2011-05-13T15:20:54-05:00 2010-06-30 Deloitte Tax LLP East Fifth East Street Suite 1900 Cincinnati OH 45202 990 2009-07-01 910349750 Our Lady of Lourdes Hospital at Pasco OURL 5095477704 520 North 4th Avenue Pasco WA 993012568 Frank R Becker 5095477704 2011-05-13 1 5137847100 2009 2016-02-24 21:20:13Z Lourdes Health Network Frank R Becker 520 North 4th Avenue Pasco WA 993012568 102969132 0 0928 X www.lourdeshealth.net X 1920 WA Respond to the health care needs of the Mid-Columbia area in a Christian spirit. 15 15 845 315 184911 177660 373998 129443 100063629 100224576 -1145930 1122010 1496858 1445498 100788555 102921527 259630 287377 0 49397613 51094124 0 0 44702363 49401023 94359606 100782524 6428949 2139003 62102270 65694871 25506597 26759565 36595673 38935306 The mission of Our Lady of Lourdes Hospital at Pasco is an extension of the healing ministry of Jesus. We are called to serve our community, our patients, their loved ones and our co-workers with respect, compassion and care. We respond to the health care needs in a Christian spirit. We strive for excellence in all we do. Our Catholic health ministry is dedicated to spiritually centered, holistic care, which sustains and improves the health of individuals and communities. In furtherance of its mission and in an effort to reduce the government's financial burden, Our Lady of Lourdes Hospital at Pasco provides essential health care services, such as inpatient acute care, emergency and ambulatory services, behavioral health care, and outpatient clinics as well as community services. 0 0 39715188 44930657 Our Lady of Lourdes Hospital at Pasco provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2010, approximately 31% of the value of services rendered were to elderly patients under the Medicare program, and approximately 25% of services were provided to patients who were deemed indigent under state, county, or Hospital Guidelines. In the spirit of principles adopted by Ascension Health, Our Lady of Lourdes Hospital at Pasco has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 30, 2010, the estimated cost of services provided to the elderly, uninsured, and the underinsured totaled $8,956,175, including $1,731,110 cost for charity care and $2,868,655 in bad debts attributable to the uninsured and underinsured, $9,362 in programs for the poor, $191,227 in services to the general community, and $4,155,821 in unpaid cost of public programs. 7662540 287377 8668798 Community benefits are programs or activities that provide treatment and/or promote health and healing as a response to identified community needs. In efforts to promote healthy living, Our Lady of Lourdes Hospital at Pasco has made available the following programs to the community: physical fitness activities, community health programs, medical research, medical education, cancer screening programs, support groups and educational classes, CPR and first aid classes, health screening, flu shot clinic, nutrition and weight loss management. 42379755 46625121 Our Lady of Lourdes Hospital at Pasco provides the following inpatient and outpatient medical services to the community: emergency care services, flight care, laboratory services, orthopedic services, pain management, primary care physicians, radiology services, rehabilitation services, sleep studies, maternity, physical therapy, occupational therapy, speech therapy, respiratory therapy, surgery, pediatrics, imaging, inpatient and outpatient alcohol and substance abuse, and inpatient and outpatient behavioral health services. Some of these services, such as rehab therapies, primary care physicians, behavioral health and maternity operate at a loss in order to ensure that all services are available to meet community health care needs. During the fiscal year ending June 30, 2010, Our Lady of Lourdes Hospital at Pasco treated 2,978 inpatient adults and children in the community for a total of 13,266 patient days of service. Our Lady of Lourdes Hospital at Pasco also provided services to 241,811 outpatients, including 1,769 outpatient surgical patients, 25,680 emergency room visits, 113,070 behavioral health and rehab therapy visits and 101,292 clinic and urgent care visits. 89757483 1 1 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 1 83 0 1 845 1 1 1 0 0 0 0 0 0 0 0 15 15 0 0 0 0 1 1 1 1 1 0 1 1 1 1 1 1 1 1 1 1 1 1 WA X Roberta Wittorf 5095423044 520 North 4th Avenue Pasco WA 99301 Julie Killian 1.00 X X 0 0 0 Ernest Parra 1.00 X X 0 0 0 Sr Anne McMullen 1.00 X X 0 0 0 Sr Pat Rosholt 1.00 X X 0 0 0 Donald Dicken MD 1.00 X 0 0 0 Bart Gallant 1.00 X 0 0 0 Greg Garcia 1.00 X 0 0 0 Chad Graves 1.00 X 0 0 0 Webster Jackson 1.00 X 0 0 0 Sr Catherine Marie Kreta 1.00 X 0 0 0 Sr Ann Patricia O'Connor 1.00 X 0 0 0 Richard Shallman MD 1.00 X 0 0 0 Randy Shoop 1.00 X 0 0 0 Sr Mary Williams 1.00 X 0 0 0 Apolonio Coronado 1.00 X 0 0 0 John Serle 50.00 X 548558 0 49699 Frank Becker 50.00 X 303156 0 60353 Janet Wright 50.00 X 224581 0 55546 Barbara Mead 50.00 X 201002 0 40922 Craig Pearsall 50.00 X 138810 0 37085 Connie Gillispie 50.00 X 38170 75026 34809 Sister Esther Polacci Sch O 50.00 X 0 0 0 Gladson Menino Vaz MD 50.00 X 483834 0 52414 James I Bucker MD 50.00 X 373924 0 10178 Wei W Qiu MD 50.00 X 372475 0 37369 Michael J Hannan 50.00 X 365069 0 41506 Suresh Kumar Piryani MD 50.00 X 316832 0 43304 3366411 75026 463185 61 0 1 0 Northwest Emergency Physicians Inc PO Box 634850 Cincinnati OH 452634850 Emergency Physicians 2831426 Chervenell Construction Co PO Box 6935 Kennewick WA 99336 Construction Services 1461875 Tri-Cities Laboratory LLC 110 West Cliff Ave Spokane WA 99204 Laboratory Services 622094 George A Grant Inc PO Box 789 Richland WA 99352 Construction Services 541114 TriMedx PO Box 636129 Cincinnati OH 452636129 Bioengineering Services 444849 24 66879 62564 5535 129443 Net Patient Services 621990 99987386 99987386 237190 237190 100224576 1114510 1114510 157453 31975 125478 125478 125478 23130 15630 7500 7500 7500 Inv in Uncon Entities 523000 1083846 184911 898935 Cafeteria and Vending 722212 188471 188471 Pharmacy 446110 47703 47703 1320020 102921527 100224576 184911 2382597 287377 287377 1732691 633666 1099025 38446157 35624986 2821171 2172566 1934887 237679 5997580 5300227 697353 2745130 2444813 300317 272848 107118 165730 8814 7320 1494 182364 182364 4934150 3838934 1095216 764840 764840 3065042 2923144 141898 3264832 2907659 357173 5052424 4759911 292513 453287 336496 116791 395238 352793 42445 3519728 3134670 385058 351489 314353 37136 Medical & Food Supplies 12610153 12576143 34010 0 Bad Debt 6951720 5973648 978072 0 Professional Fees 4795810 4792930 2880 0 Other Direct 2531104 1399832 1131272 0 Dues and Subscriptions 247180 106576 140604 0 100782524 89757483 11025041 0 7216519 6460936 9114444 10331143 1332859 1686509 1432630 1074017 32372203 13235774 19535377 19136429 45786 53742 7314021 8322909 308242 229542 15802392 18399644 62102270 65694871 11284515 11267701 146426 14075656 15491864 25506597 26759565 X 36558294 38900524 37379 34782 36595673 38935306 62102270 65694871 X 0 1 1 X 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 16035 16035 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: Lobbying expenses represent the portion of dues paid to national and state hospital associations specifically allocable to lobbying activities. 944012 944012 20143295 9163256 10980039 1704565 515997 1188568 8369347 3556521 4812826 1210984 1210984 19136429 Invst. in Tri-Cities Lab. 2106867 C Invst. in Tri-Cities Cancer Center 5707042 C Investment in BLT, LLC 509000 C 8322909 Health System Depository 15163491 Other Miscellaneous Receivables 114051 Deferred Compensation Asset 1210331 Third Party Receivables 1911771 18399644 Intercompany Debt to Ascension Health 12669278 Self Insurance Liability 236404 Miscellaneous Noncurrent Liabilities 125851 Deferred Compensation Liability 1210331 Other Long-Term Debt 1250000 15491864 102921527 100782524 2139003 1016814 -816184 200630 2339633 Part X: Description of Uncertain Tax Positions Under FIN 48: Per the financial statements of Our Lady of Lourdes Hospital of Pasco, there is no current year ASC 740 (fka FIN 48) footnote for the current year. Part XI, Line 8 - Other Adjustments: Impairment Loss: -15630. Transfer to Sponsor: -53389. Transfer to Affiliates: -747165. 1 1 1 X 1 X 1 1 1 0 1 1 1776368 1776368 0.01890 22992635 19877454 3115181 0.03320 24769003 19877454 4891549 0.05210 43692 43692 0.00050 90362 90362 0.00100 680546 492890 187656 0.00200 147216 147216 0.00160 961816 492890 468926 0.00510 25730819 20370344 5360475 0.05720 41053 41053 0.00040 150 150 0.00000 3207 3207 0.00000 20328 20328 0.00020 64738 64738 0.00060 0 6951720 2961433 25053203 19393759 5659444 X 1 1 Lourdes Medical Center

520 North 4th Avenue Pasco WA 99301

X X X X Lourdes Counseling Center

1175 Carondelet Drive Richland WA 99352

X Behavioral Health Services Part I, Line 7: The cost of providing charity care, means tested government programs, and community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost-to-charge ratio that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self-pay). The best available data was used to calculate the amounts reported in the table. Part I, Line 7g: The organization has not included costs attributable to a physician clinic as part of subsidized health services. Part I, Line 7f: The amount of bad debt expense reported on Form 990, Part IX, Line 25, column (A), but subtracted for purposes of calculating the percentages in Part I, Line 7, column (f) is $6,951,720. Part III, Line 4: The organization is a part of the Our Lady of Lourdes Hospital at Pasco consolidated audit. The footnote that references bad debt expense in the June 30, 2010 consolidated audit is as follows: The provision for bad debts is based upon management's assessment of expected net collections considering economic conditions, historical experience, trends in health care coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of allowance for uncollectible accounts based upon historical write off experience by payer category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for bad debts to establish an appropriate allowance for uncollectible accounts. After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the organization follows established guidelines for placing certain past due patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by the organization. Accounts receivable are written off after collection efforts have been followed in accordance with the Organization's policies.The organization's share of bad debt expense for the year ending June 30, 2010 was $6,951,720 at charges and at cost. Part III, Line 8: Part III, Line 9b: The organization has a written debt collection policy that also includes a provision on the collection practices to be followed for patients who are known to qualify for charity care or financial assistance. If a patient qualifies for charity or financial assistance certain collection practices do not apply. Part VI, Line 2: Lourdes Health Network is a collaborative community partner. We work with several other non-profit and state agencies to gather community needs. Our local United Way agency along with the local university conducted a large scale community needs assessment covering health care along with other needs that are frequently accessed by Lourdes. Our local Federally Qualified Health Center also conducted a community needs assessment and has shared that information with Lourdes. The public school district also provides Lourdes with valuable information about the community's health. Part VI, Line 3: Financial counselors are trained to discuss our financial assistance policy and assist those needing assistance with the application. In addition, they have knowledge of other assistance programs that patients may qualify for and assist patients in finding that information. During the pre-registration, registration, admission and discharge processes, Lourdes attempts to identify patients who may be eligible for charity or discounted care via the charity care policy. A financial counselor is provided to all patients. Lourdes charity care policy is posted in all admitting areas, the emergency room and the information desk with information about our financial assistance program and how to access it if needed. On the website is the full application available for download as well as information about the policy. A written summary and contact information is provided in all communications with patients regarding bills and account status. Part VI, Line 4: Lourdes Health Network primarily serves those residing in Franklin and Benton Counties. Lourdes offers the only acute hospital in Franklin County and provides a clinic in North Franklin County. Lourdes also offers the region's only inpatient mental health hospital in Benton & Franklin Counties. In fiscal year 2010, Lourdes Health Network provided more than $10 million in charity and uncompensated care to members of our community. The demographic makeup of the community we serves is as follows:Franklin County: -Total Population - 69,241-68% are high school educated or above -Median Household Income - $44,744-20.9% of individuals below poverty level -48.7% Hispanic or Latino-39.7 Persons per square mileBenton County:-Total Population - 168,294-87% are high school educated or above-Median Household Income - $54,544-12.7% of individuals below poverty level-15.9% Hispanic or Latino-83.7 persons per square mileThe Health Status of the Mid-Columbia region trends with the health of the nation. However, our area has a higher prevalence of childhood obesity and diabetes, which then adds to other issues, such as heart disease and stroke. Other areas rated unfavorable compared to peer counties include:-Births to women under 18-Births to unmarried women-No care in first trimester-White non-Hispanic infant-Mortality-Homicide-Lung Cancer-Stroke-Suicide-Colon CancerLourdes Health Network works diligently to provide healthy lifestyle education to the community in multiple ways such as a community newsletter, a web-based health information library, community events and educational forums and formalized relationships with schools. Part VI, Line 5: Lourdes Health Network provided the following community building activities in 2010:- Childhood Obesity - To support healthy activities and prevention of childhood obesity, Lourdes sponsored three fun runs in local schools, provided "healthy snack" education to three local schools, and sponsored America on the Move through the YMCA. Without the support of Lourdes, the schools and organizations would not have been able to offer these activities that are designed to help young children learn healthy habits. Lourdes also supports many youth sports activities, such as Kennewick Youth Baseball, Little League, Basketball teams and soccer teams to further our work to encourage children to be active.- Prenatal Outreach - Lourdes provides FREE to anyone in the community, regardless of hospital of delivery, prenatal classes. Classes include: Prenatal education in English and Spanish, Infant CPR classes, and refresher courses. In addition, a post partum clinic is available FREE of charge for any new mother and baby post discharge. A positive educational program is also provided to high-risk teen mothers via the New Horizons High School and the Pasco School District. This program provides self esteem, parenting skills, and pre and post natal education. - Community Education - For 94 years, Lourdes has been active providing community education throughout the region. A few examples: - Lourdes Health Network Nutritional Counselors are guest speakers at nursing homes, assisted living facilities, schools, volunteer groups and churches presenting healthy eating and diabetes prevention information provided by Lourdes, but at no cost to attendees. - Lourdes Health Network's Infection Control Nurse actively educated children in schools and the community at many community events about proper hand washing and flu prevention at no cost to attendees and funded by Lourdes. In addition, Lourdes spearheaded an internal and external hand washing campaign and provided the largest community event - the Benton Franklin Fair and Rodeo - with posters, hand wipes, and hand sanitizers. - Dr. Benjamin Pe, Lourdes Board Certified Child Psychiatrist provides educational sessions to local elementary schools about signs and symptoms of childhood mental illness provided by Lourdes at no cost to the school district. - Blood Drives - Lourdes works in close partnership with the Red Cross and promotes and hosts blood drives in many of our facilities. Having an adequate community blood supply is essential to our community's health. Lourdes is proud to offer these blood drives at no cost to participants or to the Red Cross.- Lourdes Foundation sponsors up to 1,000 persons on Washington State's Basic Health Plan. Funding for this important program to provide access and coverage for healthcare is provided by local donations and sponsorships. The Foundation also partners with local media and corporations such as Columbia Bank, Washington Trust Bank and others to improve the health of some of our community's most vulnerable members. To further assist those without insurance and access to care, the Foundation funds a free mammogram program. Partners financially supporting this program which provides over 100+ free mammograms each year as well as any follow-up care needed include: Susan G Komen for the Cure, Benton Franklin Fair and Rodeo, Tri-Cities Cancer Center and In Step With Hope. - Scholarships - Lourdes Foundation and Lourdes Auxiliary partner to offer six outstanding local students wanting to enter the healthcare field $1,500 scholarships to pursue their education. This is one way that we can contribute to fighting the healthcare worker shortage and further the education of our community's brightest students. Part VI, Line 6: Lourdes allows educated staff with specific expertise to provide community education. For instance, the Infection Control nurse provides hand hygiene education to schools, at community events, and to teachers. Lourdes' board-certified child psychiatrist provides education to local teachers about signs and symptoms of children's common mental health issues. Certified dieticians provide education to school children and through the YMCA about healthy after-school snacks and overall healthy eating habits. It is estimated that over 2,000 school children and staff have attended sessions in the last year. Partnership with City of Pasco for Pasco safety improvements - Lourdes Medical Center is located on 4th Avenue in Pasco. 4th Avenue is a major arterial with 4 lanes of traffic. There have been several deaths and many injuries as people attempt to cross 4th Avenue to enter the hospital. As a proactive community leader, Lourdes has partnered with the City on a safety assessment and plan to improve 4th Avenue. This partnership included a monetary donation to the City for the assessment. The safety of our community and our patients is of utmost concern for Lourdes. -Other non-profits: American Cancer Society, American Diabetes Association, American Red Cross, Boys and Girls Clubs, YMCA. Part VI, Line 7: Our Lady of Lourdes Hospital at Pasco, d/b/a Lourdes Health Network ("Health Network") is a member of Ascension Health. Ascension Health is a Catholic, national health system consisting primarily of not-for-profit corporations that own and operate local health care facilities, or Health Ministries, located in 20 states and the District of Columbia. Ascension Health is sponsored by the Northeast, Southeast, East Central and West Central Provinces of the Daughters of Charity of St. Vincent de Paul, the Congregation of st. Joseph and the Sisters of St. Joseph of Carondelet (CSJ).The Health Network consists of two separately licensed not-for-profit health care providers and a foundation: Lourdes Medical Center ("Medical Center") located in Pasco, Washington; Lourdes Counseling Center ("Counseling Center") in Richland, Washington and Lourdes Foundation ("Foundation"). The Medical Center and Counseling Center provide inpatient, outpatient and emergency care services for the residents of Pasco and its surrounding communities. Admitting physicians are primarily practitioners in the local area. The Foundation supports the Medical Center and the Counseling Center. The Health Network is related to Ascension Health's other sponsored organizations through common control. Substantially all expenses of Ascension Health are related to providing health care services.In addition to our national affiliation with Ascension Health, Lourdes has multiple local community partnerships. Lourdes is co-owner of the Tri-Cities Cancer Center and Tri-Cities Lab along with two other local acute care hospitals. This allows for no duplication of services for specialized programs in our community. Lourdes is an active participant with the Benton Franklin Community Health Alliance and assists ith funding for this program designed to collaboratively address local health issues. Other members of the alliance are: Benton Franklin Department of Health, Kadlec Regional Medical Center, Kennewick General Hospital, Group Health Cooperative (a private insurer), two Federally Qualified ealth Centers, and the Veteran's Memorial Hospital. Lourdes works collaboratively with Tri-Cities Community Health - a federally qualified health enter on multiple grants and providing space for an urgent care center. Lourdes also sponsors the following organizations committed to improving the health of our community through their independent Missions: American Cancer Society, American Diabetes Association, Neurological Center, Carson Kolzig Foundation for Autism, Grace Clinic for the uninsured, American Red Cross, Tri-Cities Cancer Center, and countless other non-profits. WA 1 Lourdes Foundation 520 North 4th Avenue Pasco WA 99301 911528577 501(C)(3) 273373 General Support Benton Franklin Community Health Alliance 7102 Okanogan Place Kennewick WA 99336 030452352 501(C)(3) 14004 General Support 2 0 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Our Lady of Lourdes Hospital at Pasco provided donations to Lourdes Foundation to assist in daily operations. Lourdes Foundation's operations are closely monitored through shared leadership and governance to ensure monies given are used as intended. In addition, Our Lady of Lourdes Hospital at Pasco donated to Benton Franklin Community Health Alliance in support of its access to care goals in the local community. The use of these funds is monitored through access to care successes and breakthrough in the community. X X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 John Serle 275109 0 216266 0 57183 0 26900 0 22799 0 598257 0 0 0 Frank Becker 197005 0 64534 0 41617 0 37370 0 22983 0 363509 0 0 0 Janet Wright 172902 0 26138 0 25541 0 39030 0 16516 0 280127 0 0 0 Barbara Mead 153916 0 26138 0 20948 0 30819 0 10103 0 241924 0 0 0 Craig Pearsall 110162 0 13828 0 14820 0 28892 0 8193 0 175895 0 0 0 Gladson Menino Vaz MD 364996 0 100671 0 18167 0 28750 0 23664 0 536248 0 0 0 James I Bucker MD 372718 0 375 0 831 0 0 0 10178 0 384102 0 0 0 Wei W Qiu MD 371459 0 375 0 641 0 16488 0 20881 0 409844 0 0 0 Michael J Hannan 363825 0 375 0 869 0 18573 0 22933 0 406575 0 0 0 Suresh Kumar Piryani MD 315501 0 575 0 756 0 28225 0 15079 0 360136 0 0 0 Part I, Line 1a An officer is allowed two annual business trips in which a single companion travel will be allowed and reimbursed. The companion fees are reimburseable according to the standard travel reimbursement policy. These reimbursements are considered taxable income to the officer and are included in Box 3 earnings on IRS Form W-2. Gross up payments are made to all employees of Lourdes Foundation and Our Lady of Lourdes Hospital at Pasco for gifts received from the employer such as Christmas gift cards and special recognition awards. An officer receives payments for tax preparation services. These reimbursements are considered taxable income to the officer and are included in Box 3 earnings on IRS Form W-2. Part I, Line 4a Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, are entirely dependent on the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision there is not guarantee that these executives will evere receive any benefit under the program. Any amount ultimately paid under the program to executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. The following individuals received payments from the supplemental nonqualified retirement plan in the amount as noted: Frank Becker - $23,297 and Janet Wright - $22,540 Form 990, Part VI, Section A, line 6 Our Lady of Lourdes Hospital at Pasco has a single corporate member, Ascension Health. Form 990, Part VI, Section A, line 7a Our Lady of Lourdes Hospital at Pasco has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of the Our Lady of Lourdes Hospital at Pasco. Form 990, Part VI, Section A, line 7b Ascension Health has designed a system authority matrix which assigns authority for key decisions that are necessary in the operation of the system. Specific areas that are identified in the authority matrix are: new organizations & major transactions; governing documents; appointments/removals; evaluation; debt limits; strategic & financial plans; assets; system policies & procedures. These areas are subject to certain levels of approval by Ascension per the system authority matrix. Form 990, Part VI, Section B, line 11 Management, including certain officers, works diligently to complete the Form 990 and attached schedules in a thorough manner. Management presents the Form to the Board, or a designated committee, to review and answer any questions. Prior to filing the return, all Board Members are provided the Form 990 and management team members are available to answer any Board Members questions. Form 990, Part VI, Section B, line 12c The organization regulary and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committe meeting will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose. Form 990, Part VI, Section B, line 15 In determing the compensation of the organization's CEO, the process included a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensation, the CEO was compared to other hospitals in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. The individual was not present when his compensation was decided. In determining the compensation of other officers or key employees of the organization, the process included a review and approval by independent persons, comparability data, and contemporaneous substatntion of the deliberation and decision. The audit committee reviewed and approved the compensation. In the review of the compensations, the other officers or key employees of the organization were compared to other hospitals' employees in the area that hold the same title. During the review and approval of the compensation, documentation of the decision was recorded in the board minutes. Form 990, Part VI, Section C, line 19 The organization will provide any documents open to public inspection upon request. Form 990, Part III, Line 4a: Community Benefit Report: For the year ended June 30, 2010 This report illustrates the significant degree to which Our Lady of Lourdes Hospital at Pasco contributes to the positive health status of the communities it serves. As a member of Ascension Health, the nation's largest Catholic healthcare system, Our Lady of Lourdes Hospital at Pasco continues to build and strengthen sustainable collaborative efforts that benefit the health of individuals, families, and society as a whole. The goal of Our Lady of Lourdes Hospital at Pasco is to perpetuate the healing mission of the church. Our Lady of Lourdes Hospital at Pasco furthers this goal through delivery of patient services, care to the elderly and indigent, patient education and health awareness programs for the community, and medical research. Our concern for all human life and dignity of each person leads the organization to provide medical services to all people in the community without regard to the patient's race, creed, national origin, economic status, or ability to pay. In order to portray the full breadth of our contribution, our community benefit information is described below: Organizational Commitment to Providing Community Benefit Our Lady of Lourdes Hospital at Pasco consists of Lourdes Medical Center, a 25 bed Acute Care Critical Access Hospital with a 10 bed Rehab Unit and Lourdes Counseling Center, a stand alone 32 bed Psychiatric Hospital offering both inpatient and outpatient behavioral health services. Our Lady of Lourdes Hospital at Pasco serves the Tri-Cities area of Washington State. Our Lady of Lourdes Hospital at Pasco seeks to improve the physical, mental, social and spiritual health status of its surrounding community. In addition to providing health care services to all individuals who require medical attention, Our Lady of Lourdes Hospital at Pasco has developed the following programs to help achieve its mission: Expanding Awareness, Education, and Health Promotion Our Lady of Lourdes Hospital at Pasco believes that it is essential to educate people regarding the types of behavior that improve their chances of living a healthy life. Our Lady of Lourdes Hospital at Pasco has invested significantly in unique, top quality health education and materials relating to first aid, health and wellness and more in order to accomplish its goals. Through its Thrive for Life, Our Lady of Lourdes Hospital has provided the following community education seminars: - Finding Joy in Everyday Life - The Wonder of Water (proper hydration) - Diabetic Education - The Flu & You - Advance Directives - Easy Exercise for Weight Loss & More - Let's Talk Turkey: Eating Healthy for the Holidays - Fending off the Winter Blues - Games to keep Your Brain Healthy - New Year, New Resolutions - Healthy Aging & Community Resources - Heart Health - Love Your Legs (leg and foot health) - Jazzed Up for Exercise! - No Excuses Exercise - Why Can't I Sleep?! - Osteoporosis & Bone Health - Wills Clinic (writing and updating your will) - Know the 10 Warning Signs of Dementia - Free bone density screenings In addition, Our Lady of Lourdes Hospital at Pasco has hosted numerous Lunch and Learn education sessions open to employees and the general public free of cost including the following: - L&L: Current Treatment Strategies for Clostridium Difficile - L&L: Anticoagulation Therapy: New Guidelines for Patient Safety - L&L: Hepatitis B Update - L&L: Infection Control: New Isolation Signs - L&L: Lung Cancer Current Treatment Options - L&L: Northwest Tissue Service - L&L: Refeeding Syndrome - L&L: Swine Flu Facts - L&L: Where's my Blood? - L&L: Zeroing in on Pressure Ulcers Our Lady of Lourdes Hospital at Pasco also offers focused Prenatal Care instruction to our community. Courses offered on a routine basis are: - C-Section Courses - Sibling Courses - English and Spanish Prenatal Courses - Refresher Courses - Infant CPR Courses -Post Partum Clinics Our Lady of Lourdes Hospital at Pasco has developed a partnership with a local Rural Health Clinic as well as the State of Washington to help facilitate the access to healthcare for local community members that are experiencing financial hardships through its Basic Health initiatives. Medical Education Our Lady of Lourdes Hospital at Pasco believes that, in order to provide the best health care to the community, its clinical personnel must receive ongoing medical education. Healthcare professionals are therefore encouraged to attend the Lunch and Learn sessions provided onsite. In addition, Our Lady of Lourdes Hospital at Pasco provides healthcare professionals with education in the following job specific areas on a routine basis: - BLS = Basic Life Support (i.e. cardiopulmonary resuscitation - CPR) - ACLS = Advance Cardiac Life Support - NRP = Neonatal Resuscitation - TNCC = Trauma Nurse Core Curriculum - PALS = Pediatric Advanced Life Support - STABLE = Advanced Neonatal Resuscitation - Advanced Rehab Documentation and FIM scoring - Advanced solution wound care - CPT Coding - E/M Documentation guidelines - Emergency Severity index: 5 level triage - First 18 hours of newborn care - PICC Line Insertion class - Prophylaxis and Management of Asthma - Radiation Safety Training - SBAR Communication - Providing Holistic, Reverent Care In the spirit of principles adopted by Ascension Health, Our Lady of Lourdes Hospital at Pasco has taken proactive steps to address those issues that will affect accessibility, the financing, and the delivery of healthcare to all persons, especially the uninsured, underinsured, and the underserved. During the fiscal year ending June 30, 2010, the estimated unreimbursed cost of services provided to the elderly, uninsured, and underinsured totaled $7,225,065 with an additional $1,731,110 in charity care delivered. Lourdes Medical Center provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2010, approximately 32% of the values of services rendered were to elderly patients under the Medicare program, and approximately 22% of the services were provided to patients who were deemed indigent under state guidelines (Medicaid). Lourdes Counseling Center also provides a substantial portion of its services to the elderly and poor. During the fiscal year ending June 30, 2010, approximately 23% of the values of its services rendered were to elderly patients under the Medicare program, and approximately 46% of the services were provided to patients who were deemed indigent under state guidelines (Medicaid). Lourdes Medical Center - Operates an emergency room that is open to all persons regardless of ability to pay; - Has an open medical staff with privileges available to all qualified physicians in the area; - Has a governing body in which independent persons representative of the community comprise a majority; - Engages in the training and education of health care professionals; and - Participates in Medicaid, Medicare, CHAMPUS, Tricare, and/or other government-sponsored health care programs. Patient Services Our Lady of Lourdes Hospital at Pasco provides the following in-patient and out-patient medical services to the community: - ICU - Acute Care - Newborn Care - Chemical Dependency and Rehabilitation - Obstetrics - Rehab - Surgery - Laboratory - Diagnostic Imaging - Diagnostic Therapeutic - Adult and Child Psychiatry - Renal - Emergency - Clinic Services (Occupational Health, Employee Assistance, Primary Care, Pediatrics, and Internal Medicine) - Ambulatory - Sleep Lab - Ear, Nose and Throat - Therapies (Physical, Occupational, and Speech) - Diabetic Education and Counseling - Inpatient Psychiatric - Outpatient Counseling and Behavioral Health Treatment Some of the services listed above operate at a loss in order to ensure that all services are available to meet community health care needs. These include: Lourdes Wilson House and Children's Day Program. During the fiscal year ending June 30, 2010, Our Lady of Lourdes Hospital at Pasco treated 3,368 adults and children in the community for a total of 13,966 patient days of service. The Medical Center also provided services to 162,867 outpatients, including 1,769 outpatient surgery patients, 25,680 emergency and 41,737 physician office visits. FINANCIAL INFORMATION The financial information presented below was prepared in accordance with the Catholic Health Association's (CHA) community benefit reporting guidelines. These guidelines recommend the following: - Report care of the poor at cost, not charges. - Do not include bad debt, contractual allowances, and quick pay discounts as part of care of the poor expense. - Do not count Medicare shortfall as a community benefit. - Report the net expense for community benefit expense minus any associated revenue from patients, payers, and other external sources. The CHA reporting guidelines reflect a conservative approach to reporting quantifiable community benefit. The goal of the reporting guidelines is to produce community benefit financial reports that reflect true costs and that describe community benefit activities that increase access to health care and improve community health. For fiscal year ended June 30, 2010 1) Care of the poor - at cost $1,731,110 2) Government sponsored health care - net expense $4,155,821 (unpaid cost of public indigent care programs includes Medicaid, SCHIP, other safety net programs; does not include Medicare shortfall) 3) Community Benefit Programs - net expense $ 200,589 Supplemental information Bad debt $6,707,442 Form 990, Part VII, Section A: Explanation of Officers Compensation: Sister Esther Polacci is paid directly from La Province of the Sisters of St. Joseph Carondelet. Form 990, Part VII, Section B: Explanation of Amounts Paid to Highest Paid Independent Contractors: Amounts paid to Chervenell Construction Co. and George A. Grant, Inc. represent amounts paid for services and materials. These amounts cannot be separated. Ascension Health PO Box 45998 St Louis MO 63145 311662309 Healthcare MO Section 501(c)(3) Schedule A, Line 11a N/A Lourdes Foundation 520 North 4th Avenue Pasco WA 99301 911528577 Fundraising WA Section 501(c)(3) Schedule A, Line 11a Our Lady of Lourdes Hospital at Pasco 0 1 1 0 0 0 0 0 0 0 0 0 0 0 1 1 1 1 Lourdes Foundation B 273373 Lourdes Foundation C 66879 Lourdes Foundation P 128746 Ascension Health O 5970852 Ascension Health Q 927130 Ascension Health R 146704