2018-05-09T13:10:11-05:00 2017-06-30 470617373 CATHOLIC HEALTH INITIATIVES 12809 WEST DODGE ROAD OMAHA NE 68154 990 2016-07-01 420782518 ALEGENT HEALTH-MERCY HOSPITAL CORNING IA ALEG 4023434323 PO BOX 368 CORNING IA 50841 Jeanette Wojtalewicz CFO 2018-05-03 true ANGELA NOEL P01051055 4023434413 2016 2022-09-23 18:48:47Z CLIFF ROBERTSON 12809 WEST DODGE ROAD OMAHA NE 68154 20289398 false X WWW.CHIHEALTH.COM X 1953 IA THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. 14 9 169 46 408 0 156192 3170 20597961 19616765 5123 18688 333076 645813 21092352 20284436 251743 422236 0 8497312 8361507 0 0 10162747 9990113 18911802 18773856 2180550 1510580 24110090 24804312 3878040 3061682 20232050 21742630 X THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. FIDELITY TO THE GOSPEL URGES THE CORPORATION TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS IT CREATES HEALTHIER COMMUNITIES. THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION. false false 1550061 32145 1493429 ALEGENT HEALTH MERCY HOSPITAL, CORNING SUPPORTS THE MISSION BY CONTINUALLY MAKING SERVICES MORE CONVENIENT AND ACCESSIBLE WHILE MAINTAINING A LEVEL OF EFFICIENCY. THE HOSPITAL OFFERS THE FOLLOWING SERVICES TO OUR PATIENTS: 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS, DIAGNOSTIC IMAGING SERVICES, CARDIOVASCULAR SERVICES, CHEMOTHERAPY AND ELECTROENCEPHALOGRAMS (EEGS) PHYSICAL THERAPY. 1077374 54018 2509651 ALEGENT HEALTH MERCY HOSPITAL, CORNING PROVIDES SEVERAL SPECIALTY CLINICS EACH WEEK THROUGH VISITING SPECIALISTS IN THE FOLLOWING AREAS: AUDIOLOGY, EAR, NOSE AND THROAT, CARDIOVASCULAR SERVICES, DERMATOLOGY, GASTROENTEROLOGY, GENERAL SURGERY/WOUND CARE, GYNECOLOGY/OBSTETRICS, ONCOLOGY, OPTHALMOLOGY, ORTHOPEDIC SURGERY, PODIATRY, UROLOGY, SPEECH AND OCCUPATIONAL THERAPY AND PSYCHIATRY. 703375 137020 6365861 ALEGENT HEALTH MERCY HOSPITAL, CORNING STRIVES TO IMPROVE THE HEALTH STATUS OF CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS IN THIS RURAL COMMUNITY. The Hospital IS PROUD TO OFFER HEALTHCARE SERVICES CLOSE TO HOME WITHIN THE COMMUNITY. ALEGENT HEALTH MERCY HOSPITAL, CORNING PROVIDES A VARIETY OF DIAGNOSTIC SERVICES TO THE COMMUNITY, SUCH AS CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND. 14635938 199053 9247824 OTHER PROGRAM SERVICES 14635938 199053 9247824 17966748 true false false true false false false false false true true true false true true true false true false false false false false false false false true true true true true false false false false false false false false false false false false false true true false false false true 0 0 169 true false false false false false false false false false false X 14 9 false false false false true true true true true false false true true true true true true true true false X JEANETTE WOJTALEWICZ 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 LARRY BUTLER Treasurer 1.0 11.0 X X 0 0 0 FR JAMES CLIFTON SJ Secretary 1.0 11.0 X X 0 0 0 RICHARD HERINK MD BOARD CHAIR 1.0 12.0 X X 0 0 0 CLIFF ROBERTSON MD Board Member/CEO CHI Health 1.0 59.0 X X 0 1824639 167740 SR Maryanne Stevens RSM VICE CHAIR 1.0 11.0 X X 0 0 0 NATHANIEL BRACKETT MD BOARD MEMBER 1.0 59.0 X 0 0 0 GREGORY HEIDRICK MD Board Member 1.0 11.0 X 0 0 0 Sister Nadine Heimann Board Member 1.0 11.0 X 0 0 0 SUSANNE L HRUZA MD BOARD MEMBER 1.0 11.0 X 0 0 0 ROBERT LANIK Board Member 1.0 31.0 X 0 241288 0 AMY L MCGAHA md BOARD MEMBER 1.0 59.0 X 0 273125 16154 MICHAEL ROWAN FACHE Board member/CHI EVP & COO 1.0 59.0 X 0 4009034 33938 BARRY SANDSTROM Board Member 1.0 11.0 X 0 0 0 Bill T Yates Board Member 1.0 11.0 X 0 0 0 Anthony Jones BOARD MEMBER 1.0 59.0 X 0 0 0 Thomas Murray PHD BOARD MEMBER 1.0 11.0 X 0 0 0 DEBRA GOLDSMITH President, Regional HOSPITAL 59.0 1.0 X 174880 34223 38083 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 5.0 55.0 X 0 962229 81520 CAROLINE AMAO MD PHYSICIAN 60.0 0 X 169976 0 21181 MAEN HADDADIN MD PHYSICIAN 60.0 0 X 66380 278054 34527 BETHEL KOPP MD PHYSICIAN 60.0 0 X 348995 0 28286 LINDA ROBINSON MD PHYSICIAN 60.0 0 X 221456 0 23579 JOHN SAFRANEK MD PHYSICIAN 60.0 0 X 263698 0 32117 1245385 7622592 477125 12 false true false Rehabvisions 11623 Arbor Street Omaha NE 68144 Therapy Services Management 287888 Gautam Jayaswal MD 8315 W 119th Terrece Overland Park KS 66213 Medical Services 275685 Donald Sabo 601 Rosary Drive Corning IA 50841 Medical Services 216520 Kinetic Medic Solutions LLC 7914 W Dodge Rd 301 Omaha NE 68114 Staffing Solutions 139048 Shared Medical Services Inc 209 Limestone Pass Cottage Grove WI 53527 Medical Services 138247 5 X 0 0 0 0 1270 1900 0 3170 Net patient services 900099 18019646 18019646 0 0 Pharmacy Services 446110 1410434 1410434 0 0 Medical Services 621300 60221 60221 0 0 Patient Services 900099 70421 70421 0 0 Emergency Medical Services 621910 38223 38223 0 0 17820 17820 0 0 19616765 18688 0 408 18280 0 0 0 0 0 0 0 0 6040 0 1083 0 4957 0 4957 0 0 4957 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5164 3879 1285 0 0 1285 Cafeteria 722100 101727 0 0 101727 Services Sold 900099 503562 0 0 503562 0 0 0 0 34282 0 0 34282 639571 20284436 19616765 408 664093 X 6125 6125 416111 416111 98468 98468 6396253 6071517 324736 343600 326420 17180 1086675 1032341 54334 436511 414685 21826 1686 1686 3762440 3575738 186702 0 40445 38423 2022 453503 430828 22675 405363 385095 20268 51941 49344 2597 367 349 18 14969 14221 748 520645 494613 26032 54348 51631 2717 Bad debts 453592 453592 Medical Supplies 1701494 1701494 Repairs and maintenance 283026 268875 14151 Intercompany Allocations 1894407 1799687 94720 351887 335505 16382 0 18773856 17966748 807108 0 -480131 -383746 5791645 196541 0 0 2088015 1773179 0 0 0 0 0 394277 359480 0 0 16702954 10316585 6785411 6386369 0 0 0 3517104 0 0 0 9530873 12955385 24110090 24804312 3497773 2682221 0 0 0 0 0 0 0 0 0 0 0 0 380267 379461 3878040 3061682 X 20232050 21742630 0 0 0 0 20232050 21742630 24110090 24804312 1510580 0 X false true X true true true X false false false false false true 1686 false false false 1686 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Amounts paid to other organizations for lobbying purposes total $1,686. This includes dues paid to the Iowa Hospital association. Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY Amounts paid to other organizations for lobbying purposes total $1,686. This includes dues paid to the Iowa Hospital association. 460904 32131 8752 484283 347026 134364 20486 460904 321001 50571 24546 347026 302345 36842 18186 321001 35634 293627 26916 302345 0.0 0.0 1.0 false true true 58867 58867 7844431 4176745 3667686 0 0 0 8375479 5862447 2513032 424177 277393 146784 6386369 CHI OPERATING INVESTMENT PROGRAM 3517104 F 3517104 INTERCOMPANY RECEIVABLES 12955385 12955385 Long Term Debt - CHI 311351 Other Current Liabilities 68110 379461 X Schedule D, Part V, Line 4 Intended uses of endowment funds ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF MERCY HEALTH CARE FOUNDATION and ALEGENT HEALTH MERCY HOSPITAL, CORNING, IA. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IOWA'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION. CHI'S FIN 48 (ASC740) FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2017 READS AS FOLLOWS: "CHI IS A TAX-EXEMPT COLORADO CORPORATION AND HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CHI OWNS CERTAIN TAXABLE SUBSIDIARIES AND ENGAGES IN CERTAIN ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE AND THEREFORE SUBJECT TO INCOME TAX. MANAGEMENT REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS." true true X true X 300 true X true true true false true true 1747 227941 0 227941 0.0121 1928 2306520 2473397 0 0.0 0 2707 3907 0 0.0 0 3675 2537168 2477304 227941 0.0121 15 1856 47176 2114 45062 0.0024 4 27 3360 0 3360 0.0002 2 0 2771636 1595024 1176612 0.0627 1 0 1380 193 1187 0.0001 4 16 43539 1570 41969 0.0022 26 1899 2867091 1598901 1268190 0.0676 26 5574 5404259 4076205 1496131 0.0797 0 0.0 0 0.0 1 26 26 0.0000 1 33 33 0.0000 0 0.0 0 0.0 0 0.0 2 2 149 149 0.0000 0 0.0 4 2 208 0 208 0.0000 true 453592 0 14838827 18910880 -4072053 X true true 1 1 ALEGENT HEALTH MERCY HOSPITAL CORNING 603 ROSARY DRIVE CORNING IA 50841 WWW.CHIHEALTH.COM 02017011 X X X ALEGENT HEALTH MERCY HOSPITAL CORNING 1 false false true X X X X X X X X X 15 true false true true X http://www.chihealth.com/CHNA X X true 16 false true false true X 300.0 300.0 X X X X true true X X X true X http://www.chihealth.com/financial-assistance X http://www.chihealth.com/financial-assistance X http://www.chihealth.com/financial-assistance X X X X X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Alegent Health Mercy Hospital, Corning. Adams County Public Health sought input on the health needs identified through secondary data from the community at a local flu shot clinic and the local Women, Infant & Children (WIC) clinic. Key stakeholders at the Adams County Board of Health meeting and the Adams County Emergency Planning meeting provided input as well as validation of the identified needs. Taylor County Public Health was able to collect 266 survey responses to their Community Health Needs Survey. Surveys were available online and were collected by program staff through regular TCPH programming, as well as at the Taylor County Fair in July 2015. The collection resulted in an even sample across all levels of income and employment. TCPH elected to request input and validation of needs from key stakeholders, which represent the aging population, violence in the community and those dealing with disparities via email communication to the West Central Community Action Partnership-Creston, and Bedford Iowa WIC Clinic. Mercy Corning was able to gain input and validation of the needs identified through the processes defined above, from the Patient Family Advisory Council/Mercy Corning Hospital Community Board. ACPH Process: During the summer of 2015, secondary data from the Iowa Department of Public Health (IDPH) was reviewed by the ACPH Administrator and highlights were provided to key informants at local boards and planning meetings. In the fall of 2015, ACPH then collected primary data by interviewing key informants representing programs that serve the greater public, low-income populations, elderly populations, women, infants and children. Other primary data collection took place in the form of interviews with participants at a local flu shot clinic and at the Women, Infant & Children (WIC) clinic. Upon completion of the secondary and primary data collection, ACPH took into account input from the community members. Through validation by local leadership and key stakeholders, ACPH was able to validate the top needs identified for the County. The completed ACPH CHNA along with listing of all parties involved can be found online at www.chihealth.com/chna. TCPH Process: During the summer of 2015, secondary data from IDPH was reviewed by the TCPH administrator. In July 2015, TCPH began collecting primary data through a survey available online and collected by staff through regular programs. TCPH also collected surveys at the County Fair. A copy of the TCPH Community Health Needs Survey along with survey results is available in the Appendix. Upon completion of the secondary and primary data collection, TCPH took into account input from local leadership and key stakeholders representing programs that serve the greater public, low-income populations, the elderly, women, infants and children, in order to validate the top needs identified for Taylor County. The completed TCPH CHNA can be found at www.chihealth.com/chna. Upon completion of the two health department processes CHI Health Mercy Corning worked to validate the top needs from processes for the Hospital. In order to evaluate the secondary data around health needs from the ACPH and TCPH processes, as well as review data on other notable needs, the Mercy Corning CBAT team conducted a secondary data review in February 2016. This review captured data, trends and benchmarks from various data sources outlined in the Mercy Corning CHNA. Upon completion of this data review, Mercy Corning leadership presented findings to the PFAC and Mercy Corning Community Board to validate the top needs identified for both Counties. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - AH - Mercy Hospital, Corning. See Part V, Section B, Line 5 Schedule H, Part V, Section B, Line 7 Facility , 1 Facility , 1 - Alegent Health Mercy Hospital, Corning. Shared with CHI Health Mercy Corning Community Board in July, 2016. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Alegent Health Mercy Hospital, Corning. The new CHNA and corresponding implementation plan was completed for the tax reporting year 2015. The following outlines the current implementation plan priorities and strategies. This plan was posted publicly on www.chihealth.com/chna. For this plan the hospital prioritized the following health needs: Priority Health Need #1: Access to Healthcare To address this need the hospital will implement the following strategies in 2016-2018: * Fund and staff emergency transportation services (ambulance) for the communities of Adams and Taylor Counties * Provide telepsych services to residents of Adams and Taylor Counties needing crisis support and psych evaluation to identify correct level of treatment. Priority Health Need #2: Behavioral Health To address this need the hospital will implement the following strategies in 2016-2018: * Increase the overall awareness of existing and potential resources among community stakeholders through an established behavioral health community coalition. * Provide community-wide training on mental health and substance abuse to stakeholders such as law enforcement, EMTs, pastors, school personnel, and elder care workers. * Expand behavioral health prevention that educates and engages parents of children and youth ages 0 to 12 years. Priority Health Need #3: Chronic Disease (Diabetes & Obesity) To address this need the hospital will implement the following strategies in 2016-2018: * Provide a free education program to participants identified as pre-diabetic and referred by physician or self-referred, in Adams and Taylor Counties. * Operate a local Wellness Center in Corning, Iowa serving Adams and Taylor Counties where other fitness centers do not exist. The hospital will not address the following significant health needs identified in its 2015 CHNA for the following reasons: Aging. Taylor County Public Health recently assumed public health related work in Adams County in the form of a joint public health office. As part of their current Health Improvement Plan (HIP) Adams and Taylor County Public Health will continue to offer home health services as well as develop a plan to increase community awareness of non-institutionalized supports, resources, and fall prevention through a serious of education and outreach efforts. As a result of this work, and in an effort to maximize impact in selected health priorities, CHI Health Mercy Corning will not directly address this health need. Cancer. Cancer was not selected for work in an effort to maximize existing resources and staff time to address needs or root causes which have the potential to impact other identified health needs. Obesity was an identified health need selected for work, as it is known to be a risk factor for cancer. Cardiovascular Disease. Three health needs were identified as part of "Chronic Disease" in the CHNA. CHI Health Mercy Corning is addressing the other two needs: Obesity and Diabetes. These were prioritized based on existing work. Cardiovascular disease was not prioritized for specific work in order to allocate and maximize resources to obesity, which is a contributing factor to cardiovascular disease, as well as diabetes. Maternal & Child Health. In an effort to maximize staff time and resources, and be mindful of the hospital's capacity to do this work, maternal and child health was not prioritized for work. Unintentional Injury. In an effort to maximize staff time and resources, and be mindful of the hospital's capacity to do this work, unintentional injury was not prioritized for work. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - Alegent Health Mercy Hospital, Corning. The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. The patient must submit a completed Financial Assistance application. Patient Cooperation Standards - A patient must exhaust all other payment options, including private coverage, federal, state and local medical assistance programs, and other forms of assistance provided by third-parties prior to being approved. An applicant for Financial Assistance is responsible for applying to public programs for available coverage. He or she is also expected to pursue public or private health insurance payment options for care provided by a CHI Hospital Organization within a Hospital Facility. A patient's and, if applicable, any Guarantor's cooperation in applying for applicable programs and identifiable funding sources, including COBRA coverage (a federal law allowing for a time-limited extension of employee healthcare benefits), shall be required. If a Hospital Facility determines that COBRA coverage is potentially available, and that a patient is not a Medicare or Medicaid beneficiary, the patient or Guarantor shall provide the Hospital Facility with information necessary to determine the monthly COBRA premium for such patient, and shall cooperate with Hospital Facility staff to determine whether he or she qualifies for Hospital Facility COBRA premium assistance, which may be offered for a limited time to assist in securing insurance coverage. A Hospital Facility shall make affirmative efforts to help a patient or patient's Guarantor apply for public and private programs. 4 CHI Health MERCY HOSP SKILLED NURSING FACILITY 603 ROSARY DRIVE CORNING IA 50841 SKILLED NURSING FACILITY CHI Health CORNING RURAL HEALTH CLINIC 601 ROSARY DRIVE CORNING IA 50841 RURAL HEALTH CLINIC CHI Health LENOX RURAL HEALTH CLINIC 810 1/2 E VAN BUREN ST LENOX IA 50851 RURAL HEALTH CLINIC CHI Health BEDFORD RURAL HEALTH CLINIC 618 COURT AVE BEDFORD IA 50833 RURAL HEALTH CLINIC Schedule H, Part I, Line 3c FINANCIAL ASSISTANCE ELIGIBILITY CRITERIA Unless eligible for Presumptive Financial Assistance, the following eligibility criteria must be met in order for a patient to qualify for Financial Assistance: * The patient must have a minimum account balance of thirty-five dollars ($35.00) with the CHI Hospital Organization. Multiple account balances may be combined to reach this amount. Patients/Guarantors with balances below thirty-five dollars ($35) may contact a financial counselor to make monthly installment payment arrangements. * The patient's Family Income must be at or below 300% of the FPG. * The patient must comply with Patient Cooperation Standards as described [in the FAP]. * The patient must submit a completed Financial Assistance application. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. In particular, presumptive eligibility may be determined on the basis of individual life circumstances that may include: * Recipient of state-funded prescription programs; * Homeless or one who received care from a homeless clinic; * Participation in Women, Infants and Children programs (WIC); * Food stamp eligibility; * Subsidized school lunch program eligibility; * Eligibility for other state or local assistance programs (e.g., Medicaid spend-down); * Low income/subsidized housing is provided as a valid address; or * Patient is deceased with no known estate. Schedule H, Part I, Line 7 Bad Debt Expense Excluded from Financial Assistance Calculation 453,592 Schedule H, Part I, Line 6a Community benefit report prepared by related organization Alegent Creighton Health Schedule H, Part I, Line 7g Subsidized Health Services Included in subsidized health services are the following physician clinics: CHI HEALTH CORNING RURAL HEALTH CLINIC CHI HEALTH BEDFORD RURAL HEALTH CLINIC CHI HEALTH LENOX RURAL HEALTH CLINIC The total expenses associated with operating these clinics were $2,181,204. Revenue offsets were $1,309,447. Accordingly, the total subsidized cost of these necessary services was $871,757. The clinics meet a community need for primary care services outside of the emergency room setting. Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using the organization's cost-to-charge ratio. The cost-to-charge ratio covers all patient segments. Schedule H, Part II Community Building Activities Alegent Health Mercy Hospital, Corning has a history of centralized community benefit investments, as well as hospital specific investments that address community health needs which include support of local health coalitions, investments in partnerships and programs that address top community health needs, participation in local committees and boards tied to top health needs, and investments in many other ways as described in other areas of the Schedule H narrative. Below are specific examples of work that falls within the definition of community building activities. These activities are critical in helping build social, health, and economic opportunities in our community that ultimately drive health status and quality of life for our residents: *Workforce development-the following activities work to strengthen the community's capacity to promote the health and well-being of our residents by driving entry into healthcare careers: - Healthcare career exploration camp-day camp funded by CHI Health for students grades 10-12 to give them the opportunity to explore a variety of healthcare professions - Presentations to high school students about healthcare careers - Provided dietitian shadowing opportunity to high school student *Community and economic development including support of local Chambers of Commerce *Strategic planning and consulting services for community partners to build capacity to address health and social needs of the community Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Costing methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 58.72%. When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Alegent Health Mercy Hospital, Corning, Iowa does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Alegent Health-Mercy Hospital, Corning, IA does not issue separate company audited financial statements. However, the organization is included in the consolidated financial statements of Catholic Health Initiatives. The consolidated footnote reads as follows: "The provision for bad debts is based upon management's assessment of historical and expected net collections, taking into consideration historical business and economic conditions, trends in health care coverage, and other collection indicators. Management routinely assesses the adequacy of the allowance for uncollectible accounts based upon historical write-off experience by payor category. The results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. After satisfaction of amounts due from insurance, CHI follows established guidelines for placing certain balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. The provision for bad debts is presented in the consolidated statements of operations as a deduction from patient services revenues, net of contractual allowances and discounts, since CHI accepts and treats all patients without regard to the ability to pay." Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs Alegent Health Mercy Hospital, Corning is designated as a Critical Access Hospital (CAH). CAHs are rural community hospitals that are certified to receive cost-based reimbursement from Medicare. The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures. CAHs are certified under a different set of Medicare Conditions of Participation (CoP). Shortfalls are created when a facility receives payments that are less than the costs of caring for program beneficiaries. Because shortfalls are based on costs, not charges, Alegent Health Mercy Hospital, Corning, due to their designation as a CAH, received cost-based reimbursement for Medicare purposes, Alegent Health Mercy Hospital, Corning will not experience Medicare related shortfalls. Although not presented on the Medicare cost report, in order to facilitate a more accurate understanding of the "true" cost of services (for "shortfall" purposes) the CHI Workbook allows a health care facility not to offset costs that Medicare considers to be non-allowable, but for which the facility can legitimately argue are related to the care of the facility's patients. In addition, although not reportable on the Medicare cost report, the CHI workbook includes the cost of services that are paid via a set fee-schedule rather than being reimbursed based on costs (e.g. outpatient clinical laboratory). Finally, the CHI Workbook allows a facility to include other health care services performed by a separate facility (such as a physician practice) that are maintained on separate books and records (as opposed to the main facility's books and records which has its costs of service included within a cost report). True costs of Medicare computed using this methodology: Total Medicare Revenue: $14,838,827 Total Medicare costs: $18,910,880 Shortfall: $4,072,053 Alegent Health Mercy Hospital, Corning believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as ''subsidized health services''. Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance The organization's billing and collections policy applies to all individuals presenting for emergency or other medically necessary care. The policy contains provisions for collecting amounts due from those patients who the organization knows to qualify for financial assistance either through the traditional financial assistance application process or through presumptive eligibility processes. Before engaging in extraordinary collection actions (ECAs) to obtain payment for EMCare, Hospital Facilities must make reasonable efforts through its billing and collections processes, pursuant to Treas. Reg. §1.501(r)-6(c), to determine whether an individual is eligible for Financial Assistance. In no event will an ECA be initiated prior to 120 days from the date the Facility provides the first post-discharge billing statement (i.e., during the Notification Period) unless all reasonable efforts have been made. Hospital Facilities will not refer accounts for collection where the patient has initially applied for Financial Assistance, and the Hospital Facility has not yet made reasonable efforts with respect to the account. For patients and Guarantors who are unable to provide required documentation, a Hospital Facility may grant Presumptive Financial Assistance based on information obtained from other resources. Patients who qualify for Medicaid are presumed to qualify for full charity write off. Any charges for days or services written off (excluding Medicaid denials related to timeliness of billing, insufficient medical record documentation, missing invoices, authorization, or eligibility issues) as a result of a Medicaid are booked as charity. Some Medicaid plans offer coverage for a limited or restricted list of services. If a patient is eligible for Medicaid, any charges for days or services not covered by the patient's coverage may be written off to charity without a completed application. This does not include any Share of Cost (SOC) or other patient cost-sharing amounts such as deductibles or copayments, as such costs are determined by the state to be an amount that the patient must pay before the patient is eligible for Medicaid. Health and Human Services (HSS) uses the term "Spend Down" instead of Share of Cost. All collection activities conducted by the Facility, a Designated Supplier, or its third-party collection agents will be in conformance with all federal and state laws governing debt collection practices. All third-party agreements governing collection and recovery activities must include a provision requiring compliance with the hospital facilities' financial assistance and billing and collections policy and indemnification for failures as a result of its noncompliance. This includes, but is not limited to, agreements between third parties who subsequently sell or refer debt of the Hospital Facility. Schedule H, Part V, Section B, Line 16a FAP website - ALEGENT HEALTH MERCY HOSPITAL, CORNING: Line 16a URL: http://www.chihealth.com/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website - ALEGENT HEALTH MERCY HOSPITAL, CORNING: Line 16b URL: http://www.chihealth.com/financial-assistance; Schedule H, Part V, Section B, Line 16c FAP plain language summary website - ALEGENT HEALTH MERCY HOSPITAL, CORNING: Line 16c URL: http://www.chihealth.com/financial-assistance; Schedule H, Part VI, Line 2 Needs assessment The process to develop assessments of the community health needs (CHNA) is collaborative in nature and involves health departments, existing health coalitions, community members and hospital leadership, and is supported by CHI Health's Community Benefit and Healthier Communities Department staff. Each CHI Health hospital participates in the CHNA process for the county in which the facility is located at least every 3 years in partnership with the local health departments. The assessment varies in each community but includes review of primary data (such as surveys, key informant interviews, focus groups) and secondary data (such as County Health Rankings, BRFRSS, YRBS, census data etc). Leadership from CHI Health participate in multiple internal and external venues to garner community input, prioritize community health needs and develop community health improvement plans. The CHNA report for each community is made available to the public by posting the report on the CHI Health external website and by making it available in community venues. The CHNAs are integrated into the governance and planning for CHI Health on two levels: * Reporting to the Board of Directors * Reporting into the annual strategic planning and budgeting processes of Alegent Creighton Health. * Implementation plans approved by Board of Directors. Alegent Health Mercy Hospital in Corning, IA collaborates with the public health agencies of both Adams and Taylor County to conduct the CHNA at least every three years. The CHNA is conducted by thorough review of available data and focus group meetings. The hospital plays a key role in the Adams County Public Health by employing staff that provide all of the county public health services through a contractual arrangement with the County Board of Supervisors. The hospital works collaboratively with the Taylor County public health agency to provide needed services through in kind arrangements and contractual agreements. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Notification about the availability of Financial Assistance from CHI Hospital Organizations shall be disseminated by various means, which may include, but not be limited to: * Conspicuous publication of notices in patient bills; * Notices posted in emergency rooms, urgent care centers, admitting/registration departments, business offices, and at other public places as a Hospital Facility may elect; and * Publication of a summary of this Policy on the Hospital Facility's website, www.catholichealth.net, and at other places within the communities served by the Hospital Facility as it may elect. Such notices and summary information shall include a contact number and shall be provided in English, Spanish, and other primary languages spoken by the population served by an individual Hospital Facility, as applicable. Referral of patients for Financial Assistance may be made by any member of the CHI Hospital Organization non-medical or medical staff, including physicians, nurses, financial counselors, social workers, case managers, chaplains, and religious sponsors. A request for assistance may be made by the patient or a family member, close friend, or associate of the patient, subject to applicable privacy laws. In addition, Hospital registration clerks are trained to provide consultation to those who have no insurance or potentially inadequate insurance concerning their financial options including application for Medicaid and for assistance under the Financial Assistance Policy. Counselors assist Medicare eligible patients in enrollment by providing referrals to the appropriate government agencies. Once it is determined that the patient does not qualify for any third party funding, the patient is verbally notified about the existence of Financial Assistance Application and additional screening takes place by a Hospital employee to determine if the patient is eligible for charity service prior to discharge. Upon registration (and once all EMTALA requirements are met), patients who are identified as uninsured (and not covered by Medicare or Medicaid) are provided with a packet of information that addresses the Financial Assistance Policy, the plain language summary of that policy, and an application for assistance. Hospital registration clerks read the organization's medical assistance policy to those who appear to be incapable of reading, and provide translators for non-English-speaking individuals. Patients that have been discharged prior to charity screening, such as emergency room patients, receive a written notification of possible eligibility for services. If the patient is determined not to be eligible for government assistance, he/she may notify the hospital that they seek charity assistance. The appropriate charity form is sent to the patient/guarantor for completion and then returned to the hospital for evaluation and qualification. Once determination of eligibility is made, the patient is sent a notice informing him/her if they qualify for full, partial, or no charity care services. Hospital Facilities must make reasonable efforts through its billing and collections processes, pursuant to Treas. Reg. §1.501(r)-6(c), to determine whether any individual is eligible for Financial Assistance. Schedule H, Part VI, Line 4 Community information Alegent Health Mercy Hospital, Corning identified Adams and Taylor Counties as their community for the purpose of the CHNA. As a Critical Access Hospital, Mercy Corning's primary service area is considered the county in which they are located (Adams County). While Mercy Corning is the only hospital located in Adams County, they also serve residents from Taylor County where there are no local hospitals. Therefore, both counties were included in the community definition. Mercy Corning resides in Corning, Iowa which is situated near the center of Adams County, bordering Taylor County on the north. Both counties are non-metropolitan and located near the western and southern border of Iowa. Adams County has one school district and 4 incorporated towns. Corning is the County Seat and there are also 10 other townships. Taylor County has 3 public school districts and 9 incorporated towns. Bedford is the County Seat and there are also 6 other townships. The two-County area is primarily rural with the vast majority of the area having a population density of fewer than 51 persons per square mile. Corning is approximately 80 miles from the Omaha, Nebraska and Council Bluffs, Iowa, which is a major metropolitan area. Population data shows a primarily Non-Hispanic White population, and a much higher percentage of residents over 65 years of age in Adams (21.1%) and Taylor (22.0%) compared to the State (15.8%). Adams County covers approximately 423 square miles and Taylor County covers 531 square miles. Both counties have a very low population density. The median household income for Adams County is $47,335 and Taylor County is $44,939 and unemployment is at 3.4% and 4.2% respectively. Poverty is at 12.2% of the population in Adams County, and 13.1% of the population in Taylor County. Both Counties have a higher percentage of children in poverty than the state overall: 18.9% in Adams, 17.4% in Taylor, compared to 15.5% in Iowa overall. Data is not available for high school graduation rates in the two Counties, however 61% of residents in both Counties who are over the age of 25 have a bachelor's degree or higher. This percentage is slightly lower than the State of Iowa which is at 69%. Both Counties have a higher rate of uninsured than the State of Iowa which is at 10% of the population. Uninsured in Adams County is at 14% and Taylor County is at 13% of the population. Adams and Taylor Counties are primarily rural in nature with manufacturing and agriculture being the major industries. POET Bio Refining is a local business that provides steady job opportunities and brings resources to the communities. Mercy Corning, local schools and local government entities provide the bulk of employment outside of the farming industry. Stable County governments as well as strong support from Iowa State University Extension services also maximize resources in the County. Population demographics Adams County: 3,875 Total population 9.5 Population density (population per square mile) 21.4% of population is under the age of 18 21.1% of population is over age 65 49.9% of population is female 0.4% of population is non-Hispanic African American 0.4% of population is American Indian & Alaskan Native 0.6% of population is Asian 0.0% of population is Native Hawaiian/other Pacific islander 1.1% of population is Hispanic 96.9% of population is non-Hispanic White Taylor County: 6,143 Total population 11.9 Population density (population per square mile) 23.1% of population is under the age of 18 22.0% of population is over age 65 49.3% of population is female 0.4% of population is non-Hispanic African American 0.3% of population is American Indian & Alaskan Native 0.3% of population is Asian 0.0% of population is Native Hawaiian/other Pacific islander 7.5% of population is Hispanic 91.0% of population is non-Hispanic White Schedule H, Part VI, Line 5 Promotion of community health The organization's hospital facility(ies) promote health for the benefit of the community. Medical staff privileges in the hospital are available to all qualified physicians in the area, consistent with the size and nature of its facilities. The organization's hospital facility(ies) have an open medical staff. Its board of trustees is composed of prominent citizens in the community. Excess funds are generally applied to expansion and replacement of existing facilities and equipment, amortization of indebtedness, improvement in patient care, and medical training, education, and research. The facility(ies) treat persons paying their bills with the aid of public programs like Medicare and Medicaid. All patients presenting at the hospital for emergency and other medically necessary care are treated regardless of their ability to pay for such treatment. CHI Health has a history of centralized community benefit and hospital specific community benefit investments to address community health needs of the particular service area. Examples of how CHI Health furthers its exempt purpose by promoting the health of the community include: * Financial Assistance and Unpaid costs of Medicaid * Community health improvement services- -Community education, classes and programs (CPR, car seat safety checks, community behavioral health support and education, diabetes, cancer, physical activity and healthy eating and cooking) -Provided nutrition education to those diagnosed as pre-diabetic to reduce the chances of developing diabetes. -Provided healthy cooking classes to community participants to learn how to prepare health meals at home. -Offered a community-wide health event to educate community on: brain health, sleep habits, healthy relationships, childhood health screenings, occupational ergonomics, and blood pressure and blood sugar screenings. -Support groups (cancer, bereavement, youth, etc.) -Community health fairs and screenings -School based healthcare services -Parish Nursing Program and Faith Community Health Network-the CHI Health Faith Community Health Network partners with congregations of all faiths to build capacity and support the growth of Health Ministries which promote health, healing and wholeness in the communities served. - Healthy Families-this program is a free, 8-week health and nutrition program for families with a child between the ages of 4-18 who has been identified in the top 85th percentile of their weight. This program invites the whole family to participate in learning about physical activity, eating healthy, and setting realistic goals as a family. - 5-4-3-2-1Go!-this program is an evidence-based healthy kids countdown message which CHI Health supports through technical assistance and resources for parents and schools to teach kids to learn and practice every day to be healthy and active. - Childcare-CHI Health provided funding to increase capacity of Nebraska Extension Nutrition & Physical Activity Self-Assessment in Child Care (NAP SACC) program to provide training and technical assistance for child care programs in Douglas, Sarpy and Cass Counties in Nebraska. - Breastfeeding-planned and funded the Beyond Best Practices: Creating a Supportive Environment for Breastfeeding Parents conference for clinic and hospital professionals (nurses, medical assistants, dieticians, health coaches/navigators and providers), as well as community based health care workers (WIC dieticians, WIC clinicians, and community and federally qualified health center clinic members). Additionally, provided funding to the Nebraska Breastfeeding Coalition to plan and implement a Certified Lactation Counselor Training for 75 individuals, and an IBCLC Exam Prep course for 25 individuals, as well as to develop a breastfeeding toolkit for worksites and clinics to support promotion of breastfeeding in these spaces. - Provided counseling and assistance in enrolling individuals in means tested insurance programs to improve access to care. - Provide support to health coalitions and investments in social and environmental improvement strategies. These are programs, activities and partnerships that improve the health of persons in the community by addressing the determinants of health, which includes the social, economic and physical environment. See specific examples by community below: Omaha/Council Bluffs Metro - Hope Medical Outreach Coalition-Personnel support and annual operating subsidy. CHI Health hospitals and physicians are one of three health systems that provide access for the patients of three area federally qualified healthcare centers to specialty physician services and hospital based diagnostics and treatment that are unable to afford medical services. - Metro Area Continuum of Care for the Homeless-Financial support to this coalition addressing homelessness in the service area. - Live Well Omaha-a coalition founded by CHI Health (formerly Alegent Health) and the county health department that serves as convener of business, healthcare and community leaders to review health trends and catalyze community action to address health issues. - Live Well Omaha Kids-a community coalition using a collective impact approach to address childhood obesity. - Community Link-a partnership with Catholic Health Initiatives to improve the health and socioeconomic status of patients by assessing and treating their non-medical needs and barriers, which are important factors of their health. - Violence Prevention-a partnership with Catholic Health Initiatives, Women's Center for Advancement and Creighton University to implement a campus based violence prevention Plan known as "Green Dot". - African American Empowerment Network- Support of the Step Up summer jobs program, a workforce development and violence prevention initiative serving a typically low-income part of the community. - Together, Inc.-provided funds to support the newly developed homeless case management project to be housed out of the CUMC emergency department and then at University Campus. The program connects high utilizers of the emergency department, who are identified as homeless, with a case manager who will then assist them in finding sustainable housing and accessing other resources associated with social determinants of health. - One World Community Health-partnership for Baby's Health and Safety between One World and CHI Health to provide education around safe sleep, safe ride, and breastfeeding to expecting mothers, and provide car seats and pack-n-plays as incentive for participation in education program. - Building Healthy Futures-provided support for research to study and create culturally relevant trauma-informed care for refugee populations to be utilized by front-line care providers. - Omaha Bridges Out of Poverty-provided support for Bridges Out of Poverty programming and training to support and train those in poverty on resources and skills to break the cycle of poverty in their family. - The 712 Initiative-provided support to administer programming by The Big Garden agency at the Creektop Community Garden in Council Bluffs, for low-income individuals to build technical skills and capacity for gardening and thereby improving their healthy food access. -Mills County Public Health-provided funding for Family Matters Substance Abuse Prevention Project Schedule H, Part VI, Line 6 Affiliated health care system The organization is affiliated with Catholic Health Initiatives (CHI). CHI, a nonprofit, faith-based health system formed in 1996 through the consolidation of four Catholic health systems, expresses its mission each day by creating and nurturing healthy communities in the hundreds of sites across the nation where we provide care. One of the nation's largest nonprofit health systems, Englewood, Colorado-based CHI serves as the Parent company of the system. It operates in 17 states and comprises 101 hospitals, including 4 academic health centers and major teaching hospitals as well as 29 critical-access facilities; community health-services organizations; accredited nursing colleges; home-health agencies; living communities; and other facilities and services that span the inpatient and outpatient continuum of care. In fiscal year 2017, CHI provided more than $1.2 billion in financial assistance and community benefit - a more than 10% increase over the previous year -- for programs and services for the poor, free clinics, education and research. Financial assistance and community benefit totaled more than $2.1 billion with the inclusion of the unpaid costs of Medicare. The health system, which generated operating revenues of $15.5 billion in fiscal year 2017, has total assets of approximately $21.9 billion. CHI provides strategic planning and management services as well as centralized "share services" for the MBOs. The provision of centralized management and shared services including areas such as accounting, human resources, payroll and supply chain provides economies of scale and purchasing power to the MBOs. The cost savings achieved through CHI's centralization enable MBOS to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society. Schedule H, Part VI, Line 7 State filing of community benefit report IA, NE true Adams Community Economic Development PO Box 102 Creston IA 50801 421301169 501(C)(3) 6000 GENERAL SUPPORT 1 0 CHARITY CARE 1747 415611 BOOK REDUCTION OR WRITE OFF OF PATIENT SERVICES ROSE ANN AUXILIARY SCHOLARSHIPS 1 500 Schedule I, Part III, Column (a) THE ROSE ANN AUXILIARY SCHOLARSHIP IS PROVIDED TO FUND THE SECOND SEMESTER OF STUDY TO ELIGIBLE HIGH SCHOOL SENIORS ENTERING THE HEALTH CARE FIELD. APPLYING STUDENTS MUST INDICATE A HEALTH CARE MAJOR AND COLLEGE OR INSTITUTION THEY PLAN TO ATTEND ACCOMPANIED BY A LETTER STATING REASONS WHY THEY SHOULD RECEIVE THE SCHOLARSHIP AND PERSONAL INFORMATION TO HELP THE SELECTION COMMITTEE IN MAKING THEIR DECISION. AFTER THE SCHOLARSHIP IS GRANTED, STUDENTS MUST PROVIDE GRADES FOR THEIR FIRST SEMESTER AND PROOF OF ENROLLMENT FOR A SECOND SEMESTER. Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds. Alegent Health-Mercy Hospital, Corning, IOWA recognizes the right to quality healthcare regardless of age, sex, race, religion, national origin, or ability to pay. Business office staff help patients seek local, state, and federal reimbursement at no charge when no other source of payment is available. Financial assistance is provided to patients with demonstrated inability to pay for medically necessary services. THESE FUNDS ARE DIRECTLY USED TO OFFSET THE PATIENTS ACCOUNTS RECEIVABLE. SCHEDULE I, PART I, LINE 2: The organization makes grants to other 501(C)(3) organizations and the funds are only provided for charitable purposes. false true false false false false false true false CLIFF ROBERTSON MD Board Member/CEO CHI Health 0 829993 0 808133 0 186513 0 148918 0 18822 0 1992379 0 163181 ROBERT LANIK Board Member 0 0 0 0 0 241288 0 0 0 0 0 241288 0 238436 AMY L MCGAHA md BOARD MEMBER 0 272114 0 500 0 511 0 15117 0 1037 0 289279 0 0 MICHAEL ROWAN FACHE Board member/CHI EVP & COO 0 1345828 0 2064833 0 598373 0 15900 0 18038 0 4042972 0 244488 DEBRA GOLDSMITH President, Regional HOSPITAL 133552 27702 33406 0 7922 6521 20552 0 17531 0 212963 34223 0 0 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 0 521281 0 361604 0 79344 0 63028 0 18492 0 1043749 0 58320 CAROLINE AMAO MD PHYSICIAN 168921 0 500 0 555 0 10206 0 10975 0 191157 0 0 0 MAEN HADDADIN MD PHYSICIAN 66380 275688 0 500 0 1866 15791 0 18736 0 100907 278054 0 0 BETHEL KOPP MD PHYSICIAN 327113 0 16563 0 5319 0 15900 0 12386 0 377281 0 0 0 LINDA ROBINSON MD PHYSICIAN 210699 0 5480 0 5277 0 11227 0 12352 0 245035 0 0 0 JOHN SAFRANEK MD PHYSICIAN 262174 0 500 0 1024 0 15430 0 16687 0 295815 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Compensation for the top management official was established and paid by the following related organizations: Catholic Health Initiatives (CHI) and Franciscan Health System (FHS). CHI and FHS used the following to establish the top management official's compensation: (1) Compensation Committee; (2) Independent Compensation Consultant; (3) Written Employment Contracts; (4) Compensation Survey or Study; (5) Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan DURING THE 2016 CALENDAR YEAR, CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MARKET BASED ORGANIZATION CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN CHI'S SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON MICHAEL ROWAN JEANETTE WOJTALEWICZ ROBERT LANIK DEBRA GOLDSMITH DURING 2016 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON - $133,018 JEANETTE WOJTALEWICZ - $47,128 DEBRA GOLDSMITH - $8,282 DURING 2016 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON - $163,181 MICHAEL ROWAN - $244,488 ROBERT LANIK - $238,436 JEANETTE WOJTALEWICZ - $58,320 DUE TO THE "SUPER" VESTING RULES UNDER THE CHI DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS TERMINATION, AGE, OR YEARS OF SERVICE WERE ELIGIBLE TO RECEIVE THEIR 2016 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION, ON SCHEDULE J, PART II. DURING 2016, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: MICHAEL ROWAN - $338,873 Schedule J, Part I, Line 7 Non-fixed payments CATHOLIC HEALTH INITIATIVES (CHI) MAINTAINS A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES, QUALITY IMPROVEMENT, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON HITTING MINIMUM LEVELS OF OPERATING MARGIN AND CHARITY CARE LEVELS, UNLESS THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES USES THEIR DISCRETION TO APPROVE AN EXCEPTION. Form 990, Part III, Line 4d Description of other program services (Expenses $ 14,635,938 including grants of $ 199,053)(Revenue $ 9,247,824) OTHER PROGRAM SERVICES Form 990, Part V, Line 1c PAYMENTS TO VENDORS PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF Catholic Health Initiatives (CHI) ARE MADE BY CHI. CHI FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY CHI ON BEHALF THE ENTITIES PART OF CHI ARE REPORTED TO THE IRS. Form 990, Part VI, Line 12c CONFLICT OF INTEREST POLICY (CONTINUED) The Board Chair or designee shall make such further investigation of any conflict of interest disclosures as he or she may deem appropriate. If the conflict involves the Board Chair, the Vice Chair will assume the Chair's role outlined in the COI Policy. Based on review and evaluation of the relevant facts and circumstances, the Board Chair will make an initial determination as to whether a conflict of interest exists and whether, pursuant to the COI Policy, review and approval or other action by the Board is required. A written record of the Board Chair's determination, including relevant facts and circumstances, will be made. The Board Chair shall then make an appropriate report to the Executive Committee of the Board concerning such review, evaluation and determination. If a difference of opinion exists between the Board Chair and another Trustee as to whether the facts and circumstances of a given situation constitute a conflict of interest or whether Board review and approval or other action is required within the COI Policy, the matter shall be submitted to the Board's Executive Committee, which shall make a final determination as to the matter presented. Such determination, including relevant facts and circumstances, will be reflected in the Executive Committee minutes and will be reported to the Board. The Board shall carefully scrutinize and must in good faith approve or disapprove any transaction in which CHI or a CHI Entity is a party and in which the Trustee or Corporate Officer either: * Has a material financial interest; or * Is a Trustee or Corporate Officer of the other party (other than a CHI-affiliated organization). The Board must approve the transaction by a majority of the Trustees on the Board, without counting the vote of any individual who has an interest in the transaction. In reviewing such transactions between CHI or CHI Entities and vendors or other contractors who are, or are affiliated with, Trustees or Corporate Officers, the Board shall act no more or less favorably than it would in reviewing transactions with unrelated third parties. The transaction will not be approved unless the Board determines that the transaction is fair to CHI or the CHI Entity. The Board shall carefully review and scrutinize any non-transactional conflict of interest (e.g., disclosure of nonpublic information, competition with CHI or a CHI Entity, failure to disclose a corporate opportunity, excessive gifts or entertainment, etc.). By a majority vote of the disinterested Trustees, the Board shall take whatever action is deemed appropriate with respect to the Trustee or Corporate Officer under the circumstances, including possible disciplinary or corrective action, in order to best protect the interests of CHI or the CHI Entity. The Board should consult with the General Counsel of CHI or his or her designee when considering disciplinary or corrective action. When any conflict of interest is considered by the Board, the Trustee or Corporate Officer, as appropriate, must disclose all of the material facts to the Board. The Trustee shall not vote and the Trustee or Corporate Officer shall not use his or her personal influence on the matter. However, if requested, such Trustee or Corporate Officer is not prevented from briefly stating his or her position in the matter, nor from answering pertinent questions from Trustees, as his or her knowledge may be of significant importance. The Trustee or Corporate Officer shall be excused from the meeting during discussion and vote on the conflict of interest. Minutes of the Board shall reflect the following: the individual making the disclosure, the nature of the disclosure, discussion regarding any proposed transaction, the decision made by the Board, and that the interested Trustee or Corporate Officer was excused during the discussion, and that the interested Trustee abstained from voting. If the Board reasonably believes that a Trustee or Corporate Officer has failed to disclose either an actual or potential conflict of interest, or all material facts surrounding an actual or possible conflict as required by the COI Policy, the Trustee or Corporate Officer will be given an opportunity to explain such alleged failure to disclose. After hearing the response of the Trustee or Corporate Officer, the Board will conduct such additional investigation as may be appropriate. If the Board determines that the Trustee or Corporate Officer has in fact failed to disclose as required by the COI Policy, the Board shall take appropriate disciplinary or corrective action. All determinations of conflicts of interest are reported as required by law, regulations, and CHI policy. Form 990, Part VI, Line 6 Classes of members or stockholders CHI Nebraska IS THE SOLE MEMBER OF ALEGENT HEALTH-MERCY HOSPITAL, CORNING, IOWA. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body According to the organization's bylaws, directors shall be appointed or refused by the corporate member. The corporate member may appoint one or more individuals to the board of directors, and may at any time remove, with or without cause, any member of the board of directors. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The organization's corporate member is CHI Nebraska. Pursuant to Section 5.4.1 of the organization's bylaws, both CHI Nebraska and Catholic Health Initiatives ("CHI") have reserved powers as outlined in the CHI governance matrix. Pursuant to the governance matrix the following rights are held by the CHI Nebraska's Board: * Approve members of the Alegent Health- Mercy, Corning board. * Amendment of the corporate documents of the Alegent Health-Mercy, Corning. *Approve removal of a member of the governing body of the Alegent Health-Mercy, Corning. * Adoption of long range and strategic plans for the Alegent Health-Mercy, Corning. The following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: * Substantial change in the mission or philosophy of the Alegent health-Mercy, Corning. * Removal of a member of the governing body of the Alegent Health-Mercy, Corning. * Approval of issuance of debt by Alegent Health-Mercy, Corning. * Approval of participation of Alegent Health-Mercy, Corning in a joint venture. *Approval of formation of a new corporation by Alegent health-Mercy, Corning. * Approval of a merger involving the Alegent Health-Mercy, Corning. * Approval of the sale of all or substantially all of the assets of the Alegent Health-Mercy, Corning. * To require the transfer of assets by the Alegent Health-Mercy, Corning to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. Pursuant to Section 5.5.2 of the organization's bylaws, CHI Nebraska or CHI may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and its President and the Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. Form 990, Part VI, Line 11b Review of form 990 by governing body FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE CHI TAX DIRECTOR AND THE LOCAL CHIEF FINANCIAL OFFICER. AFTER INCORPORATION OF ANY CHANGES RESULTING FROM THIS REVIEW, THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD A WEEK IN ADVANCE OF THE FINANCE COMMITTEE MEETING. THE FORM 990 IS REVIEWED AT THE FINANCE COMMITTEE MEETING AND THE CHIEF FINANCIAL OFFICER is PRESENT AT THE MEETING TO ANSWER QUESTIONS. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW AND ARE ABLE TO ASK THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR QUESTIONS PRIOR TO FILING WITH THE IRS. UPON CHIEF FINANCIAL OFFICER APPROVAL AND SIGNATURE, THE TAX analyst FILES THE FINAL FORM 990 AS PRESENTED TO THE BOARD AND FINANCE COMMITTEE, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. Form 990, Part VI, Line 12c Conflict of interest policy Catholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") policy (the "Policy") in place to maintain the integrity of all of its activities. The Policy applies to CHI Board of Stewardship Trustees and members of its committees; all CHI Entity board and board committee members; all CHI employees; and all CHI research personnel (both employed and non-employed). Disclosure, review and management of perceived, potential or actual conflicts of interest are accomplished through a defined COI disclosure process. Each Person must promptly and fully disclose to his/her direct manager, supervisor, medical staff office, board or board committee chair any situation or circumstance that may create a conflict of interest. The Person must disclose the actual or potential conflict as soon as she/he becomes aware of it. In any situation where the Person may be in doubt, a full disclosure should be made to permit an impartial and objective determination. In addition to the general ongoing obligation, there are initial disclosure obligations. At the time of initial appointment, a copy of the Policy shall be distributed to the board or committee member along with a conflict of interest disclosure. The board or committee member will complete and submit the disclosure. The completed disclosure shall be maintained in confidence and access shall be limited to persons who have a reasonable need to know the contents. At the time of hiring, a copy of the Policy shall be distributed to all Employees. In addition, a conflict of interest disclosure will be provided. The Employee must complete and submit a conflict of interest disclosure. The completed disclosure shall be maintained in confidence and access shall be limited to persons who have a reasonable need to know the contents. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. On an annual basis, the following Persons must complete a new conflict of interest disclosure: * Board and board committee members; * Employees at the level of vice president and above; * Researchers * Supply Chain Employees at the level of vice president and above and those employees involved in contracting regardless of employment level; * Other Employees as deemed applicable by CHI Leadership * Employees at the level of manager and above (through 6/21/17) Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC"), National or Regional Legal Services, National, Entity, or Research Corporate Responsibility Program, or the Executive Committee of the Board or Board Chair, for review depending on the position of the person involved. Among the factors that should be considered in determining whether a conflict exists are the nature and magnitude of the opportunity, transaction or arrangement, the degree to which it is related to CHI's business, whether the Person with the conflict is the ultimate decision-maker or holds significant influence over the ultimate decision-maker (i.e., degree of independence of the decision-making process), the unique nature of the opportunity, transaction or arrangement, the existence of other viable alternatives and the quality of those alternatives, and what is customary and reasonable in the health care or research industry. When a Person has, or is considering initiating, a business interest or relationship outside of CHI but is uncertain whether the interest constitutes a conflict of interest requiring disclosure under this Policy, the Person should consult with local Corporate Responsibility Program (CRP) staff or CHI Legal Services Group (LSG) staff, as appropriate. As appropriate, a COI management plan will be developed. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such COI management plan in collaboration with local CRP staff or CHI LSG staff, as appropriate. This plan will include documentation of the C-CIRC's determinations and recommendations. As necessary, reports to an appropriate governmental agency or sponsor will be made according to the relevant appendices to this Policy to provide required information regarding how the conflict of interest will be managed, reduced, or eliminated. Designated CHI Entity staff are responsible for monitoring the COI management plan and for documenting monitoring activities. At its sole discretion, a CHI Entity may reject a Person's request to enter into the relationship in question, or require the relationship be sufficiently altered to avoid a potential conflict of interest. The C-CIRC will determine whether a disclosed or otherwise identified interest is a conflict of interest. If the C-CIRC determines that a potential or actual conflict of interest exists that does not currently have appropriate controls to address the conflict of interest, it may recommend that the disclosing Person be allowed to participate in the activity or transaction subject to restrictions as outlined in a written COI management plan. All determinations of conflicts of interest will be reported as required by law, regulations, and CHI policy. If a Person, other than a board or board committee member or corporate officer, required to complete a COI disclosure does not agree with a determination made by the C-CIRC, its interpretation of the COI Policy, still seeks an exemption or exception, or seeks further clarification of the C-CIRC's decision, the following steps should be followed. Within a reasonable period of time after receiving notice of the C-CIRC's decision, the Person must present the matter to the Person's immediate direct manager or supervisor (or in the case of a Researcher, to [fill in the title or position to whom Researchers report]) and request reconsideration, submitting at that time any new or additional information that may support or recommend reconsideration. If the Person's manager individually or in consultation with the manager's Vice President (or higher if the manager is a Vice President) finds that new information supporting reconsideration has been presented, the manager will contact local or National CRP staff, as appropriate, and request that the matter be re-presented to the C-CIRC. The C-CIRC will be reconvened for this purpose and, following such reconsideration, issue a final determination. This appeals process is intended to be narrowly applied, as Persons seeking conflict of interest exemptions or exceptions are expected to offer all available information supporting an exemption or exception at the time the matter is first presented to the C-CIRC. Management of actual or potential conflicts of interest of board or board committee members and corporate officers will be determined by the appropriate board, as reflected in the Policy. Reviews and determinations involving board and board committee members and corporate officers will be the responsibility of the board, board executive committee, or board chair, with guidance from the Legal Services Group (LSG). Each Trustee and Corporate Officer must promptly and fully report to the Board Chair situations that may create a conflict of interest when he or she becomes aware of such situations. In any situation when a Trustee or Corporate Officer is in doubt, full disclosure should be made to permit an impartial and objective determination. A written record of the disclosure will be made. In addition to the ongoing disclosure obligation, all Trustees and Corporate Officers shall complete a COI disclosure questionnaire on an annual basis. A copy of the COI Policy shall be available to Trustees and Corporate Officers. Definitions of terms used in the disclosure questionnaire/form shall also be included. Each Trustee and Corporate Officer must promptly complete the COI disclosure. The disclosures will be reviewed by the CHI Senior Vice President, Legal Services, and General Counsel or his or her designee who will report potential conflicts to the applicable Board Chair. Form 990, Part VI, Line 15a Process to establish compensation of top management official The organization's top management official's compensation is paid by Catholic Health Initiatives (CHI), a related organization. CHI has a defined compensation philosophy. Both the executive and non-executive compensation structures and ranges are reviewed annually in comparison to market data. CHI uses The Korn Ferry Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of the senior most executives is reviewed annually. The Korn Ferry Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Korn Ferry Hay Group to the HR committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September 11, 2017. In addition, Korn Ferry Hay Group completed a comprehensive review of all positions at the level of vice president and above in the fall of 2014 to determine and validate appropriate compensation levels. These levels have been reviewed annually since and revised based on market data, where applicable. Form 990, Part VI, Line 15b Process to establish compensation of other employees SEE DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT. IN ADDITION, THE ARTICLES OF INCORPORATION ARE AVAILABLE FROM THE IOWA SECRETARY OF STATE WEBSITE WWW.SOS.STATE.IA.US THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG. Form 990, Part VIII, Line 2f Other Program Service Revenue Other Program Service Revenue - Total Revenue: 17820, Related or Exempt Function Revenue: 17820, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 34282, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 34282; Form 990, Part IX, Line 11g Other Fees Other Fees for Services - Total Expense: 3762440, Program Service Expense: 3575738, Management and General Expenses: 186702, Fundraising Expenses: 0; ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HEALTHCARE NE 501(c)(3) 3 ACH true ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true ALEGENT CREIGHTON HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING NE 501(c)(3) 7 ACH true ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HEALTHCARE IA 501(c)(3) 3 CHI NEBRASKA true ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HEALTHCARE IA 501(c)(3) 3 CHI NEBRASKA true ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(c)(3) 10 CHI true APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(c)(3) 10 SFH true BAYLOR ST LUKE'S HEALTH VENTURES 17200 ST LUKES WAY STE 170 THE WOODLANDS TX 77384 274499340 PHYSICIANS TX 501(c)(3) Type I SLCHS true BELLEVILLE ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 274005511 HEALTHCARE TX 501(c)(3) 3 SHSC true BISHOP DRUMM RETIREMENT CENTER 1111 6TH AVE DES MOINES IA 50314 420725196 LTERM CARE IA 501(c)(3) 10 CHI-IA CORP true BORNEMANN HEALTHCARE CORPORATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 232187242 HEALTHCARE PA 501(c)(3) Type I CHI true BRAZOSPORT HEALTH FOUNDATION INC 129 CIRCLE WAY STE 102 LAKE JACKSON TX 77566 760080110 FUNDRAISING TX 501(c)(3) Type I BRHS true BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 HEALTHCARE TX 501(c)(3) 3 BRHS true BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HEALTHCARE TX 501(c)(3) 3 SJSC true BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 HEALTHCARE TX 501(c)(3) 10 SJSC true CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HEALTHCARE ND 501(c)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(c)(3) Type I NA true CATHOLIC HEALTH INITIATIVES - COLORADO 188 INVERNESS DRIVE WEST STE 500 ENGLEWOOD CO 80112 840405257 HEALTHCARE CO 501(c)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES IA 50314 420680448 HEALTHCARE IA 501(c)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 6385 CORPORATE DR STE 301 COLORADO SPRINGS CO 80919 840902211 FUNDRAISING CO 501(c)(3) 7 CHIC true CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 6385 CORPORATE DR COLORADO SPRINGS CO 80919 270930004 FUNDRAISING CO 501(c)(3) Type I CHI true CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 HEALTHCARE CO 501(c)(3) Type I CHINS true CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 PHYSICIANS OR 501(c)(3) 10 MMC true CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 480543724 SURGERY CENTER KS 501(c)(3) 3 CHI true CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 HEALTHCARE MN 501(c)(3) 10 CHI true CHI INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(c)(3) Type I CHI true CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(c)(3) Type I CHI true CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(c)(3) 10 CHI NS true CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(c)(3) Type I CHI true CHI NEBRASKA 6940 O ST STE 200 LINCOLN NE 68510 363233121 HEALTHCARE NE 501(c)(3) Type I CHI true CHI ST JOSEPH CHILDREN'S HEALTH 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232342997 HEALTHCARE PA 501(c)(3) Type I CHI true CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(c)(3) Type I CHI true CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER 6624 FANNIN ST 1100 HOUSTON TX 77030 741161938 HEALTHCARE TX 501(c)(3) 3 SLHS true CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 710236913 HEALTHCARE AR 501(c)(3) 3 CHISVHS true CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125064 HOLDING CO AR 501(c)(3) Type II SVIMC true CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 1 MERCY LANE STE 201 HOT SPRINGS AR 71913 261125131 HEALTHCARE AR 501(c)(3) 3 CHISVHS true COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 237419853 HOLDING CO OH 501(c)(1) GSH true COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY IA 51555 421294399 FUNDRAISING IA 501(c)(3) Type I AH-CMHMV true CONTINUING CARE HOSPITAL 150 NORTH EAGLE CREEK DR LEXINGTON KY 40509 611400619 LT ACH KY 501(c)(3) 3 SJHS true COVENANT HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232028429 HOME HEALTH PA 501(c)(3) Type I CHI NHC true ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1450 BATTERSBY AVE ENUMCLAW WA 98022 910715805 HEALTHCARE WA 501(c)(3) 3 FHS true FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 611345363 HEALTHCARE KY 501(c)(3) 3 KOH true FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 562351341 FUNDRAISING KY 501(c)(3) Type I FH true FRANCISCAN CARE CENTER 4111 N HOLLAND-SYLVANIA RD TOLEDO OH 43623 341931806 HEALTHCARE OH 501(c)(3) 10 FLC true FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA WA 98405 911145592 FUNDRAISING WA 501(c)(3) 10 FHS true FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA WA 98405 910564491 HEALTHCARE WA 501(c)(3) 3 CHI true FRANCISCAN HEALTH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BROADWAY TACOMA WA 98402 431882377 PHYSICIANS MO 501(c)(3) 10 CHI true FRANCISCAN LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE OH 501(c)(3) Type II SFH true FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA WA 98402 911939739 HEALTHCARE WA 501(c)(3) 10 FHS true FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(c)(3) 10 CHI true GARRISON MEMORIAL HOSPITAL 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 450227752 HEALTHCARE ND 501(c)(3) 3 SAMC true GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 201536108 MINISTRIES CO 501(c)(3) Type I CHI true GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311778403 EDUCATION OH 501(c)(3) 2 GSH true GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311206047 FUNDRAISING OH 501(c)(3) Type I GSH true GOOD SAMARITAN HOSPITAL 110 N MAIN ST STE 500 DAYTON OH 45402 310536981 HEALTHCARE OH 501(c)(3) 3 SHP true GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY NE 68847 470659443 FUNDRAISING NE 501(c)(3) 7 GSH true GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON 110 N MAIN ST STE 500 DAYTON OH 45402 237296923 FUNDRAISING OH 501(c)(3) 7 SHP true HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON WA 98310 910565546 HEALTHCARE WA 501(c)(3) 3 FHS true HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVE BREMERTON WA 98310 911197626 FUNDRAISING WA 501(c)(3) 7 HMC true HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 760761782 FUNDRAISING MN 501(c)(3) Type I SFMC true HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN WA 98166 910712166 HEALTHCARE WA 501(c)(3) 3 FHS true HOUSE OF MERCY 1111 6TH AVE DES MOINES IA 50314 421323808 SHELTER IA 501(c)(3) 7 CHI-IA CORP true JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029768 HEALTHCARE KY 501(c)(3) 3 KOH true KENTUCKYONE HEALTH MEDICAL GROUP INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611352729 HEALTHCARE KY 501(c)(3) 10 JHSMH true KENTUCKYONE HEALTH INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029769 HEALTHCARE KY 501(c)(3) Type II CHI true LAKEWOOD HEALTH CENTER 600 MAIN AVE S BAUDETTE MN 56623 410758434 HEALTHCARE MN 501(c)(3) 3 CHI true LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVE S BAUDETTE MN 56623 411893795 FUNDRAISING ND 501(c)(3) 7 LHC true LINUS OAKES INC 2700 STEWART PKWY ROSEBURG OR 97471 930821381 SENIOR LIVING OR 501(c)(3) 10 MMC true LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON ND 58054 820558836 HEALTHCARE ND 501(c)(3) 3 CHI true LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN TX 75901 820563768 PROPERTY MGMT TX 501(c)(3) Type I MHSET true MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742761145 HEALTHCARE TX 501(c)(3) 3 SJSC true MADONNA MANOR INC 2344 AMSTERDAM ROAD VILLA HILLS KY 51017 610654635 LIVING ASSIST KY 501(c)(3) 10 FLC true MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA TN 37404 621839548 FUNDRAISING TN 501(c)(3) 7 MHCS true MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA TN 37404 620532345 HEALTHCARE TN 501(c)(3) 3 CHI true MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA TN 37411 300417049 HEALTHCARE TN 501(c)(3) 10 MHCS true MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN TX 75902 750755367 HEALTHCARE TX 501(c)(3) 3 CHI true MEMORIAL MEDICAL CENTER - LIVINGSTON PO BOX 1447 LUFKIN TX 75902 760436439 HEALTHCARE TX 501(c)(3) 3 MHSET true MEMORIAL MEDICAL CENTER - SAN AUGUSTINE PO BOX 1447 LUFKIN TX 75902 752663904 HEALTHCARE TX 501(c)(3) 3 MHSET true MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVE LUFKIN TX 95904 752721155 PHYSICIANS TX 501(c)(3) Type I MHSET true MEMORIAL SPECIALTY HOSPITAL PO BOX 1447 LUFKIN TX 95902 752492741 HEALTHCARE TX 501(c)(3) 3 MHSET true MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVE DES MOINES IA 50314 426076069 AUXILIARY IA 501(c)(3) Type I MF-DM IA true MERCY CLINICS INC 1111 6TH AVE DES MOINES IA 50314 421193699 PHYSICIANS IA 501(c)(3) 10 CHI-IA CORP true MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVE DES MOINES IA 50314 421511682 EDUCATION IA 501(c)(3) 2 CHI-IA CORP true MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES IA 50314 237358794 FUNDRAISING IA 501(c)(3) 7 CHI-IA CORP true MERCY FOUNDATION INC 2700 STEWART PKWY ROSEBURG OR 97471 936088946 FUNDRAISING OR 501(c)(3) 7 MMC true MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 421461064 FUNDRAISING IA 501(c)(3) Type I AHMH-Corning true MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450435338 FUNDRAISING ND 501(c)(3) Type I MHVC true MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS IA 51503 421178204 FUNDRAISING IA 501(c)(3) Type I AHBMHS true MERCY HOSPITAL OF DEVILS LAKE 1031 7TH ST NE DEVILS LAKE ND 58301 450227012 HEALTHCARE ND 501(c)(3) 3 CHI true MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 7TH ST NE DEVILS LAKE ND 58301 352367360 FUNDRAISING ND 501(c)(3) 7 MHDL true MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450226553 HEALTHCARE ND 501(c)(3) 3 CHI true MERCY MEDICAL CENTER 1301 15TH AVE WEST WILLISTON ND 58801 450231183 HEALTHCARE ND 501(c)(3) 3 CHI true MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 420680308 HEALTHCARE IA 501(c)(3) 3 CHI-IA CORP true MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER 1111 6TH AVE DES MOINES IA 50314 421470935 PHYSICIANS IA 501(c)(3) 3 CHI-IA CORP true MERCY MEDICAL CENTER INC 2700 STEWART PKWY ROSEBURG OR 97471 930386868 HEALTHCARE OR 501(c)(3) 3 CHI true MERCY MEDICAL FOUNDATION 1301 15TH AVE WEST WILLISTON ND 58801 450381803 FUNDRAISING ND 501(c)(3) Type I MMC true NEBRASKA HEART HOSPITAL 7500 S 91ST ST LINCOLN NE 68526 392031968 HEALTHCARE NE 501(c)(3) 3 CHI NEBRASKA true North Central Health Care Alliance dba PrimeCare Health Group 401 N 9th St BISMARCK ND 585014507 450439894 HEALTHCARE ND 501(c)(3) 8 NHCA true OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES ND 58474 450231675 HEALTHCARE ND 501(c)(3) 3 CHI true OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH ST OAKES ND 58474 710966606 FUNDRAISING ND 501(c)(3) Type I OCH true PINEYWOODS MEDICAL DEVELOPMENT CORP PO BOX 1447 LUFKIN TX 75902 752493116 PROPERTY MGMT TX 501(c)(3) Type I MHSET true PROVIDENCE CARE CENTER 2025 HAYES AVENUE SANDUSKY OH 44870 341658625 HEALTHCARE OH 501(c)(3) 10 FLC true PROVIDENCE CARE CENTERS 2025 HAYES AVENUE SANDUSKY OH 44870 341826099 HOLDING CO OH 501(c)(3) Type II FLC true PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY OH 44870 341896807 LIVING COMM OH 501(c)(3) 10 FLC true PUEBLO STEPUP 1925 E ORMAN AVE STE G52 PUEBLO CO 81004 841234295 COMMUNITY CO 501(c)(3) 7 CHIC true REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE 12844 MILITARY RD S TUKWILA WA 98168 911170040 HEALTHCARE WA 501(c)(3) 3 FHS true SET OF COLORADO SPRINGS INC 2864 S CIRCLE DR STE 450 COLORADO SPRINGS CO 80906 841183335 LTERM CARE CO 501(c)(3) 7 CHIC true SAINT CLARE'S COMMUNITY CARE INC 25 POCONO RD DENVILLE NJ 07834 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