2020-07-15T12:12:36-05:00 2019-06-30 990 2018-07-01 261720984 GOOD SAMARITAN HOSPITAL INC GOOD 7063892615 5401 LAKE OCONEE PARKWAY GREENSBORO GA 306424232 JANICE DUNN CFO 7063892615 2020-07-15 170.232.229.225 2020-07-15 12:12:26 ED P DA39A3EE5E6B4B0D3255BFEF95601890AFD80709 D1F366A5BD87A79DFDC4009DF5A22C938823A153 2018 2020-09-23 17:36:50Z D MONTEZ CARTER 5401 LAKE OCONEE PARKWAY GREENSBORO GA 306424232 31285413 0 0928 X WWW.STMARYSGOODSAM.ORG X 2008 GA TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES 7 6 239 117 0 0 219730 57048 24709988 27258598 -120976 -113825 1607864 3931570 26416606 31133391 0 0 0 0 9210294 9971495 0 0 0 17029871 17595991 26240165 27567486 176441 3565905 35124255 34689850 38901708 39109896 -3777453 -4420046 X WE, ST. MARY'S HEALTH CARE SYSTEM AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. GOOD SAMARITAN HOSPITAL IS A MEMBER OF THE ST. MARY'S HEALTH CARE SYSTEM AND TRINITY HEALTH. 0 0 25498396 31033877 GOOD SAMARITAN HOSPITAL WAS ESTABLISHED TO SERVE THE HEALTH CARE NEEDS OF THE PEOPLE OF GREENSBORO AND THE GREATER GREENE COUNTY AREAS OF EAST GEORGIA. GOOD SAMARITAN HOSPITAL OPERATES A 25-BED CRITICAL ACCESS HOSPITAL FOR THE COMMUNITY, INCLUDING GENERAL SURGERY, A 24-HOUR EMERGENCY DEPARTMENT AND MOST ANCILLARY SERVICES ASSOCIATED WITH A MODERN HEALTHCARE FACILITY. GOOD SAMARITAN HOSPITAL PROVIDES THESE SERVICES ALONG WITH OTHER WELLNESS AND EDUCATIONAL PROGRAMS TO THE COMMUNITY AT REDUCED OR IN SOME CASES NO CHARGE BASED ON THE HOSPITAL'S CHARITY CARE POLICY.PLEASE VISIT OUR WEBSITE FOR ADDITIONAL INFORMATION ABOUT PROGRAMS AND SERVICES: WWW.STMARYSGOODSAM.ORG 25498396 1 1 0 1 0 0 0 0 0 0 1 0 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 53 0 1 239 1 0 0 0 0 0 0 0 0 0 0 0 0 X 7 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 GA X JANICE DUNN CFO 7063893938 1230 BAXTER STREET ATHENS GA 30606 D MONTEZ CARTER DIRECTOR; SEC; SMHCS PRES & CEO 2.00 53.00 X X 0 490980 116785 FREDERICK WOLFERT DIRECTOR & CHAIR THROUGH 4/19 1.00 1.00 X X 0 0 0 JACK BROWN DIR; V CHAIR 4/19-6/19;CHAIR AT 6/19 1.00 1.00 X X 0 0 0 BOWEN AKERS DIRECTOR 1.00 0.00 X 0 0 0 WALTER CHANNELL DIRECTOR 1.00 0.00 X 0 0 0 JOHN FOOS DIRECTOR 1.00 0.00 X 0 0 0 JOHANNA HAAS DIRECTOR THROUGH 12/18 1.00 0.00 X 0 0 0 DEBORAH JACKSON DIRECTOR THROUGH 12/18 1.00 0.00 X 0 0 0 JAMES PEEK DIRECTOR AS OF 01/19 1.00 0.00 X 0 0 0 AVIS WILLIAMS DIRECTOR 1.00 0.00 X 0 0 0 TANYA ADCOCK PRESIDENT, GOOD SAMARITAN HOSPITAL 50.00 0.00 X 173320 0 9566 JANICE DUNN TREASURER & CFO AS OF 6/19 2.00 48.00 X 0 0 0 DANIEL POWELL TREASURER & INT CFO THROUGH 6/19 2.00 48.00 X 0 519423 31491 JOSEPH HANCOCK PHARMACIST 50.00 0.00 X 127402 0 27491 CYNTHIA DAVIS MANAGER OF REHAB 50.00 0.00 X 105258 0 25852 ELIZABETH PATRICK DIRECTOR, ADMIN & SUPPORT SERVICES 50.00 0.00 X 105090 0 15866 DONALD MCKENNA FORMER OFFICER 0.00 0.00 X 0 126239 1810 511070 1136642 228861 4 1 1 0 SHARED IMAGING LLC PO BOX 88544 MILWAUKEE WI 53288 CONTRACTED IMAGING SERVICES (MRI) 557550 CLASSIC CITY ANESTHESIA ASSOCIATES 2061 EXPERIMENT STATION RD WATKINSVILLE GA 30677 CONTRACTED CRNA SERVICES 422600 CANON MEDICAL SYSTEMS USA INC PO BOX 775220 CHICAGO IL 60677 MAINTENANCE SERVICES 175299 SODEXO INC PO BOX 360170 PITTSBURGH PA 15251 CONTRACTED DIETARY SERVICES 165458 BECKMAN COULTER DEPT CH 10164 PALATINE IL 60055 MAINTENANCE SERVICES 137089 10 12251 42497 2300 57048 NET PATIENT SERVICE REVENUE 622110 27258598 27258598 27258598 81964 31861 -81964 -31861 -113825 -113825 60235 38197 22038 22038 GOV'T SUBSIDY 622110 350000 350000 CAFETERIA REVENUE 722514 134253 134253 GOV'T SUBSIDY-EHR 622110 51860 51860 3373419 3373419 3909532 31133391 31033877 0 42466 X 182886 182886 8304944 7569651 735293 878370 792776 85594 605295 540426 64869 6488873 5892433 596440 104845 93609 11236 336503 300440 36063 123552 110311 13241 538426 480723 57703 9674 8637 1037 6671 5956 715 1410289 1410289 2277769 2033661 244108 MEDICAL SUPPLIES EXP 3463419 3463419 BAD DEBT EXPENSE 2463608 2463608 EQUIPMENT MAINTENANCE 244324 218140 26184 I/C PURCHASE SERVICES 70925 63324 7601 57113 50993 6120 27567486 25498396 2069090 0 14277 236253 3544638 4497047 485755 515188 86014 59752 42819832 13496613 30943571 29323219 2300 50000 56091 35124255 34689850 2478587 3225228 121816 162469 36301305 35722199 38901708 39109896 X -3777453 -4422346 2300 -3777453 -4420046 35124255 34689850 X 3565905 -4208498 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3085 0 0 0 3085 0 PART II-B, LINE 1: GOOD SAMARITAN HOSPITAL HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED GOOD SAMARITAN HOSPITAL WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. 2872549 2872549 28713737 6117314 22596423 11203040 7379299 3823741 30506 30506 29323219 INTERCOMPANY NOTES PAYABLE 35445596 INTERCOMPANY ACCOUNTS PAYABLE 276603 35722199 1 1 X 1 X 1 X 1 1 0 1 1 1193051 350000 843051 0.03360 1679904 1587641 92263 0.00370 2872955 1937641 935314 0.03730 10 2077 28076 28076 0.00110 1 5 153227 153227 0.00610 3 346 20645 20645 0.00080 14 2428 201948 201948 0.00800 14 2428 3074903 1937641 1137262 0.04530 1 100 1528 1528 0.00010 2 50 13152 13152 0.00050 1 77 11936 11936 0.00050 4 227 26616 26616 0.00110 1 2463608 0 7785919 7551905 234014 X 1 1 1 1 GOOD SAMARITAN HOSPITAL 5401 LAKE OCONEE PARKWAY GREENSBORO GA 306424232 PERMIT #066-638 X X X X GOOD SAMARITAN HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 1 1 1 X SEE SCHEDULE H, PART V, SECTION C X 1 18 1 SEE SCHEDULE H, PART V, SECTION C 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 3J: N/APART V, SECTION B, LINE 3E: GOOD SAMARITAN HOSPITAL INCLUDED IN ITS COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) WRITTEN REPORT A PRIORITIZED LIST AND DESCRIPTION OF THE COMMUNITY'S SIGNIFICANT HEALTH NEEDS IDENTIFIED THROUGH THE MOST RECENTLY CONDUCTED CHNA. THE FOLLOWING COMMUNITY HEALTH NEEDS WERE DEEMED SIGNIFICANT AND WERE PRIORITIZED THROUGH A COMMUNITY-INVOLVED SELECTION PROCESS: 1. CARDIOVASCULAR HEALTH 2. NUTRITION, DIABETES, AND OBESITY 3. BEHAVIORAL HEALTH4. MATERNAL AND CHILD HEALTH5. HEALTH CARE ACCESS 6. REPRODUCTIVE HEALTH7. CEREBROVASCULAR HEALTH 8. CANCER9. RESPIRATORY HEALTH10. INJURIES AND ACCIDENTS GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 5: ST. MARY'S HEALTH CARE SYSTEM (INCLUDING ST. MARY'S HOSPITAL, GOOD SAMARITAN HOSPITAL, AND ST. MARY'S SACRED HEART HOSPITAL) COLLABORATED WITH THE GOAL OF DEVELOPING A HOLISTIC UNDERSTANDING OF THE HEALTH PRIORITIES IN THE COMMUNITIES SERVED. COMMUNITY INPUT AND DATA WERE GATHERED FROM OCTOBER 2018 TO MARCH 2019.THE ST. MARY'S HEALTH CARE SYSTEM HOSPITAL SERVICE AREA WAS DEFINED AT THE PATIENT VISIT LEVEL. FOR THE PURPOSES OF THE CHNA, EXISTING PRIMARY AND SECONDARY DATA WERE GATHERED FROM LOCAL AND STATE HEALTH DEPARTMENTS, AND FEDERAL DATA SOURCES. PRIMARY DATA WAS GATHERED THROUGH ADMINISTRATION OF A HOUSEHOLD SURVEY IN ATHENS-CLARKE COUNTY AND FOCUS GROUPS IN SURROUNDING COUNTIES TO GAIN INSIGHT INTO THE MOST PRESSING COMMUNITY HEALTH NEEDS. SPECIAL FOCUS WAS GIVEN TO POPULATIONS WHERE HEALTH DISPARITIES WERE PRESENT, INCLUDING THOSE WITHOUT HEALTH INSURANCE AND LOW-INCOME FAMILIES. THE COMMUNITY ADVISORY COMMITTEE ASSESSED THIS DATA IN ORDER TO PRIORITIZE THE HEALTH CONDITIONS AND RISK FACTORS FOR WHICH THE HOSPITAL COULD CONCENTRATE THEIR EFFORTS AND IMPROVE COMMUNITY HEALTH. FOLLOWING THE IDENTIFICATION AND PRIORITIZATION OF HEALTH NEEDS, THE ST. MARY'S HEALTH CARE SYSTEM STAFF WORKED WITH FACULTY FROM THE J.W. FANNING INSTITUTE FOR LEADERSHIP TO CONSTRUCT AN IMPLEMENTATION PLAN TO SYSTEMATICALLY ADDRESS THE HEALTH NEEDS IN THE SERVICE AREA. THROUGH THIS PROCESS, THE FOLLOWING NEEDS WERE RECOGNIZED AS THE MOST IMPORTANT ISSUES TO BE ADDRESSED TO IMPROVE THE HEALTH AND QUALITY OF LIFE IN OUR COMMUNITY: HEALTH CARE ACCESS; CANCER; NUTRITION, OBESITY AND DIABETES; AND CARDIOVASCULAR AND CEREBROVASCULAR HEALTH.THE CHNA USED A COMPREHENSIVE MIXED-METHODS APPROACH, WHICH INCLUDED A COMBINATION OF QUALITATIVE AND QUANTITATIVE DATA AND ANALYSES, ALLOWING FOR MORE CONFIDENCE IN THE FINDINGS AND IDENTIFICATION OF THE TOP HEALTH NEEDS. TO SOLICIT INPUT FROM PRIMARY SOURCES, A STRONG EMPHASIS WAS PLACED ON ADMINISTERING COMMUNITY SURVEYS, CONDUCTING FOCUS GROUPS, AND INTERVIEWING KEY STAFF MEMBERS AT THE HEALTH DEPARTMENT. UPON COMPLETION OF THE HEALTH DEPARTMENT INTERVIEWS, A METHODOLOGICAL APPROACH CALLED THEME ANALYSIS WAS USED. RESPONSES WERE EXAMINED FOR COMMON PHRASES, THEMES, AND POINTS OF DISCUSSION AND GROUPED INTO SPECIFIC HEALTH NEEDS (I.E., HUNGER, ACCESS TO HEALTH FOODS, AND MENTAL HEALTH). EACH HEALTH NEED WAS THEN RECORDED BY THE NUMBER OF TIMES THAT IT WAS IDENTIFIED, AND BY THE COUNTY OF ORIGIN FOR THE RESPONSE.WHERE SECONDARY DATA SOURCES WERE USED, A QUANTITATIVE APPROACH WAS APPLIED. POPULATION ESTIMATES, SUCH AS THE PERCENTAGE OF PEOPLE EXPERIENCING HEART DISEASE, WERE EXAMINED FOR EACH COUNTY IN THE SERVICE AREA AND AGGREGATED ACROSS COUNTIES. AVERAGES WERE CALCULATED FOR THE SERVICE AREA COUNTIES IN AGGREGATE FORM WHERE APPROPRIATE. SECONDARY DATA WAS DOWNLOADED FROM THE HOSTING INSTITUTION'S WEBSITE. TIME TRENDS WERE ACCOUNTED FOR BY DOWNLOADING SEVERAL YEARS FOR EACH INDICATOR, AND WHERE POSSIBLE WE EXAMINED AT LEAST EIGHT YEARS OF DATA TO EXAMINE AND SHOW LONGITUDINAL MEASURES (TYPICALLY 2010-2017). WHEN DATA HAD LIMITED AVAILABILITY (FOR EXAMPLE, ONE CROSS SECTION, OR YEAR), THE LATEST AVAILABLE YEAR WAS COLLECTED AND REPORTED. GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 6A: THE 2018 CHNA WAS CONDUCTED BY ST. MARY'S HEALTH CARE SYSTEM (INCLUDING ST. MARY'S HOSPITAL, GOOD SAMARITAN HOSPITAL AND ST. MARY'S SACRED HEART HOSPITAL). GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 6B: THE 2018 CHNA WAS CONDUCTED IN COLLABORATION WITH THE UNIVERSITY OF GEORGIA - COLLEGE OF PUBLIC HEALTH AND THE J.W. FANNING INSTITUTE FOR LEADERSHIP.PART V, SECTION B LINE 7A:GOOD SAMARITAN HOSPITAL CHNA URL: WWW.STMARYSHEALTHCARESYSTEM.ORG/ABOUT-US/COMMUNITY-BENEFITPART V, SECTION B LINE 10A:GOOD SAMARITAN HOSPITAL STRATEGY URL: WWW.STMARYSHEALTHCARESYSTEM.ORG/ABOUT-US/COMMUNITY-BENEFIT GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 11: THE CHNA CONDUCTED IN FISCAL YEAR 2019 IDENTIFIED 10 SIGNIFICANT HEALTH NEEDS WITHIN THE ST. MARY'S HEALTH CARE SYSTEM'S COMMUNITY. THOSE NEEDS WERE THEN PRIORITIZED BASED ON THE REACTION AND REFLECTION TO THE FOLLOWING QUESTIONS: WHAT IS THE SEVERITY OR PREVALENCE IN YOUR COMMUNITY? IS THIS A HEALTH NEED YOU CAN ADDRESS? DO YOU HAVE THE NEEDED EXPERTISE, RESOURCES, AND PARTNERS? ARE YOU ALREADY ADDRESSING THIS NEED? AND DO YOU HAVE THE ABILITY TO MAKE AND SHOW IMPACT?THE FOLLOWING NEEDS WERE RECOGNIZED BY ST. MARY'S HEALTH CARE SYSTEM'S LEADERSHIP COMMITTEE AS THE MOST SIGNIFICANT ISSUES THAT MUST BE ADDRESSED TO IMPROVE THE HEALTH AND QUALITY OF LIFE IN OUR COMMUNITY.HEALTH CARE ACCESS - IN FISCAL YEAR 2019, GOOD SAMARITAN HOSPITAL CONTINUED TO SUPPORT TENDERCARE CLINIC AND ST. MARY'S MEDICAL GROUP IN THE EFFORT TO RECRUIT PRIMARY CARE PHYSICIANS. GOOD SAMARITAN HOSPITAL PARTNERED WITH AUGUSTA UNIVERSITY/UNIVERSITY OF GEORGIA MEDICAL TO PROVIDE A RURAL ROTATION FOR RESIDENT PHYSICIANS, WHICH INCLUDES A HOSPITAL AS WELL AS PHYSICIAN PRACTICES. THE RESIDENT PHYSICIANS PRACTICE AT GOOD SAMARITAN HOSPITAL AND TENDERCARE CLINIC. AFTER THE RESIDENTS COMPLETE THEIR ROTATION, IT IS HOPED THEY WILL RETURN AND PRACTICE IN GREENE COUNTY. CANCER - IN FISCAL YEAR 2019, GOOD SAMARITAN HOSPITAL OFFERED NO-COST MAMMOGRAMS IN THE MONTH OF OCTOBER. RECOMMENDATIONS AND FOLLOW-UPS WERE MADE WITH A PHYSICIAN FOR THE WOMEN WHO HAD FINDINGS. THE POWER OF ONE COMMUNITY EVENT WAS ALSO HELD IN OCTOBER TO SPREAD AWARENESS TO THE COMMUNITY ABOUT THE IMPORTANCE OF ANNUAL MAMMOGRAMS AND EARLY DETECTION. GOOD SAMARITAN HOSPITAL HAS CONTINUED A STRONG STANDING RELATIONSHIP WITH THE FOLLOWING PARTNERS: TENDERCARE CLINIC, GREENE COUNTY HEALTH DEPARTMENT, AND GREENE COUNTY FAMILY CONNECTION. NUTRITION, OBESITY AND DIABETES - GOOD SAMARITAN HOSPITAL CONTINUED TO OFFER A SIX-WEEK DIABETES EDUCATION CLASS TO ITS COMMUNITY DURING FISCAL YEAR 2019. THIS CLASS IS OFFERED TWICE A YEAR AND TAUGHT BY CERTIFIED PEER EDUCATORS FROM THE HOSPITAL. THIS CLASS IS FULL OF GREAT INFORMATION ABOUT DIABETES AND IS ALSO OPEN TO CARE GIVERS OF DIABETICS WHO WANT TO LEARN MORE AND SUPPORT THEIR LOVED ONES ON THIS JOURNEY. THERE WAS A TOTAL OF 23 DIABETICS AND SIX PRE-DIABETICS THAT ATTENDED THESE CLASSES IN FISCAL YEAR 2019.CARDIOVASCULAR AND CEREBROVASCULAR HEALTH - WALK TO WELLNESS IS ALSO A SIX-WEEK PROGRAM THAT WAS OFFERED IN FISCAL YEAR 2019. THIS PROGRAM WAS CREATED TO IMPACT THE OVERALL HEALTH OF THE PARTICIPANT JUST BY INCORPORATING AND INCREASING DAILY WALKING ACTIVITIES. THE PARTICIPANTS MUST BE ABLE TO COMMIT TO WALKING FOR AT LEAST TWO DAYS PER WEEK. THERE WAS A TOTAL OF 35 PARTICIPANTS. PARTICIPANTS ARE GIVEN A PRE- AND POST-ASSESSMENT TO DETERMINE PROGRAM EFFECTIVENESS AT THE CONCLUSION OF THE PROGRAM. THE ASSESSMENTS INCLUDE GLUCOSE TESTING, BLOOD PRESSURE CHECKS, CHOLESTEROL, AND BODY MASS INDEX. THE FOCUS IS TO INCREASE THEIR WALKING DISTANCE OVER TIME, WHILE TRACKING THEIR PROGRESS. EVERY WEEK THERE IS A HEALTH TOPIC DISCUSSED BY A GUEST SPEAKER FROM WITHIN THE COMMUNITY. THE WALK TO WELLNESS PROGRAM ALSO PROMOTED STROKE PREVENTION AND FOCUSED ON INCREASING AWARENESS OF RISK FACTORS IN ORDER TO MANAGE AND PREVENT OTHER CHRONIC DISEASE.GOOD SAMARITAN HOSPITAL ACKNOWLEDGES THE WIDE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, AND DETERMINED THAT IT COULD EFFECTIVELY FOCUS ON ONLY THOSE HEALTH NEEDS WHICH IT DEEMED MOST PRESSING, UNDER-ADDRESSED, AND WITHIN ITS ABILITY TO INFLUENCE. THEREFORE, GOOD SAMARITAN HOSPITAL WILL NOT TAKE ACTION ON THE FOLLOWING HEALTH NEEDS:- RESPIRATORY HEALTH: THE HOSPITAL WILL BE PARTICIPATING IN THE ST. MARY'S HEALTH SYSTEMWIDE RESPIRATORY HEALTH INITIATIVE.- BEHAVIORAL HEALTH: THE HOSPITAL WILL BE PARTICIPATING IN THE ST. MARY'S HEALTH SYSTEMWIDE INITIATIVE ON THIS PRIORITY NEED. THERE IS A STATEWIDE LIMITATION OF RESOURCES FOR TREATMENT AND THERE ARE ALREADY OTHER NOT-FOR-PROFIT ORGANIZATIONS IN THE AREA PROVIDING MENTAL HEALTH CARE.- INJURIES AND ACCIDENTS: THE HOSPITAL PARTICIPATES IN INDUSTRY SAFETY FAIRS AS WELL AS IN THE COUNTY BIKE SAFETY PROGRAM. HOWEVER, TO BE ABLE TO ADDRESS THIS NEED, THE HOSPITAL WILL NEED MORE DATA AND INFORMATION SINCE IT SEEMS THAT MANY OF THE INCIDENTS ARE SEASONAL (SUMMER) AND DUE TO BOAT ACCIDENTS AND TRANSIENT POPULATION.- MATERNAL AND CHILD HEALTH: THE HOSPITAL HAS PARTNERSHIPS WITH TENDERCARE CLINIC, FIRST CALL PREGNANCY CENTER, AND ATHENS OB/GYN. ALSO, THE COUNTY HAS AN ESTABLISHED PUBLIC HEALTH WOMEN, INFANTS AND CHILDREN (WIC) PROGRAM DEPARTMENT.- REPRODUCTIVE HEALTH: THE LOCAL PUBLIC HEALTH DEPARTMENT IS ADDRESSING THIS NEED IN THE COMMUNITY. THE HOSPITAL PROVIDES REFERRALS. GOOD SAMARITAN HOSPITAL PART V, SECTION B, LINE 13H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTH CARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. GOOD SAMARITAN HOSPITAL PART V, LINE 16A, FAP WEBSITE:WWW.STMARYSHEALTHCARESYSTEM.ORG/FOR-PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE GOOD SAMARITAN HOSPITAL PART V, LINE 16B, FAP APPLICATION WEBSITE:WWW.STMARYSHEALTHCARESYSTEM.ORG/FOR-PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE GOOD SAMARITAN HOSPITAL PART V, LINE 16C, FAP PLAIN LANGUAGE SUMMARY WEBSITE:WWW.STMARYSHEALTHCARESYSTEM.ORG/FOR-PATIENTS/BILLING-INSURANCE/FINANCIAL-ASSISTANCE PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: GOOD SAMARITAN HOSPITAL REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH (EIN 35-1443425) IN ITS AUDITED FINANCIAL STATEMENTS, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, GOOD SAMARITAN HOSPITAL 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, LN 7 COL(F): THE FOLLOWING NUMBER, $2,463,608, 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 II, COMMUNITY BUILDING ACTIVITIES: GOOD SAMARITAN HOSPITAL PARTICIPATES IN A VARIETY OF COMMUNITY BUILDING ACTIVITIES THAT STRENGTHEN THE COMMUNITY'S CAPACITY TO PROMOTE THE HEALTH AND WELL-BEING OF ITS RESIDENTS. ECONOMIC DEVELOPMENT - IN FISCAL YEAR 2019, GOOD SAMARITAN HOSPITAL'S PRESIDENT SERVED ON THE GREENE COUNTY CHAMBER OF COMMERCE BOARD. SHE CONTINUES TO ENCOURAGE ECONOMIC DEVELOPMENT IN OUR COMMUNITY GIVEN THAT GOOD SAMARITAN HOSPITAL IS ONE OF THE TOP EMPLOYERS IN GREENE COUNTY. ALSO IN FISCAL YEAR 2019, GOOD SAMARITAN HOSPITAL PARTICIPATED IN THE GREENE COUNTY POVERTY SIMULATION. THE PURPOSE OF THE SIMULATION IS TO TAKE ON THE IDENTITY OF SOMEONE LIVING IN POVERTY FOR ONE MONTH. THE GOAL IS TO SHIFT THE PARADIGM ABOUT POVERTY AWAY FROM BEING VIEWED AS A PERSONAL FAILURE AND TOWARD THE UNDERSTANDING THAT POVERTY IS STRUCTURAL, A FAILURE OF SOCIETY.WORKFORCE DEVELOPMENT - IN FISCAL YEAR 2019, GOOD SAMARITAN HOSPITAL PROVIDED OPPORTUNITIES TO THE LOCAL HIGH SCHOOLS. "WORK-BASED LEARNING" IS AN EDUCATIONAL STRATEGY THAT PROVIDES STUDENTS WITH REAL-LIFE WORK EXPERIENCES WHERE THEY CAN APPLY ACADEMIC AND TECHNICAL SKILLS AND DEVELOP THEIR EMPLOYABILITY. THE STUDENTS WERE ABLE TO SHADOW THE STAFF IN THE DEPARTMENT THAT THEY WERE INTERESTED IN. THE STUDENTS DEDICATE AT LEAST 10 HOURS PER WEEK FOR THE ENTIRE SCHOOL YEAR.COMMUNITY SUPPORT - GOOD SAMARITAN HOSPITAL'S DIRECTOR OF COMMUNITY OUTREACH AND ADMINISTRATIVE SERVICES CONTINUES TO SERVE AS A ROTARIAN FOR GREENE-PUTNAM COUNTIES. SHE ALSO SERVES ON THE ROTARY BOARD AND CHAIRS THE COMMUNITY INVOLVEMENT COMMITTEE. SHE IS INVOLVED IN OTHER COMMUNITY EVENTS SUCH AS THE SECOND HARVEST FOOD DISTRIBUTION AND RIVER ALIVE. THE OUTREACH COORDINATOR SERVES ON THE FAMILY CONNECTIONS EXECUTIVE BOARD AND COLLABORATIVE BOARD. THE MISSION OF GREENE COUNTY FAMILY CONNECTION IS TO REDUCE BARRIERS, SERVICE GAPS, AND INEFFICIENCIES THAT OBSCURE PROGRESS AND POSITIVE OUTCOMES FOR OUR CHILDREN, FAMILIES, AND COMMUNITIES. PART III, LINE 2: METHODOLOGY USED FOR LINE 2 - 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. PART III, LINE 3: GOOD SAMARITAN HOSPITAL USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FOR FINANCIAL STATEMENT PURPOSES, GOOD SAMARITAN HOSPITAL IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, GOOD SAMARITAN HOSPITAL IS REPORTING ZERO ON LINE 3, SINCE THEORETICALLY ANY POTENTIAL CHARITY CARE SHOULD HAVE BEEN IDENTIFIED THROUGH THE PREDICTIVE MODEL. PART III, LINE 4: GOOD SAMARITAN HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE PATIENT ACCOUNTS RECEIVABLE, ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS FOOTNOTE FROM PAGE 14 OF THOSE STATEMENTS: "THE CORPORATION HAS AGREEMENTS WITH THIRD-PARTY PAYERS THAT PROVIDE FOR PAYMENTS TO THE CORPORATION'S HEALTH MINISTRIES AT AMOUNTS DIFFERENT FROM ESTABLISHED RATES. ESTIMATED RETROACTIVE ADJUSTMENTS UNDER REIMBURSEMENT AGREEMENTS WITH THIRD-PARTY PAYERS AND OTHER CHANGES IN ESTIMATES ARE INCLUDED IN NET PATIENT SERVICE REVENUE AND ESTIMATED RECEIVABLES FROM AND PAYABLES TO THIRD-PARTY PAYERS. RETROACTIVE ADJUSTMENTS ARE ACCRUED ON AN ESTIMATED BASIS IN THE PERIOD THE RELATED SERVICES ARE RENDERED AND ADJUSTED IN FUTURE PERIODS, AS FINAL SETTLEMENTS ARE DETERMINED.FOR PATIENT ACCOUNTS RECEIVABLE RESULTING FROM REVENUE RECOGNIZED PRIOR TO JULY 1, 2018, PATIENT ACCOUNTS RECEIVABLE WERE REPORTED AT ESTIMATED NET REALIZABLE AMOUNTS FROM PATIENTS, THIRD-PARTY PAYERS, AND OTHERS FOR SERVICES RENDERED. PRIOR TO THIS DATE, AN ALLOWANCE FOR DOUBTFUL ACCOUNTS WAS ESTABLISHED TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. GENERALLY, THIS ALLOWANCE WAS ESTIMATED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES FOR EACH TYPE OF PAYER. UNDER THE PROVISIONS OF ACCOUNTING STANDARDS UPDATE ("ASU") NO. 2014-09 "REVENUE FROM CONTRACTS WITH CUSTOMERS (TOPIC 606)," WHICH WAS ADOPTED EFFECTIVE JULY 1, 2018, AN UNCONDITIONAL RIGHT TO PAYMENT, SUBJECT ONLY TO THE PASSAGE OF TIME IS TREATED AS A RECEIVABLE. PATIENT ACCOUNTS RECEIVABLE, INCLUDING BILLED ACCOUNTS AND UNBILLED ACCOUNTS FOR WHICH THERE IS AN UNCONDITIONAL RIGHT TO PAYMENT, AND ESTIMATED AMOUNTS DUE FROM THIRD-PARTY PAYERS FOR RETROACTIVE ADJUSTMENTS, ARE RECEIVABLES IF THE RIGHT TO CONSIDERATION IS UNCONDITIONAL AND ONLY THE PASSAGE OF TIME IS REQUIRED BEFORE PAYMENT OF THAT CONSIDERATION IS DUE. FOR PATIENT ACCOUNTS RECEIVABLE SUBSEQUENT TO THE ADOPTION OF ASU NO. 2014-09 ON JULY 1, 2018, THE ESTIMATED UNCOLLECTABLE AMOUNTS ARE GENERALLY CONSIDERED IMPLICIT PRICE CONCESSIONS THAT ARE A DIRECT REDUCTION TO PATIENT SERVICE REVENUE AND ACCOUNTS RECEIVABLE."PART III, LINE 5:TOTAL MEDICARE REVENUE REPORTED IN PART III, LINE 5 HAS BEEN REDUCED BY THE TWO PERCENT SEQUESTRATION REDUCTION. PART III, LINE 8: GOOD SAMARITAN HOSPITAL DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CATHOLIC HEALTH ASSOCIATION RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE 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.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: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. PART VI, LINE 2: NEEDS ASSESSMENT - GOOD SAMARITAN HOSPITAL ASSESSES THE HEALTH STATUS OF ITS COMMUNITY, IN PARTNERSHIP WITH COMMUNITY COALITIONS, AS PART OF THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. TO ASSESS THE HEALTH OF THE COMMUNITY, THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES, AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - GOOD SAMARITAN HOSPITAL 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, FEDERAL, STATE, AND LOCAL GOVERNMENT PROGRAMS, AND OTHER COMMUNITY-BASED CHARITABLE 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. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY ASSIST THEM IN OBTAINING AND PAYING FOR HEALTH CARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. GOOD SAMARITAN HOSPITAL 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 PATIENT BROCHURES, MESSAGES ON PATIENT BILLS, POSTED NOTICES IN PUBLIC REGISTRATION AREAS INCLUDING EMERGENCY ROOMS, ADMITTING AND REGISTRATION DEPARTMENTS, AND OTHER PATIENT FINANCIAL SERVICES OFFICES. SUMMARIES OF HOSPITAL PROGRAMS ARE MADE AVAILABLE TO APPROPRIATE COMMUNITY HEALTH AND HUMAN SERVICES AGENCIES AND OTHER ORGANIZATIONS THAT ASSIST PEOPLE IN NEED. INFORMATION REGARDING FINANCIAL ASSISTANCE PROGRAMS IS ALSO AVAILABLE ON HOSPITAL WEBSITES. IN ADDITION TO ENGLISH, THIS INFORMATION IS ALSO AVAILABLE IN OTHER LANGUAGES AS REQUIRED BY INTERNAL REVENUE CODE SECTION 501(R), REFLECTING OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVICED BY OUR HOSPITAL. GOOD SAMARITAN HOSPITAL HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. GOOD SAMARITAN HOSPITAL 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. PART VI, LINE 4: COMMUNITY INFORMATION - GREENE COUNTY HAD AN ESTIMATED POPULATION OF 16,490 IN 2014, REPRESENTING A 3.1% GROWTH BETWEEN 2010 AND 2014. THE COUNTY'S POPULATION DENSITY IS ONE OF THE LOWEST IN THE HOSPITAL'S SERVICE AREA WITH APPROXIMATELY 41 PERSONS PER SQUARE MILE IN THE COUNTY'S 387.44 SQUARE MILES. THE FIVE CITIES OF GREENSBORO, SILOAM, UNION POINT, WHITE PLAINS, AND WOODVILLE ARE WITHIN GREENE COUNTY, AND GREENSBORO SERVES AS THE COUNTY SEAT. GREENE COUNTY IS ONE THE MOST DIVERSE COUNTIES IN THE HOSPITAL'S SERVICE AREA, WITH 36.9% AFRICAN-AMERICANS AND 6.3% HISPANICS OR LATINOS. OF GREENE COUNTY RESIDENTS, 25% ARE OVER AGE 65, A VALUE TWICE THE STATE RATE, MAKING IT AMONG THE OLDER COUNTIES IN THE SERVICE AREA.THOUGH GREENE COUNTY'S MEDIAN HOUSEHOLD INCOME ($42,565) RANKED EIGHTH HIGHEST AMONG CATCHMENT AREA COUNTIES, THE UNEMPLOYMENT RATE IN GREENE (8.6%) WAS FIFTH WORST IN THE SAME AREA. JUST UNDER 40% OF GREENE COUNTY'S CHILDREN LIVE IN POVERTY, AND THE COUNTY REPORTED THE HIGHEST FREE AND REDUCED LUNCH PERCENTAGE IN THE AREA IN 2014 (98.6%). THE PERCENTAGE OF ADULTS LIVING IN POVERTY WAS ALSO WORSE THAN THE STATE, WITH 21.35% OF ADULTS LIVING BELOW THE POVERTY LINE.IN THE 2010 AMERICAN COMMUNITY SURVEY, ONLY 78.7% OF GREENE COUNTY ADULTS REPORTED HAVING AT LEAST GRADUATED HIGH SCHOOL, RANKING GREENE EIGHTH WORST AMONG CHNA COUNTIES ON THIS INDICATOR. IN ADDITION, 8.4% OF GREENE COUNTY'S POPULATION HAS LESS THAN A NINTH GRADE EDUCATION. ON THE OTHER HAND, 21% OF INDIVIDUALS POSSESS AT LEAST A BACHELOR'S DEGREE, FOURTH HIGHEST AMONG COUNTIES IN THE SERVICE AREA. ADDITIONALLY, OF THE 17 COUNTIES, GREENE COUNTY HAS THE HIGHEST NUMBER OF 3- AND 4-YEAR-OLDS ENROLLED IN PRESCHOOL, WITH ONLY 21.4% NOT ENROLLED. GREENE'S 2014 FOUR-YEAR COHORT GRADUATION RATE, AT 65.1%, WAS SECOND WORST AMONG CHNA COUNTIES AND AMONG THE LOWEST SYSTEM RATES IN THE STATE. GREENE COUNTY WAS ALSO THE ONLY COUNTY WITHIN WHICH THE GRADUATION RATE FOR BLACK STUDENTS WAS HIGHER THAN FOR WHITES, AT 65.9% AND 50%, RESPECTIVELY. PART VI, LINE 5: PROMOTION OF COMMUNITY HEALTH - GOOD SAMARITAN HOSPITAL IS GUIDED BY THE ST. MARY'S HEALTH CARE SYSTEM MISSION OF IMPROVING THE HEALTH OF THE PEOPLE OF OUR COMMUNITIES. GOOD SAMARITAN HOSPITAL IS A 25-BED CRITICAL ACCESS HOSPITAL ACCREDITED BY THE JOINT COMMISSION ON ACCREDITATION OF HEALTH CARE ORGANIZATIONS. THE HOSPITAL OFFERS A WIDE RANGE OF SERVICES, INCLUDING GENERAL SURGERY AND A 24-HOUR EMERGENCY DEPARTMENT THAT IS OPEN TO SERVE ALL WHO ARE IN NEED OF EMERGENT CARE, REGARDLESS OF THEIR ABILITY TO PAY. AS A ST. MARY'S HEALTH CARE SYSTEM HOSPITAL, WE ARE ABLE TO BRING SPECIALTY SERVICES TO COMMUNITY MEMBERS CONVENIENTLY LOCATED CLOSE TO HOME, PROVIDED BY A NETWORK OF PHYSICIANS. WE ALSO CAN PROVIDE COMMUNITY MEMBERS WITH ACCESS TO THE EXPERTISE AND SPECIALTY SERVICES AT ST. MARY'S HOSPITAL IN ATHENS WHEN THEY REQUIRE CARE NOT AVAILABLE LOCALLY.COMMUNITY BENEFIT IS THE WAY IN WHICH GOOD SAMARITAN HOSPITAL CARRIES OUT ITS MISSION. IT IS HOW WE DEMONSTRATE A COMMITMENT TO OUR CORE VALUES AND A REFLECTION OF HOW WE SERVE OUR COMMUNITY AS A NOT-FOR-PROFIT ORGANIZATION. GOOD SAMARITAN HOSPITAL OFFERS MANY PROGRAMS AND SERVICES TO ENSURE THE BEST QUALITY OF CARE IS GIVEN TO OUR PATIENTS AND TO HELP THOSE IN NEED WHO MAY NEVER ENTER OUR FACILITIES. THROUGH OUR HEALTH EDUCATION PROGRAMS, HEALTH CARE SUPPORT SERVICES, VALUED COMMUNITY PARTNERSHIPS, AND CHARITY CARE PROVISIONS, GOOD SAMARITAN HOSPITAL IS IMPROVING THE HEALTH AND WELL-BEING OF INDIVIDUALS AND FAMILIES THAT MAKE UP OUR COMMUNITY. EACH YEAR, GOOD SAMARITAN HOSPITAL WELCOMES STUDENTS FROM LOCAL COLLEGES AND UNIVERSITIES WHO ARE STUDYING TO BECOME THE NEXT GENERATION OF HEALTH CARE PROFESSIONALS. THE STAFF OF GOOD SAMARITAN HOSPITAL SPENDS COUNTLESS HOURS MENTORING AND EDUCATING THESE STUDENTS IN THE UNIQUE SETTINGS OF A HEALTH CARE FACILITY. THE EXPERIENCE AND KNOWLEDGE GAINED THROUGH THESE PROGRAMS IS INVALUABLE TO THEIR FUTURE CAREERS AS WELL AS THE HEALTH CARE FIELD. GOOD SAMARITAN HOSPITAL COLLABORATES WITH COMMUNITIES, CHURCHES, BUSINESSES, AND OTHER HEALTH CARE ORGANIZATIONS TO FACILITATE AND STRENGTHEN ACCESSIBILITY OF QUALITY COMPREHENSIVE HEALTH CARE SERVICES FOR ALL, PARTICULARLY THE VULNERABLE AND UNDERSERVED POPULATIONS. IN FISCAL YEAR 2019, GOOD SAMARITAN HOSPITAL'S EMPLOYEES DONATED THEIR TIME AND EXPERTISE TO ORGANIZATIONS THAT STRIVE TO IMPROVE COMMUNITY HEALTH. THE EMPLOYEES PROVIDED BLOOD PRESSURE AND GLUCOSE SCREENING FOR COMMUNITY MEMBERS FREE OF CHARGE. GOOD SAMARITAN HOSPITAL ALSO PROVIDED CASH AND IN-KIND DONATIONS TO NUMEROUS ORGANIZATIONS AND COMMUNITY EVENTS, INCLUDING THE GREENE COUNTY HABITAT FOR HUMANITY AND THE KNIGHTS OF COLUMBUS. GOOD SAMARITAN HOSPITAL HAS ALSO CONTINUED A NEWER PROGRAM CALLED WALK TO WELLNESS. THE HOSPITAL PARTNERED WITH TENDERCARE CLINIC TO DEVELOP A GROUP OF 15 INDIVIDUALS WHO MET DAILY TO WALK IN ORDER TO IMPROVE THEIR OVERALL HEALTH. THE GROUP MET EVERY DAY AT THE LOCAL HIGH SCHOOL TRACK AND WALKED AT LEAST TWO LAPS. BEFORE PARTICIPATION IN THE GROUP, PRE-TESTS WERE AVAILABLE, CONSISTING OF BODY MASS INDEX, BLOOD PRESSURE, AND GLUCOSE AND CHOLESTEROL TESTING. THE PARTICIPANTS TRACKED THEIR DAILY NUMBER OF LAPS AND AT THE END OF THE PROGRAM THE PARTICIPANTS' BMI AND GLUCOSE AND CHOLESTEROL LEVELS WERE TESTED AGAIN FOR COMPARISON. THIS PROGRAM HAD GREAT RESULTS AND GOOD SAMARITAN PLANS TO CONTINUE THIS PROGRAM IN THE COMING YEARS.IN FISCAL YEAR 2019, GOOD SAMARITAN HOSPITAL AND TENDERCARE CLINIC (A FEDERALLY QUALIFIED HEALTH CENTER), CONTINUED THEIR JOINT COMMUNITY BREAST CANCER AWARENESS PROGRAM TO INCREASE EARLY DIAGNOSIS AND DETECTION OF BREAST CANCER IN GREENE COUNTY. AWARENESS IS SPREAD THROUGH EDUCATIONAL CLASSES, EVENTS, AND THE PINK OUT DAY WHICH IS THE THIRD FRIDAY OF OCTOBER EACH YEAR.IN FISCAL YEAR 2019, GOOD SAMARITAN HOSPITAL COLLABORATED WITH GREENE COUNTY HIGH SCHOOL TO HAVE THE HOSPITAL AS A "WORK-BASED LEARNING" SITE FOR THE STUDENTS. WITH THIS PROGRAM, GOOD SAMARITAN HOSPITAL ADDRESSED THE SOCIAL INFLUENCERS OF: HEALTH, QUALITY EDUCATION, ECONOMIC, AND FUTURE JOB OPPORTUNITIES FOR THESE STUDENTS. WORK-BASED LEARNING IS AN EDUCATIONAL STRATEGY THAT PROVIDES STUDENTS WITH REAL-LIFE WORK EXPERIENCES WHERE THEY CAN APPLY ACADEMIC AND TECHNICAL SKILLS AND DEVELOP THEIR EMPLOYABILITY. THE STUDENTS SHADOW THE STAFF IN THE DEPARTMENT THAT THEY ARE INTERESTED IN. THE STUDENTS DEDICATE AT LEAST 10 HOURS PER WEEK FOR THE ENTIRE SCHOOL YEAR.GOOD SAMARITAN HOSPITAL IS GOVERNED BY A BOARD OF DIRECTORS COMMITTED TO THE VALUES OF THE SYSTEM AND TO ENSURING THAT GOOD SAMARITAN HOSPITAL CONTINUES ITS MISSION OF BEING A COMPASSIONATE, HEALING PRESENCE IN OUR COMMUNITY. GOOD SAMARITAN HOSPITAL HAS A SEVEN-MEMBER BOARD COMPRISED PRIMARILY OF COMMUNITY MEMBERS. PART VI, LINE 6: GOOD SAMARITAN HOSPITAL IS A MEMBER OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE DELIVERY SYSTEMS IN THE COUNTRY. TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER HOSPITALS DEFINE - AND ACHIEVE - SPECIFIC COMMUNITY HEALTH AND WELL-BEING GOALS. IN FISCAL YEAR 2019, EVERY TRINITY HEALTH ENTITY FOCUSED ON: 1. REDUCING TOBACCO USE 2. REDUCING OBESITY PREVALENCE3. ADDRESSING AT LEAST ONE SIGNIFICANT HEALTH NEED IDENTIFIED BY THEIR HOSPITAL'S COMMUNITY HEALTH NEEDS ASSESSMENT4. ADDRESSING AT LEAST ONE SOCIAL INFLUENCER OF HEALTH TRINITY HEALTH ACKNOWLEDGES THAT SOCIAL INFLUENCERS OF HEALTH - SUCH AS ADEQUATE HOUSING, PERSONAL SAFETY AND ACCESS TO FOOD, EDUCATION, INCOME, AND HEALTH COVERAGE - HAVE A SIGNIFICANT IMPACT ON THE HEALTH OF ITS COMMUNITIES. IN AN EFFORT TO ADDRESS SOME OF THESE INFLUENCERS, TRINITY HEALTH LAUNCHED THE TRANSFORMING COMMUNITIES INITIATIVE (TCI) IN FISCAL YEAR 2016 TO ADVANCE COMMUNITY PARTNERSHIPS THAT FOCUS ON IMPROVING THE HEALTH AND WELL-BEING IN COMMUNITIES SERVED BY THE HOSPITALS OF TRINITY HEALTH. TCI IS A SHARED FUNDING MODEL AND TECHNICAL-ASSISTANCE INITIATIVE SUPPORTING EIGHT TRINITY HEALTH HOSPITALS AND THEIR COMMUNITY PARTNERS TO IMPLEMENT POLICY, SYSTEM, AND ENVIRONMENTAL CHANGE STRATEGIES TO PREVENT TOBACCO USE AND CHILDHOOD OBESITY, AND TO AFFECT CHANGE RELATED TO THE SOCIAL INFLUENCERS OF HEALTH. IN FISCAL YEAR 2019, TRINITY HEALTH INVESTED $3.7 MILLION IN TCI AND HAS LEVERAGED OVER $6.5 MILLION IN COMMUNITY MATCH FUNDING TO DATE. ADDITIONALLY, TRINITY HEALTH'S GOOD SAMARITAN INITIATIVE (GSI) INVESTED $751,000 IN NINE REGIONAL HEALTH MINISTRIES TO SUPPORT THE INTEGRATION OF 16 COMMUNITY HEALTH WORKERS INTO CARE MANAGEMENT TEAMS. TRINITY HEALTH CONTINUES TO EXPAND THE NATIONAL DIABETES PREVENTION PROGRAM THROUGH THE SUPPORT OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION. IN ADDITION TO THE PROGRAMMATIC SPENDING DESCRIBED ABOVE, THE SYSTEM DEPLOYED NEW AND RENEWED LOANS OF $5.3 MILLION FOR PLACE-BASED INVESTING TO IMPROVE ACCESS TO AFFORDABLE HOUSING, HEALTHY FOODS, EDUCATION, AND ECONOMIC DEVELOPMENT. THE COMMUNITY-INVESTING PROGRAM ALSO HAS OUTSTANDING LOAN COMMITMENTS OF $6.0 MILLION TO COMMUNITY INFRASTRUCTURE PROJECTS, WHICH WILL BE DEPLOYED IN FUTURE YEARS.TRINITY HEALTH AND ITS MEMBER HOSPITALS ARE COMMITTED TO THE DELIVERY OF PEOPLE-CENTERED CARE AND SERVING AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN THE COMMUNITIES THEY SERVE. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITIES AND IS COMMITTED TO ADDRESSING THE UNIQUE NEEDS OF EACH COMMUNITY. IN FISCAL YEAR 2019, TRINITY HEALTH INVESTED NEARLY $1.2 BILLION IN COMMUNITY BENEFIT, SUCH AS INITIATIVES SUPPORTING THOSE WHO ARE POOR AND VULNERABLE, HELPING TO MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, AND MOVING FORWARD POLICY, SYSTEM, AND ENVIRONMENTAL CHANGE.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. 0 1 0 0 0 0 0 0 0 D MONTEZ CARTER DIRECTOR; SEC; SMHCS PRES & CEO 0 387671 0 44500 0 58809 0 91129 0 25656 0 607765 0 0 TANYA ADCOCK PRESIDENT, GOOD SAMARITAN HOSPITAL 155718 0 11333 0 6269 0 7630 0 1936 0 182886 0 0 0 DANIEL POWELL TREASURER & INT CFO THROUGH 6/19 0 515693 0 0 0 3730 0 12375 0 19116 0 550914 0 0 JOSEPH HANCOCK PHARMACIST 127262 0 0 0 140 0 6097 0 21394 0 154893 0 0 0 DONALD MCKENNA FORMER OFFICER 0 25067 0 0 0 101172 0 376 0 1434 0 128049 0 0 PART I, LINE 3 GOOD SAMARITAN HOSPITAL IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. GOOD SAMARITAN HOSPITAL'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION OF GOOD SAMARITAN HOSPITAL'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - WRITTEN EMPLOYMENT CONTRACT - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE FOLLOWING ARE PARTICIPANTS IN A TRINITY HEALTH SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP) IN 2018. THE PLAN PROVIDES RETIREMENT BENEFITS TO CERTAIN TRINITY HEALTH EXECUTIVES SUBJECT TO MEETING SPECIFIED VESTING AND EMPLOYMENT DATE REQUIREMENTS. BENEFITS FOR PARTICIPANTS VESTED IN A PLAN WERE PAID OUT IN 2018, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2018. THE FOLLOWING PAYOUT FOR 2018 FOR THE PLAN IS INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: DONALD MCKENNA - $100,172 THE FOLLOWING ACCRUAL FOR 2018 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: D. MONTEZ CARTER - $78,754 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF GOOD SAMARITAN HOSPITAL IS ST. MARY'S HEALTH CARE SYSTEM. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A ST. MARY'S HEALTH CARE SYSTEM IS THE SOLE MEMBER OF GOOD SAMARITAN HOSPITAL. ST. MARY'S HEALTH CARE SYSTEM HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF GOOD SAMARITAN HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, ST. MARY'S HEALTH CARE SYSTEM MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. ST. MARY'S HEALTH CARE SYSTEM MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, AND MODIFICATIONS TO GOVERNING DOCUMENTS. AS THE PARENT OF THE NATIONAL TRINITY HEALTH SYSTEM, CERTAIN POWERS ARE RESERVED TO TRINITY HEALTH CORPORATION. THESE INCLUDE THE AUTHORITY TO ADOPT OR MODIFY THE ORGANIZATION'S GOVERNING DOCUMENTS, TO APPROVE MAJOR CHANGES SUCH AS A MERGER OR DISSOLUTION, AND TO APPROVE SIGNIFICANT FINANCE MATTERS IN EXCESS OF CERTAIN LIMITS ESTABLISHED BY TRINITY HEALTH CORPORATION. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR GOOD SAMARITAN HOSPITAL IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE BOARD OF DIRECTORS. EACH MEMBER OF 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 GOOD SAMARITAN HOSPITAL HAS ADOPTED TRINITY HEALTH'S GOVERNANCE POLICY NO. 1, WHICH SETS FORTH THE ORGANIZATION'S CONFLICT OF INTEREST POLICY AND PROCESSES. IT APPLIES TO ALL "INTERESTED PERSONS" OF GOOD SAMARITAN HOSPITAL, WHICH INCLUDES DIRECTORS, PRINCIPAL OFFICERS, KEY EMPLOYEES, AND MEMBERS OF COMMITTEES WITH BOARD-DELEGATED POWERS. INTERESTED PERSONS ARE EXPECTED TO DISCHARGE THEIR DUTIES IN A MANNER THE PERSON REASONABLY BELIEVES TO BE IN THE BEST INTERESTS OF GOOD SAMARITAN HOSPITAL AND TO AVOID SITUATIONS INVOLVING A CONFLICT OF INTEREST. 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 PROVIDED TO INTERNAL LEGAL COUNSEL AND THE INTEGRITY AND COMPLIANCE OFFICER, FROM WHICH LEGAL COUNSEL PREPARES A REPORT FOR THE BOARD CHAIR AND CEO. A SUMMARY OF POTENTIAL CONFLICTS IS REVIEWED WITH THE BOARD OF DIRECTORS OF GOOD SAMARITAN HOSPITAL (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO GOOD SAMARITAN HOSPITAL OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. THE BOARD OF DIRECTORS OF GOOD SAMARITAN HOSPITAL (OR A DELEGATED COMMITTEE OF THE BOARD) IS RESPONSIBLE FOR THE REVIEW OF TRANSACTIONS TO DETERMINE WHETHER AN ACTUAL CONFLICT OF INTEREST EXISTS. IN THE EVENT OF AN ACTUAL CONFLICT, THE BOARD (OR A DELEGATED COMMITTEE OF THE BOARD) WILL EITHER AVOID THE CONFLICT OR APPROPRIATELY SCRUTINIZE THE TRANSACTION TO ENSURE IT IS IN THE BEST INTERESTS OF GOOD SAMARITAN HOSPITAL. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE POLICY FURTHER ADDRESSES THE PROPER DOCUMENTATION OF THE PROCEEDINGS AND POTENTIAL DISCIPLINARY AND CORRECTIVE ACTION FOR VIOLATIONS OF THE POLICY. THE POLICY IS AVAILABLE TO THE PUBLIC UPON REQUEST. FORM 990, PART VI, SECTION B, LINE 15 QUESTIONS 15A AND 15B ARE ANSWERED "NO" BECAUSE THE COMPENSATION FOR CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF GOOD SAMARITAN HOSPITAL IS ESTABLISHED BY TRINITY HEALTH, A RELATED ORGANIZATION. IN ESTABLISHING CEO AND CFO COMPENSATION, 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 THE CEO AND CFO OF GOOD SAMARITAN HOSPITAL 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 HEALTH CARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FOR OTHER EXECUTIVES WHO ARE NOT PART OF THE REBUTTABLE PRESUMPTION PROCESS, TRINITY HEALTH USES A MARKET ANALYSIS TO DETERMINE THE APPROPRIATENESS OF THE EXECUTIVE'S COMPENSATION. THE COMPENSATION OF OTHER OFFICERS AND KEY MANAGEMENT OFFICIALS OF GOOD SAMARITAN HOSPITAL IS ESTABLISHED BY ST. MARY'S HEALTH CARE SYSTEM, A RELATED ORGANIZATION. IN ESTABLISHING OFFICER AND KEY MANAGEMENT OFFICIAL COMPENSATION, ST. MARY'S HEALTH CARE SYSTEM FOLLOWS A PROCESS WHICH INCLUDES THE FOLLOWING: THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PERSONS, AS WELL AS OFFICERS AND OTHER KEY MANAGEMENT OFFICIALS. THE BOARD/COMMITTEE HAS AN ESTABLISHED COMPENSATION PHILOSOPHY WHICH DETAILS THE OBJECTIVES OF MARKET POSITIONING AND PAY ELEMENTS. THE COMMITTEE ENGAGES WITH EXTERNAL CONSULTANTS TO PROVIDE MARKET DATA COMPARING THE ORGANIZATION'S ROLES TO SIMILARLY SIZED ORGANIZATIONS UTILIZING BOTH TITLE AND JOB CONTENT COMPARISONS. THE COMMITTEE REVIEWS THE MARKET ANALYSIS, APPROVES ANY SALARY ADJUSTMENTS FOR THE EXECUTIVE POPULATION, CONSIDERS BOTH REASONABLENESS AND EFFECTIVENESS OF ALL REMUNERATIVE PROGRAMS, AND ESTABLISHES THE DETAILED PERFORMANCE EXPECTATIONS WHICH ARE INCORPORATED INTO THE INCENTIVE PLAN. ALL OF THESE DISCUSSIONS AND DECISIONS ARE DOCUMENTED THROUGH THE PROVISION OF MEETING MINUTES. FORM 990, PART VI, SECTION C, LINE 19 GOOD SAMARITAN HOSPITAL 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 CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, GOOD SAMARITAN HOSPITAL INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. GOOD SAMARITAN HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART IX, LINE 11G MISCELLANEOUS PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 4,522,842. MANAGEMENT AND GENERAL EXPENSES 542,893. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,065,735. MEDICAL SPECIALIST FEES: PROGRAM SERVICE EXPENSES 923,494. MANAGEMENT AND GENERAL EXPENSES 0. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 923,494. BILLING SERVICES: PROGRAM SERVICE EXPENSES 156,187. MANAGEMENT AND GENERAL EXPENSES 18,748. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 174,935. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 187,184. MANAGEMENT AND GENERAL EXPENSES 22,468. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 209,652. LAUNDRY AND GENERAL EXPENSES: PROGRAM SERVICE EXPENSES 102,726. MANAGEMENT AND GENERAL EXPENSES 12,331. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 115,057. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFLIATES -4,208,498. FORM 990, PART XII, LINE 2: GOOD SAMARITAN HOSPITAL'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY19 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 ALLEGANY FRANCISCAN MINISTRIES INC 33920 US HIGHWAY 19 NORTH SUITE 269 PALM HARBOR FL 34684 581492325 GRANT MAKING FL 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 ASYLUM HILL FAMILY MEDICINE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 061450170 HEALTH CARE SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 HEALTH CARE AND HOSPITAL SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 BAUM HARMON MERCY HOSPITAL AND CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 FOUNDATION IA 501(C)(3) LINE 12A, I BAUM HARMON MERCY HOSPITAL 1 BEECHWOOD INC 2212 BURDETT AVE TROY NY 12180 141651563 TITLE HOLDING COMPANY NY 501(C)(2) N/A LTC (EDDY) INC 1 BETHLEHEM HAVEN OF PITTSBURGH 905 WATSON STREET PITTSBURGH PA 15219 251436685 HOMELESS SHELTER PA 501(C)(3) LINE 7 PITTSBURGH MERCY HEALTH SYSTEM INC 1 BEVERWYCK INC 40 AUTUMN DRIVE SLINGERLANDS NY 12159 141717028 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 BRIGHTSIDE INC 114 WOODLAND STREET HARTFORD CT 06105 042182395 HEALTH CARE SERVICES MA 501(C)(3) LINE 10 THE MERCY HOSPITAL INC 1 CAPITAL REGION GERIATRIC CENTER INC 421 WEST COLUMBIA STREET COHOES NY 12047 141701597 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 CARING PARTNERS HOME HEALTH INC 1200 EARHART RD ANN ARBOR MI 48105 201681131 HOME HEALTH SERVICES MI 501(C)(3) LINE 10 GLACIER HILLS INC 1 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 HEALTH CARE SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 CATHOLIC HEALTH MINISTRIES 20555 VICTOR PARKWAY LIVONIA MI 48152 GOVERNANCE AND MANAGEMENT OF TRINITY HEALTH SYSTEM VT 501(C)(3) LINE 1 N/A 0 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HEALTH CARE AND HOSPITAL SERVICES OH 501(C)(3) LINE 3 MOUNT CARMEL HEALTH SYSTEM 1 DUBUQUE MERCY HEALTH FOUNDATION 250 MERCY DRIVE DUBUQUE IA 52001 262227941 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 FOUNDATION IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 EAST NORRITON PHYSICIANS SERVICES INC ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 232515999 HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK 1 EDDY LICENSED HOME CARE AGENCY 433 RIVER ST SUITE 3000 TROY NY 12180 141818568 HOME HEALTH SERVICES NY 501(C)(3) LINE 3 LTC (EDDY) INC 1 EMBRACING AGE INC 333 BUTTERNUT DRIVE DEWITT NY 13214 461051881 PACE PROGRAM NY 501(C)(3) LINE 12B, II ST JOSEPH'S HEALTH INC 1 EMPIRE HOME INFUSION SERVICE INC 10 BLACKSMITH DRIVE MALTA NY 12020 141795732 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 HOME AIDE SERVICE OF EASTERN NEW YORK INC 1 FARREN CARE CENTER INC 114 WOODLAND STREET HARTFORD CT 06105 042501711 LONG TERM CARE MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC 1 FRANCISCAN ELDERCARE CORPORATION PO BOX 2500 WILMINGTON DE 19805 223008680 LONG TERM CARE (INACTIVE) DE 501(C)(3) LINE 10 ST FRANCIS HOSPITAL INC 1 GLACIER HILLS FOUNDATION 1200 EARHART RD ANN ARBOR MI 48105 208072723 FOUNDATION MI 501(C)(3) LINE 12A, I GLACIER HILLS INC 1 GLACIER HILLS INC 1200 EARHART RD ANN ARBOR MI 48105 381891500 SENIOR LIVING COMMUNITY MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 GLEN EDDY INC 1 GLEN EDDY DRIVE NISKAYUNA NY 12309 141794150 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 GLOBAL HEALTH MINISTRY 20555 VICTOR PARKWAY LIVONIA MI 48152 421253527 HEALTH CARE SERVICES MI 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 GOOD SAMARITAN HOSPITAL INC 5401 LAKE OCONEE PARKWAY GREENSBORO GA 30642 261720984 HEALTH CARE AND HOSPITAL SERVICES GA 501(C)(3) LINE 3 ST MARY'S HEALTH CARE SYSTEM INC 0 GOTTLIEB COMMUNITY HEALTH SERVICES CORPORATION 701 W NORTH AVE MELROSE PARK IL 60160 363332852 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 GOTTLIEB MEMORIAL FOUNDATION 701 WEST NORTH AVENUE MELROSE PARK IL 60160 743260011 FOUNDATION IL 501(C)(3) LINE 12C, III-FI N/A 0 GOTTLIEB MEMORIAL HOSPITAL 701 W NORTH AVE MELROSE PARK IL 60160 362379649 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 HACKLEY LIFE COUNSELING 125 E SOUTHERN AVENUE MUSKEGON MI 49442 381386362 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 MERCY HEALTH PARTNERS 1 HAWTHORNE RIDGE INC 30 COMMUNITY WAY EAST GREENBUSH NY 12061 800102840 SENIOR LIVING COMMUNITY NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HEART CENTER OF GREATER WATERBURY INC 114 WOODLAND STREET HARTFORD CT 06105 830416893 MANAGEMENT CT 501(C)(3) LINE 12A, I N/A 0 HERITAGE HOUSE NURSING CENTER INC 2920 TIBBITS AVE TROY NY 12180 141725101 LONG TERM CARE NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS MI 48152 521945054 LONG TERM CARE MD 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 HOLY CROSS HEALTH FOUNDATION INC 1500 FOREST GLEN ROAD SILVER SPRING MD 20910 208428450 FOUNDATION MD 501(C)(3) LINE 7 HOLY CROSS HEALTH INC 1 HOLY CROSS HEALTH INC 1500 FOREST GLEN ROAD SILVER SPRING MD 20910 520738041 HEALTH CARE AND HOSPITAL SERVICES MD 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS HOSPITAL INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 590791028 HEALTH CARE AND HOSPITAL SERVICES FL 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 HOLY CROSS OUTPATIENT SERVICES INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 465421068 HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC 1 HOLY CROSS PRIMARY CARE INC 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 33308 812531495 HEALTH CARE SERVICES FL 501(C)(3) LINE 10 HOLY CROSS HOSPITAL INC 1 HOME & COMMUNITY HEALTH SERVICES INC 114 WOODLAND STREET HARTFORD CT 06105 810723591 HOME HEALTH SERVICES CT 501(C)(3) LINE 10 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 HOME AIDE SERVICE OF EASTERN NEW YORK INC 433 RIVER ST SUITE 3000 TROY NY 12180 141514867 HOME HEALTH SERVICES NY 501(C)(3) LINE 10 LTC (EDDY) INC 1 HOSPICE OF NORTH IOWA 232 SECOND STREET SE MASON CITY IA 50401 421173708 HOSPICE SERVICES IA 501(C)(3) LINE 10 MERCY HEALTH SERVICES-IOWA CORP 1 HOSPICE OF SIOUXLAND 4300 HAMILTON BLVD SIOUX CITY IA 51104 383320710 HOSPICE SERVICES IA 501(C)(3) LINE 12A, I N/A 0 IHA HEALTH SERVICES CORPORATION 24 FRANK LLOYD WRIGHT DR LOBBY J ANN ARBOR MI 48106 383316559 HEALTH CARE SERVICES MI 501(C)(3) LINE 10 TRINITY HEALTH-MICHIGAN 1 JOHNSON MEMORIAL HOSPITAL INC 114 WOODLAND STREET HARTFORD CT 06105 475676956 HEALTH CARE AND HOSPITAL SERVICES CT 501(C)(3) LINE 3 TRINITY HEALTH OF NEW ENGLAND CORP INC 1 LANGHORNE MRI INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 232519529 HEALTH CARE SERVICES (INACTIVE) PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER 1 LANGHORNE PHYSICIAN SERVICES INC 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 232571699 HEALTH CARE SERVICES PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER 1 LIFE AT LOURDES INC 2475 MCCLELLAN AVENUE PENNSAUKEN NJ 08109 261854750 PACE PROGRAM NJ 501(C)(3) LINE 3 TRINITY HEALTH PACE 1 LIFE AT ST FRANCIS HEALTHCARE INC 7TH AND CLAYTON STREETS WILMINGTON DE 19805 452569214 PACE PROGRAM DE 501(C)(3) LINE 10 ST FRANCIS HOSPITAL INC 1 LIFE ST FRANCIS CORPORATION 7500 K JOHNSON BOULEVARD BORDENTOWN NJ 08505 222797282 PACE PROGRAM NJ 501(C)(3) LINE 10 ST FRANCIS MEDICAL CENTER TRENTON NJ 1 LIFE ST JOSEPH OF THE PINES INC 100 GOSSMAN DRIVE SOUTHERN PINES NC 28387 272159847 PACE PROGRAM NC 501(C)(3) LINE 3 TRINITY HEALTH PACE 1 LIFE ST MARY 1201 LANGHORNE-NEWTOWN ROAD LANGHORNE PA 19047 262976184 PACE PROGRAM PA 501(C)(3) LINE 10 ST MARY MEDICAL CENTER 1 LOURDES ANCILLARY SERVICES 1600 HADDON AVENUE CAMDEN NJ 08103 222568525 HEALTH CARE SYSTEM SUPPORT NJ 501(C)(3) LINE 12B, II OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOURDES CARDIOLOGY SERVICES PC 1600 HADDON AVENUE CAMDEN NJ 08103 274357794 HEALTH CARE SERVICES NJ 501(C)(3) LINE 3 OUR LADY OF LOURDES HEALTH CARE SERVICES 1 LOYOLA MEDICINE TRANSPORT LLC 905 W NORTH AVE MELROSE PARK IL 60160 474147171 TRANSPORTATION SERVICES IL 501(C)(3) LINE 10 LOYOLA UNIVERSITY MEDICAL CENTER 1 LOYOLA UNIVERSITY HEALTH SYSTEM 2160 SOUTH FIRST AVENUE MAYWOOD IL 60153 363342448 HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT IL 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION 1 LOYOLA UNIVERSITY MEDICAL CENTER 2160 SOUTH FIRST AVENUE MAYWOOD IL 60153 364015560 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 LOYOLA UNIVERSITY HEALTH SYSTEM 1 LTC (EDDY) INC 2212 BURDETT AVE TROY NY 12180 222564710 MANAGEMENT SERVICES FOR LONG TERM CARE NY 501(C)(3) LINE 12B, II ST PETER'S HEALTH PARTNERS 1 MARIAN HOME HEALTHCARE 801 5TH STREET SIOUX CITY IA 51101 383320705 HOME HEALTH SERVICES (INACTIVE) IA 501(C)(3) LINE 12A, I MERCY HEALTH SERVICES-IOWA CORP 1 MAXIS HEALTH SYSTEM 3805 WEST CHESTER PIKE STE 100 NEWTOWN SQUARE PA 19073 911940902 HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT PA 501(C)(3) LINE 12A, I TRINITY HEALTH CORPORATION 1 MCAULEY CENTER INC 275 STEELE ROAD WEST HARTFORD CT 06117 061058086 SENIOR LIVING COMMUNITY CT 501(C)(3) LINE 10 MERCY COMMUNITY HEALTH INC 1 MCAULEY CLINIC CORPORATION PO BOX 992 ANN ARBOR MI 48106 382561013 HEALTH CARE SERVICES (INACTIVE) MI 501(C)(3) LINE 3 CATHERINE MCAULEY HEALTH SERVICES CORP 1 MCAULEY MINISTRIES 3333 FIFTH AVENUE PITTSBURGH PA 15213 943436142 GRANT MAKING PA 501(C)(3) LINE 12B, II PITTSBURGH MERCY HEALTH SYSTEM INC 1 MEMORIAL HOSPITAL ALBANY NY 600 NORTHERN BLVD ALBANY NY 12204 141338457 HEALTH CARE AND HOSPITAL SERVICES NY 501(C)(3) LINE 3 ST PETER'S HEALTH PARTNERS 1 MERCY AMICARE HOME HEALTHCARE OAKLAND 17410 COLLEGE PARKWAY STE 150 LIVONIA MI 48152 383320698 HOME HEALTH SERVICES MI 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES 1 MERCY CARE FOUNDATION INC 424 DECATUR STREET ATLANTA GA 30312 581448522 FOUNDATION GA 501(C)(3) LINE 7 SAINT JOSEPH'S HEALTH SYSTEM INC 1 MERCY CATHOLIC MEDICAL CENTER OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 231352191 HEALTH CARE AND HOSPITAL SERVICES PA 501(C)(3) LINE 3 TRINITY HEALTH OF THE MID-ATLANTIC REGION 1 MERCY COMMUNITY HEALTH INC 2021 ALBANY AVENUE WEST HARTFORD CT 06117 061492707 HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT CT 501(C)(3) LINE 12B, II TRINITY CONTINUING CARE SERVICES 1 MERCY FAMILY SUPPORT 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD PA 19064 232325059 HOME HEALTH SERVICES PA 501(C)(3) LINE 10 MERCY HOME HEALTH SERVICES 1 MERCY FOUNDATION INC 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 60616 363227350 FOUNDATION IL 501(C)(3) LINE 7 MERCY HEALTH SYSTEM OF CHICAGO 1 MERCY GENERAL HEALTH PARTNERS AMICARE HOMECARE 888 TERRACE STREET MUSKEGON MI 49440 383321856 HOME HEALTH SERVICES MI 501(C)(3) LINE 10 TRINITY HOME HEALTH SERVICES 1 MERCY HEALTH FOUNDATION OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 232829864 FOUNDATION PA 501(C)(3) LINE 12B, II TRINITY HEALTH OF THE MID-ATLANTIC REGION 1 MERCY HEALTH NETWORK INC 1449 NW 128TH ST BLDG 5 CLIVE IA 50325 421478417 HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT DE 501(C)(3) LINE 12B, II N/A 0 MERCY HEALTH PARTNERS 1500 E SHERMAN BLVD MUSKEGON MI 49444 382589966 HEALTH CARE AND HOSPITAL SERVICES MI 501(C)(3) LINE 3 TRINITY HEALTH-MICHIGAN 1 MERCY HEALTH PLAN ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 222483605 MEDICAID MANAGED CARE PLAN PA 501(C)(3) LINE 12B, II TRINITY HEALTH OF THE MID-ATLANTIC REGION 1 MERCY HEALTH SERVICES - IOWA CORP 1000 4TH STREET SW MASON CITY IA 50401 311373080 HEALTH CARE AND HOSPITAL SERVICES DE 501(C)(3) LINE 3 TRINITY HEALTH CORPORATION 1 MERCY HEALTH SYSTEM OF CHICAGO 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 60616 363163327 HEALTH CARE SYSTEM MANAGEMENT AND SUPPORT IL 501(C)(3) LINE 12B, II TRINITY HEALTH CORPORATION 1 MERCY HEALTHCARE FOUNDATION - CLINTON 1410 N 4TH ST CLINTON IA 52732 421316126 FOUNDATION IA 501(C)(3) LINE 7 N/A 0 MERCY HOME HEALTH 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD PA 19064 231352099 HOME HEALTH SERVICES PA 501(C)(3) LINE 10 MERCY HOME HEALTH SERVICES 1 MERCY HOME HEALTH SERVICES 1001 BALTIMORE PIKE SUITE 310 SPRINGFIELD PA 19064 232325058 MANAGEMENT SERVICES FOR HOME HEALTH PA 501(C)(3) LINE 12B, II TRINITY HEALTH OF THE MID-ATLANTIC REGION 1 MERCY HOSPITAL AND MEDICAL CENTER 2525 SOUTH MICHIGAN AVENUE CHICAGO IL 60616 362170152 HEALTH CARE AND HOSPITAL SERVICES IL 501(C)(3) LINE 3 MERCY HEALTH SYSTEM OF CHICAGO 1 MERCY HOSPITAL CADILLAC FOUNDATION 1820 44TH ST SE KENTWOOD MI 49508 203357131 FOUNDATION MI 501(C)(3) LINE 12A, I TRINITY HEALTH-MICHIGAN 1 MERCY LIFE CENTER CORPORATION 1200 REEDSDALE STREET PITTSBURGH PA 15233 251604115 COMMUNITY OUTREACH PA 501(C)(3) LINE 10 PITTSBURGH MERCY HEALTH SYSTEM INC 1 MERCY LIFE OF ALABAMA PO BOX 7957 MOBILE AL 36670 273163002 PACE PROGRAM AL 501(C)(3) LINE 3 TRINITY HEALTH PACE 1 MERCY LIFE INC 1221 MAIN STREET SUITE 213 HOLYOKE MA 01040 453086711 PACE PROGRAM MA 501(C)(3) LINE 3 TRINITY HEALTH PACE 1 MERCY MANAGEMENT OF SOUTHEASTERN PENNSYLVANIA ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 232627944 HEALTH CARE SERVICES PA 501(C)(3) LINE 3 MERCY PHYSICIAN NETWORK 1 MERCY MEDICAL CENTER - CLINTON INC 1410 NORTH 4TH ST CLINTON IA 52732 421336618 HEALTH CARE AND HOSPITAL SERVICES DE 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 1 MERCY MEDICAL CENTER - SIOUX CITY FOUNDATION 801 5TH STREET SIOUX CITY IA 51102 141880022 FOUNDATION IA 501(C)(3) LINE 7 MERCY HEALTH SERVICES-IOWA CORP 1 MERCY MEDICAL CENTER FOUNDATION - NORTH IOWA 1000 4TH STREET SW MASON CITY IA 50401 421229151 FOUNDATION IA 501(C)(3) LINE 7 MERCY HEALTH SERVICES-IOWA CORP 1 MERCY MEDICAL CORPORATION PO BOX 7957 MOBILE AL 36670 636002215 PACE PROGRAM AL 501(C)(3) LINE 10 TRINITY HEALTH CORPORATION 1 MERCY MEDICAL GROUP INC 114 WOODLAND STREET HARTFORD CT 06105 454884805 HEALTH CARE SERVICES MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC 1 MERCY PHYSICIAN NETWORK ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 461187365 MANAGEMENT SERVICES FOR PHYSICIAN SERVICE ORGANIZATIONS PA 501(C)(3) LINE 12B, II TRINITY HEALTH OF THE MID-ATLANTIC REGION 1 MERCY SENIOR CARE INC 424 DECATUR STREET ATLANTA GA 30312 581366508 COMMUNITY OUTREACH GA 501(C)(3) LINE 7 SAINT JOSEPH'S HEALTH SYSTEM INC 1 MERCY SERVICES DOWNTOWN INC 424 DECATUR STREET ATLANTA GA 30312 272046353 TITLE HOLDING COMPANY GA 501(C)(3) LINE 12B, II SAINT JOSEPH'S HEALTH SYSTEM INC 1 MERCY SERVICES FOR AGING NONPROFIT HOUSING CORPORATION PO BOX 9184 FARMINGTON HILLS MI 48333 382719605 LONG TERM CARE MI 501(C)(3) LINE 10 TRINITY CONTINUING CARE SERVICES 1 MERCY SPECIALIST PHYSICIANS INC 114 WOODLAND STREET HARTFORD CT 06105 264033168 HEALTH CARE SERVICES MA 501(C)(3) LINE 3 THE MERCY HOSPITAL INC 1 MERCY SUBURBAN HOSPITAL ONE WEST ELM STREET SUITE 100 CONSHOHOCKEN PA 19428 231396763 HEALTH CARE AND HOSPITAL SERVICES PA 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