2018-05-14T09:33:07-05:00 2017-06-30 990 2016-07-01 590791028 HOLY CROSS HOSPITAL INC HOLY 9542676872 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 333084603 RONALD BRANDENBURG VP AND CFO 9542676872 2018-05-14 2016 2022-09-23 18:48:47Z SEE SCHEDULE O FOR LIST PATRICK TAYLOR 4725 NORTH FEDERAL HIGHWAY FT LAUDERDALE FL 333084603 497035392 0 0928 X WWW.HOLY-CROSS.COM X 1952 FL TO PROVIDE HEALTH CARE AND HOSPITAL SERVICES 16 12 3588 312 768778 56317 4383334 12419959 471962806 458491838 125297 9829792 14856949 13102464 491328386 493844053 302318 281200 0 0 241756157 238843475 7618 1784 415780 257252513 252957651 499318606 492084110 -7990220 1759943 486123108 480979392 279121042 276481406 207002066 204497986 X WE, HOLY CROSS HOSPITAL AND TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. HOLY CROSS HOSPITAL IS A MEMBER OF TRINITY HEALTH. 0 0 470928070 281200 466864954 HOLY CROSS HOSPITAL IS A 557 BED COMMUNITY HOSPITAL LOCATED IN FT. LAUDERDALE, FLORIDA, IN OPERATION SINCE 1955. THE HOSPITAL SPECIALIZES IN HEART BYPASS SURGERY, HIP AND KNEE REPLACEMENT, HEART FAILURE, AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE. THE HOSPITAL IS ALSO WELL-REGARDED IN THE SPECIALTIES OF GERIATRICS, GYNECOLOGY, ORTHOPEDICS AND UROLOGY. IT IS BROWARD COUNTY'S FIRST MAGNET HOSPITAL, ATTRACTING THE BEST NURSES AND FOSTERING AN ENVIRONMENT WHERE ALL PEOPLE ARE WELCOMED, VALUED AND CELEBRATED. IN FY17 THE HOSPITAL PROVIDED 75,087 INPATIENT DAYS OF HEALTHCARE SERVICES TO THE COMMUNITY. HOLY CROSS ALSO OFFERS OUTPATIENT SERVICES IN BROWARD AND PALM BEACH COUNTIES AND PROVIDED OVER 600,000 OUTPATIENT VISITS DURING THE YEAR.PLEASE VISIT SCHEDULE H AND THE WEBSITE FOR ADDITIONAL INFORMATION ABOUT SERVICES, RECOGNITIONS AND AWARDS: WWW.HOLY-CROSS.COM 470928070 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 1 0 1 1 1 0 1 0 0 0 0 0 0 1 1 0 0 0 0 1 1 1 1 1 0 1 736 0 1 3588 1 1 1 0 0 0 0 1 1 0 0 0 0 X 16 12 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 1 1 X CARLOS RUBIO 9542676872 4725 N FEDERAL HIGHWAY FT LAUDERDALE FL 333084603 X PATRICK TAYLOR MD DIRECTOR; PRESIDENT & CEO 52.00 3.00 X X 0 816554 45828 KEITH KOENIG DIR; V CHR THR 12/16; CHR AS OF 1/17 1.00 0.00 X X 0 0 0 MONSIGNOR TOMAS MARIN DIRECTOR & CHAIR THROUGH 12/16 1.00 1.00 X X 0 0 0 JOANNE COURNEEN RSM DIRECTOR; VICE CHAIR AS OF 1/17 1.00 0.00 X X 0 0 0 KATHLEEN KOLB RSM DIRECTOR; SECRETARY AS OF 1/17 1.00 0.00 X X 0 0 0 JOSEPH CATANIA DIRECTOR; TREASURER AS OF 1/17 1.00 0.00 X X 0 0 0 SUSAN WELSH RSM SCH O DIRECTOR, SECR & TREAS THR 12/16 1.00 44.00 X X 0 0 14756 MARJORIE BOSSE RSM DIRECTOR THROUGH 12/16 1.00 0.00 X 0 0 0 LUIS BARRERAS MD DIRECTOR; PRESIDENT MEDICAL STAFF 1.00 0.00 X 0 0 0 THE VERY REV MICHAEL GREER DIRECTOR 1.00 0.00 X 0 0 0 PABLO GUZMAN MD DIRECTOR 1.00 0.00 X 0 0 0 JON KOTLER DIR &PRES-ELECT MED STAFF AS OF 1/17 50.00 0.00 X 294920 0 20022 KURT LANGSENKAMP DIRECTOR 1.00 0.00 X 0 0 0 PATRICIA MCKAY DIRECTOR AS OF 1/17 1.00 0.00 X 0 0 0 JANICE MORAN DIRECTOR 1.00 0.00 X 0 0 0 GERMAINE SMITH-BAUGH DIRECTOR 1.00 0.00 X 0 0 0 MARC SWERDLOFF MD DIRECTOR THR 5/17; SEC MED STAFF 1.00 0.00 X 0 0 0 MICHELE TAPIA DIRECTOR THROUGH 12/16 1.00 0.00 X 0 0 0 RAUL TAPIA MD DIRECTOR THROUGH 12/16; PHYSICIAN 50.00 0.00 X 491666 0 15712 NORA TRIOLA DIRECTOR; TRINITY SVP & CNO 1.00 49.00 X 0 879832 31338 KATHLEEN TURLEY RSM DIRECTOR AS OF 1/17 1.00 0.00 X 0 0 0 NANCY WATSON DIRECTOR AS OF 1/17 1.00 0.00 X 0 0 0 TODD RADOSEVICH INTERIM CFO AS OF 4/17 47.00 3.00 X 211316 0 31230 LINDA WILFORD SVP & CFO THROUGH 4/17 46.00 4.00 X 544255 0 154254 LUISA GUTMAN SVP & COO 50.00 0.00 X 398283 0 31745 MARK DISSETTE SVP AND ADMINISTRATOR 50.00 0.00 X 379609 0 46105 MARC BIVINS MD CMO 50.00 0.00 X 202204 0 19498 JONATHAN LEVY MD PHYSICIAN 50.00 0.00 X 1764418 0 30699 MARTIN ROCHE MD PHYSICIAN 50.00 0.00 X 1571146 0 21686 PORTER MCROBERTS MD PHYSICIAN 50.00 0.00 X 1193248 0 21544 WILLIAM LEONE JR MD PHYSICIAN 50.00 0.00 X 1179214 0 28661 PAUL WU MD PHYSICIAN 50.00 0.00 X 1037309 0 23902 TAREN RUGGIERO FORMER KEY EMPLOYEE; CNO 50.00 0.00 X 293933 0 28089 KENNETH HOMER MD FORMER KEY EMPLOYEE; MED DIRECTOR 50.00 0.00 X 457954 0 31788 DAVID TAUB MD FORMER KEY EMPLOYEE; PHYSICIAN 50.00 0.00 X 567652 0 23174 JAMES DESMARTEAU FORMER OFFICER; ADMINISTRATOR 50.00 0.00 X 399970 0 29902 10987097 1696386 649933 301 1 1 0 SODEXO INC PO BOX 81049 WOBURN MA 018131049 MANAGEMENT SERVICES 5848070 UNIVERSITY OF MIAMI MILLER SCHOOL OF MED CITI PROGRAM MIAMI FL 33101 PHYSICIAN SERVICES 2971927 ALL ABOUT STAFFING INC 1000 SAWGRASS CORP PKWY 6TH FLOOR SUNRISE FL 33323 STAFFING SERVICES 2451105 SOUND PHYSICIANS PO BOX 742936 LOS ANGELES CA 900742936 PHYSICIAN SERVICES 2238836 LAUDERDALE CRITICAL CARE SVC 6278 N FEDERAL HWY FORT LAUDERDALE FL 333081916 PHYSICIAN SERVICES 1878599 91 75921 109913 317485 1234033 10682607 24452 12419959 NET PATIENT SERVICE REVENUE 622110 457710041 457710041 OTHER PROGRAM SERVICE REVENUE 622110 591507 591507 REFERENCE LAB 621500 190290 190290 458491838 6374218 6374218 2657223 0 2657223 2657223 2657223 2732489 3826750 0 3103665 2732489 723085 3455574 3455574 75951 109913 87674 -11723 -11723 CAFETERIA REVENUE 722514 1315070 1315070 GOV'T SUBSIDY - EHR 622110 1104269 1104269 WELLNESS CENTER REVENUE 713940 644583 66095 578488 7393042 7393042 10456964 493844053 466864954 768778 13790362 281200 281200 3703201 822320 2880881 1975181 142719 1832462 195890150 188838249 6726048 325853 6200506 6106354 94152 18873729 18008057 865672 12200708 11532268 668440 737133 737133 54648 54648 1784 1784 193109 193109 39692324 38043852 1583947 64525 2727853 2578402 149451 7669005 7248158 420122 725 14540031 13743427 796604 11578850 10944480 634370 409275 386852 22423 99223 93787 5436 6636512 6636512 24253303 22924538 1328765 11559158 10925867 633291 MEDICAL SUPPLIES 78715285 78715285 BAD DEBT 31113555 31113555 I/C PURCHASED SERVICES 8416639 7955517 461122 UBI TAXES 110400 110400 14451348 13886671 541784 22893 492084110 470928070 20740260 415780 4442755 5290707 1661037 3219741 99047481 90811421 124000 47258 7242956 6403805 2242983 2252917 584937557 369634388 224189824 215303169 65184696 72045292 58147790 60068928 100000 100000 23692328 25483412 486123108 480979392 98414418 79376104 1228440 28838762 24114158 151867862 171762704 279121042 276481406 X 187014719 174860661 18046595 27696573 1940752 1940752 207002066 204497986 486123108 480979392 X 1759943 5058721 -9322744 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 5303 0 0 0 5303 0 PART II-B, LINE 1: HOLY CROSS 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 HOLY CROSS HOSPITAL WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. 1940752 1940752 1940752 1940752 1940752 1940752 1940752 1940752 1940752 1940752 0.00000 1.00000 0.00000 0 0 7419505 7419505 354262181 187420559 166841622 4067779 4060630 7149 212587299 178153199 34434100 6600793 6600793 215303169 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 26839308 F HEDGE FUNDS 12780623 F EQUITY METHOD INVESTMENTS 20448997 C 60068928 MISCELLANEOUS RECEIVABLES 2012080 OTHER LONG-TERM ASSETS 963743 INVESTMENT IN UNCONSOL. AFFILIATES 2590432 INTERCOMPANY OTHER LONG-TERM ASSETS 19917157 25483412 INTERCOMPANY ACCOUNTS PAYABLE 5713005 INTERCOMPANY NOTES PAYABLE 154344949 OTHER CURRENT LIABILITIES 5456053 OTHER LONG-TERM LIABILITIES 4065908 ASSET RETIREMENT OBLIGATION(FIN47) 989302 DEFERRED COMPENSATION LIABILITY 386465 ANNUITIES PAYABLE 807022 171762704 PART V, LINE 4: ENDOWMENTS CONSIST OF FUNDS ESTABLISHED FOR A VARIETY OF PURPOSES, ALL OF WHICH SUPPORT THE ORGANIZATION'S MISSION GOLF TOURNAMENT 124289 75558 48731 9250 21272 30787 WOMEN'S CENTER LUNCHEON 61575 34355 27220 2765 10240 13360 185864 109913 75951 12015 31512 44147 87674 -11723 1 1 X 1 X 1 X 1 1 1 0 1 1 857 8353988 0 8353988 0.01810 10851 20269629 7335852 12933777 0.02810 11708 28623617 7335852 21287765 0.04620 34 29405 1446263 166691 1279572 0.00280 3 25 289537 0 289537 0.00060 3 593 635207 0 635207 0.00140 1 0 4783 0 4783 0.00000 2 5984 100300 0 100300 0.00020 43 36007 2476090 166691 2309399 0.00500 43 47715 31099707 7502543 23597164 0.05120 1 31113555 0 136364918 149604910 -13239992 X 1 1 1 PHYSICIANS OUTPATIENT SURGERY CENTER LLC AMBULATORY SURGERY CENTER 0.63750 0.00000 0.36250 1 1 HOLY CROSS HOSPITAL INC 4725 N FEDERAL HIGHWAY FORT LAUDERDALE FL 333084603 HOLY-CROSS.COM LICENSE # 4069 X X X HOLY CROSS HOSPITAL INC 1 0 0 1 X X X X X X X X X 15 1 0 1 1 X SEE SCHEDULE H, PART V, SECTION C X 1 15 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 X 1 X HTTPS://WWW.HOLY-CROSS.COM/BILLING-INSURANCE X HTTPS://WWW.HOLY-CROSS.COM/BILLING-INSURANCE X HTTPS://WWW.HOLY-CROSS.COM/BILLING-INSURANCE X X X X X X 1 X 0 X X X X 1 X 0 0 HOLY CROSS HOSPITAL, INC. PART V, SECTION B, LINE 5: THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS WAS CONDUCTED DURING THE MONTHS OF AUGUST AND SEPTEMBER 2015. HOLY CROSS HOSPITAL'S CHNA PROCESS INCLUDED A CHNA STEERING COMMITTEE, AN ADVISORY COUNCIL, COMMUNITY FORUMS, KEY INFORMANT INTERVIEWS, AND WRITTEN SURVEYS. THESE INDIVIDUALS ASSISTED IN GUIDING THE ASSESSMENT PROCESS, ACTING AS A SOUNDING BOARD AND ASSISTING IN OBTAINING COMMUNITY INPUT, EVALUATING HEALTH ISSUES, AND IDENTIFYING KEY PRIORITIES. THE PROCESS WAS ENGAGING AND COLLABORATIVE IN NATURE AND RESULTED IN ACTION PLANNING AND FORMULATING THE IMPLEMENTATION STRATEGY. THE CHNA STEERING COMMITTEE MET FOR EIGHT MEETINGS AND THE HEALTH ADVISORY COUNCIL MET THREE TIMES.A COMMUNITY FORUM WAS CONDUCTED AND INCLUDED REPRESENTATIVES FROM THE FOLLOWING ORGANIZATIONS: DEPARTMENT OF HEALTH, BROWARD COUNTY, AGING AND DISABILITY RESOURCES OF BROWARD, AMERICAN DIABETES ASSOCIATION, URBAN LEAGUE, HEALTHY MOTHERS HEALTHY BABIES, LIGHT OF THE WORLD CLINIC, BROWARD COUNTY COMMISSION-ELDERLY AND VETERAN'S SERVICES DIVISION, BROWARD HEALTHY START COALITION, COMMUNITY HOME HEALTH SERVICE, CRISIS HOUSING SOLUTIONS, GATEWAY COMMUNITY OUTREACH, HOPE SOUTH FLORIDA, JACK AND JILL CHILDREN'S CENTER, LEADERSHIP BROWARD FOUNDATION, LIFENET 4 FAMILIES, MARCH OF DIMES, NOVA SOUTHEASTERN UNIVERSITY, PACE CENTER FOR GIRLS, SOUTH FLORIDA HUNGER COALITION, THE JIM MORAN FOUNDATION, UNITED WAY OF BROWARD COUNTY, AND BROWARD REGIONAL HEALTH PLANNING COUNCIL.MANY OF THESE COMMUNITY-BASED ORGANIZATIONS PROVIDE SERVICES TO HOMELESS FAMILIES, INDIVIDUALS, AND VETERANS; FAMILIES AND INDIVIDUALS WHO ARE FOOD INSECURE; WOMEN AND FAMILIES AT HIGH RISK OF LOW BIRTHWEIGHT INFANTS AND ABUSE; FAMILIES WHO LIVE BELOW THE FEDERAL POVERTY LEVEL; AT-RISK TEENS; PHYSICALLY, EMOTIONALLY, AND/OR MENTALLY ABUSED INDIVIDUALS; SUBSTANCE USERS AND ABUSERS; UNDOCUMENTED INDIVIDUALS; AND INDIVIDUALS WITH BEHAVIORAL/MENTAL HEALTH DISORDERS. IN ADDITION, 237 PAPER SURVEYS WERE RETURNED FROM INDIVIDUALS AND EIGHT KEY INFORMANT INTERVIEWS WERE CONDUCTED. HOLY CROSS HOSPITAL, INC. PART V, SECTION B, LINE 6B: THE FOLLOWING ORGANIZATIONS HAD REPRESENTATIVES WHO PARTICIPATED IN HOLY CROSS HOSPITAL'S CHNA PROCESS: DEPARTMENT OF HEALTH, BROWARD COUNTY, AGING AND DISABILITY RESOURCES OF BROWARD, AMERICAN DIABETES ASSOCIATION, BIG BROTHERS/BIG SISTERS, BROWARD COUNTY MEDICAL ASSOCIATION, BROWARD PARTNERSHIP FOR THE HOMELESS, URBAN LEAGUE, HEALTHY MOTHERS HEALTHY BABIES, CITY OF LAUDERDALE LAKES, PARKS AND HUMAN SERVICES DEPARTMENT, LIGHT OF THE WORLD CLINIC, BROWARD COUNTY COMMISSION-ELDERLY AND VETERAN'S SERVICES DIVISION, BROWARD HEALTHY START COALITION, COMMUNITY HOME HEALTH SERVICE, CRISIS HOUSING SOLUTIONS, GATEWAY COMMUNITY OUTREACH, GREATER FORT LAUDERDALE CHAMBER OF COMMERCE, HISPANIC UNITY, HOPE SOUTH FLORIDA, JACK AND JILL CHILDREN'S CENTER, LEADERSHIP BROWARD FOUNDATION, LIFENET 4 FAMILIES, MARCH OF DIMES, NOVA SOUTHEASTERN UNIVERSITY, PACE CENTER FOR GIRLS, SOUTH FLORIDA HUNGER COALITION, THE JIM MORAN FOUNDATION, UNITED WAY OF BROWARD COUNTY, BROWARD REGIONAL HEALTH PLANNING COUNCIL, AND WOMEN IN DISTRESS. HOLY CROSS HOSPITAL, INC. PART V, SECTION B, LINE 11: HOLY CROSS HOSPITAL IS CONTINUOUSLY FOCUSED ON DEVELOPING, PROVIDING, AND/OR SUPPORTING INITIATIVES RELATED TO ITS CHNA AND IMPLEMENTATION STRATEGY. IN ADDITION, IT MONITORS AND ASSESSES EFFECTIVENESS TO IMPROVE THE FOLLOWING IDENTIFIED HEALTH NEEDS: ACCESS TO AFFORDABLE HEALTHCARE FOR VULNERABLE POPULATIONS FOR THE PAST THREE YEARS, THROUGH AGREEMENTS WITH LOCAL COMMUNITY-BASED AGENCIES, HOLY CROSS HOSPITAL AND THE MERCY FAMILY LIFE CENTER HAVE HOSTED ON-SITE AFFORDABLE HEALTHCARE NAVIGATORS TO PROVIDE ENROLLMENT ASSISTANCE TO COMMUNITY MEMBERS. NAVIGATORS ARE AVAILABLE TO THE COMMUNITY AT LARGE IN THREE LANGUAGES. HOLY CROSS MEDICAL GROUP CONTINUES TO PARTICIPATE AS A LEVEL III PRIMARY MEDICAL HOME PROVIDER, AND DESIGNATED OFFICES HAVE RE-CERTIFIED AND ADDITIONAL OFFICES ARE TARGETED TO EXPAND PROGRAM PARTICIPATION. FLORIDA CONTINUES TO BE A NON-MEDICAID EXPANSION STATE AND HOLY CROSS HOSPITAL STRIVES TO PROVIDE AFFORDABLE, COORDINATED HEALTHCARE. HOLY CROSS HOSPITAL CONTINUES TO SEEK NEW OPPORTUNITIES TO BECOME AN INTEGRATED PARTNER IN THE TRANSITION OF CARE FOR VULNERABLE POPULATIONS AND HAS EXPLORED ALTERNATE MODELS FOR ITS CURRENT MISSION CLINIC, SUCH AS DESIGNATION AS A FEDERALLY QUALIFIED HEALTH CENTER (FQHC) OR A COMMUNITY HEALTH CENTER (CHC).HEALTH EDUCATION AND WELLNESS HOLY CROSS HOSPITAL'S COMMUNITY OUTREACH AND OTHER HOSPITAL DEPARTMENTS, INCLUDING THE WELLNESS CENTER, HOME HEALTH, AND NURSING, RESPOND TO REQUESTS FROM THE COMMUNITY FOR HEALTH SCREENINGS. IN ADDITION, IN FY17, HOLY CROSS HAD SEVERAL NAVIGATORS AVAILABLE TO ASSIST THE COMMUNITY, INCLUDING NAVIGATORS FOR BREAST, LUNG, AND GI CANCER. THE HOSPITAL ALSO HOSTS A VERY ACTIVE HEART FAILURE CLINIC AND A CONTINUOUSLY GROWING ACCOUNTABLE CARE ORGANIZATION WITH AN ACTIVE POPULATION HEALTH NURSE TEAM. IN FY17, THE COMMUNITY OUTREACH DEPARTMENT PROGRAMS FOCUSED ON PREVENTATIVE HEALTH EDUCATION, CHILDHOOD IMMUNIZATION, DECREASING CHILDHOOD OBESITY, HEALTH LITERACY, AND MORE RECENTLY THE NATIONAL DIABETES PREVENTION PROGRAM. THE DEPARTMENT'S MESSAGES, PROGRAMS, AND INTERVENTIONS ARE TARGETED TO SERVE SOME OF BROWARD'S MOST VULNERABLE POPULATIONS.HOMELESSNESS / FOOD INSECURITY / POVERTY COMMUNITY OUTREACH HEALTH SERVICES AND EDUCATION ARE PROVIDED TO AUGMENT COMMUNITY AGENCIES WHO TARGET INDIVIDUALS AND FAMILIES EXPERIENCING LIMITED INCOME, CONSTRAINED EARNINGS, EVICTIONS, JOB LOSS, AND SINGLE-HEADED HOUSEHOLDS CONTRIBUTING TO ECONOMIC HARDSHIP. EFFORTS TO ADDRESS THESE ISSUES CONTINUED IN FY17 THROUGH THE FAITH COMMUNITY NURSING PROGRAM, COMMITTEE PARTICIPATION IN BROWARD'S HOMELESS COALITION, AND THE SOUTH FLORIDA HUNGER COALITION. ADDITIONALLY, DIRECT SERVICES WERE PROVIDED IN FY17 TO THE HOMELESS POPULATION IN PARTNERSHIP WITH LOCAL SOCIAL SERVICE AGENCIES. THE HOSPITAL ALSO CONTINUED TO PROVIDE A JUST WAGE FOR ITS ASSOCIATES.MENTAL HEALTH HOLY CROSS HOSPITAL WAS LIMITED IN ITS ABILITY TO ADDRESS MENTAL HEALTH IN FY17 AS THERE IS NO INPATIENT BEHAVIORAL HEALTH PROGRAM. HOWEVER, OPPORTUNITIES TO PARTNER WITH EXISTING BEHAVIORAL HEALTH AGENCIES TO WORK TOWARD ACHIEVING IMPROVED QUALITY OF LIFE TOGETHER HAVE BEEN SUCCESSFUL. FOR THE SECOND YEAR, COMMUNITY OUTREACH PARTNERED WITH HENDERSON BEHAVIORAL HEALTH AND SPONSORED COMMUNITY MENTAL HEALTH FIRST AID TRAININGS FOR THE COMMUNITY.HOLY CROSS 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. HOLY CROSS WILL NOT TAKE ACTION ON THE FOLLOWING HEALTH NEED:ALCOHOL AND SUBSTANCE ABUSEHOLY CROSS LACKS THE APPROPRIATE EXPERTISE AND RESOURCES TO ADEQUATELY ADDRESS THIS OUTSTANDING NEED. HOLY CROSS CONTINUES TO ENGAGE AND PARTNER WITH COMMUNITY COALITIONS AND COMMITTEES TO SUPPORT AND ASSIST IN ADDRESSING ALCOHOL AND SUBSTANCE ABUSE WITHIN THE COMMUNITY.THE OTHER NEEDS AND PRIORITY AREAS IDENTIFIED IN THE CHNA WERE NOT ADDRESSED BECAUSE IMPLEMENTATION DETAILS REVEALED THAT THE APPROACH WAS UNFEASIBLE, CERTAIN KEY INPUTS (SUCH AS SKILLED STAFF, TIME FRAMES, REQUIRED ORGANIZATIONAL/POLICY CHANGES, AND COMMUNITY SUPPORT) WERE NOT ATTAINABLE, OR THE NEEDS WERE NOT ADDRESSED TO AVOID DUPLICATION OF SERVICES IN THE COMMUNITY. HOLY CROSS HOSPITAL, INC. 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. HOLY CROSS HOSPITAL, INC. - PART V, SECTION B, LINE 7A: HTTPS://WWW.HOLY-CROSS.COM/COMMUNITY-NEEDS-ASSESSMENT HOLY CROSS HOSPITAL, INC. - PART V, SECTION B, LINE 10A: HTTPS://WWW.HOLY-CROSS.COM/COMMUNITY-NEEDS-ASSESSMENT 40 1 - HOLY CROSS ORTHOPEDIC INSTITUTE 5597 N DIXIE HIGHWAY FORT LAUDERDALE FL 33334 ORTHOPEDICS, SPINE, PODIATRY, REHABILITATION 2 - HOLY CROSS HEALTHPLEX 1000 NORTH EAST 56TH STREET OAKLAND PARK FL 33334 AMBULATORY SURG, ORTHOPEDICS, IMAGING AND LAB 3 - PAIN MANAGEMENT 5601 N DIXIE HIGHWAY 209 FORT LAUDERDALE FL 33334 PAIN MANAGEMENT 4 - RIO VISTA URGENT CARE 1115 S FEDERAL HWY FORT LAUDERDALE FL 33316 URGENT CARE, IMAGING, OCCUPATIONAL MEDICINE 5 - HEART GROUP BOCA RATON 9980 CENTRAL PARK BLVD SUITE 210 BOCA RATON FL 33428 CARDIOLOGY PRACTICE 6 - GALLAGHER GASTROENTEROLOGY PRACTICE 1900 E COMMERCIAL BLVD 201 FORT LAUDERDALE FL 33308 GASTROENTEROLOGY PRACTICE 7 - CARDIOLOGY ASSOCIATES OF BOCA RATON 9980 CENTRAL PARK BLVD 304 BOCA RATON FL 33428 CARDIOLOGY PRACTICE 8 - GALLAGHER ADULT PRACTICE 1900 E COMMERCIAL BLVD 101 FORT LAUDERDALE FL 33308 INTERNAL MEDICINE 9 - HEART GROUP POMPANO 2 W SAMPLE RD SUITE 208 POMPANO BEACH FL 33064 CARDIOLOGY PRACTICE 10 - GALLAGHER PEDIATRICS 1900 E COMMERCIAL BLVD 202 FORT LAUDERDALE FL 33308 PEDIATRICS PRACTICE 11 - LIGHTHOUSE ORTHOPEDICS PRACTICE 2850 N FEDERAL HIGHWAY 2ND FLOOR LIGHTHOUSE POINT FL 33064 ORTHOPEDICS PRACTICE 12 - BOCA EAST URGENT CARE 1799 S FEDERAL HWY BOCA RATON FL 33432 URGENT CARE, IMAGING, OCCUPATIONAL MEDICINE 13 - COLORECTAL SURGERY PRACTICE 1940 NE 47TH ST SUITE 1 FORT LAUDERDALE FL 33308 COLORECTAL SURGERY PRACTICE 14 - POMPANO BEACH OFFICE 2335 E ATLANTIC BLVD SUITE 200 POMPANO BEACH FL 33062 FAMILY PRACTICE 15 - OBSTETRICS AND GYNECOLOGY PRACTICE 4701 N FEDERAL HWY B BLDG FORT LAUDERDALE FL 33308 OB/GYN PRACTICE 16 - HOLY CROSS MEDICAL PLAZA 5601 N DIXIE HIGHWAY FORT LAUDERDALE FL 33334 INTERNAL MEDICINE, INFECTIOUS DISEASE PRACTICES 17 - CARDIO PULMONARY PRACTICE 333 NW 70TH AVE 116 PLANTATION FL 33317 CARDIOLOGY PRACTICE 18 - RIO VISTA PRACTICE 1309 S FEDERAL HWY FORT LAUDERDALE FL 33316 INTERNAL MEDICINE, REHABILITATION 19 - ENDO AND INTERNAL MEDICINE PRACTICE 4701 N FEDERAL HWY A27 FORT LAUDERDALE FL 33308 INTERNAL MEDICINE 20 - NORTH BROWARD CARDIOLOGY 2800 N STATE RD 7 SUITE 101-102 POMPANO BEACH FL 33063 CARDIOLOGY PRACTICE 21 - PULMONARY PRACTICE 1930 NE 47TH STREET 205 FORT LAUDERDALE FL 33308 PULMONARY PRACTICE 22 - BOCA RATON ORTHOPEDICS PRACTICE 9970 CENTRAL PARK BLVD 400 BOCA RATON FL 33428 ORTHOPEDICS PRACTICE 23 - WILTON MANORS PRACTICE 1402 NE 26TH STREET FORT LAUDERDALE FL 33305 PEDIATRICS PRACTICE 24 - CARDIOLOGY ASSOC OF BOYNTON BEACH 10151 ENTERPRISE CENTER 203 BOYNTON BEACH FL 33437 CARDIOLOGY PRACTICE 25 - OFFICE OF RICKY SCHNEIDER MD 2901 CORAL HILLS DRIVE SUITE 240 CORAL SPRINGS FL 33065 CARDIOLOGY PRACTICE 26 - GALT OCEAN MILE PRACTICE 4004 N OCEAN BLVD FORT LAUDERDALE FL 33308 FAMILY PRACTICE 27 - MEDICAL MULTI-SPECIALTY GROUP 8391 W OAKLAND PARK BLVD SUNRISE FL 33351 INTERNAL MEDICINE 28 - BARIATRICSGENERAL SURGERY PRACTICE 4800 NORTHEAST 20TH TERRACE SUITE 30 FORT LAUDERDALE FL 33308 BARIATRICS/GENERAL SURGERY PRACTICE 29 - FAMILY LIFE CENTER PRACTICE 114 N FLAGLER AVE POMPANO BEACH FL 33060 FAMILY PRACTICE 30 - BROWARD MEDICAL GROUP 1100 E BROWARD BLVD FORT LAUDERDALE FL 33301 FAMILY PRACTICE 31 - LIGHTHOUSE POINT PRACTICE 2100 E SAMPLE ROAD SUITE 101 POMPANO BEACH FL 33064 FAMILY PRACTICE 32 - BAYVIEW PRACTICE 1124 BAYVIEW DRIVE FORT LAUDERDALE FL 33308 INTERNAL MEDICINE 33 - OFFICE OF ANIBAL LOZA MD 2000 NE 49TH STREET FORT LAUDERDALE FL 33308 FAMILY PRACTICE 34 - DOROTHY MANGURIAN COMP WOMEN'S CTR 1000 NE 56TH ST FORT LAUDERDALE FL 33334 FAMILY PRACTICE, REHABILITATION 35 - CORAL SPRINGS PRIMARY CARE 3080 NW 99TH AVENUE SUITE 200 CORAL SPRINGS FL 33065 INTERNAL MEDICINE 36 - BOCA WEST URGENT CARE 23071 STATE ROAD 7 BOCA RATON FL 33428 URGENT CARE, IMAGING, OCCUPATIONAL MEDICINE 37 - COCONUT CREEK PRACTICE 4917 COCONUT CREEK PARKWAY POMPANO BEACH FL 33063 INTERNAL MEDICINE 38 - OFFICES OF MELLIN AND SCHWARTZ 4800 NE 20TH TERRACE SUITE 211 FORT LAUDERDALE FL 33308 INTERNAL MEDICINE 39 - PULMONARY MEDICINE 5601 N DIXIE HIGHWAY 407 FORT LAUDERDALE FL 33334 PULMONARY 40 - OFFICE OF ANGELA BUSCH DO 1930 NE 47TH STREET SUITE 104 FORT LAUDERDALE FL 33308 FAMILY PRACTICE 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: HOLY CROSS 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, HOLY CROSS 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, $31,113,555, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART III, LINE 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: HOLY CROSS 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, HOLY CROSS HOSPITAL IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. THEREFORE, HOLY CROSS 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: HOLY CROSS HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 14 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED AND UNDERINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY THE HEALTH MINISTRIES AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE."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: HOLY CROSS 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 - MEMBERS OF THE HOSPITAL'S LEADERSHIP ROUTINELY PARTICIPATE ON NUMEROUS COMMUNITY COMMITTEES THAT PROVIDE ONGOING INFORMATION, INPUT, AND INSIGHT INTO THE COMMUNITY'S HEALTH CARE NEEDS. LEADERSHIP PARTICIPATES IN THE COMMUNITY BY SERVING ON BOARDS OF DIRECTORS AND COMMITTEES INCLUDING HEALTHCARE ACCESS, HOMELESS COALITION, POINT IN TIME SURVEY, AND SOUTH FLORIDA HUNGER COALITION. AWARENESS OF OUR COMMUNITY'S NEEDS IS ALSO MONITORED BY REGULARLY SCANNING THE ENVIRONMENT, REVIEWING COMMUNITY REPORT CARDS AND INFORMATION PROVIDED BY OTHER INSTITUTIONS, MONITORING VITAL STATISTICS, LOCAL MORBIDITY AND MORTALITY RATES, COUNTY HEALTH RANKINGS, PEOPLE 2020 GOALS AND BY CONTINUING RELATIONSHIPS WITH THE LOCAL HEALTH DEPARTMENT AND OTHER HEALTH CARE PROVIDERS. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - HOLY CROSS HOSPITAL IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTH CARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES- CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES- ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE - BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, HOLY CROSS HOSPITAL HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS: - PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSHOLY CROSS 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 AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. 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. FINANCIAL ASSISTANCE APPLICATIONS WILL BE ACCEPTED UNTIL ONE YEAR AFTER THE FIRST BILLING STATEMENT TO THE PATIENT. HOLY CROSS 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.HOLY CROSS HOSPITAL HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. HOLY CROSS 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 - BROWARD COUNTY IS THE SECOND MOST POPULATED COUNTY IN THE STATE AND RANKS HIGH IN DIVERSITY. ABOUT 15% OF THE POPULATION IS 65 AND OVER, WHICH IS LESS THAN THE PERCENTAGE FOR THE ENTIRE STATE. FROM 2000 TO 2010, THE GREATEST POPULATION INCREASE OCCURRED AMONG THE 45-69 AGE GROUPS, AND THE GREATEST DECREASE IN THE 30-44 AND THE 70 AND OVER AGE GROUPS. THE FORECLOSURE CRISIS AMONG FLORIDA HOMEOWNERS CREATED A NEW GROUP OF HOMELESS INDIVIDUALS AND INCREASED THE DEMAND FOR AFFORDABLE RENTAL HOUSING, WHICH IS VERY LIMITED WITHIN THE COMMUNITY. BROWARD COUNTY HAS ALSO BEEN SIGNIFICANTLY IMPACTED BY UNEMPLOYMENT (4.5% IN 2001 VS. 8.1% JULY 2012), REFLECTING THE ECONOMIC CRISIS. NEARLY 15% OF BROWARD RESIDENTS LIVE IN POVERTY. OF THE FAMILIES WITH CHILDREN UNDER THE AGE OF 18, 15.6% WERE REPORTED AT OR BELOW THE FEDERAL POVERTY LEVEL. ABOUT 43% OF CHILDREN IN BROWARD COUNTY FALL BELOW 200% OF THE FEDERAL POVERTY LEVEL. OF ADULTS 18-64 YEARS OF AGE, 30% ARE UNINSURED. THERE HAS BEEN A STEADY INCREASE IN THE NUMBER OF INDIVIDUALS AND FAMILIES RECEIVING PUBLIC ASSISTANCE (MEDICAID AND FOOD STAMPS). THE UNINSURED RATE INCREASED OVER TIME FOR BROWARD COUNTY AND IT IS ESTIMATED THAT 24% OF NON-INSTITUTIONALIZED CIVILIAN RESIDENTS ARE UNINSURED.THE HOLY CROSS SERVICE AREA IS DEFINED GEOGRAPHICALLY BY WHERE 80% OF ADMISSIONS ARE DERIVED, WITH 65% OF ADMISSIONS DEFINING THE PRIMARY SERVICE AREA AND 15% DEFINING THE SECONDARY SERVICE AREA; ADMISSIONS BEYOND THE HOLY CROSS SERVICE AREA ARE DEFINED AS "OTHER". PART VI, LINE 5: OTHER INFORMATION - COMMUNITY OUTREACH IS DEVOTED TO IMPROVING THE HEALTH OUTCOMES OF THE POOR, DISENFRANCHISED, HOMELESS, MARGINALIZED, AND NEEDY WHO LIVE IN OUR BACKYARDS, NEIGHBORHOODS, AND COMMUNITY. GOODSTART -GOALS: INCREASE KNOWLEDGE AND INSTILL GOOD HEALTH BEHAVIORS FOR LIFE.CHNA IMPLEMENTATION PLAN:- HEALTH EDUCATION AND WELLNESS (#2): PROVIDES HEALTH EDUCATION BOTH TO CHILDREN AND TO ADULTS SERVING CHILDREN IN ORDER TO INCREASE WELLNESS AND PREVENTION OUTCOMES AND MEASUREMENT:- 1,700 CHILDREN AND 1,234 ADULTS SERVED- 100% OF ELEMENTARY AGE STUDENTS PARTICIPATING IN BOOK CLUBS PASSED LANGUAGE ARTS WITH A GRADE OF C OR BETTER- 100% OF CHILDREN ATTENDING GOODSTART TARGETED CHILDCARE CENTERS RECEIVED CHILDHOOD IMMUNIZATIONS IN ACCORDANCE WITH FL STATE GUIDELINES- 100% OF DAYCARE PROVIDERS ATTENDING GOODSTART CAREGIVER WORKSHOPS RECEIVED IN-SERVICE POINTS NEEDED TO MAINTAIN THEIR EMPLOYMENT IN CHILD OR HOME DAY CARE CENTERSSCHOOL HEALTH -GOALS: IMPROVE HEALTH TO PROMOTE STUDENT HEALTH AND LEARNING.CHNA IMPLEMENTATION PLAN:- ACCESS TO AFFORDABLE HEALTHCARE FOR VULNERABLE POPULATIONS (#1): PROVIDES ACCESS TO IMMUNIZATIONS AND SCHOOL BASED HEALTH SERVICES- HEALTH EDUCATION AND WELLNESS (#2): PROVIDES STUDENT EDUCATION ON HEALTH AND WELLNESS TO INCREASE PREVENTATIVE UTILIZATION OF HEALTHCARE SYSTEMSOUTCOMES AND MEASUREMENT:- 4,790 STUDENTS AND 702 ADULTS SERVED - PUBLIC SCHOOLS OUT OF COMPLIANCE WERE PROVIDED WITH ACCESS TO FREE ON-SITE 7TH GRADE VACCINATIONS, REPRESENTING APPROXIMATELY 10% OF INCOMING 7TH GRADE STUDENTS - 100% OF BABIES BORN AT HOLY CROSS HOSPITAL WHO RECEIVE THEIR FIRST DOSAGE OF HEPATITIS B VACCINE IN THE HOSPITAL ARE ENTERED INTO THE FL SHOTS SYSTEM - 98% OF ELIGIBLE AND PARTICIPATING PAROCHIAL ELEMENTARY SCHOOL STUDENTS ARE SCREENED FOR VISION, HEARING AND SCOLIOSIS- 522 BACKPACKS DISTRIBUTED FOR BACK TO SCHOOLGROWING HEALTHY KIDS -GOALS: BUILD KNOWLEDGE, SKILLS, AND POSITIVE ATTITUDES REGARDING HEALTH. CHNA IMPLEMENTATION PLAN:- HEALTH EDUCATION AND WELLNESS (#2): PROVIDES EDUCATION FOR HEALTHY LIFESTYLE CHOICES AND IMPORTANCE OF NUTRITION AND PHYSICAL ACTIVITY TO YOUTH IN PUBLIC, PAROCHIAL AND VIRTUAL SCHOOL SYSTEMS- MENTAL HEALTH (#4): DIRECT LINK BETWEEN PHYSICAL ACTIVITY AND DECREASE IN MENTAL HEALTH DISORDERS, PROVIDING YOUTH AN OPPORTUNITY TO PARTICIPATE IN POSITIVE ACTIVITIESOUTCOMES AND MEASUREMENT:-7,108 CHILDREN AND 1,315 ADULTS WERE SERVED PARISH NURSE -GOALS: MAINTAIN INDEPENDENCE AND OPTIMAL PHYSICAL, MENTAL AND EMOTIONAL HEALTH.CHNA IMPLEMENTATION PLAN: - ACCESS TO AFFORDABLE HEALTHCARE FOR VULNERABLE POPULATIONS (#1): PROVIDES VULNERABLE POPULATIONS SUCH AS SENIORS AND/OR HOMELESS WITH ACCESS TO HEALTHCARE AND TIMELY MANAGEMENT OF CHRONIC DISEASES TO DECREASE EMERGENCY UTILIZATION AND THE LIKELIHOOD OF THE DISEASES PROGRESSING INTO A HEALTH CRISIS- MENTAL HEALTH (#4): TRANSPORTATION PROGRAM FACILITATES SOCIAL INTERACTION BETWEEN SENIORS BY PROVIDING TRANSPORTATION TO MEDICAL APPOINTMENTS AND SOCIAL ACTIVITIES- HOMELESSNESS/FOOD INSECURITY/POVERTY (#3): PROVIDES HEALTHCARE SERVICES, ACCESS TO NUTRITIOUS MEALS, AND TRANSPORTATION TO VULNERABLE POPULATIONS IN BROWARD COUNTYOUTCOMES AND MEASUREMENT:- 463 HOMELESS CLIENTS PROVIDED WITH HEALTHCARE SERVICES BY REGISTERED NURSES AND ADVANCED REGISTERED NURSE PRACTITIONERS AT THREE DIFFERENT HOMELESS LOCATIONS - 1,648 INDIVIDUALS PROVIDED WITH HEALTH EDUCATION, SCREENING, AND MONITORING OF CHRONIC DISEASES LIKE HYPERTENSION, DIABETES, AND CONGESTIVE HEART FAILURE- 711 SENIORS TRANSPORTED, FACILITATING MEDICAL VISITS, NEEDS FOR DAILY LIVING, AND SOCIALIZATION- 2.3 TONS OF FOOD DISTRIBUTED TO LOCAL FOOD PANTRIESCHRONIC DISEASE MANAGEMENT - GOALS: IMPROVE HEALTH AND WELLNESS IN PATIENTS WITH CHRONIC DISEASES.CHNA IMPLEMENTATION PLAN: - ACCESS TO AFFORDABLE HEALTHCARE FOR VULNERABLE POPULATIONS (#1): PROVIDES ACCESS TO CHRONIC DISEASE MANAGEMENT- HEALTH EDUCATION AND WELLNESS (#2): PROVIDES STUDENT EDUCATION ON HEALTH AND WELLNESS TO INCREASE UTILIZATION OF PREVENTATIVE CAREOUTCOMES AND MEASUREMENT:- 363 DIABETIC CLIENTS PROVIDED WITH HEALTH COACHING AND DISEASE SELF-MANAGEMENT CLASSES- 220 INDIVIDUALS WERE PROVIDED WITH DIABETES PREVENTION PROGRAMMING INDIVIDUALLY AND THROUGH THE DIABETES PREVENTION PROGRAM IN PARTNERSHIP WITH THE BROWARD HOUSING AUTHORITYHIV COUNSELING, TESTING, AND LINKAGE TO CARE -GOAL: KNOW YOUR HIV STATUS.CHNA IMPLEMENTATION PLAN:- ACCESS TO AFFORDABLE HEALTHCARE FOR VULNERABLE POPULATIONS (#1): PROVIDES ACCESS TO MEDICAL CARE UPON HIV POSITIVE DIAGNOSIS AND TO HIV POSITIVE INDIVIDUALS WHO HAVE FALLEN OUT OF CARE, THEREBY INCREASING MEDICATION COMPLIANCE AND DECREASING COMMUNITY VIRAL LOAD, AND ULTIMATELY DECREASING TRANSMISSION RATES IN BROWARD COUNTY- HEALTH EDUCATION AND WELLNESS (#2): PROVIDES HEALTH EDUCATION TO THOSE BEING TESTED FOR HIV. PROVIDES DISEASE EDUCATION AND DESCRIBES THE MODES OF TRANSMISSION AND ACCESS AND IMPORTANCE OF PREP MEDICATIONS FOR HIGH-RISK NEGATIVE POPULATIONS. INCREASES WELLNESS FOR INDIVIDUALS PREVIOUSLY DIAGNOSED WITH HIV/AIDS, AND PROVIDES LINKAGE TO MEDICAL CARE-MENTAL HEALTH (#4): PSYCHOSOCIAL SUPPORT AND REFERRALS TO SERVICES FOR INDIVIDUALS DIAGNOSED WITH HIVOUTCOMES AND MEASUREMENT:- 837 HIV RAPID TESTS: 1% POSITIVITY RATE, AND 100% POSITIVE CLIENTS LINKED INTO THE HEALTHCARE SYSTEM- EXPANDED TESTING INITIATIVE CONTRACT WAS IMPLEMENTED FOR THE FIRST SIX MONTHS OF THE FISCAL YEAR PARTNERS IN BREAST HEALTH (PIBH) -GOALS: DECREASE LATE STAGE BREAST CANCER DIAGNOSIS IN THE HOPE OF SAVING LIVES.CHNA IMPLEMENTATION PLAN: - ACCESS TO AFFORDABLE HEALTHCARE FOR VULNERABLE POPULATIONS (#1): PROVIDES FREE BREAST IMAGING SERVICES TO VULNERABLE POPULATIONS (LOW INCOME, UNDOCUMENTED IMMIGRATION STATUS, AND THOSE WHO ARE INELIGIBLE FOR HEALTHCARE SERVICES THROUGH OTHER PROGRAMS)- HEALTH EDUCATION AND WELLNESS (#2): COMMUNITY EDUCATION IS PROVIDED AT HEALTH FAIRS AND CHURCH EVENTS. VULNERABLE POPULATIONS ARE EDUCATED ON THE IMPORTANCE OF ANNUAL SCREENING AND EARLY DETECTIONOUTCOMES AND MEASUREMENT:- 785 LOWER INCOME CLIENTS RECEIVED A TOTAL OF 980 SERVICES (SCREENING AND DIAGNOSTIC MAMMOGRAPHY, BREAST ULTRASOUND, BREAST BIOPSY AND BREAST MRI). THIRTEEN CLIENTS DIAGNOSED WITH A BREAST ABNORMALITY: 100% NEWLY DIAGNOSED BREAST CANCER PATIENTS (#12) LINKED INTO THE SERVICE CONTINUUMBABY FRIENDLY -GOALS: THE CDC AND OTHER PUBLIC HEALTH ORGANIZATIONS HAVE ENDORSED BREASTFEEDING AS A PROMISING OBESITY PREVENTION STRATEGY. CHNA IMPLEMENTATION PLAN: TRINITY HEALTH'S PEOPLE-CENTERED 2020 STRATEGIC PLAN PRIORITIZES OBESITY PREVENTION, WHICH HAS BECOME A NATIONAL EPIDEMIC. - HOLY CROSS HOSPITAL ACCOMPLISHED AND/OR COMPLETED THE FOLLOWING STEPS:1. HAVE A WRITTEN BREASTFEEDING POLICY THAT IS ROUTINELY COMMUNICATED TO ALL HEALTH CARE STAFF. 2. TRAIN APPROPRIATE STAFF IN THE SKILLS NECESSARY TO IMPLEMENT THIS POLICY. 3. INFORM ALL PREGNANT WOMEN ABOUT THE BENEFITS AND MANAGEMENT OF BREASTFEEDING. 4. HELP MOTHERS INITIATE BREASTFEEDING WITHIN ONE HOUR OF BIRTH. 5. SHOW MOTHERS HOW TO BREASTFEED AND HOW TO MAINTAIN LACTATION, EVEN IF THEY ARE SEPARATED FROM THEIR INFANTS. 6. GIVE INFANTS NO FOOD OR DRINK OTHER THAN BREAST-MILK, UNLESS MEDICALLY INDICATED. 7. PRACTICE ROOMING IN - ALLOW MOTHERS AND INFANTS TO REMAIN TOGETHER 24 HOURS A DAY. 8. ENCOURAGE BREASTFEEDING ON DEMAND. 9. GIVE NO PACIFIERS OR ARTIFICIAL NIPPLES TO BREASTFEEDING INFANTS. 10. FOSTER THE ESTABLISHMENT OF BREASTFEEDING SUPPORT GROUPS AND REFER MOTHERS TO THEM UPON DISCHARGE FROM THE HOSPITAL OR BIRTH CENTER.HEALTHY VENDINGGOALS: IMPROVE THE FOOD AND BEVERAGE ENVIRONMENT BY IMPLEMENTING "HEALTHY VENDING," A PROVEN OBESITY-PREVENTION STRATEGY.CHNA IMPLEMENTATION PLAN: TRINITY HEALTH'S PEOPLE-CENTERED 2020 STRATEGIC PLAN PRIORITIZES OBESITY PREVENTION, WHICH HAS BECOME A NATIONAL EPIDEMIC. - HOLY CROSS HAS IMPLEMENTED TRINITY'S NEW SUPPLY CHAIN STANDARDS AND 100% OF ITEMS SOLD IN VENDING ENVIRONMENTS MEET THE "HEALTHIER STOCKING STANDARD"TOBACCO 21 AND SMOKEFREE CAMPUSGOALS: TOBACCO CONTROL POLICY HAS BEEN PRIORITIZED AS PART OF TRINITY HEALTH'S PEOPLE-CENTERED 2020 STRATEGIC PLAN.CHNA IMPLEMENTATION PLAN: SUPPORT "TOBACCO 21 AND STRONG CLEAN INDOOR AIR LAWS THAT ARE INCLUSIVE OF E-CIGARETTES.- HOLY CROSS IS A MEMBER OF BROWARD COUNTY'S TOBACCO FREE PARTNERSHIP (TFP) AND SITS ON THE EXECUTIVE COMMITTEE- SMOKE-FREE HOUSING IS A PRIORITY POLICY BEING PURSUED WITH THE BROWARD COUNTY HOUSING AUTHORITY.- HOLY CROSS IS A CONDUIT FOR PUBLIC EDUCATION AND COMMUNICATION REGARDING TOBACCO 21, SMOKE-FREE MOVIES, TOBACCO FREE BEACHES, TAKE BACK THE SHELVES AND THE CLEAN INDOOR ACT FOR THE COMMUNITY THROUGH SOCIAL MEDIA CAMPAIGNS, PRESS RELEASES, EDUCATIONAL FORUMS AND ACTIVITIES, AND OTHER FORMS OF EARNED OR PAID MEDIA PART VI, LINE 6: HOLY CROSS 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 ORGANIZATIONS DEFINE - AND ACHIEVE - SPECIFIC COMMUNITY HEALTH AND WELL-BEING GOALS. IN FISCAL YEAR 2017, GOALS INCLUDED 1) PARTICIPATING IN LOCAL COALITION AND ADVOCACY EFFORTS AIMED AT CURBING TOBACCO USE AND PREVENTING OBESITY, 2) ASSESSING CAPACITY TO IDENTIFY AND SUPPORT INDIVIDUALS THAT ARE HOUSING INSECURE AND ACKNOWLEDGING OTHER BARRIERS INDIVIDUALS HAVE ACCESSING HEALTH CARE AND 3) EXPANDING ACCESS AND DELIVERY OF DIABETES PREVENTION PROGRAMS. TRINITY HEALTH ACKNOWLEDGES THE IMPACT SOCIAL DETERMINANTS SUCH AS ADEQUATE HOUSING, SAFETY, ACCESS TO FOOD, EDUCATION, INCOME, AND HEALTH COVERAGE HAVE ON THE HEALTH OF THE COMMUNITY. IN FISCAL YEAR 2016, TRINITY HEALTH LAUNCHED THE TRANSFORMING COMMUNITIES INITIATIVE (TCI), AWARDING EIGHT COMMUNITIES FUNDING TO IMPROVE THE HEALTH AND WELL-BEING OF THEIR COMMUNITIES IN PARTNERSHIP WITH THE LOCAL TRINITY HEALTH MEMBER HOSPITAL. THE AWARDED COMMUNITIES FOCUS ON POLICY, SYSTEM, AND ENVIRONMENTAL CHANGES THAT SPECIFICALLY IMPACT COMMUNITY IDENTIFIED NEEDS AND THAT WILL REDUCE CHILDHOOD OBESITY AND YOUTH TOBACCO USE. IN FISCAL YEAR 2017, TRINITY HEALTH INVESTED $2.7 MILLION IN TCI.AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO OUR COMMUNITIES THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND VULNERABLE, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND DEVELOPING PROGRAMS AND POLICIES TO SPECIFICALLY SUPPORT VULNERABLE POPULATIONS. ANNUALLY, THE ORGANIZATION INVESTS OVER $1.1 BILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING THE SPECIFIC NEEDS OF EACH COMMUNITY.FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. 0 AMERICAN CANCER SOCIETY INC 3363 WEST COMMERCIAL BLVD SUITE 100 100 FORT LAUDERDALE FL 33309 131788491 501 (C)(3) 24000 SILVER SPONSORSHIP FOR 2016,GOLD SPONSORSHIP/CELEBRATION GALA AMERICAN HEART ASSOCIATION 4000 HOLLYWOOD BLVD STE 170-N HOLLYWOOD FL 33021 135613797 501 (C)(3) 50000 GS GALA/GS GRFW 16-17/GS GALA 16-17 FL BROWARD BROWARD PARTNERSHIP FOR THE HOMELESS 920 NW 7TH AVENUE FORT LAUDERDALE FL 33311 650777033 501 (C)(3) 16250 10TH ANNUAL CHEFS HELPING THE HOMELESS BENEFIT JACK & JILL CHILDREN'S CENTER 1315 W BROWARD BLVD FORT LAUDERDALE FL 33312 590637870 501 (C)(3) 15000 FOUNDER CIRCLE LEVEL 1000 CLUB TO BENEFIT CANCER INC 6278 N FEDERAL HIGHWAY SUITE 150 FORT LAUDERDALE FL 33308 800364095 501 (C)(3) 7500 BRONZE SPONSORSHIP/SPRING LUNCHEON 2017 SPONSORSHIP LOVE THY NEIGHBOR FUND 6864 NW 25TH WAY FORT LAUDERDALE FL 33309 650364308 501 (C)(3) 5000 PURCHASE OF FOOD AND SUPPLIES LUZ DEL MUNDO (LIGHT OF THE WORLD) 5333 N DIXIE HWY 201 OAKLAND PARK FL 33334 650266070 501 (C)(3) 7500 SPONSORSHIP NOCHE TROPICAL FEB 17TH 2017/ HISPANIC WOMEN LUNCHEON WOMEN IN DISTRESS OF BROWARD COUNTY PO BOX 50187 LIGHTHOUSE POINT FL 33074 591592524 501 (C)(3) 5000 ANNUAL STARFISH LUNCHEON URBAN LEAGUE OF BROWARD COUNTY 560 NW 27TH AVENUE FORT LAUDERDALE FL 33311 591564384 501 (C)(3) 5000 RED GALA AMERICAN RED CROSS 600 NE 3 AVENUE FORT LAUDERDALE FL 33304 530196605 501 (C)(3) 5000 HURRICANE MATTHEW RELIEF SUNRISE FIRE RESCUE BENEVOLENT ASSOC INC (FIRE CHIEFS ASSOC OF BROWARD) 10440 W OAKLAND PARK BLVD SUNRISE FL 33351 592844920 501 (C)(4) 7500 EMS CONFERENCE SPONSORSHIP HABITIAT FOR HUMANITY OF BROWARD 3564 NORTH OCEAN BLVD FORT LAUDERDALE FL 33308 592320573 501 (C)(3) 5000 SILVER SPONSOR FOR SPIRIT OF 2016 HUMANITY AWARDS HOPE SOUTH FLORIDA 5110 N FEDERAL HIGHWAY 102 FORT LAUDERDALE FL 33308 650670031 501 (C)(3) 5000 2016 TASTE HOPE GALA MARCH OF DIMES FOUNDATION 1275 MAMARONECK AVENUE WHITE PLAINS NY 10605 131846366 501 (C)(3) 5000 WOMEN OF DISTINCTION EVENT 2016 13 1 PART I, LINE 2: DONATIONS MADE BY HOLY CROSS HOSPITAL TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. 0 1 0 0 0 0 0 0 0 PATRICK TAYLOR MD DIRECTOR; PRESIDENT & CEO 0 490203 0 128463 0 197888 0 19875 0 25953 0 862382 0 0 JON KOTLER DIR &PRES-ELECT MED STAFF AS OF 1/17 262157 0 500 0 32263 0 0 0 20022 0 314942 0 0 0 RAUL TAPIA MD DIRECTOR THROUGH 12/16; PHYSICIAN 423635 0 66204 0 1827 0 0 0 15712 0 507378 0 0 0 NORA TRIOLA DIRECTOR; TRINITY SVP & CNO 0 484204 0 123983 0 271645 0 11925 0 19413 0 911170 0 0 TODD RADOSEVICH INTERIM CFO AS OF 4/17 195705 0 15338 0 273 0 9718 0 21512 0 242546 0 0 0 LINDA WILFORD SVP & CFO THROUGH 4/17 276252 0 60084 0 207919 0 140900 0 13354 0 698509 0 0 0 LUISA GUTMAN SVP & COO 338290 0 50492 0 9501 0 19875 0 11870 0 430028 0 0 0 MARK DISSETTE SVP AND ADMINISTRATOR 279121 0 42770 0 57718 0 20368 0 25737 0 425714 0 0 0 MARC BIVINS MD CMO 198858 0 0 0 3346 0 8438 0 11060 0 221702 0 0 0 JONATHAN LEVY MD PHYSICIAN 919591 0 842637 0 2190 0 0 0 30699 0 1795117 0 0 0 MARTIN ROCHE MD PHYSICIAN 893412 0 673290 0 4444 0 0 0 21686 0 1592832 0 0 0 PORTER MCROBERTS MD PHYSICIAN 794822 0 395627 0 2799 0 0 0 21544 0 1214792 0 0 0 WILLIAM LEONE JR MD PHYSICIAN 776335 0 396180 0 6699 0 0 0 28661 0 1207875 0 0 0 PAUL WU MD PHYSICIAN 490698 0 544222 0 2389 0 0 0 23902 0 1061211 0 0 0 TAREN RUGGIERO FORMER KEY EMPLOYEE; CNO 238972 0 27098 0 27863 0 12884 0 15205 0 322022 0 0 0 KENNETH HOMER MD FORMER KEY EMPLOYEE; MED DIRECTOR 344038 0 43485 0 70431 0 11925 0 19863 0 489742 0 0 0 DAVID TAUB MD FORMER KEY EMPLOYEE; PHYSICIAN 434278 0 132319 0 1055 0 0 0 23174 0 590826 0 0 0 JAMES DESMARTEAU FORMER OFFICER; ADMINISTRATOR 324992 0 50 0 74928 0 15900 0 14002 0 429872 0 0 0 PART I, LINE 3 HOLY CROSS HOSPITAL IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. HOLY CROSS 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 HOLY CROSS 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 2016. 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 2016, AND BENEFITS FOR PARTICIPANTS NOT YET VESTED IN A PLAN WERE ACCRUED IN 2016. THE FOLLOWING PAYOUTS FOR 2016 FOR THE PLAN ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: PATRICK TAYLOR, MD - $179,650 NORA TRIOLA - $255,205 THE FOLLOWING INDIVIDUALS ARE PARTICIPANTS IN A NON-QUALIFIED DEFERRED COMPENSATION PLAN. THE FOLLOWING PAYOUTS ARE INCLUDED IN COLUMN (B)(III) OF SCHEDULE J, PART II: MARK BIVINS - $-0- MARK DISSETTE - $47,290 LUISA GUTMAN - $-0- KENNETH HOMER - $56,081 JON KOTLER - $26,987 TAREN RUGGIERO - $21,936 PATRICK TAYLOR, MD - $-0- LINDA WILFORD - $183,324 THE FOLLOWING ACCRUAL FOR 2016 IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: LINDA WILFORD - $125,000 MARC TAUB FAMILY MEMBER OF DAVID TAUB, MD, KEY EMPLOYEE 103058 EMPLOYMENT ARRANGEMENT 0 JEREMY WILFORD FAMILY MEMBER OF LINDA WILFORD, OFFICER 39661 EMPLOYMENT ARRANGEMENT 0 JM FAMILY ENTERPRISES INC (JMFE) JANICE MORAN, TRUSTEE, AND HER FAMILY CONTROL MORE THAN 35% OF JMFE 437023 HOLY CROSS HOSPITAL, INC. PROVIDES MEDICAL CARE TO THE EMPLOYEES OF JM FAMILY ENTERPRISES, INC. 0 FORM 990, PART VI, SECTION A, LINE 2 RAUL TAPIA, DIRECTOR, AND MICHELE TAPIA, DIRECTOR, HAVE A FAMILY RELATIONSHIP. PATRICK TAYLOR, PRESIDENT & CEO, AND JOSEPH CATANIA, TREASURER, HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF HOLY CROSS HOSPITAL IS TRINITY HEALTH CORPORATION. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A TRINITY HEALTH CORPORATION IS THE SOLE MEMBER OF HOLY CROSS HOSPITAL. TRINITY HEALTH CORPORATION HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF HOLY CROSS HOSPITAL. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, TRINITY HEALTH CORPORATION MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. TRINITY HEALTH CORPORATION MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11B PRIOR TO FILING, THE FORM 990 FOR HOLY CROSS HOSPITAL IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE COMPENSATION COMMITTEE AS WELL AS 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 HOLY CROSS 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 HOLY CROSS 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 HOLY CROSS 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 HOLY CROSS HOSPITAL (OR A DELEGATED COMMITTEE OF THE BOARD) ON A YEARLY BASIS. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO HOLY CROSS 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 HOLY CROSS 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 HOLY CROSS 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 15B QUESTION 15A IS ANSWERED "NO" BECAUSE THE COMPENSATION FOR HOLY CROSS HOSPITAL'S CEO IS ESTABLISHED AND PAID 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 HOLY CROSS 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 THE COMPENSATION OF OTHER EXECUTIVES, HOLY CROSS HOSPITAL HAS A PROCESS FOR DETERMINING COMPENSATION WHICH INCLUDES THE FOLLOWING: THE BOARD HAS AN INDEPENDENT COMMITTEE REVIEW AND APPROVE ALL ELEMENTS OF REMUNERATION FOR ALL DISQUALIFIED PERSONS, AS WELL AS 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 HEALTH SYSTEMS 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 HOLY CROSS 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, HOLY CROSS HOSPITAL INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. HOLY CROSS HOSPITAL'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST. FORM 990, PART VII, LINE 1: SUSAN WELSH, RSM IS A MEMBER OF THE RELIGIOUS SISTERS OF MERCY. HAVING TAKEN A VOW OF POVERTY, SUSAN WELSH, RSM DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED AS CEO TO PITTSBURGH MERCY HEALTH SYSTEM, A RELATED ENTITY, EXCEPT FOR INSURANCE BENEFITS OF $14,756. INSTEAD, A TOTAL OF $427,041 WAS PAID BY TRINITY HEALTH CORPORATION DIRECTLY TO THE RELIGIOUS SISTERS OF MERCY FOR SUSAN WELSH, RSM'S SERVICES. FORM 990, PART XI, LINE 9: EQUITY TRANSFERS TO AFFILIATES -10,716,384. EQUITY GAIN IN UNCONSOLIDATED AFFILIATES 1,377,409. LOSS FROM DISCONTINUED OPERATIONS -2,242. OTHER TRANSACTIONS 18,473. FORM 990, PART XII, LINE 2: HOLY CROSS HOSPITAL'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY17 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, BOX C, DOING BUSINESS AS NAMES DOROTHY MANGURIAN COMPREHENSIVE WOMEN'S CENTER HARRY AND BEATRICE FELDMAN CENTER FOR OPTIMAL HEALTH HOLY CROSS HEALTH MINISTRIES HOLY CROSS CLINIC SERVICES HOLY CROSS HEALTHPLEX HOLY CROSS HOSPITAL HEALTHPLEX MEDICAL PLAZA HOLY CROSS HOSPITAL HOME HEALTH AGENCY HOLY CROSS MEDICAL GROUP HOLY CROSS ORTHOPEDIC INSTITUTE HOLY CROSS RESEARCH CENTER HOLY CROSS URGENT CARE AND IMAGING JIM MORAN HEART AND VASCULAR RESEARCH INSTITUTE MEDICAL PLAZA NORTH RIDGE MEDICAL CENTER THE MICHAEL AND DIANNE BIENES COMPREHENSIVE CANCER CENTER ZACHARIAH FAMILY WELLNESS PAVILION HOLY CROSS PHYSICIAN PARTNERS LLC 4725 N FEDERAL HWY FT LAUDERDALE FL 33308 364712116 MEDICAL SERVICES FL 1576040 35425 HOLY CROSS HOSPITAL INC HOLY CROSS PHYSICIAN PARTNERS ACO LLC 4725 N FEDERAL HWY FT LAUDERDALE FL 33308 465530455 ACCOUNTABLE CARE ORGANIZATION FL 0 0 HOLY CROSS HOSPITAL INC 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 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