2011-05-11T14:32:49-05:00 2010-06-30 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2009-07-01 310537486 Good Samaritan Hospital of Cincinnati Ohio GOOD 5135695126 619 Oak Street Accounting-3 West Cincinnati OH 45206 Michael Crofton 2011-05-09 MARK STOCKI 7208741500 2009 2016-02-24 21:20:13Z John Prout 619 Oak St Accounting-3 West Cincinnati OH 45206 481199476 false 0928 X WWW.TRIHEALTH.COM X 1852 OH The organization's mission is to improve the health status of the community it serves. 13 11 3827 758 800420 -567957 3862390 2011657 441158984 452506006 -8916094 17517998 5838799 7757833 441944079 479793494 56600 565970 0 0 169439038 209583482 0 0 0 264044139 225744205 433539777 435893657 8404302 43899837 519946074 587586475 217623706 236475946 302322368 351110529 The organization's mission is to nurture the healing ministry of the Church by bringing it new life, energy and viability in the 21st century. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we move toward the creation of healthier communities. false false 371838013 565970 451878043 SEE SCHEDULE H 371838013 true true false true false false false false false true false true false false false false false false false false true true true true false false false false false false false false false false false false false true true false false true 278 0 true 3827 true true true false false false false false false false false 13 11 false false false false true true true true true false false false true true true true true true true false X CRAIG RUCKER 5135696577 619 Oak Street Cincinnati OH 45206 PAUL EDGETT 1.0 X 436412 72959 Stephen Schrantz 1.0 X X James Schwab 1.0 X X Robert Hoverson 1.0 X X Michael Havercamp 1.0 X Robert Walker 1.0 X X Thomas Finn 1.0 X Myrtis Powell 1.0 X Sr Mary Ellen Murphy 1.0 X Michael McGraw 1.0 X X Edward Harness Jr 1.0 X Silvania Ng MD 1.0 X Marc Alexander MD 1.0 X Mark Serrianne 1.0 X Yvonne Washington 1.0 X George Kerlakian MD 1.0 X Craig Eisentrout MD 1.0 X John Prout 20.0 X X 1075342 134799 Craig Rucker 20.0 X 440236 82847 Donna Nienaber Esq 20.0 X 361282 116135 Dave Dornheggen 40.0 X 325846 86661 William Groneman 20.0 X 466760 133992 Gerald Oliphant 20.0 X 470122 106917 Georges Feghali 20.0 X 463745 129908 Samatha Mast MD 40.0 X 206231 26981 Michael Baggish MD 40.0 X 429519 72183 Robert Rohs MD 40.0 X 363487 39667 Richard Welling MD 40.0 X 255199 73807 Helen Koselka MD 40.0 X 199008 46994 Mike Crofton 20.0 X 235898 61113 1453444 4275643 1184963 49 true true false Tri-State Healthcare Laundry Inc 551 S Loop Road Edgewood KY 41017 Laundry 1589387 American Nursing Care Inc 1700 Edison Drive Suite 300 Milford OH 45150 Nursing 1046534 Morrison Management Specialists PO Box 102289 Atlanta GA 303682289 Food Service 805851 Cardiology Associates of Cincinnati 3219 Clifton Avenue Cincinnati OH 45220 Physician 754154 Health Alliance of Greater Cincinna 3200 Burnet Ave Cincinnati OH 45229 Medical 622688 40 2011417 240 2011657 Patient Services 900099 452389503 451761540 627963 Joint Operating Revenue 900099 4433830 4433830 Rental Income 900099 2373717 2373717 EQUITY CHANGES OF UNCONSOLIDATED ORGS 900099 -6691044 -6691044 452506006 10060232 845 10059387 0 0 114621 145938 -31317 -31317 -31317 7489697 1228112 1260044 7489697 -31932 7457766 7457766 0 0 0 Cafeteria 722100 2246070 2246070 Pharmacy Services 446110 1403666 1403666 Research Revenue 900099 853020 853020 3286394 171612 3114782 7789150 479793494 451878043 800420 25103374 540470 540470 25500 25500 0 0 0 0 164741655 139772276 24969379 8243947 6056241 2187706 24408166 19268445 5139721 12189714 10540750 1648964 1369993 1301044 68949 1794906 1794906 201240 201240 0 0 1014397 968301 46096 17289900 13233274 4056626 2380939 288346 2092593 5840706 3644362 2196344 6922593 708930 6213663 0 10739025 9239777 1499248 339277 217384 121893 0 0 6564445 6564445 5554176 5554176 22218784 18373869 3844915 6650010 5789858 860152 Medical/Dietary Supplies 92572836 92311110 261726 Bad Debts 29864399 29864399 Repairs and maintenance 6311059 5887817 423242 OHIO HOSPITAL FEE 5239848 5239848 PURCHASED EQUIPMENT 680599 680599 2195073 1320968 874105 0 435893657 371838013 64055644 0 12076148 18384195 49399717 28099105 450772 298360 1390283 1449355 152400 177600 491739041 318167411 168866666 173571630 23559568 44927953 268842692 309592250 -4792172 11086027 519946074 587586475 31523894 44394290 63844 47034 143479484 134295401 42556484 57739221 217623706 236475946 X 296934331 345900651 5388037 5209878 302322368 351110529 519946074 587586475 X false true true X true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 7333 false false false 7333 false 990 Sch C Supplemental, Part II-B Lobbying Activities Explanation Line 1(f), During the tax year, The Good Samaritan Hospital of Cincinnati, Ohio paid annual membership dues to various national, state and local organizations, of which $1,442 related to lobbying activities. The entity's controlling organization, Catholic Health Initiatives, pays annual dues to the American Hospital Association (AHA) and Catholic Hospital Association (CHA), a portion of which is allocated to lobbying. The amount shown in Line 1F above represents the entity's share of allocated lobbying expenses: AHA $3,430; CHA $2,461. 9162254 9162254 276609437 175998348 100611089 6956739 3528870 3427869 172194650 138640194 33554456 26815962 26815962 173571630 CHI OPER INVESTMENT PROGRAM 309592250 F 309592250 0 Retirement Plan Liability 47965262 Lease Payment Liability 7560000 Environmental Remediation Liability 1666367 Unclaimed Property 547592 57739221 479793494 435893657 43899837 20518410 -15630086 4888324 48788161 FIN 48 FOOTNOTE Schedule D, Part X Good Samaritan Hospital's financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI is a tax-exempt Colorado corporation and has been granted an exemption from federal income tax under Section 501(c)(3) of the Internal Revenue Code. CHI owns certain taxable subsidiaries and engages in certain activities that are unrelated to its exempt purpose and therefore subject to income tax. Management annually reviews its tax positions and has determined that there are no material uncertain tax positions that require recognition in the consolidated financial statements. OTHER CHANGES IN NET ASSETS Schedule D, Part XI, Line 8 PENSION & SERP ADJUSTMENTS ($12,680,522) CAPITAL RESOURCE POOL CONTRIBUTION ($2,949,564) true true X true X true X true true false true true 14289832 14289832 0.03520 66487598 58194315 8293283 0.02040 80777430 58194315 22583115 0.05560 1462741 152687 1310054 0.00320 17630845 9614782 8016063 0.01970 6648955 5602305 1046650 0.00260 1309169 1309169 0.00320 118445 118445 0.00030 27170155 15369774 11800381 0.02900 107947585 73564089 34383496 0.08460 352000 352000 3794 3794 355794 355794 true 8039380 0 88658904 90678686 -2019782 X true true Good Samaritan Hospital

375 Dixmyth Avenue Cincinnati OH 45220

X X X X X Good Samaritan Medical Center

6949 Good Samaritan Drive Cincinnati OH 45247

X X X Good Samaritan Physical Therapy

8748 Union Centre Drive West Chester OH 45069

Physical Therapy Good Samaritan Hospital Outpatient Ctr

6350 Glenway Avenue Cincinnati OH 45211

Outpatient Physician Clinic Good Samaritan Hospital Weight Mgmt Ctr

3219 Clifton Avenue Suite 225 Cincinnati OH 45220

Weight Management Services Good Samaritan Hospital Women's Center

3219 Clifton Avenue Suite 100 Cincinnati OH 45220

Women's Health Services (A) If applicable, describe the income-based criteria for determining eligibility for free or discounted care under the organization's charity care policy. (B) Also describe whether the organization uses an asset test or other threshold regardless of income to determine eligibility for free or discounted care. The Good Samaritan Hospital of Cincinnati, Ohio utilizes the Federal Poverty Guidelines in determining charity care eligibility. See the responses to Part I, Lines 3a and 3b. An individual's income under FPG is a significant factor in determining eligibility for charity care. However, in determining whether to extend discounted or free care to a patient, the patient's assets may also be taken into consideration. For example, a patient suffering a catastrophic illness may have a reasonable level of income, but a low level of liquid assets such that the payment of medical bills would be seriously detrimental to the patient's basic financial (and ultimately physical) well-being and survival. Such a patient may be extended discounted or free care based upon the facts and circumstances. If the organization's community benefit report is contained in a report prepared by a related organization, rather than a separate report prepared by the organization, identify the related organization. In 1995, The Good Samaritan Hospital of Cincinnati, Ohio and Bethesda Hospital, Inc. formed a partnership called TriHealth, Inc. to create an integrated health delivery system whose mission is to improve the health of the people they serve, with an emphasis on prevention, wellness and education. The community benefit provided by The Good Samaritan Hospital of Cincinnati, Ohio is tracked on a standalone basis, however its community benefit is reported in combination with Bethesda Hospital Inc.'s community benefit in a report prepared by TriHealth, Inc. (A)Provide an explanation of the costing methodology used to calculate the amounts reported in the table. If a cost accounting system was used, indicate whether the cost accounting system addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured or self pay). (B) Also indicate whether a cost-to-charge ratio was used for any of the figures reported in the table. Describe whether this cost-to-charge ratio was derived from Worksheet 2, and, if not, what kind of cost-to-charge ratio was used and how it was derived. If some other costing methodology was used besides a cost accounting system, cost-to-charge ratio, or a combination of the two, describe the method used. For the amounts reported at cost in Part I, Line 7, The Good Samaritan Hospital of Cincinnati, Ohio utilized Worksheet 2--Ratio of Patient Care Cost-to-Charges, which was provided for in the instructions to Schedule H, to calculate the cost-to-charge ratio. To the extent that an organization includes any costs associated with physician clinics as subsidized health services in Part I, line 7g it must describe that it has done so and report in Part VI such costs included in part I, line 7g, line 1 The Good Samaritan Hospital of Cincinnati, Ohio provides an obstetrics clinic which offers prenatal assessment for appropriate referral needs to the community and hospital services for underinsured and underserved patients. In addition, the clinic provides health education to underserved obstetrics patients. The services are provided by Registered Nurses. The Good Samaritan Hospital reported, in Part I, line 7(g), costs of $58,500 associated with this clinic. If applicable, state the bad debt expense included on Form 990 Part IX, line 25, column (A) but subtracted for purposes of calculating the percentage in this column. $29,864,399 of bad debt expense that was included in Form 990, Part IX, line 25, column (A) has been removed for purposes of calculating the percentage of total expenses in Schedule H, Part I, line 7, column (f). Provide the rationale and the costing methodology used to determine the amount reported in Part III lines 2 and 3. Describe how the organization accounts for discounts and payments on patient accounts in determining bad debt expense. Also describe the method the organization uses to determine the amount that reasonably could be attributable to patients who likely would qualify for financial assistance under the hospital's charity care policy, if sufficient information has been available to make a determination as to their eligibility. Also, provide if applicable, the text of the footnote to the organization's financial statements that describes bad debt expense. If the organization's financial statements include a footnote on these issues that also includes other information, report only the relevant portions of the footnote. If the organization's financial statements do not contain such a footnote, state that the organization's financial statements do not include such a footnote and explain how the financial statements account for bad debt, if at all. Net Patient Accounts Receivable (Part of Footnote A) Net patient accounts receivable and net patient service revenue have been adjusted to the estimated amounts expected to be collected. These estimated amounts are subject to further adjustments upon review by third-party payors. The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Management periodically assesses the adequacy of the allowances for uncollectible accounts based upon historical write-off experience. The results of these reviews are used to modify as necessary the provisions for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. After satisfaction of amounts due from insurance, the Company follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each the Company. Financial instruments that potentially subject the Company to concentrations of credit risk consist primarily of non-governmental patient accounts receivable. The Company grants credit without collateral to its patients, most of whom are insured under third-party payor agreements. The percentages of gross patient accounts receivable from patients and third-party payors at June 30 approximated the following: 2010 - Medicare 24%, Medicaid 3%, Managed Care 56%, Self Pay 4%, Commercial and Other 13% 2009 - Medicare 24%, Medicaid 4%, Managed Care 55%, Self Pay 5%, Commercial and Other 12% As for the amount of bad debt that reasonably could be attributable to patients who likely would qualify for financial assistance under the organization's charity care policy, The Good Samaritan Hospital of Cincinnati, Ohio does not report actual bad debt expense as community benefit. If upon further research, it is ultimately determined that a portion of bad debt expense is attributable to patients who would likely qualify for financial assistance under TriHealth Inc.'s charity care policy, those costs would be reclassified, as appropriate, to community benefit at that time. Describe the costing methodology used to determine the Medicare allowable costs reported in the organization's Medicare Cost Report, as reflected in the amount reported in Part III, line 6. Describe, if applicable, the extent to which any shortfall reported in Part III, line 7 should be treated as a community benefit, and the rationale for the organization's position. The Good Samaritan Hospital of Cincinnati, Ohio uses the "stepdown methodology" in determining the Medicare allowable costs reported on the Medicare Cost Report. This method of cost finding provides for the allocation of the cost of services rendered by each general service cost center to other cost centers which utilize such services. Once the costs of a general service cost center have been allocated, that cost center is considered closed. Once closed, it does not receive any of the costs subsequently allocated from the remaining general service cost centers. The Good Samaritan Hospital of Cincinnati, Ohio did not report any Medicare shortfall as community benefit in Part III, Line 7 of this schedule. If the organization has a written debt collection policy and answered "yes" to Part III, line 9b, describe the collection practices set forth in the policy that apply to patients who it knows qualify for charity care or financial assistance, whether or not such practices apply specifically to such patients or more broadly to also cover other types of patients. As of the filing of this return, The Good Samaritan Hospital of Cincinnati, Ohio, as part of TriHealth, Inc., maintains a written debt collection policy. TriHealth, Inc., who performs the billing services for all affiliated hospitals, will not initiate collection practices on patients who are known to qualify for charity care or financial assistance. Before collection actions are taken, TriHealth, Inc. will make reasonable efforts, generally as early in the billing process as possible, to determine whether a patient is eligible for financial assistance. After such efforts have been made, if a balance remains that is the responsibility of the patient or guarantor, TriHealth, Inc. may pursue, in its sole discretion, whatever actions it may be entitled to take under law. List the number of each type of facility, other than those required to be licensed, registered or similarly recognized as a health care facility under state law (for example, 2 rehabilitation clinics, 4 diagnostic centers, 3 skilled nursing facilities, etc) one (1) outpatient services facility, one (1) physical therapy center, one (1) women's health clinic, and one (1) weight loss management center INTRODUCTION: Mission and Charitable Purpose In 1852 the Sisters of Charity, physicians, and community members established, out of a former boarding house, the first Catholic hospital in the area. Good Samaritan Hospital was among the earliest efforts to address the needs of the growing city of Cincinnati. Almost fifteen years ago the Sisters of Charity joined with other religious congregations to form Catholic Health Initiatives, a national system. The ongoing purpose of The Good Samaritan Hospital of Cincinnati, Ohio is to provide care with compassion. Its mission is to improve the health status of the community through health related services--prevention, wellness and education. Its Board of Directors is comprised of independent community representatives. GSH provides a 24-hour emergency room, four intensive care units for neonates and adults, adult and geriatric inpatient psychiatric care, and an accredited rehabilitation medicine program. Services are open to all individuals regardless of ability to pay. GSH has an open medical staff and a history of training and educating medical residents and health care professionals. Its medical and scientific research programs include studies that are not commercially sponsored. GSH participates in Medicare and Medicaid and other government-sponsored health care programs, and has an active charity care program. Good Samaritan Hospital, and its partner, Bethesda, are acute tertiary teaching hospitals. With the rest of TriHealth, they form a system of services spanning from acute care to home care, and babies to seniors. Among other services, Good Samaritan provides a 24-hour emergency room, four intensive care units for neonates and adults, adult and geriatric inpatient psychiatric care, and an accredited rehabilitation medicine program. Services are open to all individuals regardless of ability to pay. Good Samaritan Hospital has an open medical staff and a history of training and educating medical residents and health care professionals. Its medical and scientific research programs include studies that are not commercially sponsored. Good Samaritan Hospital participates in Medicare and Medicaid and other government-sponsored health care programs, and has an active charity care program. Good Samaritan was granted tax exempt status as a hospital on March 25, 1946. Community service is central to Good Samaritan Hospital's mission. Services such as those described in this report, and others not listed here, promote a healthy community. Programs also seek to reduce the burdens on the government. For example, if Good Samaritan Hospital did not address the root causes of low birth weight and prematurity, the burden to government medical programs such as Medicaid would be even greater. Community Benefit Approach Located in Cincinnati, OH, Good Samaritan Hospital and the TriHealth system serve Hamilton, Butler, Warren and Clermont counties, as well as persons from Indiana and Kentucky. Ohio's third largest city, Cincinnati has an estimated population of 333,013. The population within the four Ohio counties served by TriHealth is estimated to be 1,613,008 and eleven to twelve percent of this population is uninsured. Community health needs, as assessed by independent groups such as the Greater Cincinnati United Way, and the Health Foundation of Greater Cincinnati, continue to correspond with the TriHealth community needs assessment completed in 2004. The significant health needs for the greater Cincinnati area are infant mortality, obesity, depression, hypertension and diabetes. Two major strategies are in place to address infant mortality and diabetes. The remaining community health needs receive the organization's expertise and focus through ongoing hospital and physician practice initiatives. Hamilton County's infant mortality rate of nineteen percent, the highest in Ohio, led Good Samaritan Hospital to create a task force and collaborate with other hospitals and agencies including the Cincinnati Children's Hospital Medical Center. Strategies include investigating the root causes of prematurity and low birth weight. Good Samaritan Hospital provides and supports a diversity of programs of prenatal care for at-risk mothers discussed later in this report. The TriHealth Community Health Initiative for Diabetes, led by the TriHealth physician practices and outpatient clinics with diabetes educators, focuses on the ongoing management of diabetes. The chronic care model focuses on patient education and empowerment. Physician practices track effectiveness in care delivery through measures such as the hemoglobin A1C, a measure of the patient's diabetes self-management. Good Samaritan Hospital, as a part of TriHealth, has dedicated staff to assist the community benefit effort including those overseeing the planning, reporting and tracking of community benefit, as well as those providing direct service to the poor and broader community. Free and discounted services are provided for those unable to pay and meeting eligibility criteria. Through the Hospital Care Assurance Program (HCAP), Good Samaritan Hospital serves patients meeting criteria set forth by the Ohio Department of Jobs and Family Services. Good Samaritan Hospital policy is to provide charity care on a sliding scale discounting when the family income is up to 400 percent of the annually established federal poverty guideline. Good Samaritan Hospitals and owned physician practices offer an uninsured discount for medically necessary services for those who have no insurance and who do not qualify for other financial assistance options. Good Samaritan Hospital financial counselors assist patients in completing the financial assistance application which is also available on the website. Brochures about financial assistance are visible and available in hospital registration and admitting areas. The Good Samaritan Hospital provided $39.8 million in total community benefit for fiscal year 2010. This includes over $24 million care in uncompensated care. The amount of benefit for both traditional charity care and for the unpaid cost of Medicaid is slightly increased from the prior year and reflects the growing number of persons without health insurance. The Medicaid public program reimburses the hospital for services but payments may not always cover the total cost of care and medications. Good Samaritan Hospital fulfills its mission of compassion to the vulnerable members of the community it serves. The Good Samaritan Hospital of Cincinnati, Ohio, as a part of TriHealth, Inc., has dedicated staff to assist the community benefit effort including those overseeing the planning, reporting and tracking of community benefit, as well as those providing direct service to the poor and broader community. Community Building Activities The Uptown Consortium ("Consortium") is recognized by the Internal Revenue Service as exempt from income tax under Internal Revenue Code Section 501(a) as an organization described in Internal Revenue Code Section 501(c)(3). It is made up of the five largest employers of Cincinnati's "Uptown" including The Good Samaritan Hospital of Cincinnati, Ohio. "Uptown" generally includes the neighborhoods of Avondale, Clifton, Clifton Heights, Corryville, Fairview, Mt. Auburn and University Heights. The Consortium is dedicated to building the human, social and physical improvement of Uptown Cincinnati. It will undertake a variety of investment and program activities in Uptown to help provide housing, health care and job opportunities. In addition, The Good Samaritan Hospital of Cincinnati, Ohio assists, through volunteering, the Work Resource Center of Cincinnati which provides skills training for individuals with disabilities and disadvantages to increase their independence through employment. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT I. Community Outreach for the Poor The following two descriptions represent significant programs provided by Good Samaritan Hospital, targeting the poor and underserved in the community. Good Samaritan Hospital funds the Parish Nurse Ministry and Community Health Worker programs comprised of a dozen paid full time equivalents in nurses and community health workers. The team provides, at no charge, home visits to referred low income clients in nine neighborhoods. Clients include seniors and frail elderly in their homes or in congregate subsidized housing, the mentally and physically handicapped living alone or in group homes, and mothers who are pregnant or who have recently delivered a baby. Client contacts average between 500 to 800 per month. Referrals come from hospital care coordinators as well as other hospitals and community agencies. The team provides consistent health screenings, teaches clients how to manage chronic illnesses and connects clients to support and assistance services. Parish Nurse and Community Health Workers along with four collaborating agencies address prematurity and low birth wei Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization's charity care policy. TriHealth, Inc. ("TriHealth") performs the billing services for all affiliated hospitals including The Good Samaritan Hospital of Cincinnati, Ohio. Brochures/Applications, provided in multiple languages, are visible and available in the registration and admitting areas of all TriHealth affiliated hospitals. In addition, the application is printed on the reverse side of a patient's bill with instructions on how to complete the application as well as how to return it. Financial counselors assist patients in completing the financial assistance application. Finally, TriHealth Inc.'s website contains information regarding its charity care and financial assistance programs with directions on how to contact the appropriate personnel to initiate an application or ask questions about the process. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above. Describe how the organization's community building activities, as reported in Part II, promote the health of the communities the organization serves. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above. Provide any other information important to describing how the organization's hospitals or other health care facilities further its exempt purpose by promoting health of the community (e.g. open medical staff, community board, use of surplus funds, etc). Please refer to the Needs Assessment Narrative, Part VI, Item 2. above. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served. In 1995, The Good Samaritan Hospital of Cincinnati, Ohio and Bethesda Hospital, Inc. formed a partnership called TriHealth, Inc. to create an integrated health delivery system whose mission is to improve the health of the people they serve, with an emphasis on prevention, wellness and education. TriHealth, Inc.'s sites include two hospital locations and various physician office buildings throughout the Greater Cincinnati area in addition to fitness, rehabilitation, occupational health, palliative care services and outpatient centers. It also provides services in homes and workplaces and delivers care and education cooperatively through community-based organizations, such as churches, schools, clinics and social agencies. Almost fifteen years ago, TriHealth joined Catholic Health Initiatives, a national faith-based nonprofit health care organization with headquarters in Englewood, Colorado. CHI's exempt purpose is to serve as an integral part of its national system of hospitals and other charitable entities, which are described as market-based organizations, or MBOs. An MBO is a direct provider of care or services within a defined market area that may be an integrated health system and/or a stand-alone hospital or other facility or service provider. CHI serves as the parent corporation of its MBOs which are comprised of 73 hospitals; 40 long-term care, assisted- and residential-living facilities; and two community health-services organizations. Together, these facilities provided $590 million in charity care and community benefit in the 2010 fiscal year, including services for the poor, free clinics, education and research. true Healthy Mom and Babies Inc 2270 Banning Road Cincinnati OH 45239 311155292 501(c)(3) 100000 Uptown Consortium Inc 629 Oak Street Ste 306 Cincinnati OH 45206 200688727 501(c)(3) 160650 American Heart Association-Great Rivers Affiliate 5455 N High Street Cincinnati OH 43214 135613797 501(c)(3) 63750 The Center for Closing the Health Gap 3120 Burnet Ave 201 Cincinnati OH 45229 200902286 501(c)(3) 58650 Bethesda Foundation 619 Oak Street Cincinnati OH 45206 237374129 501(c)(3) 29580 Center for Respite Care Inc PO Box 141301 Cincinnati OH 45229 202544994 501(c)(3) 25500 Xavier University 3800 Victory Parkway Cincinnati OH 45207 310537516 501(c)(3) 12750 Bethesda Hospital Inc 619 Oak Street Cincinnati OH 45206 310537122 501(c)(3) 24698 Healthy Beginnings Inc 47 E Hollister 201 Cincinnati OH 45219 311380939 501(c)(3) 52500 9 0 Work Agreement Program Grants 7 25500 Schedule I, Part I, Q.2 Procedures for monitoring the use of grants GOOD SAMARITAN HOSPITAL PROVIDES GRANTS TO OTHER ORGANIZATIONS AND INDIVIDUALS ON A VERY LIMITED BASIS. IN THOSE INSTANCES, THE DEPARTMENT GRANTING THE FUNDS IS RESPONSIBLE FOR OBTAINING AND STORING ALL NECESSARY INFORMATION FROM THE OTHER ORGANIZATION AND INDIVIDUALS RELATIVE TO HOW THE FUNDS WILL BE SPENT. false true false false false false false true false PAUL EDGETT 360032 54916 21464 26104 46855 509371 John Prout 749844 325498 125103 9696 1210141 256041 Craig Rucker 286286 96468 57482 75220 7627 523083 Donna Nienaber Esq 257602 71856 31824 99929 16206 477417 Mike Crofton 175098 40921 19879 39495 21618 297011 Dave Dornheggen 204679 62071 59096 73075 13586 412507 Samatha Mast MD 205944 287 10037 16944 233212 Michael Baggish MD 410158 19361 52446 19737 501702 Robert Rohs MD 217990 121278 24219 38354 1313 403154 Richard Welling MD 244341 4000 6858 57104 16703 329006 Helen Koselka MD 186617 599 11792 39887 7107 246002 William Groneman 288066 99003 79691 110011 23981 600752 13602 Gerald Oliphant 353704 104862 11556 85338 21579 577039 Georges Feghali 315280 107813 40652 107114 22794 593653 METHODS USED TO ESTABLISH CEO COMPENSATION Schedule J, Part 1, Q. 3 COMPENSATION FOR THE CHIEF EXECUTIVE OFFICER OF GOOD SAMARITAN HOSPITAL WAS ESTABLISHED AND PAID BY TRIHEALTH INC., A RELATED ORGANIZATION. TRI HEALTH INC. USED THE FOLLOWING TO ESTABLISH THE CEO'S COMPENSATION. 1)COMPENSATION COMMITTEE, 2)INDEPENDENT COMPENSATION CONSULTANT, 3)COMPENSATION SURVEY OR STUDY, 4)APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. NON-QUALIFIED DEFERRED COMPENSATION PLAN Schedule J, Part 1, Q. 4B Eligible executives (generally Vice Presidents and above) participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon 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 no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column B in the year paid. TriHealth, Inc., the related organization that paid the salaries of the following individuals listed in Schedule J, Part II, contributed, on behalf of the following individuals, to a supplemental nonqualified retirement plan in the amounts as noted: Michael Crofton - $11,894, Dave Dornheggen - $34,260, Georges Feghali, MD - $65,434, William Groneman - $62,814, Donna Nienaber, Esq. - $45,985, Gerald Oliphant - $61,222, John Prout - $93,797, Craig Rucker - $52,321. In addition, the following individual listed in Schedule J, Part II, received a payment from a supplemental nonqualified retirement plan which was treated as taxable compensation by TriHealth, Inc.: William Groneman - $13,602. Bonus Program Schedule J, Part I, Q. 7 A physician has a base salary but is also eligible for a bonus. The bonus is contingent on the profitability of his practice. Essentially, the profitability of his practice gets paid to him as a bonus up to a max of $100K. FORM 990, Part VI, Q. 1 EXECUTIVE COMMITTEE COMPOSITION AND AUTHORITY PURSUANT TO SECTION 8.1.1 OF THE BYLAWS OF GOOD SAMARITAN HOSPITAL ("GSH"), THE BOARD OF TRUSTEES MAY ESTABLISH AN EXECUTIVE COMMITTEE WHICH MAY EXERCISE SUCH POWER AND AUTHORITY OF THE BOARD OF TRUSTEES IN INTERVALS BETWEEN MEETINGS OF THE BOARD AS AUTHORIZED BY THE BOARD. THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND CEO, THE SECRETARY AND TWO OTHER BOARD MEMBERS ALL IN ACCORDANCE WITH THE NETWORK AFFILIATION AGREEMENT. PURSUANT TO SECTION 8.1.5 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS SHALL CONSIST OF AT LEAST THREE MEMBERS OF THE BOARD OF TRUSTEES. FURTHER, PURSUANT TO SECTION 8.1.1 OF THE CORPORATION'S BYLAWS, FOUR MEMBERS OF THE EXECUTIVE COMMITTEE SHALL CONSTITUTE A QUORUM FOR THE TRANSACTIONS OF BUSINESS AND THE ACT OF FOUR OF THEM SHALL CONSTITUTE THE ACT OF THE COMMITTEE. Form 990, Part VI, Q. 6 Members or Stockholders Good Samaritan Hospital has two corporate members, Catholic Health Initiatives, a Colorado Nonprofit Corporation, is the sole voting member and TriHealth, Inc, an Ohio nonprofit corporation, is the sole non-voting member. Form 990, Part VI, Q. 7 MEMBERS/STOCKHOLDERS ELECTING GOVERNING BODY MEMBERS In accordance with the Organization's Corporate ByLaws, the Trustees of the Corporation (other than the Chief Executive Officer and the Presidents of the medical staffs of Good Samaritan Hospital and Bethesda North Hospital who serve by virtue of their offices) shall be nominated an elected by the Voting Member no later than June 30 of each year in the manner provided in the Network Affiliation Agreement. Form 990, Part VI, Q. 7B APPROVAL OF GOVERNING BODY DECISIONS BY MEMBERS/STOCKHOLDERS The organization's sole corporate voting member is Catholic Health Initiatives (CHI). Pursuant to Section 5.4.2 of the organization's bylaws and the Network Affiliation Agreement, the Voting Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: Substantial change in the mission or philosophy of the Good Samaritan Hospital, Amendment of the corporate documents of the Good Samaritan Hospital, Approval of members of the Good Samaritan Hospital board, Removal of a member of the governing body of the Good Samaritan Hospital, Approval of issuance of debt by the Good Samaritan Hospital, Approval of participation of Good Samaritan Hospital in a joint venture, Approval of formation of a new corporation by Good Samaritan Hospital, Approval of a merger involving the Good Samaritan Hospital, Approval of the sale of all or substantially all of the assets of the Good Samaritan Hospital, To require the transfer of assets by the Good Samaritan Hospital to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts, Adoption of long range and strategic plans for Good Samaritan Hospital. Pursuant to Section 5.5.2 of the organization's bylaws and the Network Affiliation Agreement, CHI may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. Form 990, Part VI, Q. 11A Process, if any, the organization uses to review Form 990 MEMBERS OF THE BOARD ARE PROVIDED AN ELECTRONIC COPY OF THIS FORM 990 PRIOR TO FILING THE RETURN. HOWEVER, FOR THE PROTECTION OF DONOR PRIVACY, SCHEDULE B - SCHEDULE OF CONTRIBUTORS WAS REMOVED FROM THE COPY PROVIDED TO THE BOARD. SUBSEQUENT TO PRESENTATION TO THE BOARD, THE ORGANIZATION FILES THE RETURN MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. Form 990, Part VI, Q. 12C Procedures for monitoring and enforcing the COI policy All board members are required to annually disclose certain financial interests and fiduciary relationships. The Executive Committee and Corporate Counsel review responses, conduct further investigation (if necessary), and determine when a conflict exists with respect to a certain transaction. If a conflict exists, the transaction is not to be entered into unless alternatives are fully investigated, and in their absence, the board, without the participation of the interested member(s), determines that the transaction is in the best interest of the organization. Plans to manage the conflict during the relationship are implemented. All discussions are appropriately documented. Form 990, Part VI, Q. 15 Process for Determining Compensation In determining compensation of The Good Samaritan Hospital of Cincinnati, Ohio's officers, directors, and key employees, the annual process performed by TriHealth, Inc.(a related organization who paid the individuals) included: compensation committee; independent compensation consultant; compensation survey or study; and approval by the Board or Compensation Committee. Additionally, all discussions and decisions are contemporaneously documented. Form 990, Part VI, Q. 19 PUBLIC AVAILABILITY OF GOVERNING DOCUMENTS/FINANCIAL STATEMENTS/COI POLICY The organization's governing documents, Conflicts of Interest Policy and financial statements are available upon request. The organization's financial statements are included in the Catholic Health Initiatives' consolidated audited financial statements that are available at www.catholichealthinit.org or at http://www.DacBond.com. Form 990, Part VII Estimate of Hours Devoted to Related Organizations Officers, Directors and Key Employees (as noted with a Sch O reference) for The Good Samaritan Hospital of Cincinnati, Ohio provide services to TriHealth, Inc. (a related organization who paid the individuals) and its subsidiaries/affiliates (TriHealth). Hours worked are not tracked on an entity by entity basis. The compensation reported on the Form 990, Part VII was paid to these individuals in fulfillment of their duties as full-time, 60 hours-per-week employees of TriHealth. St Joseph Community Health Services 300 Central SW Suite 300 Albuquerque NM 87102 710897107 Community NM 501(c)(3) 11a CHI St Joseph Community Health Foundation 300 Central SW Suite 300 Albuquerque NM 87102 850253087 Foundation NM 501(c)(3) 7 SJCHS St Francis of Baker City 3325 Pocahontas Road Baker City OR 97814 930412495 Hospital OR 501(c)(3) 3 CHI St Elizabeth Health Care Foundation 3325 Pocahontas Road Baker City OR 97814 943164869 Foundation OR 501(c)(3) 7 SEHS Flaget Memorial Hospital Foundation Inc 4305 New Shepherdsville Road Bardstown KY 40004 562351341 Fundraising KY 501(c)(3) 11a FH Flaget Healthcare DBA Flaget Memorial 4305 New Shepherdsville Road Bardstown KY 40004 611345363 Hospital KY 501(c)(3) 3 CHI Lakewood Health Center 600 Main Avenue South Baudette MN 56623 410758434 LTerm Care MN 501(c)(3) 3 CHI Appletree Court 601 Oak Street Breckenridge MN 56520 411850500 Senior Homes MN 501(c)(3) 9 SFH Healthcare and Wellness Foundation 2400 St Francis Drive Breckenridge MN 56520 760761782 Foundation MN 501(c)(3) 11a SFMC St Francis Home 2400 St Francis Drive Breckenridge MN 56520 410729978 LTerm Care MN 501(c)(3) 9 CHI St Francis Medical Center 2400 St Francis Drive Breckenridge MN 56520 410695598 Healthcare MN 501(c)(3) 3 CHI Carrington Health Center 800 North 4th Street Carrington ND 58421 450227311 Healthcare ND 501(c)(3) 3 CHI Saint Clare's Community Care 66 Ford Road Denville NJ 07834 222876836 Healthcare NJ 501(c)(3) 11b SCHS Saint Clare's Foundation Inc 66 Ford Road Denville NJ 07834 222502997 Fundraising NJ 501(c)(3) 7 SCHS Good Samaritan College of Nursing & Heal 375 Dixmyth Ave Cincinnati OH 45220 311778403 Education KY 501(c)(3) 2 GHS Total Healthcare PO Box 7021 Colorado Springs CO 80933 840927232 Healthcare CO 501(c)(3) 3 CHI Colorado Memorial Health Care System Inc 2525 De Sales Avenue Chattanooga TN 37404 620532345 Hospital TN 501(c)(3) 3 CHI Memorial Health Care System Foundation 2525 De Sales Avenue Chattanooga TN 37404 621839548 Foundation TN 501(c)(3) 7 MHCS Memorial Health Partners Foundation Inc 6028 Shallowford Road Chattanooga TN 37421 030417049 Healthcare TN 501(c)(3) 9 MHCS The Community Limited Care Dialysis Cent 619 Oak Street Accounting-3 West Cincinnati OH 45206 237419853 Dialysis OH 501(c)(2) none GSH Good Samaritan Foundation of Cincinnati 619 Oak Street Accounting-3 West Cincinnati OH 45206 311206047 Foundation OH 501(c)(3) 11a GSH The Good Samaritan Hospital of Cincinnat 619 Oak Street Accounting-3 West Cincinnati OH 45206 310537486 Hospital OH 501(c)(3) 3 TRI-HEALTH Saint Clare's Hospital 66 Ford Road Denville NJ 07834 223319886 Hospital NJ 501(c)(3) 3 CHI St Francis Life Care Corporation 19 Pocono Road Denville NJ 07834 222536017 Elderly Care NJ 501(c)(3) 9 SCHS TriHealth Physician Institute 619 Oak Street Accounting-3 West Cincinnati OH 45206 311074519 Physicians OH 501(c)(3) 11a GSH Catholic Health Initiatives Colorado Fou 961 East Colorado Avenue Colorado Springs CO 80903 840902211 Foundation CO 501(c)(3) 7 CHI Colorado SET of Colorado Springs Inc 825 E Pikes Peak Avenue Bldg 29 Colorado Springs CO 80903 841183335 LTerm Care CO 501(c)(3) 7 CHI Colorado Catholic Health Initiatives 1999 Broadway Suite 4000 Denver CO 80202 470617373 Healthcare CO 501(c)(3) 9 CHI Catholic Health Care Federation 1999 Broadway Suite 4000 Denver CO 80202 208473567 Jurdic Person CO 501(c)(3) 11a CHI Global Health Initiatives 1999 Broadway Suite 4000 Denver CO 80202 201536108 Ministries CO 501(c)(3) 11a CHI Health SET 4200 West Conejos Place 436 Denver CO 80204 841102943 Low Inc.Care CO 501(c)(3) 7 CHI Colorado Bishop Drumm Retirement Center 1111 6th Avenue Des Moines IA 50314 420725196 LTerm Care IA 501(c)(3) 9 CHI-IA Corp Mercy Medical Center - Des Moines AKA 1111 6th Avenue Des Moines IA 50314 420680448 Hospital IA 501(c)(3) 3 CHI-IA Corp House of Mercy 1111 6th Avenue Des Moines IA 50314 421323808 Shelter IA 501(c)(3) 7 CHI-IA Corp Mercy Auxiliary of Central Iowa 1111 6th Avenue Des Moines IA 50314 426076069 Auxiliary IA 501(c)(3) 11a CHI-IA Corp Mercy Clinics Inc 1111 6th Avenue Des Moines IA 50314 421193699 Physician IA 501(c)(3) 9 CHI-IA Corp Mercy College of Health Sciences 1111 6th Avenue Des Moines IA 50314 421511682 Education IA 501(c)(3) 2 CHI-IA Corp Mercy Foundation of Des Moines IA 1111 6th Avenue Des Moines IA 50314 237358794 Foundation IA 501(c)(3) 7 CHI-IA Corp Mercy Medical Center - Centerville FKA 1 St Josephs Drive Centerville IA 52544 420680308 Hospital IA 501(c)(3) 3 CHI-IA Corp Mercy Professional Practice Associates 1111 6th Avenue Des Moines IA 50314 421470935 Physician IA 501(c)(3) 9 CHI-IA Corp Mercy Hospital of Devils Lake 1031 East Seventh Street Devils Lake ND 58301 450227012 Healthcare ND 501(c)(3) 3 CHI Saint Joseph's Hospital Foundation 30 West 7th Street Dickinson ND 58601 363418207 Foundation ND 501(c)(3) 11a SJHHC St Joseph's Hospital and Health Center 30 West 7th Street Dickinson ND 58601 450226429 Healthcare ND 501(c)(3) 3 CHI Mercy Regional Medical Center of Durango 1010 Three Springs Blvd Durango CO 81301 840405515 Hospital CO 501(c)(3) 3 CHI CHI Kentucky Inc 3900 Olympic Blvd Suite 400 Erlanger KY 41018 202741651 Healthcare KY 501(c)(3) 11a CHI Villa Nazareth Inc 801 Page Drive Fargo ND 58103 450226714 LT Care ND 501(c)(3) 9 CHI St Catherine Hospital 401 East Spruce Street Garden City KS 67846 480543721 Hospital KS 501(c)(3) 3 CHI St Catherine Hospital Development Found 401 East Spruce Street Garden City KS 67846 200598702 Foundation KS 501(c)(3) 11a SCH Saint Francis Medical Center Foundation PO Box 9804 Grand Island NE 68802 470630267 Foundation NE 501(c)(3) 7 SFMC Saint Francis Medical Center PO Box 9804 Grand Island NE 68802 470376601 HealthCare NE 501(c)(3) 3 CHI Nebraska Central Kansas Medical Center 3515 Broadway Great Bend KS 67530 480543724 Hospital KS 501(c)(3) 3 CHI St Joseph Memorial Hospital 923 Carroll Ave Larned KS 67550 481253246 Hospital KS 501(c)(3) 3 CKMC MNMCH Inc 220 North Pennsylvania Columbus KS 66725 481216238 Hospital KS 501(c)(3) 3 SJRMC Mercy Lifecare Systems 2727 McClelland Blvd Joplin MO 64804 431305163 Property Mgmt MO 501(c)(3) 11a SJRMC St John's Medical Group 2727 McClelland Blvd Joplin MO 64804 431882377 Phys Practice MO 501(c)(3) 9 SJRMC St John's Mercy Regional Foundation 2727 McClelland Blvd Joplin MO 64804 431308084 Foundation MO 501(c)(3) 7 SJRMC St John's Regional Medical Center 2727 McClelland Blvd Joplin MO 64804 440545809 Hospital MO 501(c)(3) 3 CHI Good Samaritan Hospital PO Box 1990 Kearney NE 68848 470379755 HealthCare NE 501(c)(3) 3 CHI Nebraska Good Samaritan Hospital Foundation PO Box 1810 Kearney NE 68848 470659443 Foundation NE 501(c)(3) 7 GSH St Joseph Health Ministries 2135 Noll Drive Suite C Lancaster PA 17603 232342997 Health PA 501(c)(3) 11a SJHM St Joseph Health Ministries Foundation 2135 Noll Drive Suite C Lancaster PA 17603 232605579 Fundraising PA 501(c)(3) 11a SJHM St Joseph Health Services Inc 2135 Noll Drive Suite C Lancaster PA 17603 201425375 Dental care PA 501(c)(3) 11a SJHM Continuing Care Hospital 150 North Eagle Creek Drive Lexington KY 40509 611400619 LTACH KY 501(c)(3) 3 SJHS Saint Joseph Berea Hospital Foundation 305 Estill Street Berea KY 40403 260152877 Foundation KY 501(c)(3) 7 SJHS Saint Joseph Health System Inc 150 N Eagle Creek Dr Lexington KY 40509 611334601 Hospital KY 501(c)(3) 3 CHI St Joseph Hospital Foundation Inc One St Joseph Drive Lexington KY 40504 611159649 Foundation KY 501(c)(3) 11a SJHS Saint Joseph Medical Foundation Inc One St Joseph Drive Lexington KY 40504 311539059 Phy Practices KY 501(c)(3) 3 SJHS Visiting Nurse Association of Saint Clar 191 Woodport Road Sparta NJ 07871 221768334 Home Health NJ 501(c)(3) 9 SCHS Saint Elizabeth Foundation 555 South 70th Street Lincoln NE 68510 470625523 Foundation NE 501(c)(3) 7 SERMC Saint Elizabeth Health Services 555 South 70th Street Lincoln NE 68510 363233120 Healthcare NE 501(c)(3) 3 SERMC CHI Nebraska 555 South 70th Street Lincoln NE 68510 363233121 Healthcare NE 501(c)(3) 11a CHI Saint Elizabeth Regional Medical Center 555 South 70th Street Lincoln NE 68510 470379836 Healthcare NE 501(c)(3) 3 CHI Nebraska The Physician Network 8055 O Street Suite 300 Lincoln NE 68510 470780857 Healthcare NE 501(c)(3) 11a CHI Nebraska Lisbon Area Health Services 905 Main Street Lisbon ND 58054 820558836 Healthcare ND 501(c)(3) 3 CHI Alverna Apartments 300 SE 8th Avenue Little Falls MN 56345 411351177 Lterm Care MN 501(c)(3) 9 CHI Unity Family Healthcare 815 2nd Street SE Little Falls MN 56345 410721642 Healthcare MN 501(c)(3) 3 CHI St Anthony's Hospital Association 4 Hospital Drive Morrilton AR 72110 710245507 Healthcare AR 501(c)(3) 3 SVIMC St Vincent Infirmary Medical Center 2 St Vincent Circle Little Rock AR 72205 710236917 Healthcare AR 501(c)(3) 3 CHI St Vincent Medical Group 2 St Vincent Circle Little Rock AR 72205 710830696 Healthcare AR 501(c)(3) 9 SVIMC Maria-Joseph Center 4830 Salem Avenue Dayton OH 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