2012-04-30T10:00:15-05:00 2011-06-30 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2010-07-01 470443636 ST MARY'S COMMUNITY HOSPITAL STMA 4028733321 1314 3rd Avenue Nebraska City NE 68410 SHAWN CLOSNER 2012-04-23 true 7208741500 2010 2016-02-24 21:20:13Z DANIEL KELLY 1314 3rd Avenue Nebraska City NE 68410 17608129 false 0928 X WWW.STMARYSHOSPITALNECITY.COM X 1927 NE ST. MARY'S IS A NOT FOR PROFIT CRITICAL ACCESS HOSPITAL THAT PROVIDES ACUTE CARE FOR THE BENEFIT OF ALL REGARDLESS OF ABILITY TO PAY AND PROMOTES HEALTH THROUGH COMMUNITY OUTREACH INITIATIVES AND PARTNERSHIPS. 11 7 162 15 15662 14662 190696 71174 15178699 16780295 345425 623610 128402 94931 15843222 17570010 9243 6927 0 0 7083475 7215703 0 0 0 7193437 8638593 14286155 15861223 1557067 1708787 16859586 19027049 2025265 1778708 14834321 17248341 THE ORGANIZATION'S MISSION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY. FIDELITY TO THE GOSPEL URGES US TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE MOVE TOWARD THE CREATION OF HEALTHIER COMMUNITIES. false false 12049758 6927 16780295 SEE SCHEDULE H. 12049758 true true false true false false false false false true true false false true true false true false false false false false false false false true true true false true false false false false false false false false false false false false false true true true false false true 0 0 162 true true true false false false false false false false false false X 11 7 false false false false true true true true true false false true true true true true false true true false X Sharon Crunk 4028738929 1314 3rd Avenue Nebraska City NE 68410 X STACY BLUM 1 X 0 254589 38416 LIDIA BORER 1 X 0 0 0 BRETT GAY 1 X 215 0 0 PATRICK HAVERTY 1 X 0 0 0 SHARON M CRUNK 1 X 0 0 0 ROBERT LANIK 1 X 0 689847 45724 MICHAEL MCCABE 1 X 0 0 0 KATHRYN NELSON 1 X X 0 0 0 DANIEL KELLY 40 X X 0 206222 40171 JONATHAN STELLING 1 X X 0 271265 38594 SCOTT VANDERVEEN 1 X X 0 0 0 SHAWN CLOSNER 40 X 91106 0 25082 JOAN BECCARD 40 X 102719 0 28997 194040 1421923 216984 1 false true false KETTER & ASSOCIATES 1819 F STREET AUBURN NE 68305 THERAPY SERVICES 451005 SLEEP TIGHT ANESTHESIA PC 2640 WHITAKER ROAD NEBRASKA CITY NE 68410 ANESTHESIA SERVICES 384450 2 26755 44419 3211 71174 PATIENT SERVICES 900099 16780295 16780295 0 0 0 0 16780295 193030 580 192450 0 0 7453 29252 -21799 0 -21799 -21799 427226 3354 427226 3354 430580 430580 0 0 13419 8867 4552 4552 CAFETERIA 722100 44473 44473 LABORATORY SERVICES 621500 47808 15082 32726 MEALS ON WHEELS 624100 12189 12189 7708 0 0 7708 112178 17570010 16780295 15662 702879 6427 6427 500 500 0 0 94592 7567 87025 0 5266783 4278115 988668 304766 243813 60953 1166310 933048 233262 383252 306602 76650 0 0 0 0 0 0 2936086 1972345 963741 0 2378718 2110020 268698 0 0 314199 226223 87976 46558 28339 18219 0 25010 9662 15348 54939 54939 502215 502215 847138 510296 336842 32786 32786 BAD DEBT EXPENSE 913450 913450 REPAIRS AND MAINTENANCE 478036 373207 104829 DUES & SUBSCRIPTIONS 35825 16915 18910 EDUCATION 19572 17989 1583 OTHER EXPENSES 54061 40301 13760 0 0 0 0 15861223 12049758 3811465 0 0 300 300 1788900 2876548 2330724 2360710 204518 208506 31975 40588 13477871 9411247 4488693 4066624 7943097 9402394 0 71379 71379 16859586 19027049 835527 686453 1189738 1092255 2025265 1778708 X 14830870 17245088 3451 3253 14834321 17248341 16859586 19027049 X 1708787 705233 X false true true X false X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 287 false false false 287 false EXPLANATION OF LOBBYING ACTIVITIES SCHEDULE C, PART II-B, LINE 1F THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $72 AND CATHOLIC HEALTH ASSOCIATION - $215 31012 31012 322014 8103637 5369080 3056571 0 4748606 3951558 797048 272602 90609 181993 4066624 0 0 CHI OIP - FIXED INCOME 4468540 F CHI OIP - EQUITY SECURITIES 4933854 F 9402394 0 UNCLAIMED PROPERTY 1058 CHI DEBT PROGRAM 1091197 1092255 17583877 15872013 1711864 0 0 1711864 0 0 0 0 0 0 0 0 0 0 0 0 FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 ST. MARY'S COMMUNITY HOSPITAL'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI'S FIN 48 (ASC 740) FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2011 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. AS OF JUNE 30, 2011, CHI HAS CURRENT NET DEFERRED TAX ASSETS OF $2.1 MILLION AND A NONCURRENT NET DEFERRED TAX LIABILITY OF $5.4 MILLION RELATED TO THESE TAXABLE ACTIVITIES. MANAGEMENT REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS." true true X false false true true false true true 245 272511 272511 0.01820 0 0.00000 0 0.00000 0 245 272511 0 272511 0.01820 10 779 105765 105 105660 0.00710 3 31 17048 17048 0.00110 0 0.00000 0 0.00000 13 7592 21545 3720 17825 0.00120 26 8402 144358 3825 140533 0.00940 26 8647 416869 3825 413044 0.02760 0 0.00000 1 1021 1021 0.00010 2 50322 50322 0.00320 1 181 6707 6707 0.00040 0 0.00000 1 200 10740 10740 0.00070 0 0.00000 2 15 1774 1774 0.00010 0 0.00000 7 396 70564 0 70564 0.00440 true 617431 0 5886157 5827633 58524 X true true 1 1 ST MARY'S COMMUNITY HOSPITAL

1314 3RD AVENUE NEBRASKA CITY NE 68410

X X X X ST MARY'S COMMUNITY HOSPITAL 1 Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c IF APPLICABLE, DESCRIBE THE INCOME-BASED CRITERIA FOR DETERMINING ELIGIBILITY FOR FREE OR DISCOUNTED CARE UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO ST. MARY'S COMMUNITY HOSPITAL) ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY IT WAS DETERMINED THAT ESTABLISHING A HOUSEHOLD INCOME SCALE BASED ON THE HUD VERY LOW INCOME GUIDELINES MORE ACCURATELY REFLECTS THE SOCIOECONOMIC DISPERSIONS AMONG THE 69 URBAN AND RURAL COMMUNITIES IN 19 STATES SERVED BY CHI HOSPITALS AND HEALTH CARE FACILITIES. IN COMPARING HUD GUIDELINES TO THE FEDERAL POVERTY GUIDELINES ("FPG"), WE FIND THAT ON AVERAGE HUD GUIDELINES COMPUTE TO APPROXIMATELY 200% TO 250% (AND SOMETIMES 300%) OF FPG. ST. MARY'S COMMUNITY HOSPITAL BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE WRITE-OFFS, BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. ALSO DESCRIBE WHETHER THE ORGANIZATION USES AN ASSET TEST OR OTHER THRESHOLD, REGARDLESS OF INCOME, TO DETERMINE ELIGIBILITY FOR FREE OR DISCOUNTED CARE. AN INDIVIDUAL'S INCOME UNDER THE HUD GUIDELINES IS A SIGNIFICANT FACTOR IN DETERMINING ELIGIBILITY FOR FINANCIAL ASSISTANCE. HOWEVER, IN DETERMINING WHETHER TO EXTEND DISCOUNTED OR FREE CARE TO A PATIENT, THE PATIENT'S ASSETS MAY ALSO BE TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE A REASONABLE LEVEL OF INCOME, BUT A LOW LEVEL OF LIQUID ASSETS SUCH THAT THE PAYMENT OF MEDICAL BILLS WOULD BE SERIOUSLY DETRIMENTAL TO THE PATIENT'S BASIC FINANCIAL (AND ULTIMATELY PHYSICAL) WELL-BEING AND SURVIVAL. SUCH A PATIENT MAY BE EXTENDED DISCOUNTED OR FREE CARE BASED UPON THE FACTS AND CIRCUMSTANCES. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 913,450 Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 PROVIDE AN EXPLANATION OF THE COSTING METHODOLOGY USED TO CALCULATE THE AMOUNTS REPORTED IN THE TABLE. IF A COST ACCOUNTING SYSTEM WAS USED, INDICATE WHETHER THE COST ACCOUNTING SYSTEM ADDRESSES ALL PATIENT SEGMENTS (FOR EXAMPLE, INPATIENT, OUTPATIENT, EMERGENCY ROOM, PRIVATE INSURANCE, MEDICAID, MEDICARE, UNINSURED OR SELF PAY). ALSO INDICATE WHETHER A COST-TO-CHARGE RATIO WAS USED FOR ANY OF THE FIGURES REPORTED IN THE TABLE. DESCRIBE WHETHER THIS COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, AND, IF NOT, WHAT KIND OF COST-TO-CHARGE RATIO WAS USED AND HOW IT WAS DERIVED. IF SOME OTHER COSTING METHODOLOGY WAS USED BESIDES A COST ACCOUNTING SYSTEM, COST-TO-CHARGE RATIO, OR A COMBINATION OF THE TWO, DESCRIBE THE METHOD USED. A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING THE ORGANIZATION'S COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/11 WAS COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 PROVIDE THE RATIONALE AND THE COSTING METHODOLOGY USED TO DETERMINE THE AMOUNT REPORTED IN PART III, LINES 2 AND 3. DESCRIBE HOW THE ORGANIZATION ACCOUNTS FOR DISCOUNTS AND PAYMENTS ON PATIENT ACCOUNTS IN DETERMINING BAD DEBT EXPENSE. COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 67.59%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. ALSO DESCRIBE THE METHOD THE ORGANIZATION USES TO DETERMINE THE AMOUNT THAT REASONABLY COULD BE ATTRIBUTABLE TO PATIENTS WHO LIKELY WOULD QUALIFY FOR FINANCIAL ASSISTANCE UNDER THE HOSPITAL'S FINANCIAL ASSISTANCE POLICY, IF SUFFICIENT INFORMATION HAS BEEN AVAILABLE TO MAKE A DETERMINATION OF THEIR ELIGIBILITY. DESCRIBE THE RATIONALE, IF ANY, FOR INCLUDING ANY PORTION OF BAD DEBT AS COMMUNITY BENEFIT. ALSO PROVIDE, IF APPLICABLE, THE TEXT OF THE FOOTNOTE TO THE ORGANIZATION'S FINANCIAL STATEMENTS THAT DESCRIBES BAD DEBT EXPENSE. IF THE ORGANIZATION'S FINANCIAL STATEMENTS INCLUDE A FOOTNOTE ON THESE ISSUES THAT ALSO INCLUDES OTHER INFORMATION, REPORT ONLY THE RELEVANT PORTIONS OF THE FOOTNOTE. IF THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT CONTAIN SUCH A FOOTNOTE, STATE THAT THE ORGANIZATION'S FINANCIAL STATEMENTS DO NOT INCLUDE SUCH A FOOTNOTE AND EXPLAIN HOW THE FINANCIAL STATEMENTS ACCOUNT FOR BAD DEBT, IF AT ALL. ST. MARY'S COMMUNITY HOSPITAL DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. ST. MARY'S COMMUNITY HOSPITAL DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS: "THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS CONSIDERING HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE, AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE-OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHI FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY." Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 DESCRIBE THE COSTING METHODOLOGY USED TO DETERMINE THE MEDICARE ALLOWABLE COSTS REPORTED IN THE ORGANIZATION'S MEDICARE COST REPORT, AS REFLECTED IN THE AMOUNT REPORTED IN PART III, LINE 6. ST. MARY'S COMMUNITY HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL ("CAH"). CAHS ARE RURAL COMMUNITY HOSPITALS THAT ARE CERTIFIED TO RECEIVE COST-BASED REIMBURSEMENT FROM MEDICARE. THE REIMBURSEMENT THAT CAHS RECEIVE IS INTENDED TO IMPROVE THEIR FINANCIAL PERFORMANCE AND THEREBY REDUCE HOSPITAL CLOSURES. CAHS ARE CERTIFIED UNDER A DIFFERENT SET OF MEDICARE CONDITIONS OF PARTICIPATION (COP). SHORTFALLS ARE CREATED WHEN A FACILITY RECEIVES PAYMENTS THAT ARE LESS THAN THE COSTS OF CARING FOR PROGRAM BENEFICIARIES. BECAUSE SHORTFALLS ARE BASED ON COSTS, NOT CHARGES, ST. MARY'S COMMUNITY HOSPITAL, DUE TO THEIR DESIGNATION AS A CAH, RECEIVED COST-BASED REIMBURSEMENT FOR MEDICARE PURPOSES, ST. MARY'S COMMUNITY HOSPITAL WILL NOT EXPERIENCE MEDICARE RELATED SHORTFALLS. Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b IF THE ORGANIZATION HAS A WRITTEN DEBT COLLECTION POLICY AND ANSWERED "YES," TO PART III, LINE 9B, DESCRIBE THE COLLECTION PRACTICES SET FORTH IN THE POLICY THAT APPLY TO PATIENTS WHO IT KNOWS QUALIFY FOR FINANCIAL ASSISTANCE, WHETHER OR NOT SUCH PRACTICES APPLY SPECIFICALLY TO SUCH PATIENTS OR MORE BROADLY TO ALSO COVER OTHER TYPES OF PATIENTS. ST. MARY'S COMMUNITY HOSPITAL'S DEBT COLLECTION POLICY PROVIDES THAT ST. MARY'S COMMUNITY HOSPITAL WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH ST. MARY'S COMMUNITY HOSPITAL'S COMMUNITY ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO MEET THE ST. MARY'S COMMUNITY HOSPITAL COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO ST. MARY'S COMMUNITY HOSPITAL FOR APPROPRIATE FOLLOW-UP. ST. MARY'S COMMUNITY HOSPITAL REQUIRES 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 FINANCIAL ASSISTANCE. 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. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 DESCRIBE HOW THE ORGANIZATION INFORMS AND EDUCATES PATIENTS AND PERSONS WHO MAY BE BILLED FOR PATIENT CARE ABOUT THEIR ELIGIBILITY FOR ASSISTANCE UNDER FEDERAL, STATE, OR LOCAL GOVERNMENT PROGRAMS OR UNDER THE ORGANIZATION'S FINANCIAL ASSISTANCE POLICY. ST. MARY'S COMMUNITY HOSPITAL INCLUDES INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, ST. MARY'S PROMINENTLY DISPLAYS ITS FINANCIAL ASSISTANCE POLICY IN BOTH ENGLISH AND SPANISH IN OBVIOUS LOCATIONS THROUGHOUT THE HOSPITALS, INCLUDING THE EMERGENCY ROOMS AND OTHER PATIENT INTAKE AREAS. IN ADDITION, ST. MARY'S REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR FINANCIAL ASSISTANCE UNDER ST. MARY'S FINANCIAL ASSISTANCE POLICY. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY AND PROCEDURES INCLUDING AN APPLICATION FOR ASSISTANCE. ST. MARY'S REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON ENGLISH-SPEAKING INDIVIDUALS. ST. MARY'S 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 IF THE ORGANIZATION IS PART OF AN AFFILIATED HEALTH CARE SYSTEM, DESCRIBE THE RESPECTIVE ROLES OF THE ORGANIZATION AND ITS AFFILIATES IN PROMOTING THE HEALTH OF THE COMMUNITIES SERVED. ST. MARY'S COMMUNITY HOSPITAL IN NEBRASKA CITY, NEBRASKA IS PART OF CATHOLIC HEALTH INITIATIVES. CATHOLIC HEALTH INITIATIVES (CHI) IS A NATIONAL FAITH-BASED NONPROFIT HEALTH CARE ORGANIZATION WITH HEADQUARTERS IN ENGLEWOOD, COLORADO. CHI'S EXEMPT PURPOSE IS TO SERVE AS AN INTEGRAL PART OF ITS NATIONAL SYSTEM OF HOSPITALS AND OTHER CHARITABLE ENTITIES, WHICH ARE DESCRIBED AS MARKET-BASED ORGANIZATIONS, OR MBOS. AN MBO IS A DIRECT PROVIDER OF CARE OR SERVICES WITHIN A DEFINED MARKET AREA THAT MAY BE AN INTEGRATED HEALTH SYSTEM AND/OR A STAND-ALONE HOSPITAL OR OTHER FACILITY OR SERVICE PROVIDER. CHI SERVES AS THE PARENT CORPORATION OF ITS MBOS WHICH ARE COMPRISED OF 73 HOSPITALS; 40 LONG-TERM CARE, ASSISTED- AND RESIDENTIAL-LIVING FACILITIES; TWO COMMUNITY HEALTH-SERVICES ORGANIZATIONS; TWO ACCREDITED NURSING COLLEGES; AND HOME HEALTH AGENCIES. TOGETHER, THESE FACILITIES PROVIDED $612 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN THE 2011 FISCAL YEAR, INCLUDING SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. CHI PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED "SHARED SERVICES" FOR THE MBOS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES - INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN -- PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE MBOS. THE COST SAVINGS ACHIEVED THROUGH CHI'S CENTRALIZATION ENABLE MBOS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. ST. MARY'S OPERATES WITH ITS WHOLLY OWNED AFFILIATES AND COMMUNITY PARTNERS, ALONG WITH ITS FUNDRAISING ARM, ST. MARY'S COMMUNITY HOSPITAL FOUNDATION, TO SERVE THE HEALTH CARE NEEDS OF THE NEBRASKA CITY AND SURROUNDING COMMUNITIES. NEEDS ASSESSMENT AND COMMUNITY INFORMATION SCHEDULE H, PART VI, LINES 1,2,4 AND 5 ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE ST. MARY'S COMMUNITY HOSPITAL WAS FOUNDED TO ALLEVIATE A SHORTAGE OF HOSPITAL BEDS IN THE COMMUNITY IN 1927. AS A CATHOLIC HOSPITAL, ST. MARY'S EMBRACED THE MISSION OF THE FOUNDING RELIGIOUS CONGREGATION, WHICH HAS SINCE JOINED WITH OTHER RELIGIOUS CONGREGATIONS TO FORM CATHOLIC HEALTH INITIATIVES. THE MISSION OF ST. MARY'S IS TO DEVELOP A HEALTHY COMMUNITY AND PROVIDE CARE TO ALL IN NEED. IT HAS A BOARD OF DIRECTORS THAT IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES. ST. MARY'S OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THAT EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. ST. MARY'S 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 ST. MARY'S ACTIVITIES. EACH YEAR, SERVICES AND PROGRAMS ARE EXPANDED TO PROMOTE A HEALTHY COMMUNITY. THE PROGRAMS AND SERVICES DESCRIBED THROUGHOUT THIS REPORT NOT ONLY SERVE THE COMMUNITY, BUT ALSO REDUCE THE BURDENS ON THE GOVERNMENT. FOR EXAMPLE, IF ST. MARY'S DID NOT PROVIDE CHARITY CARE, THE BURDEN OF PROVIDING CHARITY CARE WOULD FALL ON A GOVERNMENT-SUPPORTED INSTITUTION. ST. MARY'S COMMUNITY HOSPITAL IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. COMMUNITY BENEFIT APPROACH LOCATED IN NEBRASKA CITY, NEBRASKA, ST. MARY'S COMMUNITY HOSPITAL SERVES OTOE COUNTY, NEBRASKA AND THE SURROUNDING COUNTIES IN SOUTHEAST NEBRASKA AS WELL AS SOUTHWEST IOWA. THIS ENCOMPASSES THE HOSPITALS HOME ZIP CODE AREA AND THE 11 NEIGHBORING ZIP CODES. OTOE COUNTY HAS A POPULATION OF 15,740. ALMOST ONE HALF OF THE COUNTY'S POPULATION RESIDE IN NEBRASKA CITY WHILE THE OTHER HALF LIVE IN AND NEAR ONE OF THE NINE OTHER COMMUNITIES. OTOE COUNTY: THE MOST RECENT 2011 ESTIMATES BASED ON THE LAST OFFICIAL COUNT FROM 2010 FROM THE U.S. CENSUS BUREAU REFLECT OTOE COUNTY AS AN OLDER AND MORE DIVERSE COMMUNITY. OTOE COUNTY HAS A MEDIAN AGE OF 39.1 OTOE COUNTY MEDIAN HOUSEHOLD INCOME: $46,160 OTOE COUNTY UNEMPLOYMENT RATE: 3.9% OTOE COUNTY; PERCENTAGE OF PERSONS LIVING BELOW THE POVERTY LINE: 12.2% OTOE COUNTY HISPANIC POPULATION: 5.1% MEDICALLY UNDERSERVED POPULATION: 11.2% UNINSURED THE BABY BOOMERS BORN BETWEEN 1946 AND 1964 ARE THE LARGEST GENERATION WITH MANY REACHING THE STATUS OF A SENIOR CITIZEN. CITY OF NEBRASKA CITY: LARGEST POPULATION IS WHITE: 91.5% HISPANIC POPULATION: 7.5% MEDIAN INCOME: $55,350 JOBS HAVE DECREASED BY 70 SINCE 12/31/2011 ST. MARY'S COMMUNITY HOSPITAL HAS BEEN COMMITTED TO IMPROVING THE HEALTH OF THE COMMUNITIES IT SERVES FOR A NUMBER OF YEARS. IN 2004, ST. MARY'S OFFICIALLY LAUNCHED THE HEALTHY COMMUNITIES COALITION PROCESS TO LOOK AT AREA HEALTH ISSUES, SET PRIORITIES AND PLAN FOR IMPROVEMENT. A WIDE VARIETY OF CITIZENS FROM THE PUBLIC AND PRIVATE SECTORS PARTICIPATED IN THIS PROCESS. ST. MARY'S CONTINUES OUR DEEP COMMITMENT AND INVOLVEMENT IN THE COMMUNITY HEALTH COLLABORATIVE TODAY. PROCESS ST. MARY'S COMMUNITY HOSPITAL'S COMMUNITY BENEFIT PLAN IS BASED ON OUR UNDERSTANDING OF THE UNIQUE COMMUNITIES' NEEDS DERIVED FROM COLLABORATIVE NEEDS ASSESSMENTS, FOCUS GROUPS, AND SURVEYS CONDUCTED WITH OUR COMMUNITY PARTNERS. IN 2007, ST. MARY'S COMMUNITY HOSPITAL'S HEALTHY COMMUNITIES COALITION AND OTOE COUNTY COALITION MERGED TO FORM PARTNERS FOR OTOE COUNTY (P4OC) COALITION. THE COALITION STRIVES TO MAXIMIZE RESOURCES (FINANCIAL AND HUMAN), REDUCE DUPLICATION OF WORK AND EFFECTIVELY MEET THE NEEDS AND PRIORITIES OF NEBRASKA CITY AND OTOE COUNTY. P4OC ENCOURAGES INDIVIDUALS, ORGANIZATIONS AND INSTITUTIONS TO TAKE RESPONSIBILITY FOR IMPROVING THE HEALTH AND QUALITY OF LIFE IN THEIR COMMUNITIES. P4OC HAS BEEN WORKING FOR SEVERAL YEARS TO MEASURE AND IMPROVE THE HEALTH STATUS OF THE COMMUNITY. SUMMARY OF ASSESSMENT FINDINGS ST. MARY'S COMMUNITY HOSPITAL IN COLLABORATION WITH PARTNERS FOR OTOE COUNTY (P4OC) COALITION COMPLETED THE HEALTHY COMMUNITIES' ASSESSMENT PROCESS IN 2007. IN SUBSEQUENT YEARS, ST. MARY'S HAS WORKED WITH COMMUNITY PARTNERS TO CONDUCT ADDITIONAL FOCUS GROUPS AND SURVEYS TO GAUGE COMMUNITY NEEDS. THESE PROCESSES IDENTIFIED ISSUES HAVING A SIGNIFICANT IMPACT ON THE OVERALL HEALTH OF THE POPULATION OF NEBRASKA CITY AND OTOE COUNTY. FROM THESE IDENTIFIED ISSUES, P40C DEVELOPED GOALS. IN FISCAL YEAR 2010, THE GOAL AREAS WERE EVALUATED TO BETTER RESPOND TO COMMUNITY NEEDS. THE OVERARCHING COALITION GOAL IS TO BUILD A COMMUNITY WHERE EVERY FAMILY THRIVES. KEY FACTORS IDENTIFIED AS HAVING THE GREATEST IMPACT ON THE OVERALL WELLNESS OF THE AREA CURRENTLY GUIDE ST. MARY'S COMMUNITY HOSPITAL COMMUNITY BENEFIT PLAN AND INCLUDE THE FOLLOWING: *HEALTHY LIFESTYLES AND BEHAVIORS *VIOLENCE PREVENTION *CHILD AND MATERNAL HEALTH *ACCESS TO BASIC NEEDS/COMMUNITY HEALTH SERVICES *EDUCATIONAL PROGRAMS NEEDS ASSESSMENT AND COMMUNITY INFORMATION SCHEDULE H, PART VI, LINES 1,2,4 AND 5 QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT COMMUNITY OUTREACH FOR THE POOR ST. MARY'S COMMUNITY HOSPITAL IS DEDICATED TO SERVING ALL PEOPLE IN OUR COMMUNITY REGARDLESS OF ABILITY TO PAY. ST. MARY'S COMMUNITY HOSPITAL'S CHARITY CARE POLICY PROVIDES FOR UNCOMPENSATED OR DISCOUNTED MEDICAL SERVICES FOR INDIVIDUALS WHO HAVE DEMONSTRATED NEED IN EXCESS OF INSURANCE, PERSONAL RESOURCES, AND FUNDS AVAILABLE THROUGH FEDERAL, STATE, AND LOCAL MEDICAL FUNDING PROGRAMS. CHARITY CARE MAY BE PROVIDED TO PATIENTS WHO ARE UNINSURED, UNDERINSURED, OR DETERMINED TO BE MEDICALLY INDIGENT. TOTAL NET COMMUNITY BENEFITS FOR THE PERIOD JULY 1, 2010- JUNE 30, 2011 TOTALED $413,044, MOST OF WHICH WAS TRADITIONAL CHARITY CARE BUT ALSO INCLUDED OTHER INITIATIVES. ST. MARY'S COMMUNITY HOSPITAL PROVIDES SUPPORT TO LOW INCOME FAMILIES IN THE REGION THROUGH VARIOUS OUTREACH INITIATIVES. IN FISCAL YEAR 2011, ST. MARY'S HOSTED ITS ANNUAL BACK TO SCHOOL EVENT. THIS OUTREACH PROGRAM BENEFITED LOW INCOME CHILDREN AND FAMILIES IN THE REGION AND WAS DEVELOPED IN RESPONSE TO AN IDENTIFIED NEED. THIS INITIATIVE SERVED OVER 350 AREA CHILDREN AND PROVIDED SCHOOL SUPPLIES AS WELL AS EDUCATIONAL MATERIALS TO SUPPORT A HEALTHY LIFESTYLE. ST. MARY'S, IN A COLLABORATIVE COMMUNITY EFFORT, WORKED TO HELP AREA FAMILIES WHO REQUESTED AND QUALIFIED FOR ASSISTANCE THROUGH THE SOUTHEAST NEBRASKA COMMUNITY ACTION AND THE NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY IN COLLABORATION WITH THE UNIVERSITY OF NEBRASKA MEDICAL CENTER (UNMC), ST. MARY'S SERVES AS A TELEMEDICINE HOST SITE. TELEMEDICINE IS THE USE OF MEDICAL INFORMATION EXCHANGED FROM ONE SITE TO ANOTHER VIA ELECTRONIC COMMUNICATION TO IMPROVE A PATIENT'S HEALTH STATUS. THIS IMPORTANT SERVICE PROVIDES ACCESS TO MENTAL HEALTH CARE NOT READILY AVAILABLE LOCALLY. ST. MARY'S COMMUNITY HOSPITAL PROVIDES STAFF AND RESOURCES TO SUPPORT THE COMMUNITY MEALS ON WHEELS PROGRAM. ST. MARY'S FOOD PREPARATION AND ORGANIZATION OF THE DELIVERY ROUTES KEEP THIS MUCH NEEDED SERVICE OPERATIONAL. THIS NUTRITION PROGRAM PROVIDES IN-HOME MEALS TO SENIORS AND OTHER HOME-BOUND PERSONS AND HELPS ENSURE A HEALTHIER COMMUNITY. ADDITIONAL COMMUNITY HEALTH SERVICES PROVIDED BY ST. MARY'S THAT IMPROVE COMMUNITY HEALTH AND EXTEND BEYOND TRADITIONAL PATIENT CARE INCLUDE TELEPHONE TRIAGE SERVICES, INFANT HEARING SCREENINGS, DIABETES EDUCATION AND SMOKING CESSATION CLASSES. COLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH ST. MARY'S COMMUNITY HOSPITAL IN COLLABORATION WITH COMMUNITY PARTNERS PROVIDES COORDINATION, FUNDING AND RESOURCES FOR GROWING GREAT KIDS IN SOUTHEAST NEBRASKA (GGK). GGK IS A PARENTING EDUCATION PROGRAM THAT WORKS WITH FAMILIES WHO ARE PREGNANT, OR WHO HAVE CHILDREN NEWBORN TO AGE THREE. THIS PROGRAM PROVIDES A SYSTEMATIC APPROACH TO REACH OUT TO ALL FAMILIES IN THE PROGRAM AREA OFFERING COMMUNITY SUPPORT BASED ON THE FAMILIES' STRENGTHS AND INDIVIDUAL SITUATIONS; PROMOTES POSITIVE PARENT-CHILD RELATIONSHIPS; PROMOTES HEALTHY CHILDHOOD GROWTH AND DEVELOPMENT; AND ENHANCES FAMILY FUNCTIONING. GGK OFFERS A MOTHER/BABY HOME VISIT BY A REGISTERED NURSE (RN), COMMUNITY PARENTING CLASSES AND REGULARLY SCHEDULED IN-HOME VISITS BY A FAMILY RESOURCE SPECIALIST THAT MAY BE PROVIDED UP TO THE CHILD'S THIRD BIRTHDAY. IN ADDITION, THE PROGRAM WORKS TO ESTABLISH EFFECTIVE LINKAGES BETWEEN PARENTS AND COMMUNITY RESOURCES TO REDUCE DEPENDENCE ON PUBLIC ASSISTANCE AND INCREASE SELF-SUFFICIENCY. HEALTH PROFESSIONS EDUCATION ST. MARY'S COMMUNITY HOSPITAL SERVED AS A TRAINING SITE FOR VARIOUS HEALTH CARE PROFESSIONS WHICH EXPOSE HEALTH CARE WORKERS TO THE RURAL EXPERIENCE AND ATTRACT NEW GRADUATES TO MEET FUTURE NEEDS. IN FISCAL YEAR 2011, ST. MARY'S COMMUNITY HOSPITAL SERVED AS A TRAINING SITE FOR THE FOLLOWING HEALTHCARE PROFESSIONS; LABORATORY, IMAGING SERVICES, NURSING AND OCCUPATIONAL THERAPY. COMMUNITY BUILDING ACTIVITIES AS PART OF ITS MISSION, ST. MARY'S COMMUNITY HOSPITAL HELPS ENSURE COMMUNITY NEEDS ARE MET. THIS IS ONLY POSSIBLE THROUGH THE DEVELOPMENT OF STRONG COLLABORATIVE RELATIONSHIPS. ST. MARY'S PROVIDES DEDICATED STAFF TO SUPPORT THE WORK OF PARTNERS FOR OTOE COUNTY (P4OC). THE COALITION IS A COUNTY WIDE PARTNERSHIP OF COMMUNITY ORGANIZATIONS, BUSINESSES, AND INDIVIDUALS OF ALL AGES WORKING TOGETHER FOR POSITIVE CHANGE IN OTOE COUNTY. THE PURPOSE IS TO MAXIMIZE COMMUNITY RESOURCES, HUMAN AND FINANCIAL, WHILE CREATING POSITIVE CHANGE AND IMPROVING THE HEALTH AND QUALITY OF LIFE FOR PEOPLE OF ALL AGES WHO LIVE, WORK, ATTEND SCHOOL AND VISIT OTOE COUNTY. STATE COMMUNITY BENEFIT REPORT SCHEDULE H, PART VI, LINE 7 IF APPLICABLE, IDENTIFY ALL STATES WITH WHICH THE ORGANIZATION FILES, OR A RELATED ORGANIZATION FILES ON ITS BEHALF, A COMMUNITY BENEFIT REPORT. THE STATE OF NEBRASKA DOES NOT MANDATE COMMUNITY BENEFIT REPORTING BUT ST. MARY'S COMMUNITY HOSPITAL DOES VOLUNTARY REPORTING THROUGH THE NEBRASKA HOSPITAL ASSOCIATION. CHI'S MBO'S ARE COMPRISED OF APPROXIMATELY 100 TAX-EXEMPT ORGANIZATIONS IN 19 STATES. CHI IS IN THE PROCESS OF IDENTIFYING IN WHICH STATES EACH OF THESE ORGANIZATIONS FILES A COMMUNITY BENEFIT REPORT. COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A ST. MARY'S COMMUNITY HOSPITAL PREPARES ITS OWN ANNUAL WRITTEN COMMUNITY BENEFIT REPORT. ITS COMMUNITY BENEFIT REPORT IS NOT CONTAINED IN THAT OF A RELATED ORGANIZATION. true X Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 THE ORGANIZATION MADE A GRANT TO ST. MARY'S HOSPITAL FOUNDATION, A RELATED ORGANIZATION. UPON PROVIDING SATISFACTORY WRITTEN EVIDENCE THAT THE FUNDS WERE USED FOR THE PURPOSE THE GRANT WAS MADE, THE HOSPITAL RELEASES THE RESTRICTION AND THE FUNDS ARE TRANSFERRED. false true false false false false false true false STACY BLUM 0 212089 0 28600 0 13900 0 20228 0 18188 0 293005 0 0 ROBERT LANIK 0 503686 0 124161 0 62000 0 32478 0 13246 0 735571 0 0 DANIEL KELLY 0 140831 0 43567 0 21824 0 29250 0 10921 0 246393 0 0 JONATHAN STELLING 0 224079 0 46519 0 667 0 20228 0 18366 0 309859 0 0 Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b DURING THE 2010 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: ROBERT LANIK DANIEL KELLY DURING 2010 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: DANIEL KELLY - $12,240 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 2010 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 2010, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: ROBERT LANIK - $35,026 Non-fixed payments Schedule J, Part I, Line 7 DURING FY2011, SMCH MAINTAINED A DISCRETIONARY BONUS PROGRAM ACCRUED FOR IN FY2011, TO BE PAID OUT IN NOVEMBER, 2011 (FY2012). AWARDS OF COMPENSATION FROM THIS PLAN ARE BASED ON THE ACHIEVEMENT OF CERTAIN ORGANIZATIONAL TARGETS (GENERALLY ASSOCIATED WITH PATIENT SATISFACTION, FINANCIAL PERFORMANCE, AND QUALITY INITIATIVES) AND ARE PAYABLE AS A FIXED PERCENTAGE OF EACH PARTICIPANT'S BASE COMPENSATION IF SUCH TARGETS ARE ACHIEVED. COMPENSATION OF TOP MANAGEMENT OFFICIAL SCHEDULE J, PART I, LINE 3 COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SEVERANCE PAYMENTS SCHEDULE J, PART I, LINE 4A POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 THE SOLE MEMBER OF THE ORGANIZATION IS CHI NEBRASKA, A NEBRASKA NON-PROFIT CORPORATION. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b THE ORGANIZATION'S CORPORATE MEMBER IS CHI NEBRASKA. PURSUANT TO SECTION 5.4.1 OF THE ORGANIZATION'S BYLAWS, BOTH CHI NEBRASKA AND CATHOLIC HEALTH INITIATIVES ("CHI") (CHI NEBRASKA'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE CHI GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE CHI NEBRASKA BOARD: *APPROVE MEMBERS OF THE ST. MARY'S COMMUNITY HOSPITAL BOARD *AMENDMENT OF THE CORPORATE DOCUMENTS OF ST. MARY'S COMMUNITY HOSPITAL *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF ST. MARY'S COMMUNITY HOSPITAL *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR ST. MARY'S COMMUNITY HOSPITAL THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI CHIEF EXECUTIVE OFFICER: *SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF ST. MARY'S COMMUNITY HOSPITAL *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF ST. MARY'S COMMUNITY HOSPITAL *APPROVAL OF ISSUANCE OF DEBT BY ST. MARY'S COMMUNITY HOSPITAL *APPROVAL OF PARTICIPATION OF ST. MARY'S COMMUNITY HOSPITAL IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY ST. MARY'S COMMUNITY HOSPITAL *APPROVAL OF A MERGER INVOLVING THE ST. MARY'S COMMUNITY HOSPITAL *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF ST. MARY'S COMMUNITY HOSPITAL *TO REQUIRE THE TRANSFER OF ASSETS BY THE ST. MARY'S COMMUNITY HOSPITAL TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION 5.4.2 OF THE ORGANIZATION'S BYLAWS, CHI NEBRASKA OR CHI MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b ONCE THE RETURN IS PREPARED, IT IS REVIEWED BY THE VP OF FINANCE. THE VP OF FINANCE THEN PRESENTS THE RETURN AT THE FINANCE/AUDIT COMMITTEE BOARD MEETING FOR REVIEW. COPIES OF THE 990 ARE PROVIDED TO ALL BOARD MEMBERS AFTER THE REVIEW BY THE FINANCE/AUDIT COMMITTEE. THE TAX DEPARTMENT THE FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. Conflict of interest policy Form 990, Part VI, Section B, Line 12c ST. MARY'S COMMUNITY HOSPITAL HAS A BOARD POLICY THAT REFERENCES THE DUALITY OF INTEREST AND CONFLICT OF INTEREST POLICIES PROVIDED BY CHI NATIONAL. AT THE ANNUAL BOARD AND BOARD COMMITTEE MEETINGS ALL MEMBERS ARE REQUESTED TO SIGN CONFLICT OF INTEREST STATEMENTS. THE SIGNED STATEMENTS ARE RETAINED IN THE ADMINISTRATIVE FILES. ALL MEMBERS ARE REQUESTED TO DECLARE POTENTIAL CONFLICTS OF INTEREST AT EACH BOARD AND/OR COMMITTEE MEETING OF THE BOARD (FINANCE, AUDIT AND COMPLIANCE COMMITTEE AND THE PERFORMANCE IMPROVEMENT COMMITTEE). IF THE BOARD FINDS THAT A CONFLICT DOES EXIST REGARDING THE AGENDA ITEMS TO BE PRESENTED FOR ACTION, MEMBERS ARE REQUESTED TO ABSTAIN FROM VOTING. IN ADDITION, A QUESTIONNAIRE IS SENT ANNUALLY TO ALL BOARD MEMBERS, TOP PAID VENDORS, AND TOP PAID EMPLOYEES ASKING THEM TO DISCLOSE ANY BUSINESS OR FAMILY RELATIONSHIPS. Process used to establish compensation of top management official Form 990, Part VI, Section B, 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, 2011. 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. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b ANY EXECUTIVE COMPENSATION PAID BY ST. MARY'S COMMUNITY HOSPITAL WAS SET BY THE EXECUTIVE COMMITTEE UTILIZING COMPARABILITY STUDIES TO DETERMINE OFFICER COMPENSATION AS REQUIRED BY THE ORGANIZATION'S EXECUTIVE COMPENSATION REVIEW POLICY. THE BOARD OF DIRECTORS OVERSEES THE COMPENSATION SETTING PROCESS AND ENSURES REASONABLENESS AND COMPLIANCE WITH THE ORGANIZATION'S COMPENSATION PHILOSOPHY. Public Disclosure Form 990, Part VI, Section C, Line 19 THE ORGANIZATION'S FINANCIAL STATEMENTS AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.ORG. THE ORGANIZATION'S CONFLICT OF INTEREST POLICY IS NOT PUBLICLY AVAILABLE. EXECUTIVE COMMITTEE FORM 990, PART VI, LINE 1A THE EXECUTIVE COMMITTEE CONSISTS ONLY OF DIRECTORS OF THE CORPORATION AND IS COMPOSED OF THE CHAIR OF THE BOARD, THE VICE CHAIR OF THE BOARD, AND THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, EACH OF WHOM SERVE AS EX OFFICIO VOTING MEMBERS OF THE EXECUTIVE COMMITTEE. THE EXECUTIVE COMMITTEE HAS THE POWER TO TRANSACT THE ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIODS BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT THEIR ACTIONS ARE CONSISTENT WITH ANY ACTIONS OR POLICIES OF THE BOARD OR THE CORPORATE MEMBER. ALL ACTIONS TAKEN ARE CONTEMPORANEOUSLY DOCUMENTED AND REPORTED TO THE BOARD AT THE NEXT REGULARLY SCHEDULED MEETING. DOCUMENT RETENTION & DESTRUCTION POLICY FORM 990, PART VI, LINE 14 THE ORGANIZATION'S BOARD HAS NOT FORMALLY ADOPTED A DOCUMENT RETENTION & DESTRUCTION POLICY. THE ORGANIZATION HAS STANDARD PROCEDURES THAT ARE FOLLOWED BUT THE ORGANIZATION'S BOARD HAS NOT OFFICIALLY ADOPTED THE POLICY. THE BOARD WILL ADOPT THE DOCUMENT RETENTION & DESTRUCTION POLICY DURING THE YEAR ENDED JUNE 30, 2012. HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII 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 - 846698; CHI CONNECT DEPRECIATION - 44751; CAPITAL RESOURCE POOL CONTRIBUTION - -186216; 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 PO BOX 368 CORNING IA 50841 420782518 HEALTHCARE IA 501(C)(3) 3 AHBMHS true ALVERNA APARTMENTS 300 SE 8TH AVENUE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(C)(3) 9 CHI true APPLETREE COURT 601 OAK STREET BRECKENRIDGE MN 56520 411850500 SENIOR HOMES MN 501(C)(3) 9 SFH true BISHOP DRUMM RETIREMENT CENTER 1111 6TH AVENUE DES MOINES IA 50314 420725196 LTERM CARE IA 501(C)(3) 9 CHI-IA CORP true BORNEMANN HEALTHCARE CORPORATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 232187242 HEALTHCARE PA 501(C)(3) 11 - Type I CHI true CARRINGTON HEALTH CENTER 800 NORTH 4TH STREET CARRINGTON ND 58421 450227311 HEALTHCARE ND 501(C)(3) 3 CHI true CATHOLIC HEALTH CARE FEDERATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 208473567 JURIDIC PERSON CO 501(C)(3) 11 - Type I CHI true CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(C)(3) 9 CHI true CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 961 EAST COLORADO AVENUE COLORADO SPRINGS CO 80903 840902211 FUNDRAISING CO 501(C)(3) 7 CHI COLORADO true CENTENNIAL MEDICAL GROUP INC 2700 STEWART PARKWAY ROSEBURG OR 97470 900433062 PHYSICIANS OR 501(C)(3) 9 MMC true CHI COLORADO 188 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 840405257 HEALTHCARE CO 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 INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(C)(3) 11 - Type I 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 FOUNDATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 270930004 FUNDRAISING CO 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 true CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(C)(3) 9 CHI true CHI NEBRASKA 555 SOUTH 70TH STREET LINCOLN NE 68510 363233121 HEALTHCARE NE 501(C)(3) 11 - Type I CHI true CHI-IOWA CORP 1111 6TH AVENUE DES MOINES IA 50314 420680448 HEALTHCARE IA 501(C)(3) 3 MHN true CONTINUING CARE HOSPITAL 150 NORTH EAGLE CREEK DRIVE LEXINGTON KY 40509 611400619 LTACH KY 501(C)(3) 3 SJHS 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 CHI 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 KY 501(C)(3) 2 GHS 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 PO BOX 1810 KEARNEY NE 68848 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 CHI COLORADO 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 LAKEWOOD HEALTH CENTER 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 410758434 LTERM CARE 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 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 EAST SEVENTH STREET 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 LIFECARE SYSTEMS 2727 MCCLELLAND BLVD JOPLIN MO 64804 431305163 PROPERTY MGMT MO 501(C)(3) 11 - Type I SJRMC true MERCY MEDICAL CENTER 1301 15TH AVENUE WEST WILLISTON ND 58801 450231183 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 - CENTERVILLE 1 ST JOSEPHS DRIVE CENTERVILLE IA 52544 420680308 HEALTHCARE IA 501(C)(3) 3 CHI-IA CORP 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 MERCY REGIONAL MEDICAL CENTER OF DURANGO 1010 THREE SPRINGS BLVD DURANGO CO 81301 840405515 HEALTHCARE CO 501(C)(3) 3 CHI 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 OAKES COMMUNITY HOSPITAL 314 SOUTH 8TH STREET OAKES ND 58474 450231675 HEALTHCARE ND 501(C)(3) 3 CHI true OAKES COMMUNITY HOSPITAL FOUNDATION 314 SOUTH 8TH 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 CHI 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 CHI COLORADO true SAINT CLARE'S COMMUNITY CARE 66 FORD ROAD DENVILLE NJ 07834 222876836 HEALTHCARE NJ 501(C)(3) 11 - Type II SCHS true SAINT CLARE''S FOUNDATION INC 66 FORD 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 66 FORD ROAD DENVILLE NJ 07834 223319886 HEALTHCARE NJ 501(C)(3) 3 CHI 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 PO BOX 9804 GRAND ISLAND NE 68802 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 150 N EAGLE CREEK DR 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 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 JOSEPH HEALTH MINISTRIES FOUNDATION 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232605579 FUNDRAISING PA 501(C)(3) 11 - Type I SJHM 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 4 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 AT ONTARIO 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 MEDICAL GROUP 2727 MCCLELLAND BLVD JOPLIN MO 64804 431882377 PHYS PRACTICE MO 501(C)(3) 9 SJRMC true ST JOHN'S MERCY REGIONAL FOUNDATION 2727 MCCLELLAND BLVD JOPLIN MO 64804 431308084 FUNDRAISING MO 501(C)(3) 7 SJRMC true ST JOHN'S REGIONAL MEDICAL CENTER 2727 MCCLELLAND BLVD JOPLIN MO 64804 440545809 HEALTHCARE MO 501(C)(3) 3 CHI true ST JOSEPH COMMUNITY HEALTH SERVICES 300 CENTRAL AVE SW SUITE 3000W ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(C)(3) 11 - 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