR 2012 EMPLOYEES DONATED ROUGHLY $9,700 IN CASH, TOYS AND NON-PERISHABLE HOME ITEMS THROUGH THE ANNUAL PROJECT SNOWFLAKE DRIVE. THIS TOTAL EXCEEDS LAST YEAR'S DONATIONS BY ALMOST $2,400! THE MAINTENANCE OPEN HOUSE BROUGHT IN ANOTHER 140 POUNDS OF FOOD THAT WERE DONATED TO THE JUBILEE CENTER. LOCAL AGENCIES LIKE THE FAMILY ADVOCACY NETWORK, JUBILEE CENTER, SAFE CENTER, SALVATION ARMY, GOODFELLOWS AND EVEN OUR OWN EMPLOYEES TRULY BENEFITED FROM THIS OUTPOURING OF CARE AND SUPPORT. SECTION 4 - COMMUNITY OUTREACH FOR THE BROADER COMMUNITY IN FISCAL YEAR 2012, GOOD SAMARITAN HOSPITAL SERVED THE BROADER COMMUNITY THROUGH LEADERSHIP, ADVOCACY, COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH, DONATED FUNDS AND OTHER RESOURCES, SUPPORT OF FUNDRAISERS, CASH SPONSORSHIPS, VOLUNTEER WORK, EDUCATION OF MEDICAL PROFESSIONALS, RESEARCH, CAPITAL IMPROVEMENTS, AND COMMUNITY BUILDING ACTIVITIES. THESE EFFORTS ARE DESCRIBED IN THIS SECTION. A. LEADERSHIP IN THE COMMUNITY GOOD SAMARITAN HOSPITAL IS RECOGNIZED AS A PROGRESSIVE COMMUNITY AND REGIONAL PROVIDER OF HEALTHCARE SERVICES. THE HOSPITAL'S BOARDS OF DIRECTORS (HOSPITAL AND FOUNDATION) AND STAFF VOLUNTEER THEIR TIME AND RESOURCES TO MORE THAN 200 REGIONAL AND LOCAL BOARDS, ADVISORY COUNCILS, COMMUNITY ORGANIZATIONS AND COALITIONS. B. ADVOCACY IN AN EFFORT TO SERVE THE NEEDS OF THE POOR AND BROADER COMMUNITY, MANY STAFF AND BOARD MEMBERS OF GOOD SAMARITAN HOSPITAL PARTICIPATE IN ADVOCACY ACTIVITIES. C. COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH GOOD SAMARITAN HOSPITAL ENGAGES IN NUMEROUS COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH. THESE COLLABORATIVE PROJECTS ARE OUTLINED IN THIS SECTION. AMERICAN RED CROSS BLOOD COLLECTION CENTER THROUGH A JOINT EFFORT BETWEEN GOOD SAMARITAN HOSPITAL, THE FT. KEARNEY CHAPTER OF THE AMERICAN RED CROSS AND THE AMERICAN RED CROSS MIDWEST BLOOD REGION, A NEW BLOOD COLLECTION CENTER OPENED IN KEARNEY IN 1999. GOOD SAMARITAN IS THE LARGEST SINGLE USER OF BLOOD PRODUCTS IN THE REGION. THE MIDWEST REGION ALSO HAS THE HIGHEST PER CAPITA BLOOD AND PLATELET DONATIONS IN THE NATION. WITH THESE TWO DRIVING FACTORS, THE ABILITY TO GIVE BLOOD IN THE KEARNEY AREA IS NOW A DAILY CONVENIENCE. THIS COLLABORATION ALLOWS THE RED CROSS TO OPERATE MORE EFFICIENTLY. GOOD SAMARITAN HOSPITAL ALSO SPONSORS BLOOD DRIVES AT GOOD SAMARITAN HOSPITAL CONFERENCE CENTER. DURING FISCAL YEAR 2012, 109 PRODUCTIVE UNITS WERE DONATED. BREAST CANCER EDUCATION FISCAL YEAR 2012 - BREAST CANCER EDUCATION WAS CONDUCTED USING GROUP PRESENTATIONS AND/OR 1:1 EDUCATION WITH A LIGHTED BREAST MODEL DURING THE FOLLOWING OUTREACH EVENTS: * NEBRASKA STATE FAIR, GRAND ISLAND * JUST FOR US WOMEN'S HEALTH EVENT, KEARNEY * HUSKER HARVEST DAYS, GRAND ISLAND * PRIME SENIOR FESTIVAL, KEARNEY * LIONS CLUB AND COMMUNITY PRESENTATIONS, CAMBRIDGE * TOWN AND COUNTRY FARM AND HOME SHOW, BROKEN BOW * WOMENS' DAY OUT, LITCHFIELD * WOMENS' DAY OF ENRICHMENT, CAMBRIDGE * HOWARD COUNTY HEALTH FAIR, ST. PAUL THE SALON PROJECT TOOK PLACE IN CUSTER COUNTY DURING A TWO WEEK TIME PERIOD IN FEBRUARY 2012. THE GOAL WAS TO INCREASE AWARENESS OF, AND LIKELIHOOD OF FOLLOWING, MAMMOGRAPHY RECOMMENDATIONS AFTER AGE 40. THE PROGRAM APPROACHED RURAL WOMEN WHERE THEY ALREADY GATHERED (IN SALONS), CAPITALIZED ON PRE-EXISTING RELATIONSHIPS (BETWEEN COSMETOLOGISTS AND CUSTOMERS), AND UTILIZED LAY EDUCATORS (COSMETOLOGISTS) TO DELIVER A SCRIPTED VERBAL MESSAGE AND CREDIBLE PRINT INFORMATION ABOUT MAMMOGRAMS, BREAST HEALTH, BREAST CANCER, AND AVAILABLE RESOURCES. A LIGHT-HEARTED THEME AND AN EYE-CATCHING HANDOUT DESIGN CAPTURED CUSTOMERS' ATTENTION TO DELIVER A SERIOUS MESSAGE. 850 HANDOUTS WERE DISTRIBUTED TO SALON CUSTOMERS. 410 CUSTOMERS RETURNED SURVEYS (48%RETURN RATE). 76% INDICATED INCREASED AWARENESS ABOUT YEARLY MAMMOGRAMS AFTER AGE 40. 68% INDICATED THEY WERE "VERY LIKELY TO FOLLOW MAMMOGRAM RECOMMENDATIONS THROUGHOUT LIFETIME." THE SIXTH ANNUAL SIMPLY PINK BREAST CANCER AWARENESS STYLE SHOW WAS HELD ON OCTOBER 5, 2011 AT THE MERRYMAN PERFORMING ARTS THEATER. THIS FUN AND UPLIFTING EVENT IS DESIGNED TO RAISE AWARENESS AND TO HONOR BREAST CANCER SURVIVORS. THE HIGHLIGHT OF THE SHOW WAS A GUEST APPEARANCE OF TERESA SCANLON, MISS AMERICA 2011. APPROXIMATELY 450 PEOPLE ATTENDED THE SHOW, WHICH FEATURED 30 SURVIVOR MODELS, AND 63 FAMILY MEMBERS AND ONE DOG. AS THE GUESTS ENTERED THE THEATER THEY WERE GREETED BY CANCER CENTER STAFF AND BEAUTIFUL PIANO MUSIC PROVIDED BY A CANCER SURVIVOR MODEL. THE MODELS WERE ESCORTED BY PLAYERS OF THE TRI-CITY STORM HOCKEY TEAM. A WIDE VARIETY OF CLOTHING WAS LOANED BY OVER TWENTY LOCAL AND REGIONAL MERCHANTS. MODELS WERE OFFERED THE OPPORTUNITY TO HAVE THEIR MAKE UP APPLIED THROUGH THE COURTESY OF LOCAL MARY KAY REPRESENTATIVES. ELEGANT BITE SIZED DESSERTS DONATED BY LOCAL RESTAURANTS, WERE SERVED AT THE RECEPTION FOLLOWING THE SHOW. THE HOLIDAY INN GIFTS SHOP DONATED OVER 16 BEAUTIFUL PURSES AND WERE RAFFLED AT THE END OF THE SHOW. AS THE GUESTS EXITED THE RECEPTION, EACH GUEST WAS PRESENTED WITH A LONG STEMMED PINK ROSE AND AN INFORMATIONAL CARD PROMOTING BREAST HEALTH. THE EVENT WAS PROMOTED PRIOR TO THE SHOW IN THE LIFETIME SESSION OF THE KEARNEY HUB AND ON NTV'S THE GOOD LIFE AND IN GOOD SAMARITAN HOSPITAL'S HEALTH TALK. THE SHOW WAS FUNDED BY GOOD SAMARITAN HOSPITAL ALONG WITH PROCEEDS FROM A BAKE SALE HOSTED BY THE BREAST CANCER SUPPORT GROUP, AND TWO $500 DONATIONS FROM TWO LOCAL BUSINESSES. THE SHOW IS FREE TO THE PUBLIC, HOWEVER; FREE WILL DONATIONS ARE ACCEPTED. OVER $1,000 WAS DONATED WITH FUNDS GOING TO THE ROBE FUND FOR BREAST AND LUNG CANCER PATIENTS RECEIVING TREATMENT AT THE CANCER CENTER. GOOD SAMARITAN CANCER CENTER - SUPPORT AND EDUCATIONAL PROGRAMS FOR CANCER SURVIVORS: A TIME TO HEAL A TIME TO HEAL IS A 12-WEEK HOLISTIC REHABILITATION PROGRAM DESIGNED TO HELP CANCER PATIENTS REGAIN THEIR PHYSICAL, EMOTIONAL, AND SPIRITUAL HEALTH AFTER CANCER TREATMENT. INITIALLY, A TIME TO HEAL WAS DESIGNED FOR BREAST CANCER PATIENTS; HOWEVER, WE NOW OFFER TWO PROGRAMS, ONE FOR BREAST CANCER PATIENTS AND ANOTHER FOR ALL CANCER PATIENTS. THE EVENING SESSIONS ARE CONDUCTED OVER A 12-WEEK PERIOD, WITH EACH WEEKLY SESSION LASING APPROXIMATELY 3 HOURS. THIS RESEARCH-BASED PROGRAM IS FREE TO POST-TREATMENT CANCER PATIENTS. GOALS INCLUDE: * TO IMPROVE QUALITY OF LIFE, POST TREATMENT * TO INCREASE KNOWLEDGE ABOUT HEALTH-ENHANCING ACTIVITIES * TO ENCOURAGE SELF ADVOCACY BY MAKING PATIENTS AWARE OF SURVIVORSHIP ISSUES * TO MAKE SURVIVORSHIP RESOURCES READILY AVAILABLE * TO INCREASE THE HOPE AND LIFE SATISFACTION OF THE PARTICIPANTS IN A TIME TO HEAL AMERICAN CANCER SOCIETY FOR INFORMATION ON PATIENT SERVICES AVAILABLE CONTACT THE LOCAL AMERICAN CANCER SOCIETY AT 237-1631. SERVICES THROUGH THE AMERICAN CANCER SOCIETY INCLUDE BUT ARE NOT LIMITED TO ROAD TO RECOVERY, SUPPORT AND EDUCATIONAL RESOURCES, LODGING AND WIG BANK. BREAST CANCER SUPPORT GROUP THE BREAST CANCER SUPPORT GROUP WAS FORMED TO OFFER THERAPEUTIC SUPPORT TO WOMEN WHO HAVE BEEN DIAGNOSED WITH BREAST CANCER. THIS GROUP MEETS ON THE SECOND TUESDAY OF EACH MONTH AT 7:00 P.M. IN THE CANCER CENTER AT GOOD SAMARITAN HOSPITAL. CONT'D
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	CANCERCARE CONNECT IMPROVING THE CARE OF PEOPLE LIVING WITH CANCER CANCERCARE IS A NATIONAL NONPROFIT ORGANIZATION THAT PROVIDES FREE, PROFESSIONAL SUPPORT SERVICES TO ANYONE AFFECTED BY CANCER. THEY OFFER FREE TELEPHONE EDUCATION WORKSHOPS FOR SURVIVORS, FAMILY AND PROFESSIONALS TO LEARN ABOUT CANCER-RELATED ISSUES GIVEN BY LEADING EXPERTS IN ONCOLOGY. LISTEN FROM THE COMFORT OF YOUR OWN HOME OR OFFICE. CANCER SURVIVORS DAY CANCER SURVIVORS DAY IS AN ANNUAL EVENT HONORING CANCER SURVIVORS. A CANCER SURVIVOR IS DEFINED AS ANYONE LIVING WITH A HISTORY OF CANCER - FROM THE MOMENT OF DIAGNOSIS THROUGH THE REMAINDER OF LIFE. INFORMATION ON WHEN THIS EVENT WILL BE HELD AND WHERE THE EVENT WILL BE HELD IS DISTRIBUTED TO CANCER SURVIVORS ON THE CANCER CENTER MAILING LIST AND ADVERTISED IN THE KEARNEY HUB. LEUKEMIA AND LYMPHOMA SOCIETY TELEPHONE SUPPORT GROUP A STAFF MEMBER FROM GOOD SAMARITAN CANCER CENTER FACILITATES THE TELEPHONE SUPPORT GROUP. THIS GROUP PROVIDES AN OPPORTUNITY TO TALK WITH A SMALL GROUP OF PEOPLE WHO HAVE MULTIPLE MYELOMA, LEUKEMIA, OR LYMPHOMA. THIS IS A FREE SERVICE PROVIDED BY THE NEBRASKA AND IOWA CHAPTER OF THE LEUKEMIA & LYMPHOMA SOCIETY. LOOK GOOD FEEL BETTER THE COSMETIC, TOILETRY AND FRAGRANCE ASSOCIATION FOUNDATION, A CHARITABLE ORGANIZATION SUPPORTED BY THE COSMETIC INDUSTRY'S TRADE ASSOCIATION AND IN PARTNERSHIP WITH THE AMERICAN CANCER SOCIETY AND THE NATIONAL COSMETOLOGY ASSOCIATION, FOUNDED LOOK GOOD FEEL BETTER IN 1989. LOOK GOOD FEEL BETTER MEETS THE THIRD MONDAY OF EACH MONTH AT 10:00 A.M. IN THE CONFERENCE ROOM AT GOOD SAMARITAN CANCER CENTER. REACH TO RECOVERY THIS IS A REHABILITATION PROGRAM FOR WOMEN WITH BREAST CANCER. THIS PROGRAM PROVIDES FOR ONE-TO-ONE VISITS BY WOMEN WHO HAVE A HISTORY OF BREAST CANCER AND HAVE BEEN TRAINED THROUGH THE AMERICAN CANCER SOCIETY TO OFFER SUPPORT AND HELP WOMEN MEET THE PHYSICAL AND COSMETIC NEEDS RELATED TO THE DISEASE AND/OR ITS TREATMENT. STRONG AND SMART SERIES GOOD SAMARITAN HOSPITAL AND OTHER CATHOLIC HEALTH INITIATIVE CANCER PROGRAMS WORKED TOGETHER ON A PATIENT EDUCATION PROGRAM CALLED STRONG AND SMART. A WIDE RANGE OF TOPICS INCLUDING CANCER GENETICS, COMPLEMENTARY THERAPIES, CANCER TREATMENT, LONG TERM AND LATE EFFECTS OF CANCER TREATMENT AND MORE ARE AVAILABLE. UNITED OSTOMY GROUP THIS SUPPORT GROUP IS COMPOSED OF INDIVIDUALS WHO HAVE INTESTINAL OR URINARY STOMAS. THE GROUP MEETS THE FIRST SUNDAY OF EACH MONTH. PROGRAMS ARE DESIGNED FOR INFORMATIONAL, SOCIAL, AND PSYCHOSOCIAL SUPPORT. SURVIVORSHIP CHRISTMAS PARTY EACH YEAR THE CANCER CENTER KICKS OFF THE HOLIDAY SEASON BY HOSTING A CHRISTMAS PARTY. THIS EVENT CELEBRATES OUR CANCER SURVIVORS AND THEIR FAMILIES. CANCER SURVIVORS ARE INVITED TO SHARE THEIR BLESSINGS AND SHARE A MEAL WITH FELLOW SURVIVORS. CENTRAL NEBRASKA AREA HEALTH EDUCATION CENTER THE MISSION OF THE CENTRAL NEBRASKA AREA HEALTH EDUCATION CENTER (CN-AHEC) IS TO WORK TOWARD A SOLID FOUNDATION OF HEALTH CARE FOR ALL NEBRASKANS THROUGH SUPPORT OF EXISTING HEALTH PROFESSIONALS AND BY "GROWING OUR OWN" HEALTH PROFESSIONALS FOR FUTURE YEARS. IN ADDITION, CN-AHEC WILL SUPPORT HEALTH EDUCATION AND WELLNESS OUTREACH PROGRAMS FOR COMMUNITIES WITHIN OUR SERVICE AREA. AREA HEALTH EDUCATION CENTERS (AHEC) STRIVE TO ELIMINATE DISPARITIES IN HEALTH AND HEALTH CARE, ESPECIALLY IN UNDERSERVED COMMUNITIES. AHECS BEGAN IN 1973 AND ARE FUNDED THROUGH A COMBINATION OF STATE AND FEDERAL FUNDS. FORTY-ONE STATES CURRENTLY HAVE AHEC PROGRAMS. VIRTUALLY ALL AHEC EFFORTS ARE UNDERTAKEN WITH LOCAL PARTNERS. IN PARTICULAR, AHECS COMBINE THEIR EFFORTS WITH OTHER HEALTH PROFESSIONS PROGRAMS FUNDED THROUGH A VARIETY OF SOURCES. LOCALLY, THE CN-AHEC HELPED TO FUND A COLLABORATIVE PARTNERSHIP BETWEEN GOOD SAMARITAN HOSPITAL AND KEARNEY PUBLIC SCHOOLS (KPS). WITH KPS, GOOD SAMARITAN HAS ESTABLISHED AN ARTICULATED HEALTH SCIENCE AND TECHNOLOGY CAREER CLASS TO MOTIVATE AND PREPARE STUDENTS FOR PURSUIT OF A PROFESSIONAL HEALTH CARE CAREER. COLO-RECTAL HEALTH CHECK GOOD SAMARITAN HOSPITAL, IN CONJUNCTION WITH EIGHTEEN AREA HOSPITALS AND CLINICS, JOINED FORCES TO OFFER FREE COLO-RECTAL SCREENINGS TO COMMUNITY RESIDENTS. THE HOSPITALS OFFERED INDIVIDUALS CONVENIENT AT-HOME SCREENING KITS. APPROXIMATELY 1,800 KITS WERE DISTRIBUTED IN THE COLO-RECTAL SCREENING PROGRAM. WE HAD A 71% RETURN RATE WITH 4% OF THOSE PARTICIPANTS HAVING POSITIVE RESULTS REQUIRING FOLLOW-UP. CONFERENCE CENTER GOOD SAMARITAN HOSPITAL OFFERS A STATE OF THE ART CONFERENCE FACILITY TO THE REGION AT NO COST. IN FISCAL YEAR 2012, THE CONFERENCE CENTER WAS UTILIZED 97 PERCENT OF THE TIME BETWEEN 7 A.M. AND 10 P.M. DAILY. COMMUNITY PROGRAMS OFFERED IN THE CONFERENCE CENTER HAVE REACHED APPROXIMATELY 25,000 PARTICIPANTS THIS PAST YEAR. THE CONFERENCE CENTER ALSO SERVES AS A MEETING PLACE FOR MULTIPLE SUPPORT GROUPS. CRITICAL ACCESS HOSPITAL (CAH) NETWORK IN 1997, AS PART OF THE BALANCED BUDGET ACT (BBA), THE U.S. CONGRESS CREATED THE RURAL HOSPITAL FLEXIBILITY PROGRAM (FLEX PROGRAM). THE CRITICAL ACCESS HOSPITAL (CAH) PROGRAM IS ONE OF THE CENTRAL FEATURES OF THE FLEX PROGRAM. ITS INTENT IS TO ALLOW RURAL COMMUNITIES TO PRESERVE ACCESS TO PRIMARY CARE AND EMERGENCY SERVICES, PROVIDE HEALTH CARE SERVICES THAT MEET COMMUNITY NEEDS, AND HELP ENSURE FINANCIAL VIABILITY OF PROGRAM PARTICIPANTS THROUGH IMPROVED REIMBURSEMENT AND DIFFERENT OPERATING REQUIREMENTS. TODAY, THE NEBRASKA CAH PROGRAM CONTINUES TO BE ADMINISTERED BY THE NEBRASKA OFFICE OF PUBLIC HEALTH, IN VERY CLOSE COLLABORATION WITH THE NEBRASKA OFFICE OF RURAL HEALTH. NEBRASKA HAS BEEN EXTREMELY ACTIVE IN ESTABLISHING, IMPLEMENTING, AND GROWING THE NEBRASKA CAH PROGRAM SINCE ITS BEGINNING AND IS RECOGNIZED AROUND THE COUNTRY AS HAVING ONE OF THE MORE INNOVATIVE AND SUCCESSFUL CAH PROGRAMS. AS OF THE END OF FISCAL YEAR 2012, THE STATE HAD 65 CAH-CERTIFIED FACILITIES. THE GOOD SAMARITAN CAH NETWORK CONSISTS OF 14 HOSPITALS. THESE HOSPITAL LOCATIONS STRETCH FROM CENTRAL AND SOUTH CENTRAL NEBRASKA TO BOTH NORTHERN AND WESTERN NEBRASKA. EACH HOSPITAL PROVIDES LOCAL HEALTH SERVICES AND ACCESS TO ITS SERVICE AREA. THE VISION OF THE GOOD SAMARITAN CAH NETWORK IS TO UTILIZE A COLLABORATIVE APPROACH TO IMPROVE PROCESSES OF COMMUNICATION, QUALITY ASSURANCE, PEER REVIEW AND CREDENTIALING SO THAT CARE IS OPTIMIZED WITHIN EACH HOSPITAL IN THE NETWORK AS WELL AS WHEN PATIENTS ARE TRANSFERRED FROM CRITICAL ACCESS HOSPITALS TO THE TERTIARY CARE HOSPITAL. AS A NETWORK, WE WILL LOOK FOR WAYS TO SUPPORT THE NETWORK WHILE STRENGTHENING ITS INDIVIDUAL MEMBERS AND THE COMMUNITIES THEY SERVE. CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM GOOD SAMARITAN HOSPITAL'S CRITICAL INCIDENT STRESS MANAGEMENT (CISM) TEAM INCLUDES SEVEN STATE CERTIFIED AND TRAINED CISM DEBRIEFERS. THE TEAM IS AVAILABLE TO AID ANY STAFF MEMBER, HEALTHCARE WORKER OR ANY COMMUNITY MEMBER THROUGH WHAT IS KNOWN AS THE DEBRIEFING PROCESS WHEN THEY ENCOUNTER A CRITICAL STRESS INCIDENT. A CRITICAL STRESS INCIDENT, FOR EXAMPLE, COULD BE A LOSS OF LIFE THAT ADDS TRAUMATIC STRESS TO A HEALTHCARE PROFESSIONAL, TEACHER OR YOUTH. SINCE FORMING IN JANUARY 1997, THE CISM TEAM HAS PROVIDED APPROXIMATELY 600 HOURS OF DEBRIEFINGS WITHIN THE HEALTH SYSTEM. EN CARE PROGRAM (EMERGENCY NURSES' CARE) EN CARE IS A NATIONAL INJURY PREVENTION EFFORT SPONSORED BY THE EMERGENCY NURSES' ASSOCIATION, INJURY PREVENTION INSTITUTE. THE GSH TRAUMA OUTREACH COORDINATOR DELIVERS EN CARE PROGRAMS FOR CHILDREN, TEENS, YOUNG ADULTS AND SENIOR CITIZENS. AN ALCOHOL/DRUG/TOBACCO PREVENTION PROGRAM WAS TAUGHT TO ALL 3RD GRADE CLASSES IN KEARNEY DURING RED RIBBON WEEK. THE TRAUMA OUTREACH COORDINATOR AT GSH HAS COORDINATED THE SCHEDULING OF MANY SAFETY PROGRAMS IN THE COMMUNITY. THIS TRAINING WAS MADE POSSIBLE WITH A FINANCIAL GRANT AWARDED FROM THE NEBRASKA OFFICE OF HIGHWAY SAFETY. CONT'D
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	ENHANCED ACCESS TO RICHARD YOUNG BEHAVIORAL HEALTH CENTER IN FISCAL YEAR 1999, THE RYBHC ACCESS CENTER BEGAN PROVIDING FREE INITIAL ASSESSMENTS. THESE ASSESSMENTS ARE CONDUCTED BY LICENSED MENTAL HEALTH PROFESSIONALS AND ARE USED AS A TOOL TO ENSURE THAT INDIVIDUALS ARE REFERRED TO THE APPROPRIATE LEVEL OF CARE. IN FISCAL YEAR 2012, THE RYH ACCESS CENTER RESPONDED TO 1,174 CRISIS INTERVENTION AND INFORMATION SERVICE CALLS UTILIZING 587 STAFF HOURS AND COMPLETED 50 INITIAL ASSESSMENTS UTILIZING 76 STAFF HOURS. RICHARD YOUNG BEHAVORIAL HEALTH CENTER OFFERS SPEAKERS SPECIFIC TO BEHAVIORAL HEALTHCARE TO AGENCIES AND CIVIC ORGANIZATIONS IN AN EFFORT TO EDUCATE THE PUBLIC ABOUT MENTAL HEALTH ISSUES. THESE SERVICES ARE AVAILABLE AT NO COST FOR THE BETTERMENT OF PERSONS WITH MENTAL ILLNESSES AND THEIR FAMILIES. FAMILY ADVOCACY NETWORK (FAN) THE FAMILY ADVOCACY NETWORK (FAN) IS A COMPREHENSIVE, PATIENT-FOCUSED PROGRAM COORDINATING LAW ENFORCEMENT, HEALTH AND HUMAN SERVICES, PROSECUTORS, HEALTHCARE PROFESSIONALS AND ADVOCATES TO PROVIDE AN EXPERIENCED, MULTI-DISCIPLINARY RESPONSE TO ABUSE AND SEXUAL ASSAULT. FAN'S SERVICES INCLUDE FORENSIC INTERVIEWING, MEDICAL EXAMS, SEXUAL ASSAULT NURSE EXAMINERS (SANE) AND REFERRAL SOURCES TO THE VICTIMS OF CHILD ABUSE, SEXUAL ASSAULT, DOMESTIC VIOLENCE, AND NEGLECTED OR ABUSED VULNERABLE ADULTS. IN ADDITION TO DIRECT SERVICES, FAN PROVIDES EDUCATION ABOUT CHILD ABUSE AND DOMESTIC VIOLENCE TO COMMUNITY MEMBERS AND PROFESSIONALS IN THE REGION. GOOD SAMARITAN HOSPITAL PROVIDES IN-KIND OFFICE SPACE FOR THE FAMILY ADVOCACY NETWORK. FEETLOOSE WITH SAM THE MOOSE IN OCTOBER 2011, GOOD SAMARITAN HOSPITAL LAUNCHED A PROGRAM WITH BUFFALO COUNTY ELEMENTARY STUDENTS TO ADDRESS CHILDHOOD OBESITY AND INACTIVITY. THROUGH THE PROGRAM, FEETLOOSE WITH SAM THE MOOSE, EACH STUDENT RECEIVED A PEDOMETER THANKS TO A WELLNESS GRANT FROM BLUE CROSS BLUE SHIELD OF NEBRASKA. THOSE PEDOMETERS WERE ACCOMPANIED BY HEALTHY STEPS LOG BOOKS AND A CHALLENGE FOR EACH CHILD TO LOG 10,000 STEPS A DAY AT LEAST FIVE DAYS A WEEK IN THE MONTH OF OCTOBER. THOSE WHO LOGGED THE APPROPRIATE NUMBER OF STEPS WERE ELIGIBLE FOR PRIZES LIKE A BIKE, A RIPSTIK SKATEBOARD AND AN IPOD. THROUGH THE PROGRAM, GOOD SAMARITAN HOSPITAL HANDED OUT MORE THAN 5,000 PEDOMETERS AND BUFFALO COUNTY KIDS LOGGED MORE THAN 215 MILLION STEPS! FEETLOOSE ENCOURAGED KIDS TO USE CREATIVE IDEAS TO GET THEIR STEPS IN EACH DAY. WALKING AND JOGGING WERE EASY WAYS, BUT THE PROGRAM ALSO ENCOURAGED DANCING, PLAYING TAG, WALKING THE DOG AND LEADING A PRETEND MARCHING BAND AROUND THE YARD. FEETLOOSE IS THE NEXT ITERATION OF GIVE HEALTH A HAND, THE HOSPITAL'S EFFORT TO IMPROVE THE HEALTH OF OUR LOCAL COMMUNITIES. FOR THE LAST SEVERAL YEARS HE'S FOCUSED ON HANDWASHING AS ONE OF THE SIMPLEST AND EASIEST WAYS TO STAY HEALTHY DURING COLD AND FLU SEASON. HE'S BUILDING ON THAT ADVICE WITH FEETLOOSE TO FURTHER IMPROVE THE HEALTH OF OUR YOUNGSTERS AND THEIR FAMILIES AT HOME. HEALTH CARE SCIENCES II CLASS GOOD SAMARITAN HOSPITAL PARTNERS WITH KEARNEY HIGH SCHOOL TO OFFER THE HEALTH CARE SCIENCES II CLASS. THIS CLASS MEETS AT GOOD SAMARITAN HOSPITAL FOUR DAYS A WEEK AND PROVIDES REAL HANDS-ON LEARNING EXPERIENCES FOR STUDENTS INTERESTED IN HEALTHCARE CAREERS. EXPERTS IN THEIR FIELDS, DIFFERENT HOSPITAL REPRESENTATIVES MEET WITH THE STUDENTS OVER THE COURSE OF 8 WEEKS TO PROVIDE INFORMATION ABOUT THEIR INDUSTRY, THE SPECIFIC ASPECTS OF THE CARE THEY PROVIDE, AND VARIOUS CAREER OPPORTUNITIES WITHIN HEALTHCARE. THE PROGRAM IS DIVIDED INTO FIVE HEALTH SCIENCES CAREER PATHWAYS, MODELED AFTER THE NEBRASKA DEPARTMENT OF EDUCATION'S CAREER FIELDS AND CLUSTER MODEL: DIAGNOSTIC SERVICES, SUPPORT SERVICES, BIOTECHNOLOGY RESEARCH AND DEVELOPMENT, THERAPEUTIC SERVICES AND HEALTH INFORMATICS. FOR THE 2011-2012 SCHOOL YEAR, WE HAD 19 STUDENTS FOR CLASS I AND 18 STUDENTS FOR CLASS II. KEARNEY AREA CHAMBER OF COMMERCE CAREER OPPORTUNITY FAIR GOOD SAMARITAN HOSPITAL ACTIVELY PARTICIPATES IN THE BUFFALO COUNTY SCHOOL TO CAREER INITIATIVE AS A WAY TO EDUCATE JUNIOR HIGH AND HIGH SCHOOL STUDENTS ABOUT CAREER OPPORTUNITIES INCLUDING HEALTH CAREERS. OVER 1,500 STUDENTS FROM AROUND CENTRAL NEBRASKA REGULARLY ATTEND THE FAIR. MIDWEST TELEHEALTH NETWORK THE MIDWEST TELEHEALTH NETWORK BECAME OPERATIONAL IN 1995 WITH FIVE RURAL SITES AND GOOD SAMARITAN HOSPITAL AS THE HUB FACILITY. SINCE THEN, THE TELEHEALTH NETWORK HAS GROWN TO NOW INCLUDE TWENTY-THREE RURAL SITES FROM BOTH NEBRASKA AND KANSAS. ACTIVITY OVER THE NETWORK INCLUDES TELERADIOLOGY, CLINICAL ENCOUNTERS, TELEEMERGENCY, ADMINISTRATIVE MEETINGS AND EDUCATIONAL OFFERINGS. THE PROGRAM IS COORDINATED BY THE TELEHEALTH DEPARTMENT, WHICH IS PART OF OUTREACH SERVICES. THE NETWORK HAD RECEIVED THIRTEEN YEARS OF CONTINUOUS FUNDING THROUGH THE FEDERAL GOVERNMENT, WHICH MAKES IT THE LONGEST FEDERALLY FUNDED PROGRAM IN THE NATION THROUGH THE OFFICE FOR THE ADVANCEMENT OF TELEHEALTH. THE NETWORK SITES INCLUDE EIGHTEEN NEBRASKA SITES AND FIVE KANSAS SITES. THE PROGRAM IS RECOGNIZED ON A NATIONAL LEVEL FOR THE NETWORK'S ACHIEVEMENTS. PROGRAM STAFF PRESENT ON AN ANNUAL BASIS AT NATIONAL AND STATE CONFERENCES. THE SUCCESS OF THE MIDWEST TELEHEALTH NETWORK HAS BEEN THE CATALYST FOR THE CREATION OF THE NEBRASKA STATEWIDE TELEHEALTH PROJECT. THE NEBRASKA STATEWIDE TELEHEALTH NETWORK IS UNIQUE IN THAT IT BRINGS TOGETHER THE HOSPITALS ACROSS THE STATE, THE PUBLIC HEALTH DEPARTMENTS, STATE GOVERNMENT AND THE BIOTERRORISM LABS AT THE STATE AND REGIONAL LEVEL. THE NETWORK ALLOWS THE SHARING OF INFORMATION AND SERVICES TO MANY DIFFERENT USERS ACROSS THE STATE. THE NETWORK ALSO ALLOWS FOR INCREASED ACCESS TO MEDICAL CONSULTATION IN OUR RURAL AREAS AS WELL AS PROVIDER AND COMMUNITY EDUCATION TO THE RESIDENTS OF THOSE RURAL AREAS. IN ADDITION, IT HELPS PROVIDE ANOTHER COMMUNICATION TOOL FOR OUR HOMELAND SECURITY EFFORT IN THE CASE OF AN EMERGENCY OR FOR EDUCATIONAL PURPOSES. THIS NETWORK IS AN IMPORTANT PART OF THE STATE OF NEBRASKA'S PLAN TO ENSURE ADEQUATE BEHAVIORAL MEDICINE RESOURCES ACROSS THE STATE. RICHARD YOUNG BEHAVIORAL HEALTH CENTER ALSO PROVIDES PROFESSIONAL SUPPORT/CONSULTATION VIA TELEMEDICINE FOR PERSONS WITH PSYCHIATRIC CRISES WHO MAY PRESENT TO EMERGENCY ROOMS IN HOSPITALS THAT DO NOT HAVE THE RESOURCES TO MEET THIS NEED. WE ARE WORKING WITH CHI AND COLLABORATING WITH THEIR NEW VIRTUAL HEALTH SERVICE LINE TO PROVIDE ENHANCED TELEHEALTH SERVICES ACROSS THE MINISTRIES. GSH IS A LEADER IN THE CONSULTATION PROCESS AND COLLABORATION DUE TO OUR YEARS OF USE OF TELEHEALTH. OUTREACH SPECIALTY CLINICS NUMEROUS OUTREACH SPECIALTY CLINICS HAVE BEEN ESTABLISHED TO PROVIDE ENHANCED ACCESS TO CARE IN COMMUNITIES OUTSIDE OF KEARNEY. IN CONCERT WITH GOOD SAMARITAN HOSPITAL, THE MEDICAL STAFF HAS ESTABLISHED CLINICS IN SEVERAL SPECIALTY AREAS ALLOWING RESIDENTS IN RURAL COMMUNITIES TO RECEIVE CARE CLOSE TO HOME. THESE SPECIALTY AREAS INCLUDE: OBSTETRICS AND GYNECOLOGY, HEMATOLOGY AND ONCOLOGY, SPORTS MEDICINE, OPHTHALMOLOGY, UROLOGY, NEUROSURGERY, CARDIOLOGY, PODIATRY, SPINE AND ORTHOPEDICS, NEUROLOGY, NEPHROLOGY, PULMONOLOGY, RHEUMATOLOGY, BEHAVIORAL HEALTH AND VASCULAR SURGERY. PHYSICIAN RECRUITMENT GOOD SAMARITAN HOSPITAL WITH THE ASSISTANCE OF THE PHYSICIAN NETWORK AND MEMBERS OF THE MEDICAL STAFF CONTINUED TO SPEND SIGNIFICANT TIME AND RESOURCES TOWARD RECRUITING PHYSICIANS TO KEARNEY DURING FISCAL YEAR 2012. THESE INCLUDE PHYSICIANS SPECIALIZING IN THE AREAS OF: INTERNAL MEDICINE/HOSPITALIST, INTERVENTIONAL CARDIOLOGY, NEUROLOGY, OBSTETRICS/GYNECOLOGY, ORTHOPEDIC SURGERY-HAND, OTOLARYNGOLOGY (ENT), PEDIATRICS, PSYCHIATRY, PULMONOLOGY, AND UROLOGY. PROGRAMS FOR FAMILIES GOOD SAMARITAN HOSPITAL HAS DEVELOPED AND IMPLEMENTED SEVERAL COLLABORATIVE PROJECTS TO ASSIST FAMILIES. THESE PROJECTS HAVE BEEN DEVELOPED FROM GRANT FUNDS OBTAINED BY THE GOOD SAMARITAN HOSPITAL FOUNDATION. THEY INCLUDE: CONT'D
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	EARLY DEVELOPMENT NETWORK: THE EARLY DEVELOPMENT NETWORK (EDN) PROVIDES SERVICES COORDINATION TO FAMILIES WHO HAVE CHILDREN 0-3 YEARS OF AGE WHO HAVE A VERIFIED DISABILITY PER NE RULE 51 (SPECIAL EDUCATION LAW). THIS MEANS THAT THE PROGRAM IS AN ONGOING CENTRAL ACCESS POINT FOR FAMILIES TO HELP CONNECT THEM WITH SERVICES IN THEIR COMMUNITY THAT WILL HELP THEM CARE FOR THEIR CHILDREN AND ENSURE THE FREE AND APPROPRIATE EDUCATION GUARANTEED TO ALL CHILDREN AGES BIRTH TO 21 IN THE STATE OF NEBRASKA. FAMILIES ARE LINKED WITH DEVELOPMENTAL EVALUATIONS THROUGH THEIR LOCAL SCHOOL DISTRICT, NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES PROGRAMS, HEALTH RESOURCES, PARENT-TO-PARENT SUPPORT, AND OTHER SUPPORTS AND SERVICES AS IDENTIFIED BY THE FAMILIES' PRIORITIES. EDN SERVICES COORDINATION THROUGH GOOD SAMARITAN HOSPITAL COVERS PLANNING REGION TEAMS 10 & 28. COUNTIES LOCATED IN THESE REGIONS INCLUDE: BUFFALO, DAWSON, SHERMAN, VALLEY, LOUP, GARFIELD, GREELEY, BLAINE AND CUSTER. IN FISCAL YEAR 2012, THE EARLY DEVELOPMENT NETWORK PROVIDED SERVICES COORDINATION TO AN AVERAGE OF 158 FAMILIES PER MONTH. THIS NUMBER CONTINUES TO STEADILY INCREASE OVER THE YEARS. THE EARLY DEVELOPMENT NETWORK OPERATES FROM THE RICHARD YOUNG BEHAVIORAL HEALTH CENTER IN KEARNEY AND A SATELLITE OFFICE IN BROKEN BOW. THE PROGRAM IS CURRENTLY STAFFED WITH SIX SERVICES COORDINATORS. INJURY PREVENTION - TRAUMA DEPARTMENT: INJURY PREVENTION EFFORTS ACROSS THE AGE CONTINUUM WERE SUCCESSFULLY IMPLEMENTED WITH THE PARTNERSHIPS OF MANY COMMUNITY ENTITIES COMING TOGETHER FOR THE HEALTH AND SAFETY OF OUR NEIGHBORS. PROGRAMS FOR CHILDREN INCLUDED: * A POISON PREVENTION POSTER CONTEST ENTRY WITH EDUCATIONAL MATERIALS WAS DISTRIBUTED TO ALL ELEMENTARY AGE SCHOOL CHILDREN IN THE KEARNEY PUBLIC SCHOOL SYSTEM. THE WINNING ENTRY WAS PRINTED ON HIGHWAY 30 JUST OUTSIDE OF KEARNEY. * HAND WASHING EDUCATION WAS DONE WITH LOCAL DAY CARE CENTERS. THE "GERM LIGHT" WAS USED TO SHOW THE EFFECTIVENESS OF GOOD HAND WASHING AND SAM THE MOOSE WAS ON HAND TO GREET THE CHILDREN. * THE INJURY PREVENTION NURSE COORDINATOR ASSISTED AT CHILD PASSENGER SAFETY INSPECTION STATIONS TO PROPERLY FIT CAR SEATS IN VEHICLES. * A "SLOW DOWN IN OUR NEIGHBORHOOD" YARD SIGN CONTEST WAS IMPLEMENTED AT THE BEGINNING OF THE NEW SCHOOL YEAR. ENTRIES FROM ALL ELEMENTARY STUDENTS IN BUFFALO COUNTY WERE JUDGED FOR THEIR IMPORTANT SAFETY MESSAGE. A WINNER WAS CHOSEN FROM EACH SCHOOL, AS WELL AS AN OVERALL WINNER, WHOSE ENTRY WAS PRINTED ON 150 YARD SIGNS. THESE YARD SIGNS WERE DISTRIBUTED TO SCHOOL NEIGHBORHOODS THROUGHOUT THE COUNTY AND WERE AVAILABLE FOR PURCHASE AT THE SURE CURE GIFT SHOP. * OVER 400 THIRD GRADE STUDENTS HEARD THE MESSAGE "WHY I WON'T USE DRUGS" DURING RED RIBBON WEEK FROM THE INJURY PREVENTION NURSE COORDINATOR AND THE CANCER PREVENTION NURSE. THE EFFECTS OF ALCOHOL, DRUGS AND TOBACCO ON THE BODY, BRAIN AND LUNGS WERE DISCUSSED AND ALSO DEMONSTRATED WITH A BRAIN MODEL, REAL PIG LUNGS AND MR. GROSS MOUTH. * DURING BICYCLE SAFETY MONTH IN MAY ALL KEARNEY PUBLIC SCHOOL 3RD GRADERS WERE TAUGHT ABOUT BICYCLE AND PEDESTRIAN SAFETY. THE 45-MINUTE PROGRAM INCLUDED A BIKE SAFETY VIDEO, A DEMONSTRATION USING EGGS TO SHOW THE IMPORTANCE OF WEARING A HELMET AND HOW TO PROPERLY WEAR A BIKE HELMET DEMONSTRATION. EACH CHILD WAS GIVEN A COUPON FOR A FREE BIKE HELMET OR FIT FOR A HELMET IN THEIR CLASSROOM. * A BICYCLE HELMET FITTING TOOK PLACE AT THE GRAND OPENING OF THE NEWLY REMODELED KEARNEY PUBLIC LIBRARY FACILITY. YOUNG AND OLD ALIKE WERE INVITED TO HAVE THEIR OLD HELMET FIT PROPERLY OR WERE ABLE TO GIVE A DONATION TO HAVE A NEW HELMET FIT. PROGRAMS FOR TEENS INCLUDED: * PROGRAMS ON THE EFFECTS OF DRUG, ALCOHOL AND TOBACCO WERE PRESENTED TO STUDENTS IN THE TRUTH UNIVERSITY CLASSES AT HORIZON MIDDLE SCHOOL. * TRAUMA OUTREACH HEADED A NEW PROGRAM FOR CONCUSSION AWARENESS AND PREVENTION IN OUR REGION. GOOD SAMARITAN HOSPITAL PARTNERED WITH NEBRASKA SPORTS CONCUSSION NETWORK AND AREA SPORTS TRAINERS TO PROVIDE CONCUSSION TRAINING TO OVER 100 AREA COACHES, 50 PLUS AREA PHYSICIANS, AND HUNDREDS OF MEDICAL PROFESSIONALS RANGING FROM NURSES TO PARAMEDICS. ALSO, OVER 2000 STUDENTS IN 30 AREA HIGH SCHOOLS HAVE HAD CONCUSSION SYMPTOM TRAINING AND PRECONCUSSION NEUROCOGNITIVE TESTING COMPLETED AT THE EXPENSE OF GOOD SAMARITAN HOSPITAL. * A PRESENTATION WAS GIVEN TO KEARNEY HIGH STUDENTS IN THE HEALTH CAREER SCIENCE CLASSES ABOUT "COMMUNITY HEALTH EDUCATOR." * THE SAFE TEEN DRIVING SCHOLARSHIP PROGRAM AWARDED SEVERAL KIDS SCHOLARSHIPS RANGING FROM $50-$150 FOR A TOTAL OF $2000 TO ASSIST WITH THE COST OF DRIVER'S EDUCATION CLASSES. * ALCOHOL-FREE PROM AND GRADUATION SAFETY MESSAGES WERE IN THE MEDIA AND THE "LIVE TO SEE THE SUN RISE, THINK DON'T DRINK" TAGS WERE DELIVERED TO THE LOCAL TUX AND DRESS SHOPS, FLORISTS, AND HAIR AND NAIL SALONS TO GIVE TO THE TEENS AS A REMINDER TO BE SAFE AND SMART. PROGRAMS FOR ADULTS/SENIORS INCLUDED: * THE INJURY PREVENTION NURSE COORDINATOR ASSISTED AT THE MADD VICTIM IMPACT PANELS THAT WERE HELD IN KEARNEY. * INJURY PREVENTION HAD A BOOTH AT KEARNEY HUB'S "PRIME OF YOUR LIFE FESTIVAL." INFORMATION WAS AVAILABLE ON PREVENTING FALLS, HOW TO SAFEGUARD YOUR HOME, DRIVING AND SEATBELT SAFETY, ALCOHOL USE BY SENIORS AND MORE. SAFE KIDS PLATTE VALLEY: UNINTENTIONAL INJURY IS THE #1 KILLER OF CHILDREN IN THE UNITED STATES. SAFE KIDS U.S.A. WAS LAUNCHED IN 1988 TO ADDRESS UNINTENTIONAL INJURIES TO CHILDREN AGES 14 AND UNDER. SINCE THAT TIME, THE RATE HAS DROPPED OVER 50%. GOOD SAMARITAN HOSPITAL BECAME PART OF SAFE KIDS IN 1996 IN PARTNERSHIP WITH OTHER AREA HOSPITALS. IN 2004, GOOD SAMARITAN HOSPITAL ASSUMED A LEADERSHIP ROLE AS THE LEAD AGENCY FOR SAFE KIDS PLATTE VALLEY. SAFE KIDS PLATTE VALLEY SERVES BUFFALO, DAWSON, LINCOLN, AND OTHER SOUTH CENTRAL AND SOUTHWESTERN COUNTIES IN NEBRASKA AS A PARTNER, EDUCATOR, AND RESOURCE IN THE MISSION OF PREVENTING ACCIDENTAL INJURIES TO CHILDREN. THE MAJOR CAUSE OF DEATHS IS TRAFFIC CRASHES; FALLS ARE THE #I CAUSE OF NON-FATAL INJURIES. SAFE KIDS ADDRESSES ALL AREAS OF INJURY PREVENTION INCLUDING CHILD PASSENGER SAFETY, FALL PREVENTION, BICYCLE AND WHEELED SAFETY, WATER SAFETY, PEDESTRIAN SAFETY, FARM SAFETY, SPORTS SAFETY, HOME SAFETY, PLAYGROUND SAFETY, SIDS PREVENTION, AND MORE. FISCAL YEAR 2012 SAFE KIDS ACTIVITIES INCLUDED: * MONTHLY CHILD PASSENGER SAFETY FITTING STATIONS IN KEARNEY AND NORTH PLATTE * ASSISTING NEBRASKA OFFICE OF HIGHWAY SAFETY AND SAFE KIDS NEBRASKA WITH NEBRASKA CHILD PASSENGER SAFETY TECHNICAL UPDATE * SAFE KIDS BUCKLE UP EVENTS IN KEARNEY, MINDEN, AND HOLDREGE, INCLUDING AN EVENT COORDINATED WITH SAFE KIDS NEBRASKA AND THE NEBRASKA OFFICE OF HIGHWAY SAFETY TO ASSIST IN THE RECERTIFICATION OF NEBRASKA TECHNICIANS * BIKE SAFETY AND HELMET DISTRIBUTION PROGRAM IN KEARNEY PUBLIC SCHOOLS AND AT KEARNEY PUBLIC LIBRARY * HEALTH FAIRS, OPEN HOUSES AND IN-SERVICE PROGRAMS AT NEBRASKA MID-WINTER, UNK BLUE AND GOLD FAIR, EARLY HEAD START, THE NEBRASKA NATIONAL GUARD HAUNTED ARMORY, FARM SAFETY JUST 4 KIDS (MINDEN), FRANKLIN COUNTY HEALTH FAIR, KEARNEY HIGH FCCLA, DAWSON COUNTY INTERAGENCY, HEAD START (ORLEANS), COMMUNITY HOSPITAL HEALTH FAIR (MCCOOK), KEARNEY CATHOLIC HIGH SCHOOL KEY CLUB, GOTHENBURG COMMUNITY HEALTH FAIR, GIBBON SCHOOL CARNIVAL, COZAD IN AND OUT HEALTH FAIR, NATIONAL BIKE TO SCHOOL DAY, KEARNEY FAMILY HEALTH FAIR, AND THE PRIME LIFE FESTIVAL * CHILD PASSENGER SAFETY EDUCATION AND CAR SEATS FOR ESU#11 PRESCHOOL SPECIAL NEEDS STUDENTS FROM BERTRAND AND SOUTHERN VALLEY SCHOOLS. TEEN NET (PRENATAL AND PARENTING PROGRAM FOR TEENS): THE OBJECTIVE OF THE TEEN NET PROGRAM IS TO INSTILL HEALTHY LIFESTYLE CHOICES IN TEENS, WHICH THE PROGRAM HAS BEEN DOING SINCE ITS INCEPTION IN SCHOOL YEAR 1992-93 AT KEARNEY PUBLIC SCHOOLS. FOR PREGNANT AND PARENTING TEENS THIS MEANS TEACHING PARENTING SKILLS AND OBTAINING TIMELY PRENATAL CARE, INCREASING GRADUATION RATES, PREVENTION OF CHILD ABUSE AND IMPROVING THE FEELINGS OF SELF-WORTH. IN PREVIOUS FISCAL YEARS, THE PROGRAM HAS RECEIVED GRANT FUNDING THROUGH A VARIETY OF SOURCES INCLUDING NEBRASKA HEALTH AND HUMAN SERVICES MATERNAL AND CHILD HEALTH DIVISION, UNION PACIFIC FOUNDATION AND THE FRATERNAL ORDER OF EAGLES. FUNDING THROUGH GOOD SAMARITAN HOSPITAL AND KEARNEY PUBLIC SCHOOLS WAS PROVIDED DURING FISCAL YEAR 2012. 100% OF THE SENIORS ENROLLED IN THE PROGRAM THIS YEAR GRADUATED FROM HIGH SCHOOL AND 100% ARE GOING ON TO FURTHER THEIR EDUCATION. CONT'D
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	PROJECT SEARCH PROJECT SEARCH IS A ONE YEAR, HIGH SCHOOL TRANSITION PROGRAM, WHICH PROVIDES TRAINING AND EDUCATION LEADING TO EMPLOYMENT FOR INDIVIDUALS WITH DISABILITIES. THE PROJECT SEARCH PROGRAM OCCURS ON-SITE AT GOOD SAMARITAN HOSPITAL. THE CORNERSTONE OF PROJECT SEARCH IS TOTAL IMMERSION IN A LARGE BUSINESS. EACH DAY, STUDENTS REPORT TO THE HOST BUSINESS, LEARN EMPLOYABILITY SKILLS IN THE CLASSROOM AND JOB SKILLS WHILE PARTICIPATING IN 3 TO 4 INTERNSHIPS/EXPERIENCES DURING THE YEAR. MANAGERS AT THE INTERNSHIP SITES WORK WITH THE PROJECT SEARCH INSTRUCTOR AND JOB COACHES TO SUPPORT THE STUDENTS. FOR THE 2011 AND 2012 SCHOOL YEAR AS OF 6/30/12, ALL FOUR STUDENTS HAVE FOUND COMPETITIVE EMPLOYMENT IN THE COMMUNITY. RICHARD YOUNG/EMERGENCY SUPPORT PROGRAM RICHARD YOUNG BEHAVIORAL HEALTH CENTER OFFERS INPATIENT AND OUTPATIENT BEHAVIORAL HEALTH SERVICES TO INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. OUR FREE, NO COST TO THE CONSUMER OR REFERRAL SOURCE, CRISIS PSYCHIATRIC ASSESSMENT SERVICE IS OFFERED 24 HOURS A DAY/7 DAYS A WEEK. PSYCHIATRIC ASSESSMENTS ARE PROVIDED TO DETERMINE AN INDIVIDUAL'S TREATMENT NEEDS AND PLACED OR REFERRED TO THE APPROPRIATE LEVEL OF CARE. WE ALSO OFFER AT NO COST TELE-HEALTH PSYCHIATRIC EMERGENCY ASSESSMENT SERVICES TO RURAL HOSPITALS THAT DO NOT HAVE PSYCHIATRIC SERVICES. RYH ALSO OFFERS FREE EDUCATIONAL RESOURCES AVAILABLE UPON REQUEST. SENIOR SERVICES SENIOR SERVICES PROVIDES INFORMATION AND SUPPORT TO AREA OLDER ADULTS AND THEIR FAMILIES THROUGH A VARIETY OF SERVICES AND PROGRAMS. LIFELINE PERSONAL EMERGENCY RESPONSE SERVICE THROUGH GOOD SAMARITAN PROVIDES ALMOST 400 OLDER AND DISABLED ADULTS WITH THE ABILITY TO SIGNAL FOR HELP WITH THE PUSH OF A WATERPROOF BUTTON WORN AROUND THEIR NECK OR ON THEIR WRIST. LAST YEAR LIFELINE RESPONDED TO ALMOST 200 INCIDENT SIGNALS FOR ASSISTANCE, ARRANGING FOR HELP WHEN SUBSCRIBERS WERE UNABLE TO DIAL 911. ABOUT ONE-FOURTH OF THESE ASSISTS RESULTED IN TRANSPORT TO THE HOSPITAL; PERSONAL RESPONDERS PROVIDED ASSISTANCE WITH THE OTHER THREE-FOURTHS, HELPING REDUCE UNNECESSARY EMERGENCY DEPARTMENT VISITS AND HOSPITAL ADMISSIONS. CURRENTLY TWENTY FIVE SUBSCRIBERS HAVE THE ADDED PROTECTION OF THE SECURITY PROVIDED BY THE AUTOALERT FALL DETECTION BUTTON. THIS LIFE SAVING, INNOVATIVE DEVICE SENDS A SIGNAL TO THE LIFELINE RESPONSE CENTER IF THE SUBSCRIBER IS UNABLE TO PUSH THEIR LIFELINE BUTTON AS THE RESULT OF A SUDDEN FALL. THE SECURITY PROVIDED BY LIFELINE BENEFITS NOT ONLY THE SUBSCRIBER, BUT ALSO GIVES THOSE CLOSE TO THEM PEACE OF MIND. THE TELECARE PROGRAM, A FREE OF CHARGE SERVICE COORDINATED THROUGH SENIOR SERVICES, PROVIDES A DAILY REASSURANCE CALL FROM VOLUNTEERS TO AN AVERAGE OF SIX PEOPLE PER DAY IN THE KEARNEY COMMUNITY. THOSE WHO RECEIVE TELECARE CALLS APPRECIATE THE DAILY TELEPHONE VISIT FROM FRIENDLY, CARING VOLUNTEERS. SENIOR SERVICES ALSO COORDINATES EDUCATIONAL PROGRAMS PROVIDING THE KEARNEY AREA WITH INFORMATION ON A VARIETY OF TOPICS OF INTEREST TO OLDER ADULTS. SENIOR SERVICES STAFF IS AVAILABLE TO PRESENT PROGRAMS ON TOPICS RELATING TO OLDER ADULTS, INCLUDING "CHANGES AS WE AGE" (A HANDS-ON PROGRAM THAT DEMONSTRATES SENSORY CHANGE ASSOCIATED WITH AGING), PREVENTING SENIOR FRAUD, SENIOR SAFETY AND FALL PREVENTION FOR SENIORS. GOOD SAMARITAN PLAYS A KEY ROLE IN ASSISTING OLDER ADULTS AND THEIR FAMILIES WITH THE MEDICARE AND THE PRESCRIPTION DRUG PLAN BENEFIT. SENIOR SERVICES STAFF USES SHIIP (SENIOR HEALTH INSURANCE AND INFORMATION PROGRAM) TRAINING TO PRESENT INFORMATIONAL PROGRAMS AND COUNSEL INDIVIDUALS WITH QUESTIONS ABOUT MEDICARE AND MEDICAID BENEFITS AND OTHER HEALTH INSURANCE ISSUES. SENIOR SERVICES STAFF ALSO EDUCATES INDIVIDUALS IN NAVIGATING THE MEDICARE WEBSITE TO ENCOURAGE SELF-SUFFICIENCY IN PART D ENROLLMENT DECISION MAKING. SENIOR SERVICE STAFF ALSO PROVIDES REPRESENTATION FOR GOOD SAMARITAN AT QUARTERLY AGING SERVICES COALITION AND REGENCY RETIREMENT COMMUNITY BOARD OF DIRECTORS MEETINGS, AND MONTHLY MEETINGS OF THE END OF LIFE WORKGROUP AND COMMUNITY CONNECTIONS. SENIOR SERVICES STAFF IS CURRENTLY SERVING ON THE ALZHEIMER'S DISEASE COALITION - BCCP WHICH IS WORKING TOWARD INCREASING AD EDUCATION AND AWARENESS AND SOUTH CENTRAL COORDINATED COMMUNITY RESPONSE TEAM WHICH IS WORKING TO REDUCE ABUSE OF ADULTS AGED 50 AND OLDER WITHIN COMMUNITIES IN THE SOUTH CENTRAL NEBRASKA REGION. CONT'D
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATON	SCHEDULE H, PART VI	TELEHEALTH CLINICS SINCE THE INCEPTION OF THE TELEHEALTH NETWORK AT GOOD SAMARITAN HOSPITAL IN 1994, ITS USE BY SPECIALTY PHYSICIANS TO PROVIDE CARE TO PATIENTS IN REMOTE AREAS HAS INCREASED TREMENDOUSLY. TWENTY-FOUR ENTITIES CONNECT TO GOOD SAMARITAN AND INCLUDE HOSPITALS, PUBLIC HEALTH DEPARTMENTS AND COUNTY DETENTION CENTERS. SPECIALISTS IN KEARNEY CAN CONNECT TO PATIENTS IN THEIR LOCAL HOSPITAL FOR FOLLOW-UP VISITS, MEDICATION MAINTENANCE OR ANY OTHER NUMBER OF CLINICAL REASONS. IN FACT, GOOD SAMARITAN HOSPITAL ACCOUNTED FOR 50% OF ALL TELEHEALTH CLINICAL VISITS THROUGH THE NEBRASKA STATEWIDE TELEHEALTH NETWORK IN FY 2012. TELEHEALTH IS ONE OF THE GREENEST MEDICAL PROCESSES WE HAVE AND WILL CONTINUE TO PLAY AN EVEN BIGGER ROLE IN THE FUTURE OF RURAL HEALTHCARE. WELLNESS/FITNESS CENTER THE WELLNESS/FITNESS CENTER (W/FC) EXISTS TO SUPPORT GOOD SAMARITAN HOSPITAL IN ITS MISSION AND VISION OF IMPROVING THE HEALTH OF OUR COMMUNITY. THIS IS ACCOMPLISHED THROUGH THE PROVISION OF AN ON-SITE 29,000 SQUARE FOOT, MEDICAL FITNESS CENTER. ALSO HOUSED IN THE WELLNESS/FITNESS CENTER IS OUR WARM WATER TURTTLE POOL. TURTTLE IS AN ACRONYM FOR THERAPEUTIC UNIQUE REHABILITATIVE TWO TEMPERATURE LAP EXERCISE. THE EXTERIOR, CURRENTED TRACK OF WATER 84 TO 88 DEGREES FACILITATES WATER WALKING AND LAP SWIMMING WITH OR AGAINST THE CURRENT. THE INNER, RECTANGULAR WARM WATER WELL 92 TO 96 DEGREES IS UTILIZED FOR THERAPY AND EXERCISE. THE WELLNESS/FITNESS CENTER IS STAFFED BY PROFESSIONALS DEDICATED TO MEETING THE NEEDS OF ITS MEMBERS AND PATIENTS THROUGH COMPREHENSIVE, INTEGRATED PROGRAMS AND PERSONALIZED SERVICES SUCH AS PERSONAL TRAINING AND MASSAGE THERAPY. THE W/FC FITNESS SPECIALISTS ARE DEGREED AND CERTIFIED, PROVIDING MEMBERS WITH STRUCTURED PROGRAMMING TO HELP ACHIEVE INDIVIDUAL HEALTH AND WELLNESS GOALS. OUR LICENSED MASSAGE THERAPISTS OFFER MANY DIFFERENT TECHNIQUES AND STYLES OF MASSAGE THERAPY NOT ONLY TO HELP IMPROVE VARIOUS CONDITIONS, BUT ALSO TO MAINTAIN OVERALL WELLNESS AND RELAXATION. THE W/FC IS LOCATED IN THE LOWER LEVEL OF THE MEDICAL OFFICE BUILDING ALONG WITH THE CARDIAC AND PULMONARY REHABILITATION, AQUATICS REHABILITATION, AND COMPANY CARE DEPARTMENTS. DISCOUNTS ON MEMBERSHIP ARE GIVEN NOT ONLY TO GOOD SAMARITAN HOSPITAL EMPLOYEES, BUT ALSO SENIOR POPULATIONS, HOSPITAL VOLUNTEERS, STUDENTS AND BUSINESSES THAT PARTICIPATE IN WELLNESS WORKS. WHETHER A MEMBER IS STRIVING FOR A SPECIFIC FITNESS GOAL, CONTINUING A REHABILITATIVE PROGRAM, OR MANAGING VARIOUS PERSONAL HEALTH RISKS, THE WELLNESS/FITNESS TEAM IS THERE EACH STEP OF THE WAY. CONTINUED
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	E. FUNDRAISERS SUPPORTED AMERICAN CANCER SOCIETY - RELAY FOR LIFE THE RELAY FOR LIFE IS HELD ANNUALLY BY THE AMERICAN CANCER SOCIETY WITH ASSISTANCE FROM MANY COMMUNITY MEMBERS. IN FISCAL YEAR 2012, GOOD SAMARITAN HOSPITAL WAS A CORPORATE SPONSOR FOR THE RELAY AND SUPPORTED THE EVENT WITH $3,750. GOOD SAMARITAN STAFF PARTICIPATED ON TEAMS. THE EVENT ALLOWS PARTICIPANTS FROM ALL WALKS OF LIFE, INCLUDING PATIENTS, MEDICAL SUPPORT STAFF, CORPORATIONS, CIVIC ORGANIZATIONS, CHURCHES AND COMMUNITY VOLUNTEERS TO JOIN TOGETHER TO FIGHT CANCER. PEDIATRIC DEPARTMENT UNITED WAY BACK TO SCHOOL LINK GOOD SAMARITAN HOSPITAL'S PEDIATRIC DEPARTMENT COORDINATES AN ANNUAL SCHOOL SUPPLY DRIVE FOR AREA SCHOOL STUDENTS THROUGH THE UNITED WAY AND DOBYTOWN KIWANIS. IN FISCAL YEAR 2012, OVER 914 BACKPACKS WERE FILLED FOR CHILDREN IN BUFFALO, KEARNEY, PHELPS, HARLAN, FRANKLIN & CUSTER COUNTIES THROUGH THIS PROJECT. GOOD SAMARITAN STAFF DONATE NEEDED SCHOOL SUPPLIES INCLUDING: ERASERS, RED/BLUE PENS, SCISSORS, GLUE, SCHOOL BOXES, FOLDERS, RULERS, PAPER, NOTEBOOKS, MARKERS, PENCILS, KLEENEX, HIGHLIGHTERS, COLORED PENCILS AND CRAYONS. UNITED WAY IN FISCAL YEAR 2012, APPROXIMATELY $29,653 WAS PLEDGED BY GOOD SAMARITAN HOSPITAL EMPLOYEES TO THE LOCAL AREA UNITED WAY TO ASSIST A VARIETY OF COMMUNITY SERVICE AGENCIES. HEARTCHASE IN SEPTEMBER 2011, GOOD SAMARITAN HOSPITAL WAS THE PRESENTING SPONSOR OF HEARTCHASE, A NEW FUNDRAISER FOR THE AMERICAN HEART ASSOCIATION. KEARNEY WAS SELECTED AS JUST ONE OF A HANDFUL OF COMMUNITIES ACROSS THE COUNTRY TO PILOT THE EVENT. GOOD SAMARITAN NOT ONLY TOOK THE LEAD WITH ITS $6,500 SPONSORSHIP, BUT ALSO IN PLANNING THE EVENT AND RECRUITING COMMUNITY MEMBERS TO PARTICIPATE. HEARTCHASE IS AN INNOVATIVE COMMUNITY EVENT THAT PROVIDES A FUN NEW WAY TO PROMOTE HEALTHY LIVING AND SUPPORT THE MISSION OF THE AMERICAN HEART ASSOCIATION. THE EVENT BROUGHT FAMILIES, FRIENDS AND HOSPITAL EMPLOYEES TOGETHER IN A COMMUNITY-WIDE COMPETITION TO UNCOVER CLUES, SOLVE PUZZLES AND COMPLETE CHALLENGES IN A RACE TO THE FINISH LINE. HEARTCHASE WAS HOSTED ON THE CAMPUS OF UNK. THE INAUGURAL EVENT RAISED APPROXIMATELY $25,000 THROUGH CORPORATE SPONSORSHIPS AND TEAM FUNDRAISING, ALLOWING IT TO HOLD THE FUNDRAISING RECORD OF ALL PILOT SITES IN 2011. THIRTY TEAMS OF 2-5 PEOPLE PARTICIPATED. NEARLY 25 GOOD SAMARITAN STAFF MEMBERS VOLUNTEERED THEIR TIME ON THE PLANNING COMMITTEE WITH EVEN MORE VOLUNTEERING THE DAY OF THE EVENT AT CHECKPOINTS AND REGISTRATION. CARDIOLOGISTS DR. DAN MCGOWAN AND DR. ALAIN EFSTRATIOU SERVED AS EVENT EMCEES AND AWARD PRESENTERS. RED OUT AT KHS BASKETBALL IN MARCH, GOOD SAMARITAN HOSPITAL SPONSORED A RED OUT FOR THE BOYS' AND GIRLS' BASKETBALL GAMES AT KEARNEY SENIOR HIGH SCHOOL. THANKS TO THE LEAD SPONSORSHIP DONATION OF $1,000 FROM GOOD SAMARITAN HOSPITAL, THE EVENT NOT ONLY RAISED FUNDS FOR THE AMERICAN HEART ASSOCIATION THROUGH T-SHIRT SALES, BUT ALSO RAISED AWARENESS OF HEART DISEASE. GOOD SAMARITAN HOSPITAL PROVIDED FACTS AND INFORMATION ABOUT HEART DISEASE THAT THE ANNOUNCER READ THROUGHOUT THE GAME. F. SPONSORSHIP FUNDS GOOD SAMARITAN HOSPITAL, THROUGH ITS CORPORATE CONTRIBUTION FOR COMMUNITY BENEFIT POLICY, HAS PROVIDED SPONSORSHIP FUNDS TO GROUPS AND EVENTS MEETING THE CRITERIA FOR SPONSORSHIP ESTABLISHED IN THE POLICY. IN FISCAL YEAR 2012, $50,000 WAS DONATED TO KEARNEY PUBLIC SCHOOLS FOR SOCIAL WORK SUPPORT; $34,280 TO COMMUNITY ACTION PARTNERSHIP; $6,500 TO THE AMERICAN HEART ASSOCIATION; $5,000 TO TWO RIVERS PUBLIC HEALTH DEPARTMENT; $3,500 TO THE AMERICAN CANCER SOCIETY; $3,000 TO THE NEBRASKA KIDNEY ASSOCIATION; $3,500 TO MAKE A WISH FOUNDATION; $3,000 TO UNITED WAY; $2,000 TO SUSAN G KOMEN FOR THE CURE; $1,500 WAS DONATED TO THE NEBRASKA AIDS PROJECT; ADDITIONAL DONATIONS WERE GIVEN TO CRITICAL ACCESS HOSPITALS AND ALCOHOL FREE POST PROM EVENTS. $35,000 WAS DONATED TO THE BUFFALO COUNTY COMMUNITY PARTNERS TO ASSIST WITH FUNDING COLLABORATIVE EFFORTS IN THE COMMUNITY THAT FOCUS ON ATTAINMENT OF ONE OR MORE OF THE PARTNER'S PRIORITY HEALTH GOALS. AN ADDITIONAL $20,846 OF IN-KIND RESOURCE SUPPORT (OFFICE SPACE) WAS DEDICATED TO THE PARTNERS. G. VOLUNTEERS GOOD SAMARITAN HOSPITAL, THROUGH ITS VOLUNTEER SERVICE LEAGUE AND THE PARTICIPATION OF ITS BOARD MEMBERS, MEDICAL STAFF, HOSPITAL AND FOUNDATION STAFF IN COMMUNITY ORGANIZATIONS, PROVIDE COUNTLESS HOURS OF NON-PAID TIME AND DONATIONS TO THE COMMUNITY AND THOSE IN NEED. VOLUNTEER SERVICE LEAGUE LAST YEAR THE GOOD SAMARITAN HOSPITAL VOLUNTEER SERVICE LEAGUE VOLUNTEERS WERE RECOGNIZED FOR GIVING 82,562 HOURS OF SERVICE TO GOOD SAMARITAN HOSPITAL AND RICHARD YOUNG BEHAVIORAL HEALTH CENTER AND FOR DONATING $86,341 TO MEET NEEDS WITHIN THE HOSPITAL. HAD GOOD SAMARITAN HOSPITAL PAID FOR THESE HOURS OF SERVICE, THE ESTIMATED EXPENSES WOULD HAVE TOTALED $1,897,659. THE MISSION OF THE VOLUNTEER SERVICE LEAGUE IS TO PROVIDE HOLISTIC SERVICES TO THE PATIENTS AND THEIR FAMILIES. TO THAT END, VOLUNTEERS PROVIDE OVER 20 DIFFERENT SERVICES THROUGHOUT THE HOSPITAL. THEY DISTRIBUTE MAIL WITHIN THE ORGANIZATION AND SERVE AS HOSTS AND HOSTESSES IN MANY WAITING ROOMS AND RECEPTION AREAS. SCARED CHILDREN LEAVE GRINNING WITH THE STUFFED ANIMALS THAT VOLUNTEERS PROVIDE. VOLUNTEERS WORK IN OUR TWO GIFT SHOPS, AS WELL AS OFFERING PET THERAPY AND THERAPEUTIC "CLOWN" VISITS TO MANY PATIENTS AND FAMILIES AND STAFF. SOME VOLUNTEERS KNIT HATS FOR NEWBORNS. FOR THE LAST SEVERAL YEARS GSH HAS SENT HOME WELL OVER 1,000 NEWBORN BABIES WITH HANDMADE KNITTED OR CROCHETED HATS. OUR VOLUNTEERS ALSO MAKE KNITTED AND QUILTED LAP ROBES FOR ADULT PATIENTS. OUR VOLUNTEERS MAKE HANDMADE BLANKETS AND "CUDDLE PILLOWS" FOR OUR PEDIATRIC PATIENTS. WE HAVE TALENTED VOLUNTEER MUSICIANS DONATING MANY HOURS TO PLAY OUR CLAVINOVA. OUR VOLUNTEERS REACH OUT TO THE COMMUNITY OFFERING THEIR CARING TOUCH IN MANY DIFFERENT WAYS. H. EDUCATION OF MEDICAL PROFESSIONALS MEDICAL EDUCATION: GOOD SAMARITAN HOSPITAL SUPPORTS THE EDUCATION OF MEDICAL STUDENTS BY PROVIDING SPECIALTY SPECIFIC PHYSICIAN-SUPERVISED ROTATIONS IN CONJUNCTION WITH MEDICAL SCHOOLS, THE PRIMARY FACILITY BEING THE UNIVERSITY OF NEBRASKA MEDICAL CENTER (UNMC). THE TEACHING FACILITY CONTACTS THE PHYSICIAN TO ARRANGE FOR ONE- OR TWO-MONTH ROTATIONS OF SUPERVISION AND TRAINING. GOOD SAMARITAN HOSPITAL PROVIDED HOUSING AND/OR MEALS FOR 51 STUDENTS WHO COMPLETED 62 ROTATIONS IN FISCAL YEAR 2012. OTHER STUDENTS FROM VARIOUS PROGRAMS AND COLLEGES ARE PROVIDED EDUCATIONAL EXPERIENCES AT GOOD SAMARITAN HOSPITAL. APRNS, RNS, LPNS, PSYCH STUDENTS, MASTER'S LEVEL COUNSELING STUDENTS, AND RECREATIONAL THERAPISTS ARE PROVIDED A BROAD RANGE OF EDUCATIONAL EXPERIENCES FROM FIELD EXPERIENCES TO INTERNSHIPS. RURAL FAMILY PRACTICE RESIDENCY PROGRAM: THE KEARNEY RURAL TRAINING TRACK OF THE UNIVERSITY OF NEBRASKA MEDICAL CENTER (UNMC) FAMILY PRACTICE RESIDENCY PROGRAM BEGAN AT GOOD SAMARITAN HOSPITAL (GSH) IN JULY 1993. GSH AND UNMC ENTERED INTO AN AGREEMENT TO PROVIDE CLINICAL TEACHING FOR UNMC FAMILY PRACTICE RESIDENTS AT GOOD SAMARITAN HOSPITAL AND CLINICAL SERVICES FOR PATIENTS OF THE HOSPITAL. GOOD SAMARITAN IS COMMITTED TO PROVIDING APPROPRIATE GENERAL AND SPECIALTY REQUIREMENTS FOR GRADUATE MEDICAL EDUCATION AS DESCRIBED IN THE ESSENTIALS OF ACCREDITED RESIDENCIES IN GRADUATE MEDICAL EDUCATION. TWENTY-ONE RESIDENTS HAVE GRADUATED FROM THE UNMC/KEARNEY RURAL TRAINING TRACK PROGRAM WITH SEVERAL CURRENTLY PRACTICING FAMILY MEDICINE IN THE KEARNEY AREA. GOOD SAMARITAN HOSTED TWO FAMILY PRACTICE RESIDENTS IN THE 2012 FISCAL YEAR. THE EXPENSES OF THE RESIDENCY PROGRAM ARE SHARED BETWEEN GSH AND UNMC WHILE KEARNEY PHYSICIANS PROVIDE SPECIALTY ROTATION SUPERVISION. THIS RESIDENCY PROGRAM IS UNIQUE IN THAT THERE ARE A MAXIMUM OF FOUR FAMILY MEDICINE RESIDENTS IN KEARNEY AT ONE TIME. THE RESIDENTS COMPLETE THEIR FIRST YEAR OF RESIDENCY AT UNMC AND THE FOLLOWING TWO YEARS ARE COMPLETED IN KEARNEY. IN FISCAL YEAR 2012, THE RESIDENTS SAW PATIENTS ON A REGULAR BASIS AT FAMILY PRACTICE ASSOCIATES CLINIC IN KEARNEY. I. RESEARCH THE ONCOLOGY PHYSICIANS AND STAFF IN THE CANCER CENTER AT GOOD SAMARITAN HOSPITAL ARE ACTIVE IN CLINICAL RESEARCH FOR THE TREATMENT AND PREVENTION OF CANCER. IN FISCAL YEAR 2011, GOOD SAMARITAN HOSPITAL SPENT $263,434 ON MAINTAINING A CANCER REGISTRY AND CONDUCTING CANCER RESEARCH STUDIES.
LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	SCHEDULE H, PART VI	J. COMMUNITY BUILDING ACTIVITIES BUFFALO COUNTY COMMUNITY PARTNERS THE BUFFALO COUNTY COMMUNITY PARTNERS IS A NON-PROFIT ORGANIZATION WHOSE MISSION IS TO ASSESS, PROMOTE AND STRENGTHEN THE HEALTH OF BUFFALO COUNTY. COMMUNITY PARTNERS 'IDENTIFIES' PRIORITY WELL-BEING ISSUES IN THE COMMUNITY, 'CREATES' COUNTY-WIDE STRATEGIES TO TARGET THESE ISSUES, 'BUILDS' COMMUNITY PARTNERSHIPS, AND 'IMPROVES' OVERALL HEALTH STATUS BY MEASURING COMMUNITY PROGRESS. TODAY, 1,000 INDIVIDUALS AND 200 ORGANIZATIONS IN BUFFALO COUNTY ARE WORKING TOGETHER TO CREATE POSITIVE CHANGE IN THEIR COMMUNITY. THESE VOLUNTEERS ARE MAKING 450,000 PERSONAL CONTACTS ANNUALLY. THIS "BUILDING A HEALTHIER COMMUNITY" INITIATIVE BEGAN IN 1995, WHEN GOOD SAMARITAN HOSPITAL CONVENED A GROUP OF 25 ORGANIZATIONS TO CONDUCT A COUNTY-WIDE HEALTH ASSESSMENT. TODAY, GOOD SAMARITAN HOSPITAL IS ONE OF 25 ORGANIZATIONS REPRESENTED ON THE PARTNERS BOARD OF DIRECTORS. THE VISION OF THE PARTNERS IS THAT "EVERYONE FROM ALL CORNERS OF BUFFALO COUNTY WORK TOGETHER TO IMPROVE THE QUALITY OF LIFE OF THOSE WHO LIVE IN AND WORK IN THIS COMMUNITY." IN 2009 AND 2010, THE PARTNERS CONDUCTED A COUNTY WIDE HEALTH RE-ASSESSMENT. FROM THAT ASSESSMENT, BUFFALO COUNTY 2020 VISION WAS DEVELOPED. THE VISION IS GROUNDED IN FIVE STRATEGIC DIRECTIONS 1) ACTIVE LIVING AND HEALTHY EATING, 2) ELIMINATE HEALTH DISPARITIES, 3) HIGH IMPACT PREVENTION SERVICES, 4) HEALTHY HOMES AND SUSTAINABLE COMMUNITIES, AND 5) INJURY FREE LIVING. AS A PART OF THE 2020 VISION, COMMUNITY PARTNER COALITIONS WILL ELEVATE HEALTH ISSUES IN BUFFALO COUNTY, ENGAGE RESIDENTS IN ACCOUNTABILITY TO HEALTH, EMPOWER RESIDENTS TO CREATE CHANGE, AND EVALUATE PROGRESS TOWARD BUILDING A HEALTHIER BUFFALO COUNTY. BUILDING A HEALTHY COMMUNITY CELEBRATION 2012 GOOD SAMARITAN HOSPITAL, IN CONJUNCTION WITH THE KEARNEY PARK AND RECREATION DEPARTMENT, ORGANIZED THE 17TH ANNUAL COMMUNITY OLYMPIC GAMES, IN WHICH 879 PEOPLE REPRESENTING 32 TEAMS PARTICIPATED, THE LARGEST TEAM AND PARTICIPANT COUNT IN THE EVENT'S HISTORY. THE GAMES ARE DESIGNED TO PROMOTE A HEALTHY LIFESTYLE, COMMUNITY SPIRIT, TEAMWORK, SOCIALIZATION AND FUN. OTHER SUMMER HEALTHY COMMUNITY EVENTS INCLUDED THE GOOD SAMARITAN HOSPITAL 19TH ANNUAL 5K RUN/WALK OLYMPIAD, WITH AN ADDITIONAL 200 PARTICIPANTS. HEALTHY COMMUNITY AWARDS IN JUNE, GOOD SAMARITAN HOSPITAL RECOGNIZED AREA RESIDENTS AND ORGANIZATIONS FOR THEIR WORK IN DEVELOPING PROGRAMS THAT MAKE CENTRAL NEBRASKA A HEALTHIER PLACE TO LIVE. THE RECOGNITION IS PART OF THE HEALTHY COMMUNITY AWARDS PROGRAM, A UNIQUE OPPORTUNITY TO CELEBRATE THE GOOD HEALTH OF KEARNEY AND BUFFALO COUNTY CITIZENS AND THOSE INDIVIDUALS AND GROUPS WHO, THROUGH THEIR LEADERSHIP, EDUCATION AND ASSISTANCE, HELP MAKE THE COMMUNITY A HEALTHIER PLACE TO LIVE. THE HEALTHY COMMUNITY AWARDS PROGRAM IS IN ITS THIRD YEAR AT GOOD SAMARITAN. A COMMUNITY ADVISORY COMMITTEE SELECTED AWARD RECIPIENTS BASED ON THEIR CONTRIBUTIONS IN A PARTICULAR CATEGORY. THE AWARDS ARE WIDELY PUBLICIZED TO ENCOURAGE OTHER INDIVIDUALS AND ORGANIZATIONS TO SUPPORT HEALTHY BEHAVIORS. THE HEALTHY COMMUNITY AWARDS WERE GIVEN IN A TOTAL OF SIX CATEGORIES: ADVOCACY, EDUCATION, PREVENTION, PARTNERSHIP, LEADERSHIP AND RECREATION. WELLNESS WORKS IN 2001, KEARNEY CELEBRATED ACHIEVING WELL CITY U.S.A. STATUS IN FULFILLMENT OF A GOAL SET BY THE KEARNEY AREA WELL WORKPLACE TASK FORCE IN 1996. THE PHILOSOPHY OF WELL CITY, U.S.A. IS TO HAVE WORKSITES, INDIVIDUALLY AND COLLECTIVELY, TAKE STEPS TO CONTINUALLY IMPROVE THE HEALTH OF EMPLOYEES AND THEIR FAMILIES. WELLNESS WORKS MEMBER BENEFITS INCLUDE ANNUAL EDUCATION AND TRAINING OF SITE COORDINATORS, A WEBSITE ACCESSIBLE ONLY TO MEMBERS AS A HUB FOR ALL WELLNESS WORKS RELATED ACTIVITIES, QUARTERLY LUNCH AND LEARN OPPORTUNITIES, INCLUSION IN PARTICIPATION OF COMMUNITY EVENTS SUCH AS WALK OUT ON YOUR JOB, THE ANNUAL HEALTH AND SAFETY CONFERENCE AND THE DOMESTIC VIOLENCE 5K WALK, AN ANNUAL HEALTH RISK APPRAISAL FOR EMPLOYEES, AND DISCOUNTS FOR EMPLOYEES ON VARIOUS PRODUCTS AND SERVICES OFFERED AT PARTICIPATING WELLNESS WORKS MEMBER BUSINESSES. IN 2009, WELLNESS WORKS OF KEARNEY RELEASED NEW MEMBERSHIP CRITERIA TO PROVIDE KEARNEY AREA BUSINESSES THE OPPORTUNITY TO STRIVE TO BETTER THEIR WORKPLACE HEALTH PROMOTION PROGRAMS BY APPLYING FOR THE GOVERNOR'S AWARD FOR WELLNESS, WHICH WAS CREATED TO ENCOURAGE ALL BUSINESSES IN NEBRASKA TO OFFER WELLNESS AND HEALTH PROGRAMS FOR THEIR EMPLOYEES.
Patient education of eligibility for assistance.	Schedule H, Part VI, Line 3	GOOD SAMARITAN HOSPITAL, ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES ARE PART OF CATHOLIC HEALTH INITIATIVES ("CHI"). CHI HAS A WRITTEN POLICY (STEWARDSHIP POLICY NO. 15) GOVERNING THE PROCEDURES FOR DETERMINING AND INFORMING PATIENTS ABOUT THE ENTITY'S FINANCIAL ASSISTANCE POLICY. ALL HOSPITAL FACILITIES INCLUDED IN THE FILING ORGANIZATION HAVE ADOPTED THE POLICY. THE POLICY STATES THE ORGANIZATION WILL INCLUDE INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, GOOD SAMARITAN 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, AS WELL AS IN GOOD SAMARITAN HOSPITAL OUTPATIENT FACILITIES. IN ADDITION, GOOD SAMARITAN HOSPITAL, 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 GOOD SAMARITAN 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. GOOD SAMARITAN HOSPITAL 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. GOOD SAMARITAN 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	GOOD SAMARITAN HOSPITAL 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. GOOD SAMARITAN HOSPITAL OPERATES WITH ITS WHOLLY OWNED AFFILIATES AND COMMUNITY PARTNERS, ALONG WITH ITS FUNDRAISING ARM, THE GOOD SAMARITAN HOSPITAL FOUNDATION, TO SERVE THE HEALTH CARE NEEDS OF THE KEARNEY, NEBRASKA COMMUNITIES.

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Records Maintained	true	RecordsMaintained

Recipient Table RecipientTable (9 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EIN Of RecipientEINOfRecipient	IRC SectionIRCSection	Amount Of Cash GrantAmountOfCashGrant	Purpose Of GrantPurposeOfGrant	Amount Of Non Cash AssistanceAmountOfNonCashAssistance	Method Of ValuationMethodOfValuation	Description Of Non Cash AssistanceDescriptionOfNonCashAssistance
KEARNEY PUBLIC SCHOOLS
310 W 24TH STREET	KEARNEY	NE	68845	476001393	501(C)(3)	50000	PROGRAM SUPPORT
BUFFALO COUNTY COMMUNITY PARTNERSHIP
1755 PRAIRIE VIEW PLACE	KEARNEY	NE	68845	205852415	501(C)(3)	35000	PROGRAM SUPPORT
COMMUNITY ACTION PARTNERSHIP MID NEBRASKA
16 W 11TH STREET	KEARNEY	NE	68847	476039628	501(C)(3)	39280	PROGRAM SUPPORT
MOUNT ST FRANCIS
7665 ASSISI HTS	COLORADO SPRINGS	CO	80919	840405261	501(C)(3)	6500	PROGRAM SUPPORT
GOOD SAMARITAN HOSPITAL FOUNDATION
111 WEST 31ST STREET	KEARNEY	NE	68847	476059443	501(C)(3)	350000	PROGRAM SUPPORT
CHI NEBRASKA
555 S 70TH STREET	LINCOLN	NE	68510	363233121	501(C)(3)	8766132	PROGRAM SUPPORT
THE PHYSICIAN NETWORK
2000 Q STREET SUITE 500	LINCOLN	NE	68513	470780857	501(C)(3)	2528848	PROGRAM SUPPORT
GOOD SAMARITAN OUTREACH SERVICES
3219 CENTRAL AVENUE SUITE 105	KEARNEY	NE	68847	470659440	N/A	2780000	PROGRAM SUPPORT
JEWISH HOSPITAL
200 ABRAHAM FLEXNER WAY	LOUISVILLE	KY	40202	611029768	501(C)(3)		PROGRAM SUPPORT	20208	FMV	FIXED ASSET TRANSFER

Field	Value	IRS element (for citing)
Total Nbr Of501 C3 And Govt Grants	8	TotalNbrOf501C3AndGovtGrants
Total Nbr Of Other Organizations	1	TotalNbrOfOtherOrganizations

Form990 Schedule I Part III Form990ScheduleIPartIII

Field	Value	IRS element (for citing)
Type Of Grant	PATIENT FINANCIAL ASSISTANCE	TypeOfGrant
Number Of Recipients	422	NumberOfRecipients
Amount Of Cash Grant	42236	AmountOfCashGrant
Amount Of Non Cash Assistance	2545	AmountOfNonCashAssistance
Method Of Valuation	FMV	MethodOfValuation
Description Of Non Cash Assistance	VARIOUS HOUSING AND PHARMACY PURCHASES	DescriptionOfNonCashAssistance

Form990 Schedule I Part IV Form990ScheduleIPartIV (2 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Procedures for monitoring use of grant funds	Schedule I, Part I, Line 2	IN THE CASE OF A RELATED PARTY, A RESTRICTED FUND AGREEMENT IS IN PLACE AND, IN OTHER CASES A PLEDGE AGREEMENT MAY BE IN PLACE. DONATIONS ARE ALSO MADE AS SOLICITED BY VARIOUS EXEMPT ORGANIZATIONS AND GOOD SAMARITAN HOSPITAL RELIES ON THOSE ORGANIZATIONS TO USE THE GRANTS IN ACCORDANCE WITH EACH ORGANIZATION'S EXEMPT PURPOSE.
PROCEDURES FOR MONITORING FINANCIAL ASSISTANCE GRANTS	SCHEDULE I, PART III	FUNDS ARE RELEASED TO THE HOSPITAL FOR USE FOR CANCER PATIENTS. THE CANCER CENTER STAFF PROVIDES GAS CARDS FOR PATIENTS IN NEED TO TRAVEL TO THE CANCER CENTER TO RECEIVE WEEKLY TREATMENTS. THE FUNDS ARE MONITORED BY PATIENTS SHOWING UP FOR APPOINTMENTS. IN SOME CASES PATIENTS ARE ALSO PROVIDED HOUSING TO BE ABLE TO STAY IN KEARNEY NEAR THE HOSPITAL WHILE THEY ARE RECEIVING TREATMENT.

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Travel For Companions	X	TravelForCompanions
Idemnification Gross Up Payments	X	IdemnificationGrossUpPayments
Written Policy Re T And E Expenses	true	WrittenPolicyReTAndEExpenses
Substantiation Required	true	SubstantiationRequired
Severance Payment	true	SeverancePayment
Supplemental Nonqual Retire Plan	true	SupplementalNonqualRetirePlan
Equity Based Comp Arrangement	false	EquityBasedCompArrangement
Comp Based On Revenue Of Filing Org	false	CompBasedOnRevenueOfFilingOrg
Comp Based On Revenue Related Orgs	false	CompBasedOnRevenueRelatedOrgs
Comp Based Net Earnings Filing Org	false	CompBasedNetEarningsFilingOrg
Comp Based Net Earnings Relate Orgs	false	CompBasedNetEarningsRelateOrgs
Any Non Fixed Payments	false	AnyNonFixedPayments
Initial Contract Exception	false	InitialContractException

Form990 Schedule J Part II Form990ScheduleJPartII (14 entries)

Base Compensation Filing OrgBaseCompensationFilingOrg	Comp Based On Related OrgsCompBasedOnRelatedOrgs	Bonus Filing OrgBonusFilingOrg	Bonus Related OrgsBonusRelatedOrgs	Other Compensation Filing OrgOtherCompensationFilingOrg	Other Compensation Related OrgsOtherCompensationRelatedOrgs	Deferred Comp Filing OrgDeferredCompFilingOrg	Deferred Comp Related OrgsDeferredCompRelatedOrgs	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrg	Nontaxable Benefits Related OrgsNontaxableBenefitsRelatedOrgs	Total Compensation Filing OrgTotalCompensationFilingOrg	Total Compensation Related OrgsTotalCompensationRelatedOrgs	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrg	Comp Report Prior990 Related OrgsCompReportPrior990RelatedOrgs
CAROL WAHL
204933	0	37749	0	9669	0	27578	0	7932	0	287861	0	0	0
ELIZABETH TAYLOR-TRUJILLO
111966	0	8443	0	376	0	10078	0	21679	0	152542	0	0	0
FISHEL LIBERMAN
499699	0	90067	0	47911	0	20228	0	22154	0	680059	0	0	0
GEORGE HARMS
205696	0	38265	0	8856	0	22678	0	20282	0	295777	0	0	0
HUGO GONZALEZ NIETO
55966	181030	50118	49194	30126	1675	0	20228	16463	84	152673	252211	0	0
JOHN ALLEN
0	0	0	0	0	203513	0	0	0	6955	0	210468	0	10554
KENNETH SMOOT
119768	0	21854	0	8496	0	12331	0	6970	0	169419	0	0	0
LEIGH BERTHOLF
0	184384	0	25599	0	386	0	24181	0	19454	0	254004	0	0
MICHAEL SCHNIEDERS
0	357443	0	108676	0	271854	0	52520	0	20074	0	810567	0	0
NICKI L BOHL
128500	0	12002	0	109	0	13053	0	14188	0	167852	0	0	0
ROBERT CUNNINGHAM
181923	0	33243	0	12491	0	21114	0	19190	0	267961	0	0	0
ROBERT LANIK
0	532784	0	194611	0	154814	0	32478	0	13968	0	928655	0	81987
STEPHEN LEURCK
0	0	0	0	199502	71892	0	0	0	0	199502	71892	0	0
TODD STOVER
141947	0	10256	0	7085	0	17286	0	19932	0	196506	0	0	0

Form990 Schedule J Part III Form990ScheduleJPartIII (5 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Travel for companions	Schedule J, Part I, Line 1a	GOOD SAMARITAN HOSPITAL PROVIDES FOR COMPANION TRAVEL FOR ITS BOARD MEMBERS WHEN DEEMED APPROPRIATE. THESE BENEFITS ARE PAID AND GROSSED-UP PURSUANT TO A WRITTEN POLICY. ALL SUCH BENEFITS ARE INCLUDED IN THE INDIVIDUAL'S FORM W-2.
Tax indemnification and gross-up payments	Schedule J, Part I, Line 1a	GOOD SAMARITAN HOSPITAL PROVIDES FOR COMPANION TRAVEL FOR ITS BOARD MEMBERS WHEN DEEMED APPROPRIATE. THESE BENEFITS ARE PAID AND GROSSED-UP PURSUANT TO A WRITTEN POLICY. ALL SUCH BENEFITS ARE INCLUDED IN THE INDIVIDUAL'S FORM W-2.
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 or change-of-control payment	Schedule J, Part I, Line 4a	POST-TERMINATION PAYMENTS ARE ADDRESSED IN THE EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVE'S ("CHI") 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 CATHOLIC HEALTH INITIATIVES (A RELATED ORGANIZATION) DURING THE 2011 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE COMPENSATION ON SCHEDULE J: JOHN ALLEN; $195,195.
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: JOHN ALLEN, ROBERT LANIK, MICHAEL SCHNIEDERS DURING 2011 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: MICHAEL SCHNIEDERS $32,292. DURING 2011 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: JOHN ALLEN $10,554. 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: ROBERTLANIK $45,883. DURING THE CALENDAR YEAR 2011 GOOD SAMARITAN HOSPITAL INSTITUTED A CALL PAY PLAN. THE PLAN IS A DEFINED CONTRIBUTION, NONQUALIFIED DEFERRED COMPENSATION PLAN THAT PROVIDES FOR CONTRIBUTIOINS TO A PARTICIPANT'S ACCOUNT, BUT DOES NOT PROMISE ANY PARTICULAR ULTIMATE BENEFIT TO PARTICIPANTS. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THE PLAN: RICHARD HRANAC DURING THE CALENDAR YEAR 2011 THE FOLLOWING CONTRIBUTIONS WERE MADE TO THE CALL PAY PLAN; RICHARD HRANAC, $29,603. DURING THE CALENDAR YEAR 2011 THE FOLLOWING DISTRIBUTIONS WERE MADE FROM THE CALL PAY PLAN; RICHARD HRANAC, $25,196.

Schedule O IRS990ScheduleO

General Explanation GeneralExplanation (12 entries)

IdentifierIdentifier	Return ReferenceReturnReference	ExplanationExplanation
Delegate broad authority to a committee	Form 990, Part VI, Section A, Line 1a	PURSUANT TO SECTION 8.6 OF THE BYLAWS OF GOOD SAMARITAN HOSPITAL, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND CEO, THE VICE PRESIDENT OF MEDICAL AFFAIRS, THE TREASURER, AND THE PRESIDENT OF THE MEDICAL STAFF EACH OF WHOM SERVES AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND AT LEAST THREE DIRECTORS APPOINTED BY THE BOARD. 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 HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS.
Classes of members or stockholders	Form 990, Part VI, Section A, Line 6	THE SOLE MEMBER OF THE CORPORATION IS CHI NEBRASKA, A NEBRASKA NONPROFIT CORPORATION.
Members or stockholders electing members of governing body	Form 990, Part VI, Section A, Line 7a	CHI NEBRASKA HAS THE POWER TO APPOINT, REMOVE OR REPLACE 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 CHI NEBRASKA. PURSUANT TO SECTION 5.1 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI NEBRASKA BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI NEBRASKA CHIEF EXECUTIVE OFFICER: -APPROVE MEMBERS OF THE GOOD SAMARITAN HOSPITAL BOARD -AMENDMENT OF THE CORPORATE DOCUMENTS OF THE GOOD SAMARITAN HOSPITAL -APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE GOOD SAMARITAN HOSPITAL -ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE GOOD SAMARITAN HOSPITAL -SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE GOOD SAMARITAN HOSPITAL -REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE GOOD SAMARITAN HOSPITAL -APPROVAL OF ISSUANCE OF DEBT BY GOOD SAMARITAN HOSPITAL -APPROVAL OF PARTICIPATION OF GOOD SAMARITAN HOSPITAL IN A JOINT VENTURE -APPROVAL OF FORMATION OF A NEW CORPORATION BY GOOD SAMARITAN HOSPITAL -APPROVAL OF A MERGER INVOLVING THE GOOD SAMARITAN HOSPITAL -APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE GOOD SAMARITAN HOSPITAL -TO REQUIRE THE TRANSFER OF ASSETS BY THE GOOD SAMARITAN HOSPITAL TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION 5.2 OF THE ORGANIZATION'S BYLAWS, GOOD SAMARITAN HOSPITAL OR CHI NEBRASKA 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, THE RETURN IS REVIEWED BY THE VICE PRESIDENT OF FINANCE. THE VICE PRESIDENT OF FINANCE PROVIDES A COPY OF THE RETURN TO THE GOOD SAMARITAN HOSPITAL BOARD EITHER AT A BOARD MEETING OR ELECTRONICALLY. SUBSEQUENT TO PROVIDING A COPY 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	DISCLOSURE, REVIEW AND INITIAL DETERMINATION 1) GENERAL OBLIGATION. EACH DIRECTOR MUST PROMPTLY AND FULLY REPORT TO THE BOARD CHAIR SITUATIONS THAT MAY CREATE A CONFLICT OF INTEREST WHEN HE OR SHE BECOMES AWARE OF SUCH SITUATIONS. IN ANY SITUATION WHEN A DIRECTOR IS IN DOUBT, FULL DISCLOSURE SHOULD BE MADE SO AS TO PERMIT AN IMPARTIAL AND OBJECTIVE DETERMINATION. A WRITTEN RECORD OF THE DISCLOSURE WILL BE MADE. 2) ANNUAL DISCLOSURE STATEMENT. IN ADDITION TO THE ONGOING DISCLOSURE OBLIGATION, THE CORPORATION'S PRESIDENT AND CHIEF EXECUTIVE OFFICER SHALL ANNUALLY SEND TO ALL DIRECTORS A COPY OF THIS POLICY AND THE CONFLICT OF INTEREST DISCLOSURE STATEMENT. THE DIRECTOR MUST PROMPTLY COMPLETE, SIGN AND RETURN THE STATEMENT TO THE CORPORATION'S PRESIDENT AND CHIEF EXECUTIVE OFFICE. THE COMPLETED STATEMENT WILL BE REVIEWED BY THE PRESIDENT AND CHIEF EXECUTIVE OFFICER AND THE BOARD CHAIR. 3) REVIEW, EVALUATION AND INITIAL DETERMINATION. THE BOARD CHAIR OR DESIGNEE SHALL MAKE SUCH FURTHER INVESTIGATION OF ANY CONFLICT OF INTEREST DISCLOSURES AS HE OR SHE MAY DEEM APPROPRIATE. IF THE CONFLICT INVOLVES THE BOARD CHAIR, THE VICE CHAIR WILL ASSUME THE CHAIR'S ROLE OUTLINED IN THIS POLICY. BASED ON REVIEW AND EVALUATION OF THE RELEVANT FACTS AND CIRCUMSTANCES, THE BOARD CHAIR WILL MAKE AN INITIAL DETERMINATION AS TO WHETHER A CONFLICT OF INTEREST EXISTS AND WHETHER, PURSUANT TO THIS POLICY, REVIEW AND APPROVAL OR OTHER ACTION BY THE BOARD OF DIRECTORS IS REQUIRED. A WRITTEN RECORD OF THE BOARD CHAIR'S DETERMINATION, INCLUDING RELEVANT FACTS AND CIRCUMSTANCES, WILL BE MADE. THE BOARD CHAIR SHALL THEN MAKE AN APPROPRIATE REPORT TO THE EXECUTIVE COMMITTEE OF THE BOARD CONCERNING SUCH REVIEW, EVALUATION AND DETERMINATION. IF A DIFFERENCE OF OPINION EXISTS BETWEEN THE BOARD CHAIR AND ANOTHER DIRECTOR AS TO WHETHER THE FACTS AND CIRCUMSTANCES OF A GIVEN SITUATION CONSTITUTE A CONFLICT OF INTEREST OR WHETHER BOARD OF DIRECTORS REVIEW AND APPROVAL OR OTHER ACTION IS REQUIRED WITHIN THIS POLICY, THE MATTER SHALL BE SUBMITTED TO THE BOARD'S EXECUTIVE COMMITTEE, WHICH SHALL MAKE A FINAL DETERMINATION AS TO THE MATTER PRESENTED. SUCH DETERMINATION, INCLUDING RELEVANT FACTS AND CIRCUMSTANCES, WILL BE REFLECTED IN THE COMMITTEE MINUTES AND WILL BE REPORTED TO THE BOARD OF DIRECTORS. BOARD REVIEW: 1) TRANSACTIONAL CONFLICTS OF INTEREST. THE BOARD OF DIRECTORS SHALL CAREFULLY SCRUTINIZE AND MUST IN GOOD FAITH APPROVE OR DISAPPROVE ANY TRANSACTION IN WHICH THE CORPORATION AND/OR ANY OF ITS AFFILIATES IS A PARTY AND IN WHICH ONE OR MORE OF THE CORPORATION'S DIRECTORS EITHER: * HAS A MATERIAL FINANCIAL INTEREST; OR * IS A DIRECTOR OF THE OTHER PARTY (OTHER THAN THE CORPORATION'S OWN AFFILIATES). 2) THE BOARD OF DIRECTORS MUST APPROVE THE TRANSACTION BY A MAJORITY OF THE DIRECTORS ON THE BOARD, WITHOUT COUNTING THE VOTE OF ANY DIRECTOR WHO HAS AN INTEREST IN THE TRANSACTION. IN REVIEWING SUCH TRANSACTIONS BETWEEN THE CORPORATION AND VENDORS OR OTHER CONTRACTORS WHO ARE, OR ARE AFFILIATED WITH, DIRECTORS, THE BOARD SHALL ACT NO MORE OR LESS FAVORABLY THAN IT WOULD IN REVIEWING TRANSACTIONS WITH UNRELATED THIRD PARTIES. THE TRANSACTION WILL NOT BE APPROVED UNLESS THE BOARD DETERMINES THAT THE TRANSACTION IS FAIR TO THE CORPORATION. 3) OTHER CONFLICTS OF INTEREST. THE BOARD SHALL CAREFULLY REVIEW AND SCRUTINIZE ANY NON- TRANSACTIONAL CONFLICT OF INTEREST (E.G. DISCLOSURE OF NONPUBLIC INFORMATION, COMPETITION WITH THE CORPORATION, FAILURE TO DISCLOSE A CORPORATE OPPORTUNITY, EXCESSIVE GIFTS OR ENTERTAINMENT, ETC.)BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS, THE BOARD SHALL TAKE WHATEVER ACTION IS DEEMED APPROPRIATE WITH RESPECT TO THE DIRECTOR UNDER THE CIRCUMSTANCES, INCLUDING POSSIBLE DISCIPLINARY OR CORRECTIVE ACTION, IN ORDER TO BEST PROTECT THE INTERESTS OF THE CORPORATION. THE BOARD SHOULD CONSULT WITH A MEMBER OF THE CHI LEGAL RESOURCE GROUP WHEN CONSIDERING DISCIPLINARY OR CORRECTIVE ACTION. 4) DISCLOSURE BY INTERESTED DIRECTOR. WHEN ANY CONFLICT OF INTEREST IS CONSIDERED BY THE BOARD, THE DIRECTOR MUST DISCLOSE ALL OF THE MATERIAL FACTS TO THE BOARD. THE DIRECTOR SHALL NOT VOTE OR USE HIS OR HER PERSONAL INFLUENCE ON THE MATTER. HOWEVER, IF REQUESTED, SUCH DIRECTOR IS NOT PREVENTED FROM BRIEFLY STATING HIS OR HER POSITION IN THE MATTER, NOR FROM ANSWERING PERTINENT QUESTIONS FROM BOARD MEMBERS, AS HIS OR HER KNOWLEDGE MAY BE OF SIGNFICIANT IMPORTANCE. THE DIRECTOR SHALL BE EXCUSED FROM THE MEETING DURING DISCUSSION AND VOTE ON THE CONFLICT OF INTEREST. 5) RECORD OF PROCEEDINGS. MINUTES OF THE BOARD OF DIRECTORS SHALL REFLECT THE FOLLOWING: THE INDIVIDUAL MAKING THE DISCLOSURE, THE NATURE OF THE DISCLOSURE, DISCUSSSION REGARDING ANY PROPOSED TRANSACTION, THE DECISION MADE BY THE BOARD, AND THAT THE INTERESTED DIRECTOR ABSTAINED FROM VOTING. 6) IMPLEMENTATION AND INTERPRETATION. QUESTIONS REGARDING THE IMPLEMENTATION AND INTERPRETATION OF THIS POLICY SHALL BE REFERRED TO A MEMBER OF THE CHI LEGAL RESOURCE GROUP. POLICY VIOLATIONS: IF THE BOARD REASONABLY BELIEVES THAT A DIRECTOR HAS FAILED TO DISCLOSE EITHER AN ACTUAL OR POTENTIAL CONFLICT OF INTEREST, OR ALL MATERIAL FACTS SURROUNDING AN ACTUAL OR POSSIBLE CONFLICT AS REQUIRED BY THIS POLICY, THE DIRECTOR WILL BE GIVEN AN OPPORTUNITY TO EXPLAIN SUCH ALLEGED FAILURE TO DISCLOSE. AFTER HEARING THE RESPONSE OF THE DIRECTOR, THE BOARD WILL CONDUCT SUCH ADDITIONAL INVESTIGATION AS MAY BE APPROPRIATE. IF THE BOARD DETERMINES THAT THE DIRECTOR HAS IN FACT FAILED TO DISCLOSE AS REQUIRED BY THIS POLICY, THE BOARD SHALL TAKE APPROPRIATE DISCIPLINARY OR CORRECTIVE ACTION. WHETHER BOARD OF DIRECTORS REVIEW AND APPROVAL OR OTHER ACTION IS REQUIRED WITHIN THIS POLICY, THE MATTER SHALL BE SUBMITTED TO THE BOARD'S EXECUTIVE COMMITTEE, WHICH SHALL MAKE A FINAL DETERMINATION AS TO THE MATTER PRESENTED. SUCH DETERMINATION, INCLUDING RELEVANT FACTS AND CIRCUMSTANCES, WILL BE REFLECTED IN THE COMMITTEE MINUTES AND WILL BE REPORTED TO THE BOARD OF DIRECTORS. IT IS ESSENTIAL THAT ALL EMPLOYEES OF GOOD SAMARITAN HOSPITAL AVOID ANY SITUATION OR ENDEAVOR THAT COULD INTERFERE WITH OR CREATE CONFLICTS WITH PERSONAL INTEREST. ALL MANAGEMENT EMPLOYEES OF GOOD SAMARITAN HOSPITAL (GSH) WILL COMPLETE THE "AGREEMENT TO DISCLOSE CONFLICT OF INTEREST AND MAINTAIN CONFIDENTIALITY OF INFORMATION" FORM UPON ASSUMING OFFICE OR EMPLOYMENT, AND ANNUALLY THEREAFTER. IF A POTENTIAL CONFLICT OF INTEREST ARISES BETWEEN ANNUAL DISCLOSURE DATES, THE INDIVIDUAL WILL IMMEDIATELY DISCLOSE RELEVANT INFORMATION TO THE CEO OR VP, HR OF GSH. DISCLOSURE STATEMENTS PROVIDE GSH WITH A METHOD OF RESOLVING POTENTIAL CONFLICTS OF INTEREST. THE GUIDING PRINCIPLES ARE FAIRNESS AND REASONABLENESS. IT IS NOT THE INTENT TO INHIBIT INVESTMENT OR CONDUCT EXCEPT WHEN SUCH INVESTMENT OR CONDUCT MAY BE HARMFUL TO GSH.
PROCESS USED TO EXTABLISH COMPENSATION OF 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 FOR DETERMINING COMPENSATION	FORM 990, PART VI, LINE 15B	HR ADVANTAGE HAS SERVED AS THE INDEPENDENT COMPENSATION CONSULTANT FOR THE NEBRASKA FACILITIES IN 2010. HR ADVANTAGE REVIEWED ALL NEBRASKA MINISTRIES' VP AND EXECUTIVE DIRECTORS COMPENSATION LEVELS AND PROVIDED A REPORT WITH COMPARABILITY DATA TO CHI NEBRASKA HR LEADERS TO REVIEW WITH LOCAL CEOS, CONFIRMING THE REASONABLENESS OF MBO EXECUTIVE'S COMPENSATION AND PHILOSOPHY. COMPENSATION PACKAGE AND BONUS POTENTIAL FOR EXECUTIVE LEADERS IS APPROVED BY EACH MINISTRIES LOCAL BOARDS. THE HIGHEST PAID EMPLOYEES ARE PHYSICIANS. THEIR COMPENSATION WAS REVIEWED BY AN INDEPENDENT COMPENSATION CONSULTANT. THERE IS A PHYSICIAN EMPLOYMENT AGREEMENT CONTRACT WITH EACH EMPLOYED PHYSICIAN. CONTRACTS INCLUDE A MAXIMUM COMPENSATION BASED UPON AN OVERALL PERCENTILE NATIONAL COMPENSATION PER SPECIALTY AS REPORTED IN THE MOST RECENT VERSION OF THE PHYSICIAN COMPENSATION AND PRODUCTION SURVEY AS PUBLISHED BY THE MGMA. NONE OF THE ABOVE REVIEWS TOOK PLACE DURING THE FISCAL YEAR 2012.
FORMAL POLICIES CONCERNING PARTICIPATION IN JOINT VENTURES	FORM 990, PART VI, LINE 16B	GOOD SAMARITAN HOSPITAL HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER CHI'S SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S-LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. ANY JOINT VENTURE AGREEMENTS THAT DO NOT CONFORM TO THE MODEL AGREEMENT ARE GENERALLY REVIEWED BY COUNSEL.
Governing documents, conflict of interest policy and financial statements available to the public	Form 990, Part VI, Section C, Line 19	THE ORANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAIULABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.ORG.
ESTIMATE OF 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 - -5377376; CHI CONNECT DEPRECIATION - 485163;

Schedule R IRS990ScheduleR

Form990 Schedule R Part II Form990ScheduleRPartII (127 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivities	Legal Domicile StateLegalDomicileState	Exempt Code SectionExemptCodeSection	Public Charity StatusPublicCharityStatus	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrgControlledOrg
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	NA	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 - 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 - Type I	CHI	true
ST JOSEPH HOSPITAL FOUNDATION INC
305 ESTILL STREET	LEXINGTON	KY	40504	611159649	FUNDRAISING	KY	501(C)(3)	11 - Type I	SJHS	true
ST JOSEPH MEDICAL CENTER FOUNDATION
2500 BERNVILLE ROAD PO BOX 316	READING	PA	19603	232649362	FUNDRAISING	PA	501(C)(3)	11 - Type I	SJRHN	true
ST JOSEPH MEDICAL CENTER FOUNDATION INC
7601 OSLER DRIVE	TOWSON	MD	21204	521681044	FUNDRAISING	MD	501(C)(3)	7	SJMC	true
ST JOSEPH MEDICAL CENTER INC
7601 OSLER DRIVE	TOWSON	MD	21204	520591461	HEALTHCARE	MD	501(C)(3)	3	CHI	true
ST JOSEPH MEDICAL GROUP
2500 BERNVILLE ROAD PO BOX 316	READING	PA	19603	208544021	HEALTHCARE	PA	501(C)(3)	9	BHC	true
ST JOSEPH PHYSICIAN ENTERPRISES
7601 OSLER DRIVE	TOWSON	MD	21204	521311775	PHYSICIANS	MD	501(C)(3)	11 - Type I	SJMC	true
ST JOSEPH REGIONAL HEALTH NETWORK
2500 BERNVILLE ROAD PO BOX 316	READING	PA	19603	231352211	HEALTHCARE	PA	501(C)(3)	3	CHI	true
ST JOSEPH'S AREA HEALTH SERVICES
600 PLEASANT AVENUE	PARK RAPIDS	MN	56470	410695603	HEALTHCARE	MN	501(C)(3)	3	CHI	true
ST JOSEPH'S HOSPITAL AND HEALTH CENTER
30 WEST 7TH STREET	DICKINSON	ND	58601	450226429	HEALTHCARE	ND	501(C)(3)	3	CHI	true
MERCY MEDICAL CENTER - CENTERVILLE
ONE ST JOSEPHS DRIVE	CENTERVILLE	IA	52544	420680308	HEALTHCARE	IA	501(C)(3)	3	CHI-IA CORP	true
ST MARY'S COMMUNITY HOSPITAL
1314 3RD AVENUE	NEBRASKA CITY	NE	68410	470443636	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	true
ST MARY'S HEALTHCARE CENTER
801 EAST SIOUX AVENUE	PIERRE	SD	57501	460230199	HEALTHCARE	SD	501(C)(3)	3	CHI	true
ST MARY'S HOSPITAL FOUNDATION
1314 3RD AVENUE	NEBRASKA CITY	NE	68410	470707604	FUNDRAISING	NE	501(C)(3)	7	SMH	true
ST VINCENT FOUNDATION
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	510169537	FUNDRAISING	AR	501(C)(3)	11 - Type I	SVIMC	true
ST VINCENT INFIRMARY MEDICAL CENTER
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710236917	HEALTHCARE	AR	501(C)(3)	3	CHI	true
ST VINCENT MEDICAL GROUP
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710830696	HEALTHCARE	AR	501(C)(3)	9	SVIMC	true
THE COMMUNITY LIMITED CARE DIALYSIS CENTER
619 OAK STREET ACCOUNTING-3 W	CINCINNATI	OH	45206	237419853	DIALYSIS	OH	501(C)(2)	N/A	GSH	true
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH
619 OAK STREET ACCOUNTING-3 W	CINCINNATI	OH	45206	310537486	HEALTHCARE	OH	501(C)(3)	3	CHI	true
THE MERCY HOSPITAL OF DEVILS LAKE FDN
1031 SEVENTH STREET NE	DEVILS LAKE	ND	58301	352367360	FUNDRAISING	ND	501(C)(3)	7	MHDL	true
THE PHYSICIAN NETWORK
2000 Q STREET SUITE 500	LINCOLN	NE	68503	470780857	PHYS PRACTICE	NE	501(C)(3)	11 - Type I	CHI NEBRASKA	true
TOTAL HEALTHCARE
188 INVERNESS DRIVE WEST SUITE 500	ENGLEWOOD	CO	80112	840927232	HEALTHCARE	CO	501(C)(3)	3	CHIC	true
UNITY FAMILY HEALTHCARE
815 2ND STREET SE	LITTLE FALLS	MN	56345	410721642	HEALTHCARE	MN	501(C)(3)	3	CHI	true
VILLA NAZARETH INC
801 PAGE DRIVE	FARGO	ND	58103	450226714	LT CARE	ND	501(C)(3)	9	CHI	true
VISITING NURSE ASSOCIATION OF SAINT CLARE'S
191 WOODPORT ROAD	SPARTA	NJ	07871	221768334	HOME HEALTH	NJ	501(C)(3)	9	SCHS	true

Form990 Schedule R Part III Form990ScheduleRPartIII (23 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Predominant Income TypePredominantIncomeType	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Disproportionate AllocationsDisproportionateAllocations	General Or Managing PartnerGeneralOrManagingPartner	Percentage OwnershipPercentageOwnership	Code VCodeVAmount
AUDUBON LAND COMPANY LLC
5390 N ACADEMY BLVD SUITE 300	COLORADO SPRINGS	CO	80918	841513085	REAL ESTATE	CO	CHIC	RELATED	34991	-694032	false	false	0.501
AVANTAS LLC
11128 JOHN GALT BLVD SUITE 400	OMAHA	NE	68137	392045003	HEALTHCARE	NE	AHBMHS	RELATED	-2862040	-2537888	false	false	0.95
BERYWOOD OFFICE PROPERTIES LLC
400 BERYWOOD TRAIL	CLEVELAND	TN	37312	621875199	PHYS OFFICE	TN	MHCS	RELATED	57545	1013237	false	true	0.63
BLUEGRASS REGIONAL IMAGING CENTER
1218 SOUTH BROADWAY SUITE 310	LEXINGTON	KY	40504	611386736	DIAGNOSTIC	KY	SJHS	RELATED			false	false	0.65
CENTRAL NEBRASKA HOME CARE SERVICES
PO BOX 1146-4510 SECOND AVENUE	KEARNEY	NE	68848	470692112	HEALTHCARE SRVC	NE	NA	RELATED	-92336	745068	false	true	1
CENTRAL NEBRASKA REHAB SERVICE
3004 W FAIDLEY AVE	GRAND ISLAND	NE	68802	810653461	PHYSICAL THERAPY	NE	SFMC	RELATED	1835812	2199571	false	false	0.51
CHI OPERATING INVESTMENT PROGRAM LP
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	470727942	INVESTMENTS	CO	CHI	UNRELATED	397241271	6272650880	false	true	1
HEALTHCARE SUPPORT SERVICES
PO BOX 9804	GRAND ISLAND	NE	68802	721546196	LAUNDRY	NE	NA	RELATED	-11179	3069835	false	false	1
MRI AT ST JOSEPH MEDICAL CENTER LLC
7253 AMBASSADOR ROAD	BALTIMORE	MD	21244	521958002	MEDICAL IMAGING	MD	SJMC	RELATED	423167	2174155	false	true	0.51
NORTH RIVER SURGERY CENTER LLC
2209 WILDWOOD AVENUE	SHERWOOD	AR	72120	710799771	AMBUL SURG CTR	AR	SVIMC	RELATED	81071	1077536	false	false	0.5744
O'DEA MEDICAL ARTS LIMITED PARTNERSHIP
7601 OSLER DRIVE	TOWSON	MD	21204	521682964	REAL ESTATE	MD	TOWSON MANAGEMENT INC	RELATED	111933	5418117	false	false	0.65122
ORTHOCOLORADO LLC
11650 WEST 2ND PLACE	LAKEWOOD	CO	80255	371577105	ORTHO HOSPITAL	CO	CHIC	RELATED	-3249434	-2760206	false	false	0.6
PENINSULA RADIATION ONCOLOGY
315 MARTIN LUTHER KING JR WAY 111	TACOMA	WA	98405	710799771	HEALTHCARE SRVC	WA	FHS	RELATED	135014	85985	false	false	0.6
PENRAD IMAGING
1390 KELLY JOHNSON BLVD	COLORADO SPRINGS	CO	80920	841072619	MEDICAL IMAGING	CO	CHIC	RELATED	715094	2397488	false	false	0.7
RUXTON SURGICENTER LLC
8322 BELLONA AVENUE SUITE 201	BALTIMORE	MD	21204	522095835	SURGERY CENTER	MD	SJMC	RELATED	-69345	2802932	false	true	0.51
SAINT JOSEPH - SCA HOLDINGS LLC
424 LEWIS HARGETT CIRCLE STE 160	LEXINGTON	KY	40503	453801157	OP SURGERY	DE	SJHS	RELATED			false	true	0.51
SCA PREMIER SURGERY CENTER OF LOUISVILLE LLC
200 ABRAHAM FLEXNER WAY	LOUISVILLE	KY	40202	721386840	SURGERY CENTER	KY	JH	RELATED	68676	446063	false	true	0.51
ST FRANCIS LAND COMPANY
5390 N ACADEMY BLVD SUITE 300	COLORADO SPRINGS	CO	80918	263134100	REAL ESTATE	CO	CHIC	RELATED	-130967	408090	false	false	0.51
ST FRANCIS MEDICAL CENTER ASSOCIATES
1717 SOUTH J STREET	TACOMA	WA	98405	911352698	MED. OFFICE	WA	FHS	RELATED	110986	1672098	false	false	0.5421
ST JOSEPH-PAML LLC
424 LEWIS HARGETT CIRCLE STE 160	LEXINGTON	KY	40503	452116736	MGMT SVCS	KY	SJHS	RELATED			false	true	0.625
SUPERIOR MEDICAL IMAGING LLC
5000 NORTH 26TH STREET	LINCOLN	NE	68521	262884555	OP DIAGNOSTICS	NE	SERMC	RELATED	-254775	796941	false	false	0.51	$0
SURGERY CENTER OF LEXINGTON LLC
424 LEWIS HARGETT CIRCLE STE 160	LEXINGTON	KY	40503	621179539	SURGERY CENTER	DE	SJHS	RELATED	393519	2214599	false	true	0.51
SURGERY CENTER OF LOUISVILLE LLC
200 ABRAHAM FLEXNER WAY	LOUISVILLE	KY	40202	621179537	SURGERY CENTER	KY	JH	RELATED	-3676	395845	false	true	0.51

Form990 Schedule R Part IV Form990ScheduleRPartIV (45 entries)

Address Line1AddressUS/AddressLine1	CityAddressUS/City	StateAddressUS/State	ZIP CodeAddressUS/ZIPCode	EINEIN	Primary ActivityPrimaryActivity	Legal Domicile StateLegalDomicileState	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Type Of EntityTypeOfEntity	Share Of Total IncomeShareOfTotalIncome	Share Of EOY AssetsShareOfEOYAssets	Percentage OwnershipPercentageOwnership	Address Line1AddressForeign/AddressLine1	CityAddressForeign/City	Province Or StateAddressForeign/ProvinceOrState	CountryAddressForeign/Country	Postal CodeAddressForeign/PostalCode	Legal Domicile Foreign CountryLegalDomicileForeignCountry
ALTERNATIVE INSURANCE MANAGEMENT SERVICE
3900 OLYMPIC BOULEVARD SUITE 400	ERLANGER	KY	41018	841112049	MANAGEMENT SERVICES	CO	CHI	C CORPORATION	0	3267441	1
AMERICAN NURSING CARE
1700 EDISON DRIVE	MILFORD	OH	45150	311085414	HOME HEALTH	OH	CHS	C CORPORATION	4648726	44654199	1
AMERIMED INC
1700 EDISON DRIVE	MILFORD	OH	45150	311158699	HOME HEALTH	OH	ANC	C CORPORATION	662062	11666874	1
BC HOLDING COMPANY INC
1850 BLUEGRASS AVE	LOUISVILLE	KY	40215	311542851	FITNESS CLUB	KY	JH	C CORPORATION	0	0	1
CADUCEUS MEDICAL ASSOCIATES INC
5600 BRAINERD ROAD SUITE 500	CHATTANOOGA	TN	37411	621570736	HEALTHCARE	TN	MHCS	C CORPORATION	0	1008	1
CAPTIVE MANAGEMENT INITIATIVES
				980663022	CAPTIVE MANAGEMENT		CHI	C CORPORATION	0	0	1	PO BOX 10073 APO	GEORGETOWN	GRAND CAYMAN	CJ	KY1-1001	CJ
CATHOLIC HEALTH INITIATIVES CENTER FOR TRANSLATIONAL RESEARCH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	272269511	RESEARCH	CO	CIRI	TRUST	-2864605	2809707	1
CGH REALTY COMPANY INC
215 N 12TH ST	READING	PA	19603	232326801	REAL ESTATE	PA	SJHM	C CORPORATION			1
COMCARE SERVICES
4231 W 16TH AVENUE	DENVER	CO	80204	840904813	INACTIVE	CO	CHIC	C CORPORATION	0	0	1
CONSOLIDATED HEALTH SERVICES
1700 EDISON DRIVE	MILFORD	OH	45150	311378212	HOME HEALTH	OH	CHI	C CORPORATION	-1525246	65844862	1
DAVID DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810	KEARNEY	NE	68848	476192395	INVESTMENTS	NE	GSHF	TRUST			1
DES MOINES MEDICAL CENTER INC
1111 6TH AVENUE	DES MOINES	IA	50314	420837382	REAL ESTATE	IA	CHI-IA CORP	C CORPORATION	71497	1221667	0.9298
FIRST INITIATIVES INSURANCE LTD
				980203038	INSURANCE		CHI	C CORPORATION	0	0	1	PO BOX 10073 APO	GEORGETOWN	GRAND CAYMAN	CJ	KY1-1001	CJ
FRANCISCAN SERVICES INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	232487967	HEALTHCARE	CO	CHI	C CORPORATION	-5719	5837142	1
GOOD SAMARITAN OUTREACH SERVICES
PO BOX 1990	KEARNEY	NE	68848	470659440	MEDICAL CLINIC	NE	CHI NEBRASKA	C CORPORATION	-165666	355110	1
HAROLD W RASE 1995 CHARITABLE UNITRUST
30 WEST 7TH STREET	DICKINSON	ND	58601	456090420	INVESTMENTS	ND	SJHHC	TRUST	1240	22148	1
HAROLD W RASE 1996 CHARITABLE UNITRUST
30 WEST 7TH STREET	DICKINSON	ND	58601	206037112	INVESTMENTS	ND	SJHHC	TRUST	1057	15462	1
HAROLD W RASE 1997 CHARITABLE UNITRUST
30 WEST 7TH STREET	DICKINSON	ND	58601	206037104	INVESTMENTS	ND	SJHHC	TRUST	0	20520	1
HAROLD W RASE 1999 CHARITABLE UNITRUST
30 WEST 7TH STREET	DICKINSON	ND	58601	206037099	INVESTMENTS	ND	SJHHC	TRUST	0	25036	1
HEALTH SYSTEMS ENTERPRISES INC
PO BOX 1990	KEARNEY	NE	68848	470664558	MANAGEMENT	NE	GSH	C CORPORATION	102136	1443049	1
HEALTHCARE MGMT SERVICES ORG INC
1149 MARKET ST	TACOMA	WA	98402	911865474	HEALTH ORG.	WA	FHS	C CORPORATION	0	0	1
JAMES & HENRIETTA NISTLER UNITRUST
30 WEST 7TH STREET	DICKINSON	ND	58601	206021899	INVESTMENTS	ND	SJHHC	TRUST	692	39075	1
JEANNE DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810	KEARNEY	NE	68848	476192398	INVESTMENTS	NE	GSHF	TRUST			1
JOSEPH A SCHUSTER ANNUITY TRUST #1
400 UNIVERSITY AVENUE	DES MOINES	IA	50314	421195122	INVESTMENTS	IA	MFDM	TRUST	7834	416349	1
LODESCA MILLER CHARITABLE REMAINDER UNITRUST
PO BOX 1810	KEARNEY	NE	68848	476186933	INVESTMENTS	NE	GSHF	TRUST			1
MEDQUEST
1301 15TH AVENUE WEST	WILLISTON	ND	58801	450392137	SALE OF DME	ND	MMC WILLISTON	C CORPORATION	151498	962554	1
MERCY PARK APARTMENTS LTD
1111 6TH AVENUE	DES MOINES	IA	50314	421202422	HOUSING	IA	CHI-IA CORP	C CORPORATION	369905	1937220	1
MERCY SERVICES CORP
2700 STEWART PARKWAY	ROSEBURG	OR	97470	930824308	RETAIL SALES	OR	MMC	C CORPORATION	0	956003	1
MHSERVICES CORPORATION
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	431457881	DME	MO	SJRMC	C CORPORATION	-4061	0	1
MOUNTAIN MANAGEMENT SERVICES INC
5600 BRAINERD ROAD SUITE 500	CHATTANOOGA	TN	37411	621570739	MGMT SVC ORG	TN	MHCS	C CORPORATION	-33152	4679435	1
NAZARETH ASSURANCE COMPANY
				030304831	INSURANCE		CHI	C CORPORATION	0	0	1	PO BOX 10073 APO	GEORGETOWN	GRAND CAYMAN	CJ	KY1-1001	CJ
PATIENT TRANSPORT SERVICES INC
1700 EDISON DRIVE	MILFORD	OH	45150	311100798	HOME HEALTH	OH	ANC	C CORPORATION	479940		1
PHYSICIAN HEALTH SYSTEM NETWORK
1149 MARKET ST	TACOMA	WA	98402	911746721	HEALTH ORG.	WA	FHS	C CORPORATION	0	0	1
RAY & SHIRLEY DAVID 1999 UNITRUST
30 WEST 7TH STREET	DICKINSON	ND	58601	206037077	INVESTMENTS	ND	SJHHC	TRUST	0	26110	1
ROBERT & WANDA CHARITABLE REMAINDER UNITRUST
PO BOX 1810	KEARNEY	NE	68848	266191916	INVESTMENTS	NE	GSHF	TRUST			1
SAINT CLARE''S PRIMARY CARE INC
66 FORD ROAD	DENVILLE	NJ	07834	222441202	BILLING SERVICES	NJ	SCCC	C CORPORATION	-469962	1772016	1
SAMARITAN FAMILY CARE INC
40 W FOURTH ST 1700	DAYTON	OH	45402	311299450	HEALTHCARE	OH	SHP	C CORPORATION			1
SJH SERVICES CORPORATION
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	232307408	HEALTHCARE	CO	FSI	C CORPORATION	-192777	2973858	1
SJL PHYSICIAN MANAGEMENT SERVICES INC
424 LEWIS HARGETT CR 160	LEXINGTON	KY	40503	270164198	MANAGEMENT	KY	SJHS	C CORPORATION	0	0	1
ST ANTHONY DEVELOPMENT COMPANY
1415 SOUTHGATE	PENDLETON	OR	97801	931216943	ATHLETIC CLUB	OR	SAH	C CORPORATION	92139	3007550	1
ST VINCENT COMMUNITY HEALTH SERVICES INC
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710710785	HEALTHCARE	AR	SVIMC	C CORPORATION	2804485	14049374	1
ST JOSEPH DEVELOPMENT COMPANY INC
1717 SOUTH J STREET	TACOMA	WA	98405	911480569	RENTAL	WA	FSI	C CORPORATION	63164	11845439	1
ST JOSEPH OFFICE PARK ASSOCIATION
1401 HARRODSBURG ROAD BLDG B70	LEXINGTON	KY	40504	611079899	MANAGEMENT	KY	SJHS	C CORPORATION		882139	0.85
TOM DEYLE CHARITABLE REMAINDER UNITRUST
PO BOX 1810	KEARNEY	NE	68848	476192393	INVESTMENTS	NE	GSHF	TRUST			1
TOWSON MANAGEMENT INC
7601 OSLER DRIVE	TOWSON	MD	21204	521710750	MANAGEMENT SERVICES	MD	FSI	C CORPORATION		266960	1

Field	Value	IRS element (for citing)
Receipt Of Int Ann Rents Royalties	false	ReceiptOfIntAnnRentsRoyalties
Gift Grant Or Cap Contr To Other Org	true	GiftGrantOrCapContrToOtherOrg
Gift Grant Or Cap Contr Fr Other Org	true	GiftGrantOrCapContrFrOtherOrg
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrg
Loans Or Guarantees From Other Org	true	LoansOrGuaranteesFromOtherOrg
Sale Of Assets To Other Org	false	SaleOfAssetsToOtherOrg
Purchase Of Assets From Other Org	false	PurchaseOfAssetsFromOtherOrg
Exchange Of Assets	false	ExchangeOfAssets
Rental Of Facilities To Other Orgs	true	RentalOfFacilitiesToOtherOrgs
Rental Of Facilities Fr Other Orgs	true	RentalOfFacilitiesFrOtherOrgs
Perform Of Services For Other Orgs	false	PerformOfServicesForOtherOrgs
Perform Of Services By Other Orgs	true	PerformOfServicesByOtherOrgs
Sharing Of Facilities	false	SharingOfFacilities
Sharing Of Paid Employees	false	SharingOfPaidEmployees
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrg
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrg
Other Transfer To Other Org	true	OtherTransferToOtherOrg
Other Transfer From Other Org	true	OtherTransferFromOtherOrg

Transactions Related Orgs Table TransactionsRelatedOrgsTable (2 entries)

Transaction TypeTransactionType	Amount InvolvedAmountInvolved	Method Of Amt DeterminationMethodOfAmtDetermination
GOOD SAMARITAN HOSPITAL FOUNDATION
L	1702580	FMV
GOOD SAMARITAN HOSPITAL FOUNDATION
B	350000	FMV