2011-05-16T11:39:32-05:00 2010-06-30 990 2009-07-01 820200895 SAINT ALPHONSUS REGIONAL MEDICAL CENTER SAIN 2083672121 1055 NORTH CURTIS ROAD BOISE ID 83706 KENNETH FRY 2083672121 2011-05-16 2009 2016-02-24 21:20:13Z SEE SCHEDULE O KENNETH FRY 1055 NORTH CURTIS ROAD BOISE ID 83706 457023867 0 0928 X www.sarmc.org X 1958 ID HEALTHCARE SERVICES 14 11 3326 2440 22238 0 4301522 1900167 412804464 438611592 -6384763 5602454 5092544 3850488 415813767 449964701 500130 884456 0 163288999 193960296 0 1477355 229683608 241355859 393472737 436200611 22341030 13764090 536356778 564591645 212499502 226076616 323857276 338515029 HEALTHCARE SERVICES - SEE LINE 4 AND SCHEDULE H FOR ADDITIONAL INFORMATION 0 0 371575786 884456 441950396 SAINT ALPHONSUS REGIONAL MEDICAL CENTER, A NOT-FOR-PROFIT CORPORATION, OWNS AND OPERATES AN ACUTE CARE HOSPITAL IN BOISE, IDAHO. THE HOSPITAL PROVIDES SERVICES TO RESIDENTS OF THE LOCAL GEOGRAPHIC REGION. THE HOSPITAL IS A MEMBER OF TRINITY HEALTH, AN INDIANA NOT-FOR-PROFIT CORPORATION SPONSORED BY CATHOLIC HEALTH MINISTRIES, A PUBLIC JURIDIC PERSON OF THE HOLY ROMAN CATHOLIC CHURCH. FOR MORE INFORMATION ON SPECIFIC SERVICES PROVIDED, PLEASE SEE SAINT ALPHONSUS REGIONAL MEDICAL CENTER'S WEBSITE AT www.sarmc.org. The Mission statement of the Hospital is as follows:We serve together in Trinity Healthin the spirit of the Gospel to heal body, mind, and spiritto improve the health of our communitiesand to steward the resources entrusted to us. 371575786 1 1 0 1 0 0 0 0 1 1 0 1 0 0 0 0 0 0 1 0 1 1 0 1 0 0 0 1 0 0 1 1 1 1 0 0 0 1 1 0 0 1 615 0 1 3326 1 1 1 0 0 0 0 1 1 0 0 0 14 11 1 0 1 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 OR X RYAN SPEAS CONTROLLER 2083677192 6600 EMERALD ST BOISE ID 83706 BRENT LLOYD 1.00 X X 4200 0 0 DIANA NICHOLSON 1.00 X X 1400 0 0 SEVERINA HAWS 1.00 X X 0 0 0 SALLY JEFFCOAT 50.00 X X 0 411969 35688 JANELLE G REILLY 50.00 X 0 417029 35902 KENNETH FRY 50.00 X 0 335242 44373 MICHAEL SLUBOWSKI 3.00 X X 0 1617841 154389 J RICHARD O'CONNELL 3.00 X X 0 495143 11123 SR JEANETTE FETTIG CSC 1.00 X 0 0 0 MARK MEIER MD 1.00 X 2800 0 0 KAYE O'RIORDAN 1.00 X 1400 0 0 CHARLES WHITE 1.00 X 0 0 0 GEORGE JUETTEN 1.00 X 1400 0 0 ROBERT LOKKEN 1.00 X 0 0 0 SHAUNA WILLIAMS MD 1.00 X 24444 0 0 SR SHARLET WAGNER CSC 1.00 X 0 0 0 MARY MCFARLAND 1.00 X 0 0 0 COYLA ANDERSON 1.00 X 0 0 0 JOSEPH SWEDISH 2.00 X 0 3023292 798303 KEDRICK ADKINS 2.00 X 0 1453695 130171 JAMES POLK 50.00 X 0 377581 52737 JEAN BASOM 50.00 X 0 231429 99064 KAREN HODGE 50.00 X 149467 84063 63411 CHRISTIAN ZIMMERMAN MD 50.00 X 1623775 0 16193 JEFFREY SHILT MD 50.00 X 704837 0 34321 MARK G PARENT MD 50.00 X 695756 0 45175 KARL SCHULTHEISS MD 50.00 X 661769 0 39654 STEPHANIE B HODSON MD 50.00 X 640786 0 30258 4512034 8447284 1590762 136 0 1 0 REHABILITATION MANAGEMENT ASSOCIATES INC 901 N CURTIS 204 BOISE ID 83706 REHABILITATION SERVICES 6259898 INTERMOUNTAIN MEDICAL IMAGING LLC 877 WEST MAIN ST STE 603 bOISE ID 83702 RADIOLOGY SERVICES 3375498 AIR METHODS PO BOX 172892 DENVER CO 80217 HELICOPTER SERVICES 2799578 THOMAS CUISINE MANAGEMENT 640 EAST FRANKLIN ROAD MERIDIAN ID 83642 HOSPITAL CAFETERIA MANAGEMENT 1960541 BOISE ANESTHESIA PA PO BOX 5641 PORTLAND OR 97228 ANESTHESIA SERVICES 1470177 89 406306 184637 806453 502771 87390 1900167 NET PATIENT SVC REV 900099 437480734 437480734 INTERCO. ALLOCATION 900099 1130858 1130858 438611592 4873699 4873699 434545 434545 434545 434545 7397456 299207 6369494 -299207 1027962 728755 728755 432227 406306 390465 41762 41762 13139 13139 13139 OTHER REVENUE 900099 3338804 3338804 BIOMEDICAL REPAIR 811000 16343 16343 DAYCARE SERVICES 624410 5895 5895 3361042 449964701 441950396 22238 6091900 884456 884456 2460438 2460438 50851 50851 158192723 147576285 10171059 445379 9187657 8667317 493977 26363 13502259 12512972 951204 38083 10566368 9744614 793225 28529 1476798 1192782 284016 1372199 243440 1128759 194919 10133 184786 44875129 38436350 6098030 340749 1825808 421178 1389287 15343 83405063 79655333 3280407 469323 19745394 1143786 18596198 5410 8435916 8271436 146466 18014 1034551 648793 324261 61497 525 525 6689546 6689546 26832902 23289708 3542761 433 2425284 59395 2365889 BAD DEBT 22985121 22985121 INTERCO. PURCHASED SVCS 7131554 39378 7092176 EQUIPMENT MAINTENANCE 5305539 5139694 165153 692 CONTRACT LABOR EXPENSE 3765426 485706 3279720 HOSPITAL PROVIDER TAX 1948123 1948123 1906062 1478864 399658 27540 436200611 371575786 63147470 1477355 10192322 7663251 2783252 2111489 2385257 676909 71290561 68535958 274823 444342 5306820 6616014 546358 985208 450858632 178815914 281843614 272042718 82556472 123331106 47904095 48265902 31273204 33918748 536356778 564591645 35007416 49760199 348000 248000 177144086 176068417 212499502 226076616 X 314389447 335200057 9467829 3314972 323857276 338515029 536356778 564591645 X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 1 0 0 0 1 18506 1 76125 0 1 122195 216826 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: LOBBYING ACTIVITIES PERFORMED BY SAINT ALPHONSUS REGIONAL MEDICAL CENTER (SARMC) INCLUDED THE RETENTION OF AN INDIVIDUAL WHO WAS PAID A RETAINER TO PERFORM THE FOLLOWING: 1. MONITOR AND REPORT ON ALL SIGNIFICANT DEVELOPMENTS IN IDAHO STATE LEGAL, LEGISLATIVE, POLICY AND REGULATORY MATTERS AFFECTING SARMC. 2. REGULARLY MEET IDAHO STATE OFFICIALS ON ISSUES OF CONTINUING CONCERN AND INTEREST TO SARMC AND REPORT THE RESULTS OF SUCH MEETINGS. 3. MONITOR ALL LEGISLATION INTRODUCED DURING EACH LEGISLATIVE SESSION, LOBBY AGAINST LEGISLATION DETERMINED TO BE ADVERSE TO SARMC AND LOBBY IN FAVOR OF ALL MATTERS OF INTEREST AND CONCERN TO SARMC DURING THE SAME LEGISLATIVE SESSION. SAINT ALPHONSUS REGIONAL MEDICAL CENTER ALSO PAYS DUES TO SEVERAL HEALTH ASSOCIATIONS WHO USE A PORTION OF THESE DUES FOR LOBBYING PURPOSES. THESE ORGANIZATIONS HAVE PROVIDED SARMC WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. THAT LOBBYING PORTION IS AS FOLLOWS: IDAHO HOSPITAL ASSOCIATION - $9,922; AMERICAN HOSPITAL ASSOCIATION - $4,866; CATHOLIC HOSPITAL ASSOCIATION - $3,718. 8914610 1704880 381743 10237747 11601314 -2363278 323426 8914610 1.00000 0 0 1284141 8129490 9413631 303888585 92799313 211089272 129975614 86016601 43959013 7580802 7580802 272042718 ABSOLUTE RETURN STRATEGY FUNDS 22871097 F COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 25394805 F 48265902 INTERCOMPANY NOTES RECEIVABLES 719674 OTHER RECEIVABLES 1994280 INTERCOMPANY OTHER LONG TERM ASSETS 23107175 OTHER LONG TERM PREPAID ASSET 1260000 INTERCOMPANY RECEIVABLES 2806186 INVESTMENT IN MRI MOBILE LIMITED PARTNERSHIP 617547 INVESTMENT IN HUMPHREYS DIABETES CENTER, INC. 1019816 INVESTMENT IN IMQUANT INC. 196364 INVESTMENT IN EAGLE REAL ESTATE LLC 369575 INVESTMENT IN LIFE FLIGHT NETWORK, LLC 451761 INVESTMENT IN MRI LIMITED PARTNERSHIP 1376370 33918748 INTERCOMPANY ACCOUNTS PAYABLE 2714954 DEFERRED COMPENSATION LIABILITY 1513682 ASSET RETIREMENT OBLIGATION (FIN 47) 638776 INTERCOMPANY NOTES PAYABLE 171020799 OTHER LONG TERM LIABILITIES 180206 176068417 Part V, Line 4: Description of Intended Use of Endowment Funds: THE INTENDED USES OF THE ORGANIZATION'S ENDOWMENT FUNDS ARE FOR: - PROJECTS DESIGNED TO ELEVATE THE QUALITY OF HEALTHCARE (INTERNAL GRANTS) - PROJECTS TO MEET IMMEDIATE NEEDS RELATED TO PATIENT CARE QUALITY (OPPORTUNITY GRANTS) - PROJECTS FOR HEALTH AND WELFARE-RELATED COMMUNITY BENEFIT PROJECTS THAT MEET THE NEEDS OF THE POOR AND UNDERSERVED. Part X: Description of Uncertain Tax Positions Under FIN 48: SAINT ALPHONSUS REGIONAL MEDICAL CENTER is included in the consolidated financial statements of Trinity Health. Trinity Health's financial statements for the year ended June 30, 2010 did not include a FIN 48 footnote. 2009 FESTIVAL OF THE TREES 708776 332222 376554 4775 145513 196825 2010 CAPITOL CLASSIC 49666 26946 22720 22947 2 80091 47138 32953 2803 750 16852 838533 406306 432227 7578 146263 236624 390465 41762 1 1 X 1 X 1 X 1 1 0 1 1 1 8358 10185793 10185793 0.02470 25 45055 53917563 45835249 8082314 0.01960 26 53413 64103356 45835249 18268107 0.04430 11 96904 1491855 150 1491705 0.00360 3 1994 2472813 2472813 0.00600 9 48456 8109260 4010005 4099255 0.00990 1 50 1053 1053 0.00000 4 0 2265699 2265699 0.00550 28 147404 14340680 4010155 10330525 0.02500 54 200817 78444036 49845404 28598632 0.06930 1 20000 20000 0.00000 2 8026 50045 50045 0.00010 3 184038 105496 105496 0.00030 6 192064 175541 175541 0.00040 0 10743774 1933879 77657881 85054434 -7396553 X 1 1 MRI LIMITED PARTNERSHIP MRI DIAGNOSTICS 0.14170 0.00000 0.83050 MRI MOBILE LIMITED PARTNERSHIP MRI DIAGNOSTICS 0.16160 0.00000 0.50380 SAINT ALPHONSUS REGIONAL MEDICAL CENTER

1055 N CURTIS ROAD BOISE ID 83706

X X X X BOISE MEDICAL ARTS CENTER

999 N CURTIS ROAD BOISE ID 83706

AMBULATORY CLINIC ORTHO INST & BOISE HRT CARE

1070-1071 N CURTIS ROAD BOISE ID 83706

EMPLOYED PHYSICIANS MEDICAL OFFICE BUILDING

6140 W CURTISIAN BOISE ID 83706

SLEEP DISORDER CENTER, EMPLOYED PHYSICIANS SAINT ALPHONSUS MERIDIAN HEALTH PLAZA

3025 W CHERRY LANE MERIDIAN ID 83742

X X LAB, PT, EMPLOYED PHYSICIANS SAINT ALPHONSUS EAGLE HEALTH PLAZA

323 E RIVERSIDE EAGLE ID 83616

X X LAB, IMAGING, PT, EMPLOYED PHYSICIANS FAMILY PRACTICE ASSOCIATES

6533 EMERALD ST BOISE ID 83704

EMPLOYED PHYSICIANS VIEWPOINTE CLINIC

1880 W JUDITH LN BOISE ID 83705

EMPLOYED PHYSICIANS BANBURY MEDICAL CENTER

12273 W MCMILLAN RD BOISE ID 83713

EMPLOYED PHYSICIANS SHORELINE CLINIC

1673 W SHORELINE DR BOISE ID 83702

EMPLOYED PHYSICIANS LIBERTY MEDICAL PARK

900 N LIBERTY BOISE ID 83704

EMPLOYED PHYSICIANS BOISE OBSTETRICS & GYNECOLOGICAL CLINIC

5966 CURTISIAN BOISE ID 83704

EMPLOYED PHYSICIANS SAINT ALPHONSUS MEDICAL BUILDING

901 N CURTIS BOISE ID 83706

EMPLOYED PHYSICIANS MENTAL HEALTH SERVICES

131 N ALLUMBAUGH BOISE ID 83704

EMPLOYED PHYSICIANS HARTMAN BUILDING

1075 N CURTIS RD BOISE ID 83706

EMPLOYED PHYSICIANS PEDIATRIC ORTHOPEDICS

6500 W EMERALD BOISE ID 83704

EMPLOYED PHYSICIANS PHYSICIANS OFFICE BUILDING

1000 N CURTIS RD BOISE ID 83706

EMPLOYED PHYSICIANS ELM CLINIC

315 E ELM CALDWELL ID 83605

EMPLOYED PHYSICIANS Part I, Line 3c: Part I, Line 6a: saint alphonsus regional medical center reports its community benefit information as part of the consolidated community benefit information reported by Trinity Health in its annual report, available at www.trinity-health.org.In addition, saint alphonsus regional medical center includes a copy of its most recently filed schedule H on both its own website and trinity health's website. Part I, Line 7: The best available data was used to calculate the cost amounts reported in item 7. For certain categories, primarily total charity care and means-tested government programs, specific cost-to-charge ratios were calculated and applied to those categories. The cost-to-charge ratio was derived from worksheet 2, ratio of patient care cost-to-charges. In other categories, the best available data was derived from the Hospital's cost accounting system. Part I, Line 7f: The following number, $22,985,121, represents the amount of bad debt expense included in total functional expenses in Form 990, Part IX, Line 25. Per IRS instructions, this amount was excluded from the denominator when calculating the percent of total expense for Schedule H, Part I, Line 7, column (f). Part III, Line 4: SAINT ALPHONSUS REGIONAL MEDICAL CENTER is included in the consolidated financial statements of Trinity Health. The following is the text of the allowance for doubtful accounts footnote from those statements: "Substantially all of the corporation's receivables are related to providing healthcare services to patients. Accounts receivable are reduced by an allowance for amounts that could become uncollectible in the future. The corporation's estimate for its allowance for doubtful accounts is based upon management's assessment of historical and expected net collections by payor."Costing methodology for lines 2 and 3: Amounts are calculated on line 2 using a cost to charge ratio methodology.Any discounts provided or payments made to a particular patient account are applied to that patient account prior to any bad debt write-off and are thus not included in bad debt expense. As a result of the payment and adjustment activity being posted to bad debt accounts, we are able to report bad debt expense net of these transactions.THE AMOUNT ON LINE 3 WAS CALCULATED BASED ON INFORMATION SUPPLIED BY NCO, OUR COLLECTION AGENCY. Part III, Line 8: Similar to CHA recommendations, which state that serving Medicare patients is not a differentiating feature of tax-exempt healthcare organizations and that the existing community benefit framework allows community benefit programs that serve the Medicare population to be counted in other community benefit categories, sAINt alphonsus regional medical center does not believe any Medicare shortfall should be treated as community benefit.Part III, Line 8: Costing methodology for line 6 - Medicare costs were obtained from the filed Medicare cost report. The costs are based on Medicare allowable costs as reported on worksheet B, column 27, which exclude direct medical education costs. Inpatient Medicare costs are calculated based on a combination of allowable cost per day times Medicare days for routine services and cost to charge ratio times Medicare charges for ancillary services. Outpatient Medicare costs are calculated based on cost to charge ratio times Medicare charges by ancillary department. Part III, Line 9b: SAINT ALPHONSUS REGIONAL MEDICAL CENTER's collection policy contains the criteria for financial assistance, and contains the following verbiage for arrangements with outside collection agencies: The agreement must define the standards and scope of practices to be used by outside collection agents acting on behalf of SAINT ALPHONSUS REGIONAL MEDICAL CENTER, all of which must be in compliance with this policy. Part VI, Line 2: NEEDS ASSESSMENT - SAINT ALPHONSUS REGIONAL MEDICAL CENTER ASSESSES THE HEALTH NEEDS OF THE COMMUNITY THROUGH COMMUNITY NEEDS ASSESSMENTS EVERY THREE YEARS. A COMMUNITY NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY. IT SERVES AS THE BASIS FOR SAINT ALPHONSUS REGIONAL MEDICAL CENTER'S STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES.THE SAINT ALPHONSUS COMMUNITY NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED- IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS- PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNINGTHE SAINT ALPHONSUS COMMUNITY NEEDS ASSESSMENT PROCESS INVOLVES THE GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELPS SUPPORT SHORT-TERM AND LONG-TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES.The current Saint Alphonsus community needs assessment was finalized in June 2008 (with several key areas updated in December 2009), and action plans to address identified community needs have been developed through FISCAL YEAR 2012. The community needs assessment was conducted by Saint Alphonsus staff and has been made available to the community on our website. We also have shared hard copies with other nonprofit agencies, such as United Way of Treasure Valley and the Idaho Nonprofit Center.IN ANTICIPATION OF COMPLETING A NEW STRATEGIC PLAN, A COMMUNITY NEEDS ASSESSMENT UPDATE WAS COMPLETED BY OUR BOARD'S MISSION SUBCOMMMITTEE IN DECEMBER 2009. THIS UPDATE FOCUSED ON PRIMARY CARE, MENTAL HEALTH AND THE NEEDS OF MEDICAID PATIENTS. During FY11 Saint Alphonsus will be participating in and supporting a comprehensive community needs assessment to be led by United Way of Treasure Valley, focusing on community needs relating to health, education and financial stability. Part VI, Line 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SAINT ALPHONSUS IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES;- CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES;- ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE;- BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITY.IN ACCORDANCE WITH AHA RECOMMENDATIONS, SAINT ALPHONSUS HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS:- PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS;- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS;- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS;- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER;- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONS.SAINT ALPHONSUS COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. SAINT ALPHONSUS HAS SIGNS POSTED IN ALL REGISTRATION AREAS AND PLASTIC TABLE TOP CARDS IN THE REGISTRATION WAITING ROOMS, NOTIFYING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. ALL SELF-PAY PATIENTS ARE OFFERED FINANCIAL ASSISTANCE FORMS. EACH PATIENT RECEIVES A BILLING BROCHURE THAT LISTS PAYMENT OPTIONS AND HOW TO APPLY FOR CHARITY CARE. PATIENTS ALSO ARE SCREENED FOR MEDICAID ELIGIBILITY, UTILIZING FINANCIAL ASSISTANCE FORMS.FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY HELP THEM OBTAIN AND PAY FOR HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.SAINT ALPHONSUS OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE THROUGH SIGNS POSTED IN REGISTRATION AREAS, PLASTIC TABLE TOP CARDS IN REGISTRATION WAITING ROOMS AND PATIENT BROCHURES. SELF-PAY INPATIENTS AND SURGERY PATIENTS RECEIVE A VISIT FROM A PATIENT ADVOCATE WHO ASSISTS THEM IN COMPLETING FINANCIAL ASSISTANCE FORMS FOR COUNTY INDIGENT ASSISTANCE, MEDICAID, SOCIAL SECURITY AND HOSPITAL CHARITY CARE.SAINT ALPHONSUS HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SAINT ALPHONSUS MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. THE MEDICAL CENTER EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) ABOUT THESE POLICIES WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. Part VI, Line 4: COMMUNITY INFORMATION - Saint Alphonsus Regional Medical Center (SARMC) serves patients from the primary, secondary and tertiary service areas listed below:- Primary Service Area: A five-county region including Ada, Canyon, Elmore, Gem and Malheur counties. - Secondary Service Area: Payette, Twin Falls, Valley, Washington, Baker and Union Counties. - Tertiary Service Area: Adams, Blaine, Boise, Cassia, Gooding, Jerome, Minidoka, Owyhee and Elko Counties.Area hospital facilities within SARMC's primary service area include St. Luke's Boise and Meridian, Idaho Elks Rehabilitation Center, Treasure Valley Hospital, Saint Alphonsus Medical Center-Nampa, West Valley Medical Center, Elmore Medical Center, Saint Alphonsus Medical Center-Ontario, and Walter Knox Memorial Hospital.Saint Alphonsus' primary service area is a mix of urban and rural communities within the Treasure Valley, bordered by rugged mountainous terrain and desert. The region has experienced rapid population growth over the past decade (from 2000-2009), with dramatic growth rates in Ada & Canyon Counties, the two largest counties in the service area:- Ada County population grew 27.8% from 2000-2009- Canyon County population grew 42% from 2000-2009THE FOLLOWING ARE RELEVANT STATISTICS FOR THE SAINT ALPHONSUS REGIONAL MEDICAL CENTER PRIMARY SERVICE AREA (FROM CENSUS.GOV QUICK FACTS, 2010):TOTAL POPULATION (2009):ADA COUNTY - 384,656CANYON COUNTY - 186,615ELMORE COUNTY - 28,820GEM COUNTY - 16,437MALHEUR COUNTY - 30,745PERCENT WHITE PERSONS NOT HISPANIC:ADA COUNTY - 87%CANYON COUNTY - 73%ELMORE COUNTY - 76%GEM COUNTY - 88%MALHEUR COUNTY - 66%PERCENT HISPANIC/LATINO ORIGIN:ADA COUNTY - 7%CANYON COUNTY - 22%ELMORE COUNTY - 15%GEM COUNTY - 9%MALHEUR COUNTY - 28%MEDIAN HOUSEHOLD INCOME:ADA COUNTY - $57,159CANYON COUNTY - $43,976ELMORE COUNTY - $47,561GEM COUNTY - $43,555MALHEUR COUNTY - $36,403PERSONS BELOW POVERTY LEVEL (2008):ADA COUNTY - 9%CANYON COUNTY - 15%ELMORE COUNTY - 14%GEM COUNTY - 15%MALHEUR COUNTY - 21%Approximately 17% of non-elderly Idaho residents lack health insurance (Kaiser Health Facts). Medically Underserved Populations and Health Professional Shortage Areas within our service area include a shortage of primary care and mental health services.The local refugee population has more than doubled since 2005; most of these individuals are of childbearing age. Approximately 3,800 refugees currently live in Ada County, with four refugee resettlement agencies in that county placing 724 new refugees in 2007. In 2008, 1,193 refugees and special immigrants arrived in Idaho, from 23 different countries, speaking 27 different languages (Idaho Office for Refugees). The region sees a high prevalence of mental health AND substance abuse issues, with inadequate public behavioral health systems in place to meet the existing needs for community-based and inpatient services.On review of demographic and socio-economic data and trends, several factors clearly have an impact on the health status of the communities served by Saint Alphonsus, with implications for future planning. Dramatic population growth, especially in Ada and Canyon Counties, is expected to continue, with a growing Hispanic population. The growing refugee population has greater language interpretation and health education needs as well.Growth in Idaho's senior population is also projected to accelerate, which will require increased health care spending. Mammography rates, the rising rate of low birth weight babies, overweight and obesity, tobacco use, mental health and drinking/drug use are also ISSUES of great concern. Part VI, Line 5: COMMUNITY BUILDING ACTIVITIES - SAINT ALPHONSUS REGIONAL MEDICAL CENTER STRIVES TO MAKE THE CITIZENS OF OUR COMMUNITY MORE PRODUCTIVE, HEALTHY MEMBERS OF SOCIETY. THROUGH OUR COMMUNITY NEEDS ASSESSMENT AND OTHER COMMUNITY DATA, WE LEARNED THAT SEVERAL AREAS CAN BENEFIT FROM OUR HEALTH CARE EXPERTISE AND MONETARY SUPPORT. THESE INCLUDE AGENCIES THAT SUPPORT ECONOMIC DEVELOPMENT AND JOB CREATION; SUPPORT THE UNINSURED; ADDRESS WELLNESS ISSUES IN THE WORKFORCE; IMPROVE END OF LIFE CARE; EDUCATE REFUGEES REGARDING CHILDBIRTH AND PARENTING; IMPROVE CHILD SAFETY, HEALTH AND EDUCATION; AND SUPPORT SUBSTANCE ABUSE DETOXIFICATION AND SOBERING SERVICES, AND CRISIS MENTAL HEALTH.Specific examples of our community building activities are described below:- Support of the Valley Initiative for Prosperity - Saint Alphonsus supported this broad-based economic development initiative (in partnership with local Chambers of Commerce and other local companies) that aimed to bring new businesses and jobs to the local community. Saint Alphonsus has invested $20,000 per year over 5 years, as part of our commitment to help our communities grow and thrive.- Participation in Local Boards AND Task Forces: Saint Alphonsus leaders and associates participate in a variety of local nonprofit boards and task forces aimed at improving the health of our communities and making our community a more livable place. Examples of board participation include:Family Medicine Residency of Idaho: Through active participation on the board of Family Medicine Residency of Idaho, Saint Alphonsus has been able to help guide the continuing development and expansion of family medicine residency capacity in Idaho - a critical need since Idaho ranks 49th nationwide in terms of primary care physicians per capita. Through this partnership, we were also able to develop a new psychiatric residency program based in Boise THREE years ago, which over time will expand the pipeline of new psychiatrists practicing in our region, which is a health provider shortage area for mental health.Boys AND Girls Clubs of Ada County: Enhancement of before AND after-school programming for local at-risk youth, including a new location in Meridian, Idaho. Saint Alphonsus' representative on the Boys AND Girls Club board has chaired several important committees, including Strategic Planning, Programs, and the annual signature fundraising event, the Wild West Auction, which brings in the bulk of annual operating funds for the clubs. The clubs have also taken on a significant role in providing feeding programs for low income children in Ada and Canyon Counties.Health Improvement Advocacy: Saint Alphonsus has been an active participant in advocacy supporting health improvement initiatives such as:Childhood Immunizations: During the 2010 Idaho legislative session, Saint Alphonsus worked with a coalition of other stakeholders to craft a solution to the state's discontinuation of funding for immunizations for insured children. The end product was passed into law, creating a system by which insurance plans would be assessed a fee to help cover the cost of immunizations for insured children - with the immunization fund being overseen by a newly created Immunization Assessment Board. This remedied confusion and frustration that had been expressed by providers and the public following budget cutbacks the prior year. Focus is now shifting to coalition efforts to improve Idaho's low immunization rates.Idaho End of Life Coalition: Advance care planning in Idaho has been improved and streamlined. Advance Care Committee members provide professional consultation on the development of Idaho advance care legislation including revision and streamlining of the Idaho Natural Death Act (living will and durable power of attorney for health care), creation of the Health Care Directive Registry housed in the office of the Secretary of State, and the POST (Physician Orders for Scope of Treatment) - the new Idaho DNR (do not resuscitate) program. In addition, coalition committees develop initiatives to raise community awareness and encourage professional development about end-of-life issues.Workforce Health Initiative: Saint Alphonsus has provided health risk assessments to employees of local companies, followed by presentations showing the company's overall risk profile and potential interventions that may help improve the health of the workforce and contain future healthcare costs. Saint Alphonsus has facilitated numerous "Biggest Loser" type weight loss challenges that have resulted in improved employee health and presented a significant team-building opportunity at participating companies. Staff from Saint Alphonsus have provided targeted education and screenings based on the risk profiles and preferences of each participating company. Part VI, Line 6: OTHER INFORMATION - CONSISTENT WITH ITS NONPROFIT STATUS, SAINT ALPHONSUS USES SURPLUS REVENUES TO REINVEST IN FACILITIES, TECHNOLOGY AND MEDICAL SERVICES FOR THE COMMUNITY, AND COLLABORATES WITH COMMUNITY PARTNERS AND INVESTS IN NEEDED COMMUNITY PROGRAMS SUCH AS HUMPHREYS DIABETES CENTER, FAMILY MEDICINE RESIDENCY OF IDAHO, ALLUMBAUGH HOUSE (SOBERING, DETOXIFICATION AND CRISIS MENTAL HEALTH SERVICES), HEALTH TEACHER HEALTH LITERACY CURRICULUM FOR THE BOISE SCHOOL DISTRICT, AND MATCH (A CHILDREN'S MENTAL HEALTH PROGRAM).Saint Alphonsus also collaborates with United Way of Treasure Valley to address community needs in the areas of health, education and income. Saint Alphonsus is represented on the United Way Board of Directors and the Health Vision Council. In addition, Saint Alphonsus has an annual United Way workplace giving campaign to support United Way initiatives and grants to local nonprofits producing measurable outcomes in addressing top community needs.SAINT ALPHONSUS STRONGLY SUPPORTS HEALTHCARE WORKFORCE DEVELOPMENT EFFORTS, INCLUDING ANNUAL FINANCIAL SUPPORT TO THE FAMILY MEDICINE RESIDENCY OF IDAHO, PSYCHIATRIC RESIDENCY, ISU DENTAL RESIDENCY, AND THE BOISE STATE UNIVERSITY NURSING BUILDING FUND. IN ADDITION, SAINT ALPHONSUS SERVES AS A KEY CLINICAL TRAINING SITE FOR NEW PHYSICIANS, NURSES AND OTHER ALLIED HEALTH PROFESSIONALS.Saint Alphonsus is a regional trauma center and takes a leadership role in improving systems of care for trauma patients. Trauma prevention and disaster preparedness efforts in the region are often led by staff at Saint Alphonsus, who have championed tougher seat belt and helmet laws, coordinated drunk driving prevention events in local high schools, and led in response planning for events like the Special Olympics World Winter Games. Saint Alphonsus also hosts an annual Ski & Mountain Trauma Conference to train first responders (EMS, fire, ski patrol, etc.) throughout the Northwest on best practices for trauma care in the pre-hospital setting.SAINT ALPHONSUS COORDINATES A REGIONAL TELEMEDICINE NETWORK THROUGHOUT WESTERN AND NORTHERN IDAHO AND EASTERN OREGON. SERVICES PROVIDED THROUGH THE NETWORK INCLUDE MUCH-NEEDED SERVICES SUCH AS TELEPSYCHIATRY, STROKE CARE, CLINICAL EDUCATION AND EMERGENCY MEDICINE CONSULTATIONS TO RURAL HOSPITALS IN REMOTE LOCATIONS, OFTEN PREVENTING UNNECESSARY TRANSPORTS AND ALLOWING PATIENTS TO BE CARED FOR CLOSER TO HOME.Saint Alphonsus is governed by a Board of Trustees consisting of community members who serve in a voluntary capacity. Additional community volunteers are engaged in Board Committees such as Quality, Mission, and Planning & Finance. Part VI, Line 7: SAINT ALPHONSUS REGIONAL MEDICAL CENTER is a member organization of Trinity Health, the fourth-largest Catholic health care system in the country. Based in Novi, Michigan, Trinity Health annually requires that all member organizations develop, and are held accountable for achieving, community benefit goals that include developing needed services or expanding access to services for low-income individuals. As a not-for-profit health system, Trinity Health reinvests its profits back into the community through programs to serve the poor and uninsured, manage chronic conditions like diabetes, health education and promotion initiatives, and outreach for the elderly. In fiscal year 2010, this included nearly $456 million in such community benefits. Therefore, Trinity Health takes a systems approach in its community benefit planning and implementation, and is consequently able to ensure that its member hospitals and other entities/affiliates are helping promote and address the health needs of their respective communities.For more information about Trinity Health, visit www.trinity-health.org. 1 COMMUNITY HEALTH CLINICS INC 211 16TH AVE NORTH NAMPA ID 83653 820300537 501(C)3 112546 SPONSORSHIP GENESIS WORLD MISSION INC 215 W 35TH ST GARDEN CITY ID 83714 820505073 501(C)3 5600 SPONSORSHIP ROMAN CATHOLIC DIOCESE OF BOISE 1501 S FEDERAL WAY STE 400 BOISE ID 83705 820200748 501(C)3 5000 SPONSORSHIP WOMEN'S AND CHILDREN'S ALLIANCE 720 W WASHINGTON ST BOISE ID 83702 820204464 501(C)3 5350 SPONSORSHIP BOISE METRO CHAMBER OF COMMERCE 250 S 5TH STREET 300 BOISE ID 83702 820100595 501(C)6 20000 SPONSORSHIP BOYS AND GIRLS CLUB OF ADA COUNTY IDAHO INC 610 E 42ND ST GARDEN CITY ID 83714 820481687 501(C)3 5000 198 fmv raffle basket SPONSORSHIP AMERICAN CANCER SOCIETY 2120 FIRST AVENUE NORTH SEATTLE WA 98109 841316555 501(C)3 7000 SPONSORSHIP CALDWELL TREASURE VALLEY RODEO INC PO BOX 98 CALDWELL ID 83606 820128057 501(C)4 10000 SPONSORSHIP AMERICAN HEART ASSOCIATION INC 7272 GREENVILLE AVE DALLAS TX 75231 135613797 501(C)3 11000 SPONSORSHIP FAMILY ADVOCACY CENTER & EDUC SVC 417 S 6TH STREET BOISE ID 83702 204883532 501(C)3 15000 SPONSORSHIP TREASURE VALLEY FAMILY YMCA 1050 WEST STATE ST BOISE ID 83702 820200908 501(C)3 13000 SPONSORSHIP TREY MCINTYRE PROJECT LTD PO BOX 2698 BOISE ID 83701 651239526 501(C)3 5000 SPONSORSHIP MAIN STREET MILE INC PO BOX 6331 BOISE ID 83707 113735163 501(C)3 18750 SPONSORSHIP SUSAN G KOMEN BREAST CANCER FOUNDATION DBA SUSAN G KOMEN FOR THE CURE 5005 LBJ FREEWAY DALLAS TX 75244 751835298 501(C)3 30000 SPONSORSHIP ST PAULS BENEVOLENT INSTITUTE 1181 SW 76TH AVE MIAMI FL 33144 226034713 501(C)3 405607 SPONSORSHIP MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVENUE WHITE PLAINS NY 10605 131846366 501(C)3 19000 SPONSORSHIP BOISE STATE UNIVERSITY 1910 UNIVERSITY DR BOISE ID 83725 820290701 501(C)3 123100 SUPPORT EXPANDING NURSING PROGRAM 15 2 Procedure for Monitoring Grants in the U.S.: Part I, Line 2: Schedule I, Part I, Line 2: Donations made by SAINT ALPHONSUS REGIONAL MEDICAL CENTER to charitable organizations are made in furtherance of the recipient organization's exempt purpose and are considered unrestricted with regard to the use of the funds. THE CONTRIBUTIONS COMMITTEE REVIEWS REQUESTS AND RECOMMENDS APPROVAL. X X 1 1 X X X X X 0 1 0 0 0 0 0 0 0 SALLY JEFFCOAT 0 287778 0 40000 0 84191 0 26928 0 8760 0 447657 0 0 JANELLE G REILLY 0 314925 0 68721 0 33383 0 14964 0 20938 0 452931 0 13169 KENNETH FRY 0 257392 0 60915 0 16935 0 26226 0 18147 0 379615 0 12945 MICHAEL SLUBOWSKI 0 696108 0 681725 0 240008 0 125922 0 28467 0 1772230 0 94766 J RICHARD O'CONNELL 0 440925 0 0 0 54218 0 11123 0 0 0 506266 0 0 JOSEPH SWEDISH 0 1214458 0 1607837 0 200997 0 769899 0 28404 0 3821595 0 0 KEDRICK ADKINS 0 712415 0 611975 0 129305 0 117250 0 12921 0 1583866 0 0 JAMES POLK 0 280207 0 67096 0 30278 0 33450 0 19287 0 430318 0 0 JEAN BASOM 0 176231 0 42070 0 13128 0 82907 0 16157 0 330493 0 0 KAREN HODGE 98490 83368 35312 0 15665 695 0 56049 3997 3365 153464 143477 0 0 CHRISTIAN ZIMMERMAN MD 1203230 0 417506 0 3039 0 13447 0 2746 0 1639968 0 0 0 JEFFREY SHILT MD 642573 0 50000 0 12264 0 10391 0 23930 0 739158 0 0 0 MARK G PARENT MD 650406 0 41207 0 4143 0 21147 0 24028 0 740931 0 0 0 KARL SCHULTHEISS MD 204567 0 456771 0 431 0 22377 0 17277 0 701423 0 0 0 STEPHANIE B HODSON MD 212511 0 428088 0 187 0 12676 0 17582 0 671044 0 0 0 Part I, Line 1a CERTAIN BOARD MEMBERS RECEIVED BOARD RECOGNITION FEES IN CALENDAR 2009. THESE AMOUNTS WERE INCLUDED ON A 1099-MISC, ALONG WITH A GROSS-UP TO COVER TAXES ON THE FEE. ONE BOARD MEMBER WAS PROVIDED WITH REIMBURSEMENT OF COMPANION TRAVEL EXPENSES IN CALENDAR 2009. THE EXPENSES WERE INCLUDED ON A 1099-MISC. Part I, Line 4a THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH PENSION RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2009). THE FOLLOWING ACCRUALS FOR 2009 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $59,584 SALLY JEFFCOAT - $13,299 MICHAEL SLUBOWSKI - $42,832 JOSEPH SWEDISH - $249,263 PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUALS FOR 2009 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $38,675 MICHAEL SLUBOWSKI - $55,733 JOSEPH SWEDISH - $493,225 PART I, LINE 4B: THE FOLLOWING INDIVIDUALS ARE PARTICIPANTS IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN UNDER SECTION 457(F): CHRISTIAN ZIMMERMAN, MD JEFFREY SHILT, MD MARK G. PARENT, MD KARL SCHULTHEISS, MD STEPHANIE B. HODSON, MD NONE OF THE ABOVE INDIVIDUALS HAD 457(F) DEFERRALS IN CALENDAR 2009. Part II, Column B (ii): The following individuals received amounts in 2009 from a long-term incentive plan (LTIP). Participants in the LTIP (CEOs and certain Trinity executives) were eligible to receive a payment under the plan only if certain patient loyalty improvement targets were achieved by the end of a three-year period (FY07 through FY09). The following LTIP amounts are included in Schedule J, Part II, Column B(ii): KEDRICK ADKINS - $337,826 MICHAEL SLUBOWSKI - $403,918 JOSEPH SWEDISH - $1,042,563 JEFFREY SHILT MD X 50000 28333 0 0 1 28333 REGENCE BLUE SHIELD OF IDAHO (RBSI) MARY MCFARLAND, BOARD TRUSTEE, ALSO SERVES ON THE BOARD OF RBSI 52549155 PAYMENTS MADE BY REGENCE BLUE SHIELD OF IDAHO TO SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. FOR HEALTH CARE SERVICES PROVIDED TO RBSI COVERED MEMBERS. 0 BLUE CROSS OF IDAHO (BCI) SALLY JEFFCOAT, CEO, ALSO SERVES ON THE BOARD OF BCI 74010707 PAYMENTS MADE BY BLUE CROSS OF IDAHO TO SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. FOR HEALTH CARE SERVICES PROVIDED TO BCI COVERED MEMBERS. 0 ETHAN FRY FAMILY MEMBER OF KENNETH FRY, KEY EMPLOYEE 50851 EMPLOYMENT ARRANGEMENT 0 X 3 3350 OPINION OF EXPERTS X 340 OPINION OF EXPERTS X 7281 OPINION OF EXPERTS X 7 6662 OPINION OF EXPERTS X 11 10356 COST X 4 5492 OPINION OF EXPERTS X ENTERTAINMENT 25 5721 COST X GIFT CERTIFICATES 23 2630 COST X CONSULTING SERVICES 1 23928 COST X PRINTING SERVICES 4 5095 COST X RENTAL EQUIPMENT 6 3785 COST X ADVERTISING 2 12500 COST X CELL PHONE SERVICES 1 250 COST 0 1 1 Third Party Use: Part I, Line 32b: THE REPORTING ENTITY HAS USED THIRD PARTIES TO PROCESS OR SELL NON-CASH CONTRIBUTIONS WHEN SPECIFIC EXPERTISE IS WARRANTED. WHERE AN EXPERT APPRAISAL IS NECESSARY, A THIRD PARTY APPRAISER WILL BE ENGAGED. OCCASIONALLY THE SERVICES OF AN AGENT ARE ENGAGED TO SELL NON-CASH CONTRIBUTIONS THAT WILL NOT BE USED BY THE REPORTING ENTITY. Form 990, Part VI, Section A, line 2 KAYE O'RIORDAN, TRUSTEE, AND BRENT LLOYD, CHAIR, HAVE A BUSINESS RELATIONSHIP. CHARLES WHITE, TRUSTEE, AND KAYE O'RIORDAN, TRUSTEE, HAVE A BUSINESS RELATIONSHIP. CHARLES WHITE, TRUSTEE, AND BRENT LLOYD, CHAIR, HAVE A BUSINESS RELATIONSHIP. Form 990, Part VI, Section A, line 4 EFFECTIVE APRIL 1, 2010, THE ARTICLES OF INCORPORATION OF SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. WERE AMENDED TO CHANGE THE SOLE MEMBER OF THE CORPORATION. SEE LINE 7A FOR MORE INFORMATION. EFFECTIVE MAY 13, 2010, THE BYLAWS WERE AMENDED TO REFLECT THAT THE BOARD OF TRUSTEES SHALL INCLUDE (I) AT LEAST ONE REPRESENTATIVE OF THE NEW CORPORATE MEMBER, DESIGNATED BY THE CORPORATE MEMBER (WHO SHALL SERVE EX OFFICIO WITH VOTE) AND (II) THE PRESIDENT OF SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. (WHO SHALL SERVE EX OFFICIO WITH VOTE), AND (III) MEMBERS OF THE COMMUNITY. IN ADDITION, A CONFIDENTIALITY SECTION AND A CONFLICT OF INTEREST SECTION WERE ADDED TO THE BYLAWS. Form 990, Part VI, Section A, line 6 TRINITY HEALTH CORPORATION WAS THE SOLE MEMBER OF SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. UNTIL MARCH 31, 2010. EFFECTIVE APRIL 1, 2010, SAINT ALPHONSUS HEALTH SYSTEM BECAME ITS SOLE MEMBER. (TRINITY HEALTH CORPORATION IS IN TURN THE SOLE MEMBER OF SAINT ALPHONSUS HEALTH SYSTEM.) SEE LINE 7 FOR ADDITIONAL INFORMATION. Form 990, Part VI, Section A, line 7a AS SOLE MEMBER OF THE CORPORATION, SAINT ALPHONSUS HEALTH SYSTEM (AND PREVIOUS TO APRIL 1, 2010, TRINITY HEALTH CORPORATION) HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. Form 990, Part VI, Section A, line 7b AS SOLE MEMBER OF THE CORPORATION, SAINT ALPHONSUS HEALTH SYSTEM (AND PREVIOUS TO APRIL 1, 2010, TRINITY HEALTH CORPORATION) MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. SAINT ALPHONSUS HEALTH SYSTEM (AND PREVIOUSLY, TRINITY HEALTH CORPORATION) MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. Form 990, Part VI, Section B, line 11 PRIOR TO FILING, THE FORM 990 FOR SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE FINANCE COMMITTEE OF SAINT ALPHONSUS HEALTH SYSTEM. (SAINT ALPHONSUS HEALTH SYSTEM IS THE SOLE MEMBER OF THE CORPORATION.) THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. Form 990, Part VI, Section B, line 12c SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. has adopted a conflict of interest policy which contains the elements in the model conflict of interest policy issued by the IRS. It applies to all Interested persons of SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC., which includes trustees, principal officers and executives, and members of committees with board designated powers. Interested persons are required to act at all times in a manner consistent with SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC.'S charitable purpose and service to the community and to avoid conflicts of interest. Interested persons are required to make full disclosure to SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. of any financial or business interests that might result in or have the appearance of a conflict of interest. Interested persons are required to recuse themselves from discussion and voting on matters involving a conflict of interest. The board of trustees of SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. is responsible for the review and approval of transactions with interested persons, including determining that such transactions are fair and reasonable to SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. On an annual basis, interested persons are required to complete a conflict of interest disclosure statement and to affirm their receipt of the conflict of interest policy, compliance with its requirements, and agree to notify the organization of changes impacting their annual disclosure in accordance with the policy. The annual disclosures are reviewed with the board of trustees of SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. on an annual basis. Form 990, Part VI, Section B, line 15 Trinity Health follows a process and policy that is intended to mirror the IRC Section 4958 guidelines for obtaining a "rebuttable presumption of reasonableness" with regard to compensation and benefits. As part of that process, the compensation and benefits of certain officers and key management officials of SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. are reviewed at least annually by the Trinity Health Board or the Trinity Health Human Resources and Compensation Committee (HRCC) of the Board, authorized to act on behalf of the Board with respect to certain compensation matters. As part of its review process, the HRCC retains an independent firm experienced in compensation and benefit matters for not-for-profit healthcare organizations to advise it in the determinations it makes on the reasonableness of proposed compensation and benefits arrangements. Form 990, Part VI, Section C, line 19 SAINT ALPHONSUS REGIONAL MEDICAL CENTER IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, SAINT ALPHONSUS REGIONAL MEDICAL CENTER INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. FORM 990, PART VII, SECTION A, LINE 1, COLUMN B ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: THE HOURS LISTED IN COLUMN B OF PART VII, SECTION A, LINE 1 REFLECT ONLY THE INDIVIDUALS' AVERAGE WEEKLY HOURS SPENT DIRECTLY ON THE ACTIVITIES OF THE REPORTING ORGANIZATION. IN ADDITION, THESE ARE THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: KEDRICK ADKINS - 53 HOURS KENNETH FRY - 5 HOURS SALLY JEFFCOAT - 5 HOURS J. RICHARD O'CONNELL - 52 HOURS JANELLE REILLY - 5 HOURS MICHAEL SLUBOWSKI - 52 HOURS JOSEPH SWEDISH - 53 HOURS FORM 990, PART VII, SECTION A, LINE 1: DIRECTORS/TRUSTEES OR OFFICERS DR. SHAUNA WILLIAMS, BOARD TRUSTEE, PROVIDED SERVICES TO SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. AS AN INDEPENDENT CONTRACTOR. THE AMOUNT SHOWN ON PART VII, SECTION A, LINE 1, REPRESENTS FEES FOR INDEPENDENT CONTRACTOR SERVICES, NOT BOARD FEES. FORM 990, PART VII, SECTION A, LINE 1: DIRECTORS/TRUSTEES OR OFFICERS SR. JEANETTE FETTIG, CSC, IS A MEMBER OF THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS. HAVING TAKEN A VOW OF POVERTY, SR. JEANETTE FETTIG DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. INSTEAD, A TOTAL OF $2,000 WAS PAID BY SAINT ALPHONSUS REGIONAL MEDICAL CENTER, INC. DIRECTLY TO THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS FOR SR. JEANETTE FETTIG'S SERVICES. Form 990, Part XI, Line 2: SAINT ALPHONSUS REGIONAL MEDICAL CENTER's financial statements were included in the FY10 consolidated financial statements of Trinity Health, which were audited by an independent public accounting firm. FORM 990, PART I, DOING BUSINESS AS: SAINT ALPHONSUS FOUNDATION, SAINT ALPHONSUS LIFE FLIGHT, IDAHO NEUROLOGICAL INSTITUTE, IDAHO ORTHOPAEDIC INSTITUTE, IDAHO REHABILITATION AND PAIN CENTER, SAINT ALPHONSUS BREAST CARE CENTER, SAINT ALPHONSUS CANCER TREATMENT CENTER, SAINT ALPHONSUS CANCER CARE CENTER, SAINT ALPHONSUS SLEEP DISORDERS CENTER, SAINT ALPHONSUS PRIMARY STROKE CENTER, SAINT ALPHONSUS MEDICAL GROUP, SAINT ALPHONSUS EXPRESS CARE CLR Investments LLC 120 W HARRIS ST CADILLAC MI 49601 320008631 Real estate rental & development MI 19827 175469 Trinity Health-Michigan Saint Agnes Home Health and Hospice LLC 17410 COLLEGE PARKWAY STE 150 LIVONIA MI 48152 382621935 Provide home health services CA 9367604 1116725 Trinity Home Health Services Inc Saint Mary's Pharmacy LLC 200 JEFFERSON AVE SE GRAND RAPIDS MI 49503 383404443 Pharmacy MI 0 0 Trinity Health-Michigan Mount Carmel HealthProviders Two LLC 6150 E BROAD STREET COLUMBUS OH 43213 201983271 MEDICAL SERVICES OH 0 0 MOUNT CARMEL HEALTH PROVIDERS INC PATHWAY HOSPICE LLC 1050 SW 3RD AVE SUITE 1600 ONTARIO OR 97914 931310235 HOSPICE CARE OR 262248 1512716 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO TRINITY HEALTH-WARDE LAB LLC 34605 W TWELVE MILE ROAD FARMINGTON HILLS MI 48331 272681908 REAL ESTATE RENTAL DE 0 0 TRINITY HEALTH - MICHIGAN MOUNT CARMEL HEALTH PROVIDERS III LLC 10 West Broad St Ste 2100 COLUMBUS OH 43215 204145781 MEDICAL SERVICES OH 1741059 6043 MOUNT CARMEL HEALTH PROVIDERS INC AMICARE HOSPICE SERVICES INC 27870 CABOT DRIVE NOVI MI 483772920 382949053 PROVIDE HOSPICE SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO BATTLE CREEK HEALTH SYSTEM 300 NORTH AVENUE BATTLE CREEK MI 49016 382776791 HEALTHCARE SERVICES MI 501(C)(3) 3 TRINITY HEALTH - MICHIGAN BATTLE CREEK HEALTH SYSTEM AUXILIARY 300 NORTH AVENUE BATTLE CREEK MI 49016 383355520 SUPPORT OF TAX EXEMPT HEALTH ORGANIZATION MI 501(C)(3) 11, TYPE I BATTLE CREEK HEALTH SYSTEM BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 Acute/Ambulatory healthcare services IA 501(C)(3) 3 Mercy Health Services-Iowa Corp BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 Support the services of related hospital IA 501(C)(3) 11, TYPE I Baum Harmon Mercy Hospital CAPITAL PARK FAMILY HEALTH CENTER INC 6150 EAST BROAD STREET COLUMBUS OH 43213 311387838 Operation of a federally qualified health center (formerly) OH 501(C)(3) 3 Mount Carmel Health System CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 Further Trinity Health activities, organize and develop medical services MI 501(C)(3) 11, TYPE II Trinity Health-Michigan Cranbrook Hospice Care 281 ENTERPRISE COURT BLOOMFIELD HILLS MI 48302 383320699 Provide hospice health services MI 501(C)(3) 11, TYPE I Trinity Home Health Services Inc Diley Ridge Medical Center 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 Hospital campus in Fairfield County Ohio OH 501(C)(3) 3 Mount Carmel Health System Dubuque Mercy Health Foundation Inc 250 MERCY DRIVE DUBUQUE IA 52001 262227941 Support the services of related hospital IA 501(C)(3) 11, TYPE I Mercy Health Services-Iowa Corp Dyersville Health Foundation Inc 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 Support the services of related hospital IA 501(C)(3) 11, TYPE I Mercy Health Services-Iowa Corp Hackley Hospital 1700 CLINTON ST PO BOX 3302 MUSKEGON MI 494433302 381358196 HEALTHCARE SERVICES MI 501(C)(3) 3 Mercy Health Partners Hackley Hospital Self Insurance Professional Liability Trust PO BOX 3302 MUSKEGON MI 494433302 382299878 Self insurance for general and malpractice liability MI 501(C)(3) 11, TYPE III-FI Mercy Health Partners Hackley Life Counseling 1352 TERRACE ST MUSKEGON MI 494423545 381386362 Counseling, education, and support MI 501(C)(3) 9 Mercy Health Partners Hackley Visiting Nurse Services and Hospice Inc 888 TERRACE ST MUSKEGON MI 49440 381359598 Provide home health care services MI 501(C)(3) 7 Mercy Health Partners Holy Cross Carenet Inc PO BOX 9184 FARMINGTON HILLS MI 48333 521945054 Long-term care and rehabilitation for the elderly MD 501(C)(3) 9 Trinity Continuing Care Services Holy Cross Hospital Foundation Inc 11801 TECH ROAD SILVER SPRING MD 20904 208428450 Charitable fundraising MD 501(C)(3) 11, TYPE I Holy Cross Hospital of Silver Spring Inc Holy Cross Hospital of Silver Spring Inc 1500 FOREST GLEN RD SILVER SPRING MD 209101484 520738041 HEALTHCARE SERVICES MD 501(C)(3) 3 Trinity Health Corporation Holy Cross Medical Center 27870 CABOT DRIVE NOVI MI 483772920 951985442 HEALTHCARE SERVICES (FORMERLY) CA 501(C)(3) 3 Trinity Health Corporation HOLY ROSARY MEDICAL CENTER FOUNDATION 351 SW 9TH STREET ONTARIO OR 97914 202683560 SUPPORT THE SERVICES OF RELATED HOSPITAL OR 501(C)(3) 11, TYPE I SAINT ALPHONSUS MEDICAL CENTER-ONTARIO Hospice of North Iowa 232 SECOND STREET SE MASON CITY IA 504016208 421173708 Hospice health care services IA 501(C)(3) 7 Mercy Health Services-Iowa Corp Hospice of Washtenaw II 806 AIRPORT BLVD ANN ARBOR MI 48108 383320707 Hospice health care services MI 501(C)(3) 11, TYPE I Trinity Health-Michigan HPCN 1675 LEAHY STREET MUSKEGON MI 49442 300207909 HEALTHCARE SERVICES MI 501(C)(3) 11, TYPE II Mercy Health Partners Lakeshore Community Hospital Inc 72 S STATE STREET SHELBY MI 494551228 382549295 Acute healthcare services MI 501(C)(3) 3 Mercy Health Partners Lifespan Inc 166 EAST GOODALE AVE BATTLE CREEK MI 490372728 383298476 Provide hospice health services MI 501(C)(3) 9 Battle Creek Health System Marian Home Healthcare 801 5TH STREET SIOUX CITY IA 51101 383320705 Provide home health care services IA 501(C)(3) 11, TYPE I Mercy Health Services-Iowa Corp McAuley Clinic Corporation PO BOX 992 ANN ARBOR MI 48106 382561013 HEALTHCARE SERVICES (FORMERLY) MI 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