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CHI LISBON HEALTH: Form 990, tax year 2015

View the entire original 990 at ProPublica ↗

Organization
CHI LISBON HEALTH (EIN 82-0558836)
Tax period
2015-07-01 to 2016-06-30
Filed
2017-05-13
IRS object ID
201731339349300708
Schema version
2015v3.0
Source
Download XML · Original 990 at ProPublica

Every field in the e-filed return. Faint text is the IRS element name, for citing.

Return header ReturnHeader

FieldValueIRS element (for citing)
Return2017-05-13T08:00:14-05:00ReturnTs
Tax Period End2016-06-30TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

FieldValueIRS element (for citing)
Preparer Firm EIN470617373PreparerFirmEIN

Preparer Firm Name PreparerFirmName

FieldValueIRS element (for citing)
Business Name Line1Catholic Health InitiativesBusinessNameLine1Txt

Preparer US Address PreparerUSAddress

FieldValueIRS element (for citing)
Address Line1198 Inverness Drive WestAddressLine1Txt
CityEnglewoodCityNm
State AbbreviationCOStateAbbreviationCd
ZIP80112ZIPCd
FieldValueIRS element (for citing)
Return Type990ReturnTypeCd
Tax Period Begin2015-07-01TaxPeriodBeginDt

Filer Filer

FieldValueIRS element (for citing)
EIN820558836EIN

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Lisbon Area Health ServicesBusinessNameLine1Txt
FieldValueIRS element (for citing)
Business Name ControlLISBBusinessNameControlTxt
Phone7016835241PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line1905 Main StreetAddressLine1Txt
CityLisbonCityNm
State AbbreviationNDStateAbbreviationCd
ZIP58054ZIPCd

Business Officer BusinessOfficerGrp

FieldValueIRS element (for citing)
PersonAmber StowmanPersonNm
Person TitleDivision Director of FinancePersonTitleTxt
Signature2017-05-13SignatureDt
Discuss With Paid PreparerYes (true)DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

FieldValueIRS element (for citing)
Preparer PersonPamela Krohn CPAPreparerPersonNm
PTINP01210500PTIN
Phone3032989100PhoneNum
FieldValueIRS element (for citing)
Tax2015TaxYr
Build TS2021-01-29 14:40:06ZBuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

FieldValueIRS element (for citing)
Business Name Line1CHI Lisbon HealthBusinessNameLine1Txt

Principal Ofcr Business Name PrincipalOfcrBusinessName

FieldValueIRS element (for citing)
Business Name Line1Peggy ReinkeBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1905 Main StreetAddressLine1Txt
CityLisbonCityNm
State AbbreviationNDStateAbbreviationCd
ZIP58054ZIPCd
FieldValueIRS element (for citing)
Gross Receipts$12,703,409GrossReceiptsAmt
Group Return For AffiliatesfalseGroupReturnForAffiliatesInd
Group Exemption0928GroupExemptionNum
Organization501c3Yes (X)Organization501c3Ind
Website Addresswww.lisbonhospital.comWebsiteAddressTxt
Type Of Organization CorpYes (X)TypeOfOrganizationCorpInd
Formation2002FormationYr
Legal Domicile StateNDLegalDomicileStateCd
Activity Or MissionTo provide high quality health care within ideals of compassion and concern, to be committed to maintain our presence into the future by serving our customers, to assure continuity of total care.ActivityOrMissionDesc
Voting Members Governing Body8VotingMembersGoverningBodyCnt
Voting Members Independent6VotingMembersIndependentCnt
Total Employee121TotalEmployeeCnt
Total Volunteers10TotalVolunteersCnt
Total Gross UBI$155TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm$0NetUnrelatedBusTxblIncmAmt
PY Contributions Grants$95,802PYContributionsGrantsAmt
CY Contributions Grants$78,916CYContributionsGrantsAmt
PY Program Service Revenue$11,243,188PYProgramServiceRevenueAmt
CY Program Service Revenue$12,410,689CYProgramServiceRevenueAmt
PY Investment Income$62,722PYInvestmentIncomeAmt
CY Investment Income$110,741CYInvestmentIncomeAmt
PY Other Revenue$42,873PYOtherRevenueAmt
CY Other Revenue$91,086CYOtherRevenueAmt
PY Total Revenue$11,444,585PYTotalRevenueAmt
CY Total Revenue$12,691,432CYTotalRevenueAmt
PY Grants And Similar Paid$92,332PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid$126,186CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members$0PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members$0CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid$4,496,764PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid$4,655,452CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns$0PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns$0CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense$0CYTotalFundraisingExpenseAmt
PY Other Expenses$7,332,865PYOtherExpensesAmt
CY Other Expenses$6,064,733CYOtherExpensesAmt
PY Total Expenses$11,921,961PYTotalExpensesAmt
CY Total Expenses$10,846,371CYTotalExpensesAmt
PY Revenues Less Expenses-$477,376PYRevenuesLessExpensesAmt
CY Revenues Less Expenses$1,845,061CYRevenuesLessExpensesAmt
Total Assets BOY$9,218,384TotalAssetsBOYAmt
Total Assets EOY$12,247,718TotalAssetsEOYAmt
Total Liabilities BOY$1,788,457TotalLiabilitiesBOYAmt
Total Liabilities EOY$3,077,022TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY$7,429,927NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY$9,170,696NetAssetsOrFundBalancesEOYAmt
MissionSee Schedule OMissionDesc
Significant New Program SrvcfalseSignificantNewProgramSrvcInd
Significant ChangefalseSignificantChangeInd
Expense$9,735,938ExpenseAmt
Grant$126,186GrantAmt
Revenue$12,410,689RevenueAmt
DescSEE SCHEDULE HDesc
Total Program Service Expenses$9,735,938TotalProgramServiceExpensesAmt
Described In Section501c3Yes (true)DescribedInSection501c3Ind
Schedule B RequiredYes (true)ScheduleBRequiredInd
Political Campaign ActyfalsePoliticalCampaignActyInd
Lobbying ActivitiesYes (true)LobbyingActivitiesInd
Subject To Proxy TaxfalseSubjectToProxyTaxInd
Donor Advised FundfalseDonorAdvisedFundInd
Conservation EasementsfalseConservationEasementsInd
Collections Of ArtfalseCollectionsOfArtInd
Credit CounselingfalseCreditCounselingInd
Temp Or Permanent EndowmentsYes (true)TempOrPermanentEndowmentsInd
Report Land Building EquipmentYes (true)ReportLandBuildingEquipmentInd
Report Investments Other SecYes (true)ReportInvestmentsOtherSecInd
Report Program Related InvstfalseReportProgramRelatedInvstInd
Report Other AssetsYes (true)ReportOtherAssetsInd
Report Other LiabilitiesYes (true)ReportOtherLiabilitiesInd
Include FIN48 FootnoteYes (true)IncludeFIN48FootnoteInd
Independent Audit Fincl StmtfalseIndependentAuditFinclStmtInd
Consolidated Audit Fincl StmtYes (true)ConsolidatedAuditFinclStmtInd
School OperatingfalseSchoolOperatingInd
Foreign OfficefalseForeignOfficeInd
Foreign ActivitiesfalseForeignActivitiesInd
More Than5000 K To OrgfalseMoreThan5000KToOrgInd
More Than5000 K To IndividualsfalseMoreThan5000KToIndividualsInd
Professional FundraisingfalseProfessionalFundraisingInd
Fundraising ActivitiesYes (true)FundraisingActivitiesInd
Gaming ActivitiesYes (true)GamingActivitiesInd
Operate HospitalYes (true)OperateHospitalInd
Audited Financial Stmt AttYes (true)AuditedFinancialStmtAttInd
Grants To OrganizationsfalseGrantsToOrganizationsInd
Grants To IndividualsYes (true)GrantsToIndividualsInd
Schedule J RequiredYes (true)ScheduleJRequiredInd
Tax Exempt BondsfalseTaxExemptBondsInd
Engaged In Excess Benefit TransfalseEngagedInExcessBenefitTransInd
PY Excess Benefit TransfalsePYExcessBenefitTransInd
Loan OutstandingYes (true)LoanOutstandingInd
Grant To Related PersonfalseGrantToRelatedPersonInd
Business Rln With Org MemfalseBusinessRlnWithOrgMemInd
Business Rln With Fam MemfalseBusinessRlnWithFamMemInd
Business Rln With Officer EntfalseBusinessRlnWithOfficerEntInd
Deductible Non Cash ContrifalseDeductibleNonCashContriInd
Deductible Art ContributionfalseDeductibleArtContributionInd
Terminate OperationsfalseTerminateOperationsInd
Partial LiquidationfalsePartialLiquidationInd
Disregarded EntityfalseDisregardedEntityInd
Related EntityYes (true)RelatedEntityInd
Related Organization Ctrl EntfalseRelatedOrganizationCtrlEntInd
Trnsfr Exmpt Non Chrtbl Rltd OrgfalseTrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted PrtshpfalseActivitiesConductedPrtshpInd
Schedule O RequiredYes (true)ScheduleORequiredInd
IRP Document0IRPDocumentCnt
IRP Document W2 G0IRPDocumentW2GCnt
Employee121EmployeeCnt
Employment Tax Returns FiledYes (true)EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over LimitfalseUnrelatedBusIncmOverLimitInd
Foreign Financial AccountfalseForeignFinancialAccountInd
Prohibited Tax Shelter TransfalseProhibitedTaxShelterTransInd
Taxable Party NotificationfalseTaxablePartyNotificationInd
Nondeductible ContributionsfalseNondeductibleContributionsInd
Quid Pro Quo ContributionsfalseQuidProQuoContributionsInd
Form8282 Property Disposed OffalseForm8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft CntrctfalseRcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft CntrctfalsePayPremiumsPrsnlBnftCntrctInd
Indoor Tanning ServicesfalseIndoorTanningServicesInd
Info In Schedule O Part VIYes (X)InfoInScheduleOPartVIInd
Governing Body Voting Members8GoverningBodyVotingMembersCnt
Independent Voting Member6IndependentVotingMemberCnt
Family Or Business RlnfalseFamilyOrBusinessRlnInd
Delegation Of Mgmt DutiesfalseDelegationOfMgmtDutiesInd
Change To Org DocumentsfalseChangeToOrgDocumentsInd
Material Diversion Or MisusefalseMaterialDiversionOrMisuseInd
Members Or StockholdersYes (true)MembersOrStockholdersInd
Election Of Board MembersYes (true)ElectionOfBoardMembersInd
Decisions Subject To ApprovaYes (true)DecisionsSubjectToApprovaInd
Minutes Of Governing BodyYes (true)MinutesOfGoverningBodyInd
Minutes Of CommitteesYes (true)MinutesOfCommitteesInd
Officer Mailing AddressfalseOfficerMailingAddressInd
Local ChaptersfalseLocalChaptersInd
Form990 Provided To Gvrn BodyYes (true)Form990ProvidedToGvrnBodyInd
Conflict Of Interest PolicyYes (true)ConflictOfInterestPolicyInd
Annual Disclosure Covered PrsnYes (true)AnnualDisclosureCoveredPrsnInd
Regular Monitoring EnfrcYes (true)RegularMonitoringEnfrcInd
Whistleblower PolicyYes (true)WhistleblowerPolicyInd
Document Retention PolicyfalseDocumentRetentionPolicyInd
Compensation Process CEOfalseCompensationProcessCEOInd
Compensation Process OtherfalseCompensationProcessOtherInd
Investment In Joint VenturefalseInvestmentInJointVentureInd
Upon RequestYes (X)UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Amber StowmanBusinessNameLine1Txt
FieldValueIRS element (for citing)
Phone7012378022PhoneNum

US Address USAddress

FieldValueIRS element (for citing)
Address Line14784 Amber Valley ParkwayAddressLine1Txt
CityFargoCityNm
State AbbreviationNDStateAbbreviationCd
ZIP58104ZIPCd

Form990 Part VII Section A Form990PartVIISectionAGrp (15 entries)

TitleTitleTxtAverage Hours Per WeekAverageHoursPerWeekRtAverage Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRtIndividual Trustee Or DirectorIndividualTrusteeOrDirectorIndOfficerOfficerIndReportable Comp From OrgReportableCompFromOrgAmtReportable Comp From Rltd OrgReportableCompFromRltdOrgAmtOther CompensationOtherCompensationAmtHighest Compensated EmployeeHighestCompensatedEmployeeIndFormer Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
PEGGY REINKE
PRESIDENT40.00.0Yes (X)Yes (X)$0$262,430$20,207
NEIL OLERUD
Vice Chair1.00.0Yes (X)Yes (X)$0$0$0
BRIAN SHELTON
CHAIR1.00.0Yes (X)Yes (X)$0$0$0
Sister Donna Welder
Secretary1.00.0Yes (X)Yes (X)$0$0$0
LIZ ANDERSON
Board member1.00.0Yes (X)$0$0$0
JEFFREY DROP
Board Member/CHI SVP Division Officer1.060.0Yes (X)$0$1,216,002$27,308
Jason Enger
BOARD MEMBER1.00.0Yes (X)$0$0$0
Dwayne Horgeshimer
BOARD MEMBER1.00.0Yes (X)$0$0$0
AMBER STOWMAN
Division Director of Finance (Beginning 11/8/15)40.00.0Yes (X)$0$107,927$39,760
SAMMY KING
VP OPERATIONAL FINANCE (Through 9/18/15)20.040.0Yes (X)$0$100,749$507
Julie A Mallett
VP PATIENT CARE SERVICES40.00$109,656$0$6,251Yes (X)
KEVIN JACOBSON
Nurse Practitioner40.00$146,770$0$29,711Yes (X)
JILL MCRITCHIE
MANAGER PHARMACY40.00$119,864$0$37,381Yes (X)
OSCAR FERNANDEZ
PHYSICIAN40.00$338,431$0$34,386Yes (X)
BECKI THOMPSON
VP OPERATIONAL FINANCE (THROUGH 7/31/14)0.060.0$0$180,787$24,001Yes (X)
FieldValueIRS element (for citing)
Total Reportable Comp From Org$714,721TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org$1,867,895TotReportableCompRltdOrgAmt
Total Other Compensation$219,512TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K4IndivRcvdGreaterThan100KCnt
Former Ofcr Employees ListedYes (true)FormerOfcrEmployeesListedInd
Total Comp Greater Than150 KYes (true)TotalCompGreaterThan150KInd
Compensation From Other SrcsfalseCompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1TxtCityContractorAddress/USAddress/CityNmState AbbreviationContractorAddress/USAddress/StateAbbreviationCdZIPContractorAddress/USAddress/ZIPCdServicesServicesDescCompensationCompensationAmt
NATIONAL MEDICAL RESOURCES
2900 E BROADWAY AVE SUITE 1BISMARCKND58501EMERGENCY ROOM COVERAGE$299,738
LOPERENA RUDOLF MD
PO BOX 71LISBONND58054ER PHYSICIAN COVERAGE$273,073
NISC NATIONAL INFO SOLUTIONS COOP
3201 NYGREN DRIVEMANDANND58554IT SERVICES$233,579
PRECISION MECHANICAL SERVICES
751 ARMOUR STWEST FARGOND58078MECHANICAL SERVICES$232,500
MOBILITY PLUS
26295 CRYSTAL RDPELICAN RAPIDSMN56572PHYSICAL/OCCUPATIONAL THERAPY SERVICES$223,241
FieldValueIRS element (for citing)
Cntrct Rcvd Greater Than100 K6CntrctRcvdGreaterThan100KCnt
Info In Schedule O Part VIIIYes (X)InfoInScheduleOPartVIIIInd
Federated Campaigns$0FederatedCampaignsAmt
Membership Dues$0MembershipDuesAmt
Fundraising$24,530FundraisingAmt
Related Organizations$0RelatedOrganizationsAmt
Government Grants$16,647GovernmentGrantsAmt
All Other Contributions$37,739AllOtherContributionsAmt
Noncash Contributions$5,478NoncashContributionsAmt
Total Contributions$78,916TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
Patient Services900099$12,410,689$12,410,689$0$0
$0$0$0$0
$0$0$0$0
$0$0$0$0
$0$0$0$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt
FieldValueIRS element (for citing)
Total Program Service Revenue$12,410,689TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

FieldValueIRS element (for citing)
Total Revenue Column$41,260TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$155UnrelatedBusinessRevenueAmt
Exclusion$41,105ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Royalties Revenue RoyaltiesRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Gross Rents GrossRentsGrp

FieldValueIRS element (for citing)
Real$69,205RealAmt
Personal$0PersonalAmt

Less Rental Expenses LessRentalExpensesGrp

FieldValueIRS element (for citing)
Real$0RealAmt
Personal$0PersonalAmt

Rental Income Or Loss RentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Real$69,205RealAmt
Personal$0PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$69,205TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$69,205ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

FieldValueIRS element (for citing)
Securities$69,481SecuritiesAmt
Other$0OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

FieldValueIRS element (for citing)
Securities$0SecuritiesAmt
Other$0OtherAmt

Gain Or Loss GainOrLossGrp

FieldValueIRS element (for citing)
Securities$69,481SecuritiesAmt
Other$0OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

FieldValueIRS element (for citing)
Total Revenue Column$69,481TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$69,481ExclusionAmt
FieldValueIRS element (for citing)
Fundraising Gross Income$15,088FundraisingGrossIncomeAmt
Contri Rpt Fundraising Event$24,530ContriRptFundraisingEventAmt
Fundraising Direct Expenses$8,707FundraisingDirectExpensesAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

FieldValueIRS element (for citing)
Total Revenue Column$6,381TotalRevenueColumnAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$6,381ExclusionAmt
FieldValueIRS element (for citing)
Gaming Gross Income$16,448GamingGrossIncomeAmt
Gaming Direct Expenses$3,270GamingDirectExpensesAmt

Net Income From Gaming NetIncomeFromGamingGrp

FieldValueIRS element (for citing)
Total Revenue Column$13,178TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$13,178ExclusionAmt
FieldValueIRS element (for citing)
Gross Sales Of Inventory$0GrossSalesOfInventoryAmt
Cost Of Goods Sold$0CostOfGoodsSoldAmt

Net Income Or Loss NetIncomeOrLossGrp

FieldValueIRS element (for citing)
Total Revenue Column$0TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$0ExclusionAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDescBusinessBusinessCdTotal Revenue ColumnTotalRevenueColumnAmtRelated Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmtUnrelated Business RevenueUnrelatedBusinessRevenueAmtExclusionExclusionAmt
Medical Records Revenue/Transcription541200$862$0$0$862
Cafeteria722100$287$0$0$287
Education611710$20$0$0$20

Miscellaneous Revenue MiscellaneousRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$1,153TotalRevenueColumnAmt
Related Or Exempt Func Income$0RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$0UnrelatedBusinessRevenueAmt
Exclusion$1,153ExclusionAmt
FieldValueIRS element (for citing)
Other Revenue Total$2,322OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

FieldValueIRS element (for citing)
Total Revenue Column$12,691,432TotalRevenueColumnAmt
Related Or Exempt Func Income$12,410,689RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue$155UnrelatedBusinessRevenueAmt
Exclusion$201,672ExclusionAmt
FieldValueIRS element (for citing)
Info In Schedule O Part IXYes (X)InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

FieldValueIRS element (for citing)
Total$901TotalAmt
Program Services$901ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

FieldValueIRS element (for citing)
Total$125,285TotalAmt
Program Services$125,285ProgramServicesAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

FieldValueIRS element (for citing)
Total$3,654,271TotalAmt
Program Services$3,340,417ProgramServicesAmt
Management And General$313,854ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

FieldValueIRS element (for citing)
Total$207,787TotalAmt
Program Services$189,941ProgramServicesAmt
Management And General$17,846ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

FieldValueIRS element (for citing)
Total$546,486TotalAmt
Program Services$499,551ProgramServicesAmt
Management And General$46,935ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

FieldValueIRS element (for citing)
Total$246,908TotalAmt
Program Services$225,702ProgramServicesAmt
Management And General$21,206ManagementAndGeneralAmt

Fees For Services Legal FeesForServicesLegalGrp

FieldValueIRS element (for citing)
Total$19,621TotalAmt
Management And General$19,621ManagementAndGeneralAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

FieldValueIRS element (for citing)
Total$637TotalAmt
Management And General$637ManagementAndGeneralAmt

Fees For Services Other FeesForServicesOtherGrp

FieldValueIRS element (for citing)
Total$2,727,770TotalAmt
Program Services$2,214,406ProgramServicesAmt
Management And General$513,364ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Advertising AdvertisingGrp

FieldValueIRS element (for citing)
Total$15,723TotalAmt
Management And General$15,723ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

FieldValueIRS element (for citing)
Total$317,970TotalAmt
Program Services$253,192ProgramServicesAmt
Management And General$64,778ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

FieldValueIRS element (for citing)
Total$676,985TotalAmt
Program Services$643,136ProgramServicesAmt
Management And General$33,849ManagementAndGeneralAmt

Occupancy OccupancyGrp

FieldValueIRS element (for citing)
Total$216,911TotalAmt
Program Services$198,281ProgramServicesAmt
Management And General$18,630ManagementAndGeneralAmt

Travel TravelGrp

FieldValueIRS element (for citing)
Total$7,306TotalAmt
Program Services$3,656ProgramServicesAmt
Management And General$3,650ManagementAndGeneralAmt

Conferences Meetings ConferencesMeetingsGrp

FieldValueIRS element (for citing)
Total$192TotalAmt
Program Services$21ProgramServicesAmt
Management And General$171ManagementAndGeneralAmt

Interest InterestGrp

FieldValueIRS element (for citing)
Total$29,726TotalAmt
Program Services$29,726ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

FieldValueIRS element (for citing)
Total$272,592TotalAmt
Program Services$272,592ProgramServicesAmt

Depreciation Depletion DepreciationDepletionGrp

FieldValueIRS element (for citing)
Total$607,753TotalAmt
Program Services$607,753ProgramServicesAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDescTotalTotalAmtProgram ServicesProgramServicesAmtManagement And GeneralManagementAndGeneralAmt
Medical Supplies$726,354$726,354
Bad debts$198,899$198,899
Repairs and maintenance$164,791$163,206$1,585
Dues & subscriptions$30,670$16,755$13,915

All Other Expenses AllOtherExpensesGrp

FieldValueIRS element (for citing)
Total$50,833TotalAmt
Program Services$26,164ProgramServicesAmt
Management And General$24,669ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

FieldValueIRS element (for citing)
Total$10,846,371TotalAmt
Program Services$9,735,938ProgramServicesAmt
Management And General$1,110,433ManagementAndGeneralAmt
Fundraising$0FundraisingAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

FieldValueIRS element (for citing)
BOY$570BOYAmt
EOY$770EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

FieldValueIRS element (for citing)
BOY$1,051,427BOYAmt
EOY$1,904,968EOYAmt

Pledges And Grants Receivable PledgesAndGrantsReceivableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Accounts Receivable AccountsReceivableGrp

FieldValueIRS element (for citing)
BOY$2,234,452BOYAmt
EOY$2,050,352EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

FieldValueIRS element (for citing)
EOY$5,296EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

FieldValueIRS element (for citing)
BOY$8,557BOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

FieldValueIRS element (for citing)
BOY$204,057BOYAmt
EOY$172,868EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

FieldValueIRS element (for citing)
BOY$11,801BOYAmt
EOY$11,801EOYAmt
FieldValueIRS element (for citing)
Land Bldg Equip Cost Or Other Bss$7,692,565LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec$3,667,321LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

FieldValueIRS element (for citing)
BOY$4,023,495BOYAmt
EOY$4,025,244EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

FieldValueIRS element (for citing)
BOY$1,066,413BOYAmt
EOY$2,560,799EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt

Intangible Assets IntangibleAssetsGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Assets Total OtherAssetsTotalGrp

FieldValueIRS element (for citing)
BOY$617,612BOYAmt
EOY$1,515,620EOYAmt

Total Assets TotalAssetsGrp

FieldValueIRS element (for citing)
BOY$9,218,384BOYAmt
EOY$12,247,718EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

FieldValueIRS element (for citing)
BOY$393,963BOYAmt
EOY$1,158,960EOYAmt

Grants Payable GrantsPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Deferred Revenue DeferredRevenueGrp

FieldValueIRS element (for citing)
BOY$3,410BOYAmt
EOY$0EOYAmt

Tax Exempt Bond Liabilities TaxExemptBondLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Escrow Account Liability EscrowAccountLiabilityGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

FieldValueIRS element (for citing)
EOY$0EOYAmt

Mortg Notes Pybl Scrd Invst Prop MortgNotesPyblScrdInvstPropGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Unsecured Notes Loans Payable UnsecuredNotesLoansPayableGrp

FieldValueIRS element (for citing)
BOY$0BOYAmt
EOY$0EOYAmt

Other Liabilities OtherLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,391,084BOYAmt
EOY$1,918,062EOYAmt

Total Liabilities TotalLiabilitiesGrp

FieldValueIRS element (for citing)
BOY$1,788,457BOYAmt
EOY$3,077,022EOYAmt
FieldValueIRS element (for citing)
Organization Follows SFAS117Yes (X)OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

FieldValueIRS element (for citing)
BOY$7,289,831BOYAmt
EOY$9,106,772EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$136,596BOYAmt
EOY$60,424EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

FieldValueIRS element (for citing)
BOY$3,500BOYAmt
EOY$3,500EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$7,429,927BOYAmt
EOY$9,170,696EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

FieldValueIRS element (for citing)
BOY$9,218,384BOYAmt
EOY$12,247,718EOYAmt
FieldValueIRS element (for citing)
Info In Schedule O Part XIYes (X)InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss$1,845,061ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst-$104,299NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets$7OtherChangesInNetAssetsAmt
Method Of Accounting AccrualYes (X)MethodOfAccountingAccrualInd
Accountant Compile Or ReviewfalseAccountantCompileOrReviewInd
FS AuditedYes (true)FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

FieldValueIRS element (for citing)
Consolidated Basis Fincl StmtYes (X)ConsolidatedBasisFinclStmtInd
FieldValueIRS element (for citing)
Audit CommitteeYes (true)AuditCommitteeInd
Federal Grant Audit RequiredYes (true)FederalGrantAuditRequiredInd
Federal Grant Audit PerformedYes (true)FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

FieldValueIRS element (for citing)
HospitalYes (X)HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

FieldValueIRS element (for citing)
ContributorRESTRICTEDContributorNum

Contributor Business Name ContributorBusinessName

FieldValueIRS element (for citing)
Business Name Line1RESTRICTEDBusinessNameLine1

Contributor US Address ContributorUSAddress

FieldValueIRS element (for citing)
Address Line1RESTRICTEDAddressLine1
Address Line2RESTRICTEDAddressLine2
CityRESTRICTEDCity
StateRESTRICTEDState
ZIP CodeRESTRICTEDZIPCode
FieldValueIRS element (for citing)
Total ContributionsRESTRICTEDTotalContributionsAmt

Schedule C IRS990ScheduleC

FieldValueIRS element (for citing)
VolunteersfalseVolunteersInd
Paid Staff Or ManagementfalsePaidStaffOrManagementInd
Media AdvertisementsfalseMediaAdvertisementsInd
Mailings MembersfalseMailingsMembersInd
Publications Or BroadcastfalsePublicationsOrBroadcastInd
Grants Other OrganizationsYes (true)GrantsOtherOrganizationsInd
Grants Other Organizations$637GrantsOtherOrganizationsAmt
Direct Contact LegislatorsfalseDirectContactLegislatorsInd
Rallies DemonstrationsfalseRalliesDemonstrationsInd
Other ActivitiesfalseOtherActivitiesInd
Total Lobbying Expenditures$637TotalLobbyingExpendituresAmt
Not Described Section501c3falseNotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYTHE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION $396 CATHOLIC HEALTH ASSOCIATION $241
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITYTHE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION $396 CATHOLIC HEALTH ASSOCIATION $241

Schedule D IRS990ScheduleD

CY Endwmt Fund CYEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,500BeginningYearBalanceAmt
End Year Balance$3,500EndYearBalanceAmt

CY Minus1 Yr Endwmt Fund CYMinus1YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,500BeginningYearBalanceAmt
End Year Balance$3,500EndYearBalanceAmt

CY Minus2 Yr Endwmt Fund CYMinus2YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$3,500BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses$0InvestmentEarningsOrLossesAmt
Grants Or Scholarships$0GrantsOrScholarshipsAmt
Other Expenditures$0OtherExpendituresAmt
Administrative Expenses$0AdministrativeExpensesAmt
End Year Balance$3,500EndYearBalanceAmt

CY Minus3 Yr Endwmt Fund CYMinus3YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
Contributions$3,500ContributionsAmt
Investment Earnings Or Losses$0InvestmentEarningsOrLossesAmt
End Year Balance$3,500EndYearBalanceAmt

CY Minus4 Yr Endwmt Fund CYMinus4YrEndwmtFundGrp

FieldValueIRS element (for citing)
Beginning Year Balance$0BeginningYearBalanceAmt
Contributions$0ContributionsAmt
Investment Earnings Or Losses$0InvestmentEarningsOrLossesAmt
Grants Or Scholarships$0GrantsOrScholarshipsAmt
Other Expenditures$0OtherExpendituresAmt
Administrative Expenses$0AdministrativeExpensesAmt
End Year Balance$0EndYearBalanceAmt
FieldValueIRS element (for citing)
Board Designated Balance EOY0.0BoardDesignatedBalanceEOYPct
Prmnnt Endowment Balance EOY1.0PrmnntEndowmentBalanceEOYPct
Term Endowment Balance EOY0.0TermEndowmentBalanceEOYPct
Endowments Held Unrelated OrgfalseEndowmentsHeldUnrelatedOrgInd
Endowments Held Related OrgfalseEndowmentsHeldRelatedOrgInd

Land LandGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$103,303OtherCostOrOtherBasisAmt
Book Value$103,303BookValueAmt

Buildings BuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$1,244,182OtherCostOrOtherBasisAmt
Depreciation$1,052,541DepreciationAmt
Book Value$191,641BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$0OtherCostOrOtherBasisAmt
Depreciation$0DepreciationAmt
Book Value$0BookValueAmt

Equipment EquipmentGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$6,186,623OtherCostOrOtherBasisAmt
Depreciation$2,504,669DepreciationAmt
Book Value$3,681,954BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

FieldValueIRS element (for citing)
Other Cost Or Other Basis$158,457OtherCostOrOtherBasisAmt
Depreciation$110,111DepreciationAmt
Book Value$48,346BookValueAmt
FieldValueIRS element (for citing)
Total Book Value Land Buildings$4,025,244TotalBookValueLandBuildingsAmt

Other Securities OtherSecuritiesGrp (4 entries)

DescDescBook ValueBookValueAmtMethod ValuationMethodValuationCd
CHI OIP - Fixed Income
CHI OIP - Equity Securities
CHI OIP
CHI OIP$2,560,799F
FieldValueIRS element (for citing)
Total Book Value Securities$2,560,799TotalBookValueSecuritiesAmt

Other Assets Org OtherAssetsOrgGrp (6 entries)

DescDescBook ValueBookValueAmt
Equity in CMDI
Intercompany Receivables
Equity in CMDI
Intercompany Receivables
Equity in CMDI$164,522
Intercompany Receivables$1,351,098
FieldValueIRS element (for citing)
Total Book Value Other Assets$1,515,620TotalBookValueOtherAssetsAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (4 entries)

DescDescAmtAmt
CHI Debt Management Program
Intercompany Payables
CHI Debt Management Program$534,427
Intercompany Payables$1,383,635
FieldValueIRS element (for citing)
Total Liability$1,918,062TotalLiabilityAmt
Footnote TextYes (X)FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail (2 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule D, Part V, Line 4 Intended uses of endowment fundsEndowment funds are held to provide support to and for the benefit of Lisbon Area Health Services.
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnoteLisbon Area Health Services' financial information is included in the consolidated audited financial statements of Catholic Health Initiatives (CHI), a related organization. CHI's FIN 48 (ASC 740) footnote for the year ended June 30, 2016, 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."

Schedule G IRS990ScheduleG

Fundraising Event Information FundraisingEventInformationGrp

FieldValueIRS element (for citing)
Event1FALL GALAEvent1Nm
Gross Receipts Event1$39,618GrossReceiptsEvent1Amt
Charitable Contri Event1$24,530CharitableContriEvent1Amt
Gross Revenue Event1$15,088GrossRevenueEvent1Amt
Rent Facility Costs Event1$5,521RentFacilityCostsEvent1Amt
Food And Beverage Event1$184FoodAndBeverageEvent1Amt
Entertainment Event1$3,002EntertainmentEvent1Amt
Gross Revenue Event2$0GrossRevenueEvent2Amt
Gross Revenue Other Events$0GrossRevenueOtherEventsAmt
Gross Receipts Total$39,618GrossReceiptsTotalAmt
Charitable Contributions Tot$24,530CharitableContributionsTotAmt
Gross Revenue Total Events$15,088GrossRevenueTotalEventsAmt
Rent Fclty Costs Total Events$5,521RentFcltyCostsTotalEventsAmt
Food And Beverage Total Events$184FoodAndBeverageTotalEventsAmt
Entertainment Total Events$3,002EntertainmentTotalEventsAmt
Direct Expense Summary Events$8,707DirectExpenseSummaryEventsAmt
Net Income Summary$6,381NetIncomeSummaryAmt

Gaming Information GamingInformationGrp

FieldValueIRS element (for citing)
Gross Revenue Pull Tabs$14,230GrossRevenuePullTabsAmt
Non Cash Prizes Pull Tabs$3,235NonCashPrizesPullTabsAmt
Other Direct Expenses Pull Tabs$20OtherDirectExpensesPullTabsAmt
Volunteer Labor Pull TabsfalseVolunteerLaborPullTabsInd
Gross Revenue Other Gaming$2,218GrossRevenueOtherGamingAmt
Oth Direct Expnss Other Gaming$15OthDirectExpnssOtherGamingAmt
Volunteer Labor Other GamingfalseVolunteerLaborOtherGamingInd
Gross Revenue Total Gaming$16,448GrossRevenueTotalGamingAmt
Non Cash Prizes Total Gaming$3,235NonCashPrizesTotalGamingAmt
Oth Direct Expnss Total Gaming$35OthDirectExpnssTotalGamingAmt
FieldValueIRS element (for citing)
States Where Gaming ConductedNDStatesWhereGamingConductedCd
LicensedYes (true)LicensedInd
License Suspended EtcfalseLicenseSuspendedEtcInd
Gaming With NonmembersfalseGamingWithNonmembersInd
Member Of Other EntityfalseMemberOfOtherEntityInd
Gaming Own Facility0.0GamingOwnFacilityPct
Gaming Other Facility1.0GamingOtherFacilityPct
Individual With BooksAmber StowmanIndividualWithBooksNm

Persons With Books US Address PersonsWithBooksUSAddress

FieldValueIRS element (for citing)
Address Line1905 Main StreetAddressLine1Txt
CityLIsbonCityNm
State AbbreviationNDStateAbbreviationCd
ZIP58054ZIPCd
FieldValueIRS element (for citing)
Cntrct With3rd Prty For Game RevfalseCntrctWith3rdPrtyForGameRevInd

Gaming Manager Business Name GamingManagerBusinessName

FieldValueIRS element (for citing)
Business Name Line1Jill McritchieBusinessNameLine1Txt
FieldValueIRS element (for citing)
Gaming Manager Compensation$0GamingManagerCompensationAmt
Gaming Manager Services ProvOrganized, promoted, and led the Fall Gala.GamingManagerServicesProvTxt
Gaming Manager Is EmployeeYes (X)GamingManagerIsEmployeeInd
Charitable Distribution RqrfalseCharitableDistributionRqrInd
Distributed$0DistributedAmt

Supplemental Information Detail SupplementalInformationDetail

FieldValueIRS element (for citing)
Form And Line ReferenceSchedule G, Part III, Line 16 Additional Gaming Manager InformationFormAndLineReferenceDesc
ExplanationGAMINGMANAGERBUSINESSNAME=KELLY LARSON,GAMINGMANAGERCOMPENSATIONAMT=0,GAMINGMANAGERSERVICESPROVTXT=ORGANIZED, PROMOTED, AND LED THE FALL GALA.,GAMINGMANAGERISEMPLOYEEIND;ExplanationTxt

Schedule H IRS990ScheduleH

FieldValueIRS element (for citing)
Financial Assistance PolicyYes (true)FinancialAssistancePolicyInd
Written PolicyYes (true)WrittenPolicyInd
All Hospitals PolicyYes (X)AllHospitalsPolicyInd
FPG Reference Free CarefalseFPGReferenceFreeCareInd
FPG Reference Discounted CarefalseFPGReferenceDiscountedCareInd
Free Care Medically IndigentYes (true)FreeCareMedicallyIndigentInd
Financial Assistance BudgetYes (true)FinancialAssistanceBudgetInd
Expenses Exceed BudgetYes (true)ExpensesExceedBudgetInd
Unable To Provide CarefalseUnableToProvideCareInd
Annual Community Bnft ReportYes (true)AnnualCommunityBnftReportInd
Report Publically AvailableYes (true)ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

FieldValueIRS element (for citing)
Persons Served34PersonsServedCnt
Total Community Benefit Expns$70,683TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$70,683NetCommunityBenefitExpnsAmt
Total Expense0.0066TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

FieldValueIRS element (for citing)
Persons Served836PersonsServedCnt
Total Community Benefit Expns$307,582TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$307,582NetCommunityBenefitExpnsAmt
Total Expense0.0289TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

FieldValueIRS element (for citing)
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served870PersonsServedCnt
Total Community Benefit Expns$378,265TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$378,265NetCommunityBenefitExpnsAmt
Total Expense0.0355TotalExpensePct

Community Health Services CommunityHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs6ActivitiesOrProgramsCnt
Persons Served679PersonsServedCnt
Total Community Benefit Expns$25,268TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$25,268NetCommunityBenefitExpnsAmt
Total Expense0.0024TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

FieldValueIRS element (for citing)
Activities Or Programs3ActivitiesOrProgramsCnt
Persons Served33PersonsServedCnt
Total Community Benefit Expns$18,226TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$18,226NetCommunityBenefitExpnsAmt
Total Expense0.0017TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served133PersonsServedCnt
Total Community Benefit Expns$28,029TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,650DirectOffsettingRevenueAmt
Net Community Benefit Expns$21,379NetCommunityBenefitExpnsAmt
Total Expense0.0020TotalExpensePct

Research ResearchGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

FieldValueIRS element (for citing)
Activities Or Programs6ActivitiesOrProgramsCnt
Persons Served322PersonsServedCnt
Total Community Benefit Expns$6,347TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,347NetCommunityBenefitExpnsAmt
Total Expense0.0006TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs16ActivitiesOrProgramsCnt
Persons Served1167PersonsServedCnt
Total Community Benefit Expns$77,870TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,650DirectOffsettingRevenueAmt
Net Community Benefit Expns$71,220NetCommunityBenefitExpnsAmt
Total Expense0.0067TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

FieldValueIRS element (for citing)
Activities Or Programs16ActivitiesOrProgramsCnt
Persons Served2037PersonsServedCnt
Total Community Benefit Expns$456,135TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$6,650DirectOffsettingRevenueAmt
Net Community Benefit Expns$449,485NetCommunityBenefitExpnsAmt
Total Expense0.0422TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Economic Development EconomicDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$1,983TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$1,983NetCommunityBenefitExpnsAmt
Total Expense0.0002TotalExpensePct

Community Support CommunitySupportGrp

FieldValueIRS element (for citing)
Activities Or Programs5ActivitiesOrProgramsCnt
Persons Served706PersonsServedCnt
Total Community Benefit Expns$2,997TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$2,997NetCommunityBenefitExpnsAmt
Total Expense0.0003TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs1ActivitiesOrProgramsCnt
Persons Served20PersonsServedCnt
Total Community Benefit Expns$48TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$48NetCommunityBenefitExpnsAmt
Total Expense0.0000TotalExpensePct

Coalition Building CoalitionBuildingGrp

FieldValueIRS element (for citing)
Activities Or Programs4ActivitiesOrProgramsCnt
Persons Served111PersonsServedCnt
Total Community Benefit Expns$6,929TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$6,929NetCommunityBenefitExpnsAmt
Total Expense0.0007TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

FieldValueIRS element (for citing)
Activities Or Programs2ActivitiesOrProgramsCnt
Persons Served282PersonsServedCnt
Total Community Benefit Expns$10,595TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$10,595NetCommunityBenefitExpnsAmt
Total Expense0.0010TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs0ActivitiesOrProgramsCnt
Persons Served0PersonsServedCnt
Total Community Benefit Expns$0TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$0NetCommunityBenefitExpnsAmt
Total Expense0.0TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

FieldValueIRS element (for citing)
Activities Or Programs13ActivitiesOrProgramsCnt
Persons Served1119PersonsServedCnt
Total Community Benefit Expns$22,552TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue$0DirectOffsettingRevenueAmt
Net Community Benefit Expns$22,552NetCommunityBenefitExpnsAmt
Total Expense0.0021TotalExpensePct
FieldValueIRS element (for citing)
Bad Debt Expense ReportedYes (true)BadDebtExpenseReportedInd
Bad Debt Expense$198,899BadDebtExpenseAmt
Bad Debt Expense Attributable$0BadDebtExpenseAttributableAmt
Reimbursed By Medicare$7,718,798ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr$7,737,942CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall-$19,144MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

FieldValueIRS element (for citing)
Cost To Charge RatioYes (X)CostToChargeRatioInd
FieldValueIRS element (for citing)
Written Debt Collection PolicyYes (true)WrittenDebtCollectionPolicyInd
Financial Assistance PrvsnYes (true)FinancialAssistancePrvsnInd
Hospital Facilities1HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp

FieldValueIRS element (for citing)
Facility1FacilityNum

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Lisbon Area Health ServicesBusinessNameLine1Txt

US Address USAddress

FieldValueIRS element (for citing)
Address Line1905 Main StreetAddressLine1Txt
CityLisbonCityNm
State AbbreviationNDStateAbbreviationCd
ZIP58054ZIPCd
FieldValueIRS element (for citing)
Website Addresswww.lisbonhospital.comWebsiteAddressTxt
State License5031StateLicenseNum
Licensed HospitalYes (X)LicensedHospitalInd
General Medical And SurgicalYes (X)GeneralMedicalAndSurgicalInd
Critical Access HospitalYes (X)CriticalAccessHospitalInd
Emergency Room24 HrsYes (X)EmergencyRoom24HrsInd

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

FieldValueIRS element (for citing)
Business Name Line1Lisbon Area Health ServicesBusinessNameLine1Txt
FieldValueIRS element (for citing)
Facility1FacilityNum
First Licensed CY Or PYfalseFirstLicensedCYOrPYInd
Tax Exempt Hospital CY Or PYfalseTaxExemptHospitalCYOrPYInd
CHNA ConductedYes (true)CHNAConductedInd
Community DefinitionYes (X)CommunityDefinitionInd
Community DemographicsYes (X)CommunityDemographicsInd
Existing ResourcesYes (X)ExistingResourcesInd
How Data ObtainedYes (X)HowDataObtainedInd
Community Health NeedsYes (X)CommunityHealthNeedsInd
Other Health IssuesYes (X)OtherHealthIssuesInd
Community Hlth Needs Id ProcessYes (X)CommunityHlthNeedsIdProcessInd
Consulting ProcessYes (X)ConsultingProcessInd
Information GapsYes (X)InformationGapsInd
CHNA Conducted15CHNAConductedYr
Take Into Account Others InputYes (true)TakeIntoAccountOthersInputInd
CHNA Conducted With Other FcltsfalseCHNAConductedWithOtherFcltsInd
CHNA Conducted With Non FcltsYes (true)CHNAConductedWithNonFcltsInd
CHNA Report Widely AvailableYes (true)CHNAReportWidelyAvailableInd
Rpt Available On Own WebsiteYes (X)RptAvailableOnOwnWebsiteInd
Own Website URLhttp://www.lisbonhospital.com/chna-report.htmOwnWebsiteURLTxt
Paper Copy Public InspectionYes (X)PaperCopyPublicInspectionInd
Implementation Strategy AdoptYes (true)ImplementationStrategyAdoptInd
Implementation Strategy Adpt16ImplementationStrategyAdptYr
Strategy Posted WebsiteYes (true)StrategyPostedWebsiteInd
Strategy Website URLhttp://www.lisbonhospital.com/chna-report.htmStrategyWebsiteURLTxt
Strategy AttachedfalseStrategyAttachedInd
Organization Incur Excise TaxfalseOrganizationIncurExciseTaxInd
Elig Criteria ExplainedYes (true)EligCriteriaExplainedInd
Income Level CriteriaYes (X)IncomeLevelCriteriaInd
Asset Level CriteriaYes (X)AssetLevelCriteriaInd
Medical Indigency CriteriaYes (X)MedicalIndigencyCriteriaInd
Insurance Status CriteriaYes (X)InsuranceStatusCriteriaInd
Underinsurance Stat CriteriaYes (X)UnderinsuranceStatCriteriaInd
Other CriteriaYes (X)OtherCriteriaInd
Explained BasisYes (true)ExplainedBasisInd
App Financial Asst ExplnYes (true)AppFinancialAsstExplnInd
Described InfoYes (X)DescribedInfoInd
Described Suprt DocYes (X)DescribedSuprtDocInd
Provided Hospital ContactYes (X)ProvidedHospitalContactInd
Includes Publicity MeasuresYes (true)IncludesPublicityMeasuresInd
FAP Available On WebsiteYes (X)FAPAvailableOnWebsiteInd
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FAP App Available On WebsiteYes (X)FAPAppAvailableOnWebsiteInd
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FAP Avlbl On Request No ChargeYes (X)FAPAvlblOnRequestNoChargeInd
FAP App Avlbl On Request No ChrgYes (X)FAPAppAvlblOnRequestNoChrgInd
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Documented Elig DeterminationYes (X)DocumentedEligDeterminationInd
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Gross ChargesfalseGrossChargesInd

Supplemental Information SupplementalInformationGrp (6 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part V, Section B, Line 5 Facility , 1Facility , 1 - Lisbon Area Health Services. To help determine future decisions and strategic planning, LAHS conducted a community health needs assessment survey. This was done through a joint effort of LAHS and Sargent County District Health Unit and Ransom County Public Health Department. Community health data was used and solicited input from community members by interviews and a public survey. The survey was distributed throughout Ransom and Sargent County as an on line survey through Survey Monkey. Additional information was collected through key informant interviews of locally identified community leaders. One-on-one interviews with key informants were conducted in person or via phone in Ransom and Sargent counties. Representatives from CHI Lisbon Health conducted the interviews. The individuals selected for interview included those persons who had special knowledge of public health as well as broad interests of the community that CHI Lisbon Health serves. This included individuals from Ransom and Sargent Public Health, area law enforcement, City Mayor, senior service coordinator for the counties, School superintendent and presidents of local community service groups of Civic and Commerce and Kiwanis. These interviews took place from Jan 2016-Mar 2016. Topics covered during these interviews included but not limited to, the most troubling health problems in our communities, issues of concern to the general public officials and the programs already in place to address some of the items identified.
Schedule H, Part V, Section B, Line 6b Facility , 1Facility , 1 - Lisbon Area Health Services. Lisbon Area Health Services (LAHS) conducted a community health needs assessment survey through a joint effort of LAHS and Sargent County District Health Unit and Ransom County Public Health Department.
Schedule H, Part V, Section B, Line 11 Facility , 1Facility , 1 - Lisbon Area Health Services. Prioritized List of Significant Health Needs Identified in CHNA The process used to identify priorities was the discussion and debate method. Preliminary areas of need were identified by the hospital internal assessment team and local public health departments. Discussion was held with external entities, leadership and LAHS Board of Directors. Priorities were selected based on burden, urgency of need and estimated feasibility and effectiveness of possible interventions. Significant health Needs to be Addressed The first significant health need identified was obesity, poor nutrition and inactivity. The objective in addressing this need is to decrease adult obesity by 3% in each county while increasing education and available information regarding obesity and healthy nutrition. Furthermore, exercise opportunities will be increased. LAHS has applied for a $110,000 grant through the Mission and Ministry fund .The goal of the grant is to hire a coordinator to collaborate with local organizations. These include but are not limited to, public health, clinics, schools NDSU extension office and weight loss groups such as weight watchers. These groups will provide education on nutrition and healthy choices. In addition, LAHS is looking for a funding source to collaborate with local community members to implement a walking path. The second significant health need identified was violence prevention. The objective of addressing this need is to reduce reported incidents 20% by 2018. LAHS has collaborated with local law enforcement, social services, county extension, schools and the local domestic violence prevention coalition. The purpose of the coalition is to provide a forum for networking of local agencies. Additionally, the coalition will provide guidance regarding education in the community. LAHS has received a Violence Prevention grant to collaborate with Abuse Resource Network to provide education in the community. Two specific curriculums have been chosen. The first curriculum, Within My Reach focuses on education potential victims and community members about intimate partner violence. The second curriculum, Futures Without Violence focuses on training professionals to incorporate intimate partner violence prevention efforts into their existing work. The third significant health need identified was mental health and caring for patients with addictions and mental health needs. LAHS has collaborated with local law enforcement, ambulance staff, state and city attorneys, South East Human Service Center and Prairie St. Johns. State legislatures will be invited to the group at a later time. The focus of the group is to address obstacles which prevent patients with mental health and addiction concerns from getting help they require. One major obstacle is transportation for persons who need to be transferred to another facility. Due to lack of resources, LAHS will be investigating the feasibility of contracting with Secure Transport for transportation needs. Another obstacle faced by these patients is the wait time for an available bed at a treatment facility. At times these patients may be in the ED for upwards of eight hours waiting for placement. Due to the amount of time in the ED waiting, LAHS will explore the possibility of a "safe room" for these patients. LAHS staff will receive "Handle With Care" training. LAHS will also explore Global Crises Intervention to help care for patients with addictions and mental health concerns. Lack of mental services locally has also been identified as a concern. LAHS will explore contracting with a local counselor to provide services in our facility. Finally, LAHS will continue to use tele psych in the ED setting and pursue this service in an outpatient arena. Significant Health Needs Not Addressed Three areas of identified need are as follows. The first area identified was the cost of health care. This includes cost of services and insurance which include cost of health, dental and vision insurance. LAHS has a Charity Care Program for persons in need to apply for. LAHS is a part of Catholic Health Initiatives, a nonprofit organization with a longstanding commitment to assist those who seek our care, regardless of ability to pay. If a patient is unable to pay for all or part of the care they receive at our hospital, they may be eligible for free or discounted services. Complete explanation and information can be found at www.lisbonhospital.com. The second area identified was the access and cost of child care and infant care. This is an area identified as high need. This will be shared with both counties through Economic Development for their information and planning purposes. This would be out of scope of the mission of LAHS. The third area also identified as high need was bullying. Currently, the Lisbon School system has a bullying program in place to address this topic with school age children. Bullying takes place in a variety of places such as the work place .With the focus on Mental Health concerns, it is felt that an indirect impact may occur to this area of need.
Schedule H, Part V, Section B, Line 13 Facility , 1Facility , 1 - Lisbon Area Health Services. HUD LOW INCOME GUIDELINES, AS WELL AS SIZE OF THE FAMILY ARE USED BY LISBON AREA HEALTH SERVICES TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE.
Schedule H, Part V, Section B, Line 13 Facility , 1Facility , 1 - Lisbon Area Health Services. HUD LOW INCOME GUIDELINES, AS WELL AS SIZE OF THE FAMILY ARE USED BY LISBON AREA HEALTH SERVICES TO DETERMINE ELIGIBILITY FOR DISCOUNTED CARE.
Schedule H, Part V, Section B, Line 22 Facility , 1Facility , 1 - Lisbon Area Health Services. LISBON AREA HEALTH SERVICES USES THE AVERAGE OF MANAGED CARE DISCOUNTS TO DETERMINE THE MAXIMUM AMOUNTS THAT CAN BE CHARGED TO FAP-ELIGIBLE INDIVIDUALS FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE.
FieldValueIRS element (for citing)
Facility0FacilityNum

Supplemental Information Detail SupplementalInformationDetail (19 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule H, Part VI SCHEDULE H PART II AND PART VI, LINES 2, 4, AND 5Community Health Needs Assessment Process To help determine future decisions and strategic planning, LAHS conducted a community health needs assessment survey. This was done through a joint effort of LAHS and Sargent County District Health Unit and Ransom County Public Health Department. Community health data was used and solicited input from community members by interviews and a public survey. The survey was distributed throughout Ransom and Sargent County as an on line survey through Survey Monkey. Additional information was collected through key informant interviews of locally identified community leaders. The survey covered the following information: Economical, environmental, and transportation concerns, concerns surrounding youth, concerns with aging population, concern with safety, level of concern with healthcare, concern with substance use/abuse, preventative screenings, barriers to medical care, demographics, (employment, gender, race, income, years in the community, insurance status) and where care is sought and distance to care. Additionally chronic diseases, routine physical exam, dental care, access to care, concern with physical and mental health and tobacco use were also covered. The survey period was from May 1, 2015 through June 30, 2015. 102 surveys were completed for the assessment, 61 in Ransom County and 41 in Sargent County. This is significantly down from the prior assessment three years ago. There were no information gaps that were identified that impacted the hospitals ability to assess the health needs due to the quantitative information for demographic and health status were available for both counties. The survey tool was designed to: -Understand community's general rating of their own health and health issues -Understand the community's awareness of services -Understand the community's needs for services and concerns -Obtain suggestion for future needs/gaps in services Several sources were reviewed as part of this assessment. The North Dakota Kids Count Fact Book shows that children ages 0-17 living in poverty in 2015 was 121 or 9.5% in Ransom County while Sargent County is 50 or 5.9% a decrease from 2010 in both counties respectively 178 or 13.2% and 97 or 10.5%. North Dakota was 21,403 or 14.1%. Looking at the Ransom and Sargent counties community health profiles on vital statistics data on births and deaths from 2009-2013 you will find that Ransom county's leading cause of death was heart disease followed by cancer while Sargent county's was cancer followed by heart disease. For both counties, the leading cause of death for age group 45-84 was cancer, then heart, and then COPD/unintentional injury. The 85 plus age group came in with heart as number one for Ransom County and cancer for Sargent County. This data would indicate that reductions in mortality may be achieved by focusing on the prevention of cancer and heart disease for the over 45 age group. There are quality of life issues and conditions noted for individuals 18 years or older. The areas included for reference are high blood pressure, obesity, cholesterol, Chronic lung disease, arthritis, cardiovascular disease, stroke, physical activity, smoking, general health, health insurance, drinking habits, vaccination, and crime. The following information was taken from the Ransom and Sargent County Community Health Profile/Adult Behavioral Risk Factors from 2011-2013. Flu vaccinations and pneumonia vaccinations for respondents age 65 or older in Ransom County and Sargent County were not reported with comparison to the North Dakota rate of 40.3% that did not have a flu vaccination and 29.4% that did not receive a pneumonia vaccination. The County Health Rankings for 2015 of North Dakota note ranking of counties in ND. These maps help locate the healthiest and least healthy counties in the state. Ransom County is ranked #16 in Health outcomes and Sargent County is #2 a significant change for both counties from 3 years ago where Ransom county was #6 and Sargent County was ranked #31. In ND county ranking for Health Factors include health behaviors, clinical care, social and economic factors, and physical environmental factors. Ransom County ranks #26 and Sargent County was #3. Three years ago Ransom County was ranked #22 and Sargent County ranked #18. Again dramatic changes. Each of these ranks represents a weighted summary of a number of different measures. Additional information is available at the County Health Rankings website, www.countyhealthrankings.org . It is important to note that these statistics describe the population of Ransom and Sargent County, regardless of where these county residents receive their medical care. The rankings and survey reveal that there is opportunity for improvement in several areas in the LAHS service area. In Ransom and Sargent Counties showed respondents with a body mass index of 25 or greater was 67.2%. This compares to ND overall of 66.1%, which is slightly lower than the two counties. Health and Human resources reported in November of 2015 reported 36.5% of American adults are obese with 40% in the age group of 40-59. According to the State of Obesity: Better policies for a healthier America 2014 , North Dakota is the 9th highest adult obesity rate in the nation, which is significantly up from 2010 which was 28%. For reporting of ever being told that they have diabetes in Ransom County is 9.4% compared to the state of 8.5% which is down a percent for comparisons with the last survey. High Cholesterol is another Risk Factor that showed up as being above the North Dakota average by 4% in the Community Health Profile. Along with this is High Blood Pressure (Hypertension) that comes in at 34% in the two counties when the North Dakota average is 29.5% demonstrating an overall increase in the state. This is respondents who reported ever having been told by a doctor, nurse or other health professional that they had high blood pressure. Respondents who had 8 or more days in a month where their mental health was not good was 9.6% for both Ransom and Sargent Counties. This is compared to ND of 10.8%. Respondents that reported that they did not get the recommended level of activity for Ransom and Sargent counties was 55.3% compared to the state of ND at 53.8%. Those respondents reporting little or no physical activity was 34.5% for both counties compared to ND which is 30.4%. Heavy drinking defined as more than two drinks per day for men and more than one drink for women in Ransom and Sargent Counties is 12.1% while the state is 6.8%. Respondents with binge drinking which is defined as 5 drinks for men and 4 drinks for women was 28.1% for the two counties compared to 24.2% for ND. Secondary Data Secondary data was collected from a variety of sources including U.S. Census Bureau, the North Dakota Department of Health, 2015 North Dakota Kids Count Fact Book, the Robert Wood Johnson Foundation's County Health Rankings, the National Survey of Children's Health Data Resource Center, the North Dakota Behavioral Risk Factor Surveillance System, State of Obesity, and Health and Human Services November 2015. Demographic Information Total population in Ransom County is 5,472 and Sargent County 3,859 contributing to the state of ND population which is 724,840. The statistics show for the two counties (Sargent and Ransom) have a greater percentage of individuals between the age of 50 and 59 have a higher median age than the North Dakota average which is 20-29. The second greatest category for Ransom County is ages 10-19 with Sargent County ages 60-69. Ransom County had the highest education as high school degree while Sargent County was some college/associate degree which is the same category as the state statistics. Those with a disability are 14.5 % for Ransom County and 10.8% in Sargent County with the state percentage of disability at 10.6% for both counties. Both counties and the state seeing the greatest noted with disability seen with those 65 and older. Below Poverty level category results in 504 in Ransom County at 9.5%. Sargent County is at 7.4% ND comparison is 11.9%.
Schedule H, Part VI SCHEDULE H PART II AND PART VI, LINES 2, 4, AND 5 CONTINUEDCommunity Served by Lisbon Area Health Services. LAHS primary service area encircles the two counties of Ransom and Sargent in North Dakota. Although the secondary service area includes parts of 5 counties, Ransom and Sargent counties are the defined primary areas for this assessment as CHI Lisbon health is the only hospital in the county and approximately 10 miles from the Sargent county line. This was determined by the internal assessment team. The communities in these 2 counties are Cogswell, Gwinner, Forman, Milnor, Lisbon, Enderlin, McLeod, Sheldon, Havana, Stirum, Rutland, and Fort Ransom. This community was determined in conjunction with public health from Ransom and Sargent counties. The survey tool was to benefit both of the future work of both public health entities. The survey was available in all of these communities to gain information for LAHS and Ransom and Sargent Public Health Departments. The survey was not intended to be a scientific or statistically valid sampling of the population. This survey was designed to be an additional tool for collecting data from the communities at large. The survey had broad general questions on it also to be able to utilize responses in respective counties/ communities. This is indicated by request for zip codes. The hospital's community benefits programs serve the designated geographical areas. Priority populations include low income seniors, uninsured and underinsured and persons with disabilities and medical conditions. ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE The mission of CHI Lisbon Health and Catholic Health Initiatives is "to nurture the healing ministry of the Church, supported by education and research. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we create healthier communities." Our Vision is to live up to our name as one CHI: Catholic: Living our Mission and Core Values. Health: Improving the health of the people and communities we serve. Initiatives: Pioneering models and systems of care to enhance care delivery Primary tax-exempt purpose: to provide healthcare to the residents of the surrounding communities regardless of their ability to pay. The goal of CHI Lisbon Health is to provide high quality healthcare to meet the needs of the communities we serve. We are committed to maintain our presence into the future by serving our customers with dedicated skilled staff. As a provider of a community based, family oriented healthcare, CHI Lisbon Health believes it can best maintain this level of service through a customer focus, where we continually strive to understand and exceed the expectations of our customers. CHI Lisbon Health, originally known as Community Memorial Hospital, opened its doors on February 1, 1952. Lutheran Hospitals & Homes Society (LHHS) of Fargo worked on this project with the local Community Memorial Hospital Association and assumed operations of the hospital. In 1967 an addition was added to the northeast portion of the hospital, which became a 20-bed nursing home wing. It was determined that additional space was needed and another addition was made to the south of the existing structure. This was completed in 1976 and became the new hospital wing. The previous hospital wing was converted to 25 nursing home beds. In 1992, Community Memorial Hospital and Nursing Home celebrated 40 years of dedicated service to the sick. By 1996 a remodeling project had been completed and a clinic was moved into the facility. At this time the facility's name changed to Lisbon Medical Center. CHI Lisbon Health changed to Critical Access Hospital status effective January 1, 2001. The facility was acquired by Catholic Health Initiatives on October 1, 2002. Shortly thereafter, clinic services were discontinued. On October 15, 2013 CHI Lisbon Health re-opened the clinic within the facility to better serve their community. This clinic is staffed with a Family Nurse Practitioner Certified and a Family Practice Physician. The clinic saw 2,035 patients in FY16. The Clinic is open Monday-Friday from 9am-5pm. CHI Lisbon Health is served by physicians and allied professional staff from CHI Lisbon Health Clinic, Family Medical Clinic and Essentia Health-Lisbon. In addition to LAHS, Lisbon has 3 other clinics, two home care agencies, two hospice agencies and two long term care facilities (LTC) as well as a LTC facility in Enderlin and one in Forman. There are two assisted living facilities and two facilities that offer basic care. Lisbon is located in southeast ND which is one hour away from Fargo. Its economy is based on agriculture, manufacturing, and retail trades. Lisbon Public School System offers curriculum for students K-12 and offers a variety of sports, music and drama. The Historical Opera House hosts several cultural events throughout the year. The scenic theatre offers a variety of selections for diverse ages. The park board maintains 2 city parks, a swimming pool, a ball diamond, and a tennis court. The surrounding areas provide recreational areas such as skiing, water sports, hunting, golf and camping. Medical need and care come first at CHI Lisbon Health. CHI Lisbon Health will provide medically necessary health care services to all persons who are in need, regardless of age, race, religion, national origin, gender, handicap, sexual orientation or ability to pay. Community benefit programs for the poor are geared to reducing morbidity and mortality in beneficiaries of Medicaid, state or local indigent programs. CHI Lisbon Health has a governing Board of Directors whose membership includes 8 representatives from Lisbon and the immediate surrounding area. This includes one woman religious from our founding order, the Sisters of the Presentation of the Blessed Virgin Mary. CHI Lisbon Health also has a Quality Committee-Patient Family Advisory Council and a Foundation Board/ Advisory Council of 9. COMMUNITY BENEFIT APPROACH A community health needs assessment is a systematic process involving community input to identify community health needs, prioritize needs and act on unfulfilled needs. The implementation will be CHI Lisbon Health's plan to address community health needs also known as the community benefit plan. The purpose for conducting a community health needs assessment is to describe the health of the local population, identify community needs, and identify action needed to address the future delivery of health care in Ransom and Sargent counties. A health needs assessment benefits the local community by: 1) opening the discussion between community members about the future of health care in the community, 2) organizing information to help guide, inform and education, 3) collecting input from the local community including providers. CHI Lisbon Health is a 25-bed critical access hospital in Lisbon, North Dakota. This is with 12 acute beds and 13 swing beds. It is a state-designated Level V Trauma Center, a Stroke Ready Hospital and employs approximately 85 people. CHI Lisbon Health is the only hospital in Ransom and Sargent counties and serves 9286 people throughout 1720.87 square miles. Lisbon is in the Health Professional Shortage Areas (HPSAs), the Medically Underserved Areas / Populations, as well as a shortage area for mental health services. HPSA's are designated by Health Resources and Service Administration (HRSA); Dept of Health & Human Services and the Center for Rural Health - UND as having shortages of primary medical care, dental or mental health providers and may be geographic (a county or service area), demographic (low income population) or institutional (comprehensive health center, federally qualified health center or other public facility). Medically Underserved Areas/Populations are areas or populations designated by HRSA as having too few primary care providers, high infant mortality, high poverty and/or high elderly population. Access to an adequate supply of health care providers is a concern in both North Dakota and nationally.
Schedule H, Part VI SCHEDULE H PART II AND PART VI, LINES 2, 4, AND 5 CONTINUEDCOMMUNITY ASSESSMENT, PROCESS AND SUMMARY To help determine future decisions and strategic planning, CHI Lisbon Health conducted a Community Health Needs Assessment survey May 1, 2015 thru June 30, 2015. This was done through a joint effort of CHI Lisbon Health, Sargent County District Health Unit and Ransom County Public Health Department. Community health data was used and solicited input from community members by interviews and a public survey. The survey was widely distributed throughout Ransom and Sargent County on line through Survey Monkey. Additional information was collected through key informant interviews of locally identified community leaders. The complete CHNA is on http://www.lisbonhospital.com/documents/CommunityHealthNeedsAssessmentwebsiteBoardApproved.pdf A needs assessment was previously conducted in the community when Open Door was new to the area. They contacted businesses to work for their clients with Developmental Disabilities. CHI Lisbon Health continues to donate to the non-profit with an hourly stipend, supervision and training in the dietary department. Open Door is a non-profit organization. UNCOMPENSATED CARE FOR THE POOR CHI Lisbon Health provides care to everyone, regardless of his or her ability to pay. Benefits for the poor are persons who cannot afford health care because they have inadequate resources and/or are uninsured or underinsured. Charity Care is free or discounted health and health-related services provided to person who cannot afford to pay for medically necessary health care. Eligibility is based on household income as well as other assets. Consideration is given to a patient who has significant or catastrophic medical bills and does not meet the income guidelines. Charity Care is given to uninsured, low-income patients who are not expected to pay all or part of a bill, or who are able to pay only a portion using an income-related fee schedule. Community benefit programs for the poor are geared to reducing morbidity and mortality in beneficiaries of Medicaid or state or local indigent programs. Financial Assistance applications may be obtained from CHI Lisbon Health or on the website: http://www.lisbonhospital.com/patientsvisitors_financialassistance.htm QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT: FY16 July 1, 2015 - June 30, 2016 Community Benefit Provided to the Poor: Financial Assistance: Number of people served - 34 Community benefit cost $70,683 Unpaid Cost of Medicaid: Number of people served - 836 Community benefit cost $307,582 Community Benefit Operations: Number of people served - 74 Community benefit cost $6,938 Community Building Activities: Number of people served - 111 Community benefit cost $9,891 Financial and In-Kind Contributions: Number of people served - 120 Community benefit cost $4,874 Cost of community benefit provided to the Poor: Number of people served - 1175 Community Benefit Cost $399,968 Community Benefit Provided to the Broader Community: Community Benefit Operations: Number of people served - 3 Community benefit cost $13,259 Community Building Activities: Number of people served - 1,008 Community benefit cost $12,661 Community Health Improvement Services: Number of people served - 735 Community benefit cost $ 26,450 Financial and In-kind Contributions: Number of people served - 202 Community benefit cost $1,473 Health Professions Education: Number of people served - 33 Community benefit cost $18,226 Total Benefit for the Broader Community: Number of people served - 1,981 Community benefit cost $72,069 Total Cost of Community Benefit: Number of people served - 3,156 Community benefit cost $472,037 The unpaid cost of Medicare is not included in total community benefit. Human Investments and Statistics Number of activities: 29 Staff hours: 2,228.50 Volunteer hours: 131 The Total Quantifiable Community Benefits costs $472,037 serving 3,156 persons. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT Community Benefit is the name given to the programs we create in response to health needs in our service areas. An important part of our mission is building healthier communities through programs designed to serve the needs of people who are poor and disadvantaged in our community. This type of Community Benefit has the added, positive side-effect of delivering an improved quality of life for everyone. Community Benefit most often takes place outside the walls of our facilities and involves partner organizations in the community. Our Community Benefit activities are designed to: -Identify and increase awareness of health needs in Lisbon. -Provide resources to meet those needs. -Create collaboration between community organizations that focus on health and well being. COMMUNITY OUTREACH CHI Lisbon Health and CHI's Fargo Division international sister-to-sister hospital program of the new Indigenous People's Hospital opened on May 18, 2012 in Nueva Vizcaya, Philippines. The hospital, located in a remote region of the country, provides care to impoverished tribal people. The new clinic and hospital was immediately busy and had provided care to more than 600 people the day they opened. CHI Lisbon Health gathers supplies and equipment as well as donations for the hospital. CHI Lisbon Health sends supplies to project HERO (Healthcare Equipment Recycling Organization), a non-profit clearinghouse that collects and redistributes donated healthcare materials to benefit those in need. HERO works with several agency and healthcare partners to redistribute viable medical products and getting them to those with health needs. The Fargo Division Philippines Outreach Program received a generous three-year grant from the CHI Mission & Ministry Fund to cover the cost of shipping containers full of medical equipment and supplies to the Indigenous People's Hospital, our sister hospital, in the Philippines. Sister Adellina Javellana, hospital administrator, provided a list of what is most needed to treat the impoverished tribal people of a remote, mountainous region of the Philippines at the Indigenous People's Hospital. We have partnered with MedShare, a nonprofit medical equipment recovery and redistribution organization in the San Leandro, California, to acquire the requested items. CHI Lisbon Health also supports this hospital with an annual monetary donation in the amount of $2,000. The Open Door Project provides an opportunity for the Developmentally Disabled to develop new daily living skills working side by side with the CHI Lisbon Health dietary department. Training and supervision is provided for the tasks they do daily. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY CHI Lisbon Health is dedicated to caring for the broader community, a strong tradition that is vital and necessary to maintain progress in rural areas with limited resources. CHI Lisbon Health provides and supports various services and programs that benefit the community for which there is no reimbursement or reimbursement is not adequate to cover the hospital's cost. Benefits for the Broader Community are persons other than a "target population" who benefit from a health care organization's community services and programs. In-kind services include hours spent by staff as part of their work assignment while on health care organization work time, overhead expenses of space provided to not-for-profit community groups (for meetings) and donation of food, equipment and supplies. Organizations include the Economic and Community Development, Emergency Disaster, Ministerial Association, Lisbon Civic and Commerce, and Kiwanis.
Schedule H, Part VI SCHEDULE H PART II AND PART VI, LINES 2, 4, AND 5 CONTINUEDCOLLABORATIVE EFFORTS TO IMPROVE COMMUNITY HEALTH These activities are carried out to improve community health. They extend beyond patient care activities. They include services directed to individuals and to a larger population. Community health improvement services do not generate inpatient or outpatient bills, although they may involve a nominal patient fee and/or a sliding scale fee. The programs in CBISA and summarized in this report not only benefit and serve the community as a whole, but also greatly reduce the burdens on our local health department, a government funded health care system. Relay for Life is the American Cancer Society's signature activity. It offers everyone in the community an opportunity to participate in the fight against cancer. The funds raised at Relay save lives by funding cutting-edge cancer research, early detection and prevention education, advocacy efforts, and life-affirming patient services. It is because of community involvement that lives are saved, help reaches those battling cancer, and empowers all to fight back against the disease. CHI Lisbon Health sponsored a Relay for Life team and various activities were held to raise $7,344 to the fight against cancer. CHI Lisbon Health supports the Abuse Resource Network by providing after hours call service. CHI Lisbon Health provides staff to present community education through different venues such as Community Education and Health Fair and a community education window that displays educational messages. HEALTH PROFESSIONS EDUCATION Helping prepare future health care professionals is a distinguishing characteristic of not-for-profit health care and constitutes a significant community benefit. Lab, Radiology, Pharmacy, and Nursing students have the advantage of spending time with the professionals for on the job mentoring. COMMUNITY BUILDING ACTIVITIES Community-building activities include programs that address underlying causes of health problems in order to improve health status and quality of life. They focus on the root causes of health problems, such as poverty, homelessness and environmental problems. These activities support community assets by offering the expertise and resources of the health care organization. Community-building activities include cash, in-kind donations and budgeted expenditures for the development of community health programs and partnerships. CHI Lisbon Health employees participate in community coalitions and other collaborative efforts with organizations in Sargent, and Ransom Counties to address health and safety issues. The vision brings people together and forms the foundation of both short and long term strategies to meet identified needs and problems. It develops a common thread encompassing a diverse array of viewpoints, opinions, facts and trends. CHI Lisbon Health encourages employees to belong to organizations that work together to promote healthy communities. Membership partners include: Kiwanis, Ministerial Association, Emergency Planning Committee, Students Against Destructive Decisions (SADD), and Violence Prevention Coalition. Economic development is important to CHI Lisbon Health to assist small business development in neighborhoods with vulnerable populations and creating new employment opportunities in areas with high rates of joblessness. Lisbon Civic and Commerce Organization promotes community and civic events including economic development. COMMUNITY BENEFIT OPERATIONS: Community benefit operations include costs associated with dedicated staff who work with Charity Care and with planning and operating community benefit programs. There are expenses involved for the Community Benefit tracking and reporting. Looking towards the future, CHI Lisbon Health will continue to thrive because of the support from our patients, our physicians, and the area communities. CHI Lisbon Health looks forward to providing care that the community members have come to trust and expect for many years to come.
Schedule H, Part I, Line 3c Eligibility criteria for free or discounted careWhen Catholic Health Initiatives (the ultimate parent organization to Lisbon Area Health Services) established its financial assistance policy it was determined that establishing a household income scale based on the HUD very low income guidelines more accurately reflects the socioeconomic dispersions among urban and rural communities in 18 states served by CHI hospitals and health care facilities. In comparing HUD guidelines to the Federal Poverty Guidelines (FPG), we find that on average HUD guidelines compute to approximately 200% to 250% (and sometimes 300%) of FPG. Lisbon Area Health Services bases its financial assistance eligibility on HUD's 130% of Very Low Income Guidelines based on geography, and affords the uninsured and underinsured the ability to obtain financial assistance write-offs, based on a sliding scale, ranging from 25%-100% of charges. An individual's income under the HUD guidelines is a significant factor in determining eligibility for financial assistance. However, in determining whether to extend discounted or free care to a patient, the patient's assets may also be taken into consideration. For example, a patient suffering a catastrophic illness may have a reasonable level of income, but a low level of liquid assets such that the payment of medical bills would be seriously detrimental to the patient's basic financial (and ultimately physical) well-being and survival. Such a patient may be extended discounted or free care based upon the facts and circumstances.
Schedule H, Part I, Line 7g Subsidized Health ServicesTHERE ARE NO PHYSICIAN CLINICS INCLUDED IN SUBSIDIZED HEALTH SERVICES.
Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation198899
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistanceA 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. THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/2016 WAS COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE. $10,510,397/$18,555,188=56.6%. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amountCosting methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 56.6%. 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 MethodologyLisbon Area Health Services 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 footnoteLisbon Area Health Services 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 on the consolidated statements of operations as a deduction from patient services revenues (net of contractual allowances and discounts) since CHI accepts and treats substantially all patients without regard to the ability to pay."
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costsLisbon Area Health Services 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, Lisbon Area Health Services, due to their designation as a CAH, received cost-based reimbursement for Medicare purposes, Lisbon Area Health Services 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: $7,718,798 Total Medicare costs: $7,737,942 Surplus or Shortfall $(19,144) Lisbon Area Health Services 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 assistanceLisbon Area Health Services debt collection policy provides that Lisbon Area Health Services will perform a reasonable review of each inpatient account prior to turning an account over to a third-party collection agent and prior to instituting any legal action for non-payment, to assure that the patient and patient guarantor are not eligible for any assistance program (e.g. Medicaid) and do not qualify for coverage through Lisbon Area Health Services community assistance policy. After having been turned over to a third-party collection agent, any patient account that is subsequently determined to meet the Lisbon Area Health Services community assistance policy is required to be returned immediately by the third-party collection agent to Lisbon Area Health Services for appropriate follow-up. Lisbon Area Health Services requires its third-party collection agents to include a message on all statements indicating that if a patient or patient guarantor meets certain stipulated income requirements, the patient or patient guarantor may be eligible for financial assistance. All of Catholic Health Initiatives' hospitals' contracts with third party collection agencies include the following standards: * Neither CHI hospitals nor their collection agencies will request bench or arrest warrants as a result of non-payment; * Neither CHI hospitals nor their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and * No Catholic Health Initiatives' collection agency may seek court action without hospital approval. Finally, collection agencies are trained on the Catholic Health Initiatives Mission, Core Values and Standard of Conduct to make sure all patients are treated with dignity and respect.
Schedule H, Part V, Section B, Line 16a FAP website- Lisbon Area Health Services: Line 16a URL: http://www.lisbonhospital.com/patientsvisitors_financialassistance_docs.htm;
Schedule H, Part V, Section B, Line 16b FAP Application website- Lisbon Area Health Services: Line 16b URL: http://www.lisbonhospital.com/patientsvisitors_financialassistance_docs.htm;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website- Lisbon Area Health Services: Line 16c URL: http://www.lisbonhospital.com/patientsvisitors_financialassistance_docs.htm;
Schedule H, Part VI, Line 3 Patient education of eligibility for assistanceLisbon Area Health Services (LAHS), includes information concerning its financial assistance policy on its website. In addition, LAHS prominently displays its financial assistance policy in both English and Spanish in obvious locations throughout the hospitals, including the emergency rooms and other patient intake areas, as well as in LAHS outpatient facilities. In addition, LAHS 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 financial assistance under LAHS' financial assistance policy. 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 and procedures including an application for assistance. LAHS 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. LAHS' staff will also assist the patient/guarantor with applying for other available coverage (such as Medicaid), if necessary. Counselors assist Medicare eligible patients in enrollment by providing referrals to the appropriate government agencies.
Schedule H, Part VI, Line 6 Affiliated health care systemLisbon Area Health Services, along with its affiliated outpatient facilities, are part of Catholic Health Initiatives. Catholic Health Initiatives (CHI) is a national faith-based nonprofit health care organization with headquarters in Englewood, Colorado. CHI's exempt purpose is to serve as an integral part of its national system of hospitals and other charitable entities, which are described as market-based organizations, or MBOs. An MBO is a direct provider of care or services within a defined market area that may be an integrated health system and/or a stand-alone hospital or other facility or service provider. CHI serves as the parent corporation of its MBOs which are comprised of 104 hospitals, including four academic medical centers, and 30 critical access facilities; community health service organizations; accredited nursing colleges; home health agencies; and other facilities that span the inpatient and outpatient continuum of care. Together, these facilities provided $1.1 billion in financial assistance and community benefit in the 2016 fiscal year, including services for the poor, free clinics, education and research. CHI provides strategic planning and management services as well as centralized "shared 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. Lisbon Area Health Services operates with its wholly owned affiliates and community partners, to serve the health care needs of the Lisbon, ND communities.
Schedule H, Part VI, Line 7 State filing of community benefit reportND

Schedule I IRS990ScheduleI

FieldValueIRS element (for citing)
Grant Records MaintainedYes (true)GrantRecordsMaintainedInd

Grants Other Asst To Indiv In US GrantsOtherAsstToIndivInUSGrp (2 entries)

Grant TypeGrantTypeTxtRecipientRecipientCntNon Cash AssistanceNonCashAssistanceAmtValuation Method UsedValuationMethodUsedDescNon Cash AssistanceNonCashAssistanceDescCash GrantCashGrantAmt
Charity Care34$124,785Book(See Statement)
Employee Assistance1$500

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule I, Part III, Column (f) DESCRIPTION OF NONCASH ASSISTANCECHARITY CARE: REDUCTION OR WRITE OFF OF PATIENT SERVICES.
Schedule I, Part III CHARITY CARELISBON AREA HEALTH SERVICES RECOGNIZES THE RIGHT TO QUALITY HEALTHCARE REGARDLESS OF AGE, SEX, RACE, RELIGION, NATIONAL ORIGIN, OR ABILITY TO PAY. BUSINESS OFFICE STAFF HELPS 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 III Employee Assistance FundCHI Lisbon Health Employee Assistance Fund exists as a program for employees of CHI Lisbon Health. The fund reinforces CHI Lisbon Health's mission and values. Funds are available to employees facing personal tragedy or significant hardship. The program provides employees who are experiencing financial difficulties help with basic needs such as food, shelter, utilities and emergency travel. The fund will be available for current employees only. The maximum amount requested and/or awarded may not exceed $500 in a 12-month period. If an employee receives a partial gift, the employee may reapply for additional assistance in the year should the need arise. All applications/nominations will be reviewed by the MBO Executive Leadership Committee, however, it is not a guarantee of an award. The MBO Executive Leadership Committee decides who will receive an award by consensus. Once the Committee's decision is made, the applicant will be notified of the decision and supporting reasons.

Schedule J IRS990ScheduleJ

FieldValueIRS element (for citing)
Severance PaymentfalseSeverancePaymentInd
Supplemental Nonqual Rtr PlanYes (true)SupplementalNonqualRtrPlanInd
Equity Based Comp ArrngmfalseEquityBasedCompArrngmInd
Comp Based On Revenue Of Flng OrgfalseCompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related OrgsfalseCompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng OrgfalseCompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd OrgsfalseCompBsdNetEarnsRltdOrgsInd
Any Non Fixed PaymentsfalseAnyNonFixedPaymentsInd
Initial Contract ExceptionfalseInitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (6 entries)

TitleTitleTxtBase Compensation Filing OrgBaseCompensationFilingOrgAmtCompensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmtBonus Filing OrganizationBonusFilingOrganizationAmountBonus Related OrganizationsBonusRelatedOrganizationsAmtOther Compensation Filing OrgOtherCompensationFilingOrgAmtOther Compensation Rltd OrgsOtherCompensationRltdOrgsAmtDeferred Compensation Flng OrgDeferredCompensationFlngOrgAmtDeferred Comp Rltd OrgsDeferredCompRltdOrgsAmtNontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmtNontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmtTotal Compensation Filing OrgTotalCompensationFilingOrgAmtTotal Compensation Rltd OrgsTotalCompensationRltdOrgsAmtComp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmtComp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
PEGGY REINKE
PRESIDENT$0$150,922$0$30,164$0$81,344$0$7,832$0$12,375$0$282,637$0$12,746
JEFFREY DROP
Board Member/CHI SVP Division Officer$0$509,375$0$472,560$0$234,067$0$15,428$0$11,880$0$1,243,310$0$42,295
BECKI THOMPSON
VP OPERATIONAL FINANCE (THROUGH 7/31/14)$0$122,391$0$12,352$0$46,044$0$18,725$0$5,276$0$204,788$0$0
KEVIN JACOBSON
Nurse Practitioner$145,739$0$0$0$1,031$0$9,371$0$20,340$0$176,481$0$0$0
JILL MCRITCHIE
MANAGER PHARMACY$114,784$0$0$0$5,080$0$7,005$0$30,376$0$157,245$0$0$0
OSCAR FERNANDEZ
PHYSICIAN$311,644$0$22,570$0$4,217$0$4,279$0$30,107$0$372,817$0$0$0

Supplemental Information Detail SupplementalInformationDetail (3 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Schedule J, Part I, Line 4a SEVERANCE OR CHANGE-OF-CONTROL PAYMENTSPOST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES (CHI) AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. NO REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE 2015 CALENDAR YEAR.
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensationCompensation for the top management official was established and paid by Catholic Health Initiatives (CHI), a related organization. CHI 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 planDuring the 2015 calendar year Catholic Health Initiatives (CHI), a related organization, maintained a supplemental non-qualified deferred compensation plan for MBO CEOs and other CHI employees at the level of Senior Vice President and above. The following reportable individuals were eligible to participate in that plan: Jeffrey Drop Peggy Reinke Rebecca Thompson During 2015 the following contributions were made by CHI to the deferred compensation plan: Rebecca Thompson - $9,902 During 2015 the following distributions were made by CHI from the deferred compensation plan: Jeffrey Drop - $42,295 Peggy Reinke - $12,746 DUE TO THE "SUPER" VESTING RULES UNDER THE CHI DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS AGE, OR YEARS OF SERVICE ARE ELIGIBLE TO RECEIVE THEIR 2015 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 2015, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: JEFFREY DROP $79,113 PEGGY REINKE $13,788

Schedule L IRS990ScheduleL

Loans Btwn Org Interested Prsn LoansBtwnOrgInterestedPrsnGrp

Business Name BusinessName

FieldValueIRS element (for citing)
Business Name Line1Oscar FernandezBusinessNameLine1Txt
FieldValueIRS element (for citing)
Relationship With OrgHighest compensated employeeRelationshipWithOrgTxt
Loan PurposeSigning bonusLoanPurposeTxt
Loan From OrganizationYes (X)LoanFromOrganizationInd
Original Principal$10,000OriginalPrincipalAmt
Balance Due$5,296BalanceDueAmt
DefaultfalseDefaultInd
Board Or Committee ApprovalYes (true)BoardOrCommitteeApprovalInd
Written AgreementYes (true)WrittenAgreementInd
FieldValueIRS element (for citing)
Total Balance Due$5,296TotalBalanceDueAmt

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDescExplanationExplanationTxt
Form 990, Part III, Line 1 ORGANIZATION'S MISSIONTHE 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.
Form 990, Part VI, Line 14 DOCUMENT RETENTION AND DESTRUCTION POLICYTHE ORGANIZATION HAS A DOCUMENT RETENTION AND DESTRUCTION POLICY THAT IT FOLLOWS; HOWEVER, THE POLICY HAD NOT BEEN FORMALLY ADOPTED BY THE ORGANIZATION'S GOVERNING BODY AT YEAR-END.
Form 990, Part VI, Line 15a PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIALThe 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 13, 2016. 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 USED TO ESTABLISH COMPENSATION OF OTHER EMPLOYEESDURING THE TAX YEAR ENDED 6/30/2016, NO OFFICERS, DIRECTORS OR TRUSTEES RECEIVED COMPENSATION FROM THE ORGANIZATION. ANY EXECUTIVE COMPENSATION PAID TO OFFICERS, DIRECTORS OR TRUSTEES BY RELATED ORGANIZATIONS WAS SET BY THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. THEREFORE, THESE QUESTIONS ARE MORE APPROPRIATELY ANSWERED AS N/A.
Form 990, Part VI, Line 1a Delegate broad authority to a committeePursuant to Section 8.6 of the Bylaws of Lisbon Area Health Services, the Executive Committee is composed of the board chair, the board vice chair, the President and CEO, each of whom shall serve as an ex officio voting member of the Executive Committee, and two voting members appointed by the Board of Directors. Each individual appointed to the Executive Committee shall serve for a term of one year or until his or her successor is duly appointed by the Board of Directors. The Executive Committee shall consist of only directors of the Corporation. Pursuant to Section 8.1 of the Corporation's bylaws, committees, such as the executive committee, that are granted the authority to act on behalf of the board of directors may include only directors of the corporation. Further, pursuant to Section 8.6 of the Corporation's bylaws, the executive committee has and may exercise such powers as may be delegated to it by the board of directors. The Executive Committee also possesses the power to transact routine business of the corporation in the interim period between regularly scheduled meetings of the board of directors.
Form 990, Part VI, Line 6 Classes of members or stockholdersAccording to the bylaws of Lisbon Area Health Services the entity's sole member is Catholic Health Initiatives, a Colorado nonprofit organization.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing bodyAccording 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.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders"The organization's corporate member is Catholic Health Initiatives (CHI). Pursuant to Section 5.4 of the organization's bylaws, the Corporate Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: * Substantial change in the mission or philosophy of the Lisbon Area Health Services * Amendment of the corporate documents of Lisbon Area Health Services * Approve members of the Lisbon Area Health Servicesboard * Removal of a member of the governing body of the Lisbon Area Health Services * Approval of issuance of debt by Lisbon Area Health Services * Approval of participation of Lisbon Area Health Servicesin a joint venture * Approval of formation of a new corporation by Lisbon Area Health Services * Approval of a merger involving Lisbon Area Health Services * Approval of the sale of all or substantially all of the assets of Lisbon Area Health Services * To require the transfer of assets by Lisbon Area Health Services to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. * Adoption of long range and strategic plans for Lisbon Area Health Services Pursuant to Article V Section 5.5.2 of the organization's bylaws, CHI may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate."
Form 990, Part VI, Line 11b Review of form 990 by governing bodyOnce the return is prepared, the return is presented to the board at a board meeting or an electronic copy of the return is sent to each board member by email for their review, etc. Subsequent to presentation to the board, the tax department files the return with the appropriate federal and state agencies, making any non-substantive changes necessary to effect e-filing. Any such changes are not re-submitted to the board.
Form 990, Part VI, Line 12c Conflict of interest policyCatholic Health Initiatives ("CHI") has a Conflicts of Interest ("COI") 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 board and board committee members of CHI Entities; all CHI employees; all CHI physicians (both employed and non-employed) and all physician administrators and leaders; advanced practice clinicians (both employed and non-employed); 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 has a general ongoing obligation to promptly and fully report 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 report 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. The board, board committee members, and new employees are required to make disclosures at the time of their initial hiring/appointment. All non-employed, credentialed or contracted physicians are required to make disclosures at the time of their credentialing and during any subsequent reappointment or recredentialing. All researchers are required to make disclosures upon consideration of affiliation with a research sponsor. In addition to the general ongoing and initial disclosure obligations, there is an annual disclosure obligation. All corporate officers, board and board committee members, employees at the level of manager and above, researchers, supply chain employees, employed physicians, physician administrators and leaders, and employed advanced practice clinicians must complete a new conflict of interest disclosure annually. Disclosures of perceived, potential or actual conflicts involving financial interests are forwarded to the Conflicts of Interest Review Committee ("C-CIRC") or Legal Services Group for review depending on the position of the person involved. The C-CIRC reviews COI questionnaires containing disclosures of perceived or possible conflicts for employees at a level of manager or above, supply chain employees, researchers and physicians, physician administrators and leaders, and advanced practice clinicians (both employed and non-employed). In the determination of a conflict, a COI management plan will be developed for that person. With respect to those audiences for which the C-CIRC has review responsibility, the C-CIRC will facilitate development of any such conflict of interest management plan in collaboration with local CRP staff. A designated CHI Entity staff will be 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 COI. If the C-CIRC determines that there is a potential or actual conflict of interest 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 the COI management plan. If a Person does not agree with a determination made by the C-CIRC, its interpretation of the Policy or Addenda, or seeks an exemption or exception, the following steps should be followed. The Employee disputing the review decision, interpretation of the Policy, or seeking exemption or exception must present the matter to the Employee's immediate direct manager or supervisor for review and determination. If the Employee and the manager do not agree with the review decision, interpretation of the Policy, or seek exemption or exception, the manager shall consult with the manager's Vice President (or higher if the manager is a Vice President) to reach a determination. If the matter remains unresolved, it shall be referred to the CHI Vice President of Human Resources and the CHI Corporate Responsibility Officer. If they are unable to reach agreement, the matter shall be referred to the CHI General Counsel, whose decision shall be final. 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). Annual COI disclosures of all trustee and corporate officers 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. 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. 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. 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. The trustee or corporate officer shall be excused from the meeting during discussion and vote on the conflict of interest. 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 will act as it would in reviewing transactions with unrelated third parties. The transaction is not be approved unless the Board determines that the transaction is fair to CHI or the CHI Entity. 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. All determinations of conflicts of interest are reported as required by law, regulations, and CHI policy.
Form 990, Part VI, Line 19 Required documents available to the publicThe organization's financial statements, conflict of interest policy and governing documents are available to the public upon request. The organization's financial statements are included in Catholic Health Initiatives' consolidated audited financial statements that are available at www.CatholicHealthInit.org or at www.DACBOND.org. In addition, the governing documents are available from the North Dakota Secretary of State.
Form 990, Part VIII, Line 11d Other Miscellaneous RevenueOther Miscellaneous Revenue - Total Revenue: 1153, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 1153;
Form 990, Part IX, Line 11g Other FeesOther Fees for Services - Total Expense: 1413890, Program Service Expense: 1016834, Management and General Expenses: 397056, Fundraising Expenses: 0; Clinical Engineering - Total Expense: 86669, Program Service Expense: 86669, Management and General Expenses: , Fundraising Expenses: ; Consulting - Total Expense: 25512, Program Service Expense: , Management and General Expenses: 25512, Fundraising Expenses: ; Contract Nursing - Total Expense: 215934, Program Service Expense: 215934, Management and General Expenses: , Fundraising Expenses: ; Facilities Management - Total Expense: 90796, Program Service Expense: , Management and General Expenses: 90796, Fundraising Expenses: ; Intracompany Allocations - Total Expense: 173176, Program Service Expense: 173176, Management and General Expenses: , Fundraising Expenses: ; RRC Fees - Total Expense: 577824, Program Service Expense: 577824, Management and General Expenses: , Fundraising Expenses: ; Support Fees - Total Expense: 37274, Program Service Expense: 37274, Management and General Expenses: , Fundraising Expenses: ; VHS - Total Expense: 106695, Program Service Expense: 106695, Management and General Expenses: , Fundraising Expenses: ;
Form 990, Part XI, Line 9 Other changes in net assets or fund balancesOther Changes - 7;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (187 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdExempt Code SectionExemptCodeSectionTxtPublic Charity StatusPublicCharityStatusTxtBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtControlled OrganizationControlledOrganizationInd
ALEGENT CREIGHTON CLINIC
12809 W DODGE RDOMAHANE68154470765154HEALTHCARENE501(c)(33ACHYes (true)
ALEGENT CREIGHTON HEALTH
12809 W DODGE RDOMAHANE68154470757164HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
ALEGENT CREIGHTON HEALTH FOUNDATION
12809 W DODGE RDOMAHANE68154470648586FUNDRAISINGNE501(c)(37ACHYes (true)
ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM
7500 MERCY RDOMAHANE68124470484764HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA
631 N 8TH STMISSOURI VALLEYIA51555420776568HEALTHCAREIA501(c)(33CHI NEBRASKAYes (true)
ALEGENT HEALTH - IMMANUEL MEDICAL CENTER
6901 N 72ND STOMAHANE68122470376615HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER
104 W 17TH STSCHUYLERNE68661470399853HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA
PO BOX 368CORNINGIA50841420782518HEALTHCAREIA501(c)(33CHI NEBRASKAYes (true)
ALVERNA APARTMENTS
300 SE 8TH AVELITTLE FALLSMN56345411351177LTERM CAREMN501(c)(39CHIYes (true)
APPLETREE COURT
601 OAK STBRECKENRIDGEMN56520411850500SENIOR LIVINGMN501(c)(39SFHYes (true)
BAYLOR ST LUKE'S HEALTH VENTURES
17200 ST LUKES WAY STE 170THE WOODLANDSTX77384274499340PHYSICIANSTX501(c)(39SLCHSYes (true)
BELLEVILLE ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVEBRYANTX77802274005511HEALTHCARETX501(c)(33SHSCYes (true)
BISHOP DRUMM RETIREMENT CENTER
1111 6TH AVEDES MOINESIA50314420725196LTERM CAREIA501(c)(39CHI-IA CORPYes (true)
BORNEMANN HEALTHCARE CORPORATION
2500 BERNVILLE RD PO BOX 316READINGPA19603232187242HEALTHCAREPA501(c)(3Type ICHIYes (true)
BRAZOSPORT HEALTH FOUNDATION INC
129 CIRCLE WAY STE 102LAKE JACKSONTX77566760080110FUNDRAISINGTX501(c)(3Type IBRHSYes (true)
BRAZOSPORT REGIONAL PHYSICIAN SERVICES
100 MEDICAL DRIVELAKE JACKSONTX77566800240261HEALTHCARETX501(c)(33BRHSYes (true)
BURLESON ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVEBRYANTX77802742759890HEALTHCARETX501(c)(33SJSCYes (true)
BURLESON ST JOSEPH MANOR
2801 FRANCISCAN DRIVEBRYANTX77802742913931HEALTHCARETX501(c)(39SJSCYes (true)
CARRINGTON HEALTH CENTER
800 N 4TH STCARRINGTONND58421450227311HEALTHCAREND501(c)(33CHIYes (true)
CATHOLIC HEALTH INITIATIVES
198 INVERNESS DRIVE WESTENGLEWOODCO80112470617373HEALTHCARECO501(c)(3Type INAYes (true)
CATHOLIC HEALTH INITIATIVES - COLORADO
188 INVERNESS DRIVE WEST STE 500ENGLEWOODCO80112840405257HEALTHCARECO501(c)(33CHIYes (true)
CATHOLIC HEALTH INITIATIVES - IOWA CORP
1111 6TH AVEDES MOINESIA50314420680448HEALTHCAREIA501(c)(33CHIYes (true)
CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION
6385 CORPORATE DR STE 301COLORADO SPRINGSCO80919840902211FUNDRAISINGCO501(c)(37CHICYes (true)
CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION
6385 CORPORATE DRCOLORADO SPRINGSCO80919270930004FUNDRAISINGCO501(c)(3Type ICHIYes (true)
CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES
198 INVERNESS DRIVE WESTENGLEWOODCO80112460992796HEALTHCARECO501(c)(3Type ICHINSYes (true)
CENTENNIAL MEDICAL GROUP INC
2700 STEWART PKWYROSEBURGOR97471263946191PHYSICIANSOR501(c)(39MMCYes (true)
CENTRAL KANSAS MEDICAL CENTER
3515 BROADWAYGREAT BENDKS67530480543724SURGERY CENTERKS501(c)(33CHIYes (true)
CHI HEALTH CONNECT AT HOME - FARGO
4816 AMBER VALLEY PKWY SFARGOND58104271966847HEALTHCAREMN501(c)(39CHIYes (true)
CHI INSTITUTE FOR RESEARCH AND INNOVATION
198 INVERNESS DRIVE WESTENGLEWOODCO80112271050565HEALTHCARECO501(c)(3Type ICHIYes (true)
CHI KENTUCKY INC
3900 OLYMPIC BLVD STE 400ERLANGERKY41018202741651HEALTHCAREKY501(c)(3Type ICHIYes (true)
CHI NATIONAL HOME CARE
198 INVERNESS DRIVE WESTENGLEWOODCO80112451261716HEALTHCARECO501(c)(39CHI NSYes (true)
CHI NATIONAL SERVICES
198 INVERNESS DRIVE WESTENGLEWOODCO80112452532084HEALTHCARECO501(c)(3Type ICHIYes (true)
CHI NEBRASKA
6940 O ST STE 200LINCOLNNE68510363233121HEALTHCARENE501(c)(3Type ICHIYes (true)
CHI ST JOSEPH CHILDREN'S HEALTH
1929 LINCOLN HWY E STE 150LANCASTERPA17602232342997HEALTHCAREPA501(c)(3Type ICHIYes (true)
CHI ST JOSEPH'S CHILDREN
1516 5TH ST NWALBUQUERQUENM87102710897107COMMUNITYNM501(c)(3Type ICHIYes (true)
CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER
6624 FANNIN STHOUSTONTX77030741161938HEALTHCARETX501(c)(33SLHSYes (true)
CHI ST VINCENT HOSPITAL HOT SPRINGS
300 WERNER STHOT SPRINGSAR71913710236913HEALTHCAREAR501(c)(33CHISVHSYes (true)
CHI ST VINCENT HOT SPRINGS
300 WERNER STHOT SPRINGSAR71913261125064HOLDING COAR501(c)(3Type IISVIMCYes (true)
CHI ST VINCENT MEDICAL GROUP HOT SPRINGS
1 MERCY LANE STE 201HOT SPRINGSAR71913261125131HEALTHCAREAR501(c)(33CHISVHSYes (true)
COMMUNITY LIMITED CARE DIALYSIS CENTER
619 OAK ST ACCOUNTING-3 WCINCINNATIOH45206237419853HOLDING COOH501(c)(2GSHYes (true)
COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION
631 N 8TH STMISSOURI VALLEYIA51555421294399FUNDRAISINGIA501(c)(3Type IAH-CMHMVYes (true)
CONTINUING CARE HOSPITAL
150 NORTH EAGLE CREEK DRLEXINGTONKY40509611400619LT ACHKY501(c)(33SJHSYes (true)
COVENANT HOME CARE
198 INVERNESS DRIVE WESTENGLEWOODCO80112232028429HOME HEALTHPA501(c)(3Type IICHI NHCYes (true)
ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
1450 BATTERSBY AVEENUMCLAWWA98022910715805HEALTHCAREWA501(c)(33FHSYes (true)
FLAGET HEALTHCARE INC
4305 NEW SHEPHERDSVILLE RDBARDSTOWNKY40004611345363HEALTHCAREKY501(c)(33KOHYes (true)
FLAGET MEMORIAL HOSPITAL FOUNDATION INC
4305 NEW SHEPHERDSVILLE RDBARDSTOWNKY40004562351341FUNDRAISINGKY501(c)(3Type IFHYes (true)
FRANCISCAN CARE CENTER
4111 N HOLLAND-SYLVANIA RDTOLEDOOH43623341931806HEALTHCAREOH501(c)(39FLCYes (true)
FRANCISCAN FOUNDATION
1717 SOUTH J STTACOMAWA98405911145592FUNDRAISINGWA501(c)(39FHSYes (true)
FRANCISCAN HEALTH SYSTEM
1717 SOUTH J STTACOMAWA98405910564491HEALTHCAREWA501(c)(33CHIYes (true)
FRANCISCAN HEALTH VENTURES FKA SJMGROUP
TACOMA FNC CTR BLDG 1145 BROADWAYTACOMAWA98402431882377PHYSICIANSMO501(c)(39CHIYes (true)
FRANCISCAN LIVING COMMUNITIES
5942 RENAISSANCE PLACE STE ATOLEDOOH43623341892096HEALTHCAREOH501(c)(3Type ISFHYes (true)
FRANCISCAN MEDICAL GROUP
1313 BROADWAY STE 200TACOMAWA98402911939739HEALTHCAREWA501(c)(39FHSYes (true)
FRANCISCAN VILLA OF SOUTH MILWAUKEE INC
3601 S CHICAGO AVESOUTH MILWAUKEEWI53172391093829HEALTHCAREWI501(c)(39CHIYes (true)
GARRISON MEMORIAL HOSPITAL
407 THIRD AVENUE SOUTHEASTGARRISONND58540450227752HEALTHCAREND501(c)(33SAMCYes (true)
GLOBAL HEALTH INITIATIVES
198 INVERNESS DRIVE WESTENGLEWOODCO80112201536108MINISTRIESCO501(c)(3Type ICHIYes (true)
GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE
619 OAK ST ACCOUNTING-3 WCINCINNATIOH45206311778403EDUCATIONOH501(c)(32GSHYes (true)
GOOD SAMARITAN FOUNDATION OF CINCINNATI INC
619 OAK ST ACCOUNTING-3 WCINCINNATIOH45206311206047FUNDRAISINGOH501(c)(3Type IGSHYes (true)
GOOD SAMARITAN HOSPITAL
PO BOX 1990KEARNEYNE68848470379755HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
GOOD SAMARITAN HOSPITAL FOUNDATION
111 W 31ST STKEARNEYNE68847470659443FUNDRAISINGNE501(c)(37GSHYes (true)
GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON
110 N MAIN ST STE 500DAYTONOH45402237296923FUNDRAISINGOH501(c)(37SHPYes (true)
HARRISON MEDICAL CENTER
2520 CHERRY AVEBREMERTONWA98310910565546HEALTHCAREWA501(c)(33FHSYes (true)
HARRISON MEDICAL CENTER FOUNDATION
2520 CHERRY AVEBREMERTONWA98310911197626FUNDRAISINGWA501(c)(37HMCYes (true)
HEALTHCARE AND WELLNESS FOUNDATION
2400 ST FRANCIS DRBRECKENRIDGEMN56520760761782FUNDRAISINGMN501(c)(3Type ISFMCYes (true)
HIGHLINE MEDICAL CENTER
16251 SYLVESTER RD SWBURIENWA98166910712166HEALTHCAREWA501(c)(33FHSYes (true)
HOUSE OF MERCY
1111 6TH AVEDES MOINESIA50314421323808SHELTERIA501(c)(37CHI-IA CORPYes (true)
JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202611029768HEALTHCAREKY501(c)(33KOHYes (true)
KENTUCKYONE HEALTH MEDICAL GROUP INC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202611352729HEALTHCAREKY501(c)(39JHSMHYes (true)
KENTUCKYONE HEALTH INC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202611029769HEALTHCAREKY501(c)(39CHIYes (true)
LAKEWOOD HEALTH CENTER
600 MAIN AVE SBAUDETTEMN56623410758434HEALTHCAREMN501(c)(33CHIYes (true)
LAKEWOOD REGIONAL HEALTHCARE FOUNDATION
600 MAIN AVE SBAUDETTEMN56623411893795FUNDRAISINGND501(c)(37LHCYes (true)
LINUS OAKES INC
2700 STEWART PKWYROSEBURGOR97471930821381SENIOR LIVINGOR501(c)(39MMCYes (true)
LISBON AREA HEALTH SERVICES
905 MAIN STLISBONND58054820558836HEALTHCAREND501(c)(33CHIYes (true)
LUFKIN VISION ACQUISITIONS
PO BOX 1447LUFKINTX75901820563768PROPERTY MGMTTX501(c)(3Type III-FIMHSETYes (true)
MADISON ST JOSEPH HEALTH CENTER
2801 FRANCISCAN DRIVEBRYANTX77802742761145HEALTHCARETX501(c)(33SJSCYes (true)
MADONNA MANOR INC
2344 AMSTERDAM ROADVILLA HILLSKY51017610654635LIVING ASSISTKY501(c)(31FLCYes (true)
MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC
2525 DE SALES AVECHATTANOOGATN37404621839548FUNDRAISINGTN501(c)(37MHCSYes (true)
MEMORIAL HEALTH CARE SYSTEM INC
2525 DE SALES AVECHATTANOOGATN37404620532345HEALTHCARETN501(c)(33CHIYes (true)
MEMORIAL HEALTH PARTNERS FOUNDATION INC
5600 BRAINERD RD STE 500CHATTANOOGATN37411030417049HEALTHCARETN501(c)(39MHCSYes (true)
MEMORIAL HEALTH SYSTEM OF EAST TEXAS
PO BOX 1447LUFKINTX75902750755367HEALTHCARETX501(c)(33CHIYes (true)
MEMORIAL MEDICAL CENTER - LIVINGSTON
PO BOX 1447LUFKINTX75902760436439HEALTHCARETX501(c)(33MHSETYes (true)
MEMORIAL MEDICAL CENTER - SAN AUGUSTINE
PO BOX 1447LUFKINTX75902752663904HEALTHCARETX501(c)(33MHSETYes (true)
MEMORIAL MULTISPECIALTY ASSOCIATES
1201 FRANK AVELUFKINTX95904752721155PHYSICIANSTX501(c)(3Type III-FIMHSETYes (true)
MEMORIAL SPECIALTY HOSPITAL
PO BOX 1447LUFKINTX95902752492741HEALTHCARETX501(c)(33MHSETYes (true)
MERCY AUXILIARY OF CENTRAL IOWA
1111 6TH AVEDES MOINESIA50314426076069AUXILIARYIA501(c)(3Type IMF-DM IAYes (true)
MERCY CLINICS INC
1111 6TH AVEDES MOINESIA50314421193699PHYSICIANSIA501(c)(39CHI-IA CORPYes (true)
MERCY COLLEGE OF HEALTH SCIENCES
1111 6TH AVEDES MOINESIA50314421511682EDUCATIONIA501(c)(32CHI-IA CORPYes (true)
MERCY FOUNDATION OF DES MOINES IA
1111 6TH AVEDES MOINESIA50314237358794FUNDRAISINGIA501(c)(37CHI-IA CORPYes (true)
MERCY FOUNDATION INC
2700 STEWART PKWYROSEBURGOR97471936088946FUNDRAISINGOR501(c)(37MMCYes (true)
MERCY HEALTH CARE FOUNDATION
PO BOX 368CORNINGIA50841421461064FUNDRAISINGIA501(c)(3Type IAHMH-CorningYes (true)
MERCY HEALTHCARE FOUNDATION
570 CHAUTAUQUA BLVDVALLEY CITYND58072450435338FUNDRAISINGND501(c)(3Type IMHVCYes (true)
MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS
800 MERCY DRCOUNCIL BLUFFSIA51503421178204FUNDRAISINGIA501(c)(3Type IAHBMHSYes (true)
MERCY HOSPITAL OF DEVILS LAKE
1031 7TH ST NEDEVILS LAKEND58301450227012HEALTHCAREND501(c)(33CHIYes (true)
MERCY HOSPITAL OF DEVILS LAKE FOUNDATION
1031 7TH ST NEDEVILS LAKEND58301352367360FUNDRAISINGND501(c)(37MHDLYes (true)
MERCY HOSPITAL OF VALLEY CITY
570 CHAUTAUQUA BLVDVALLEY CITYND58072450226553HEALTHCAREND501(c)(33CHIYes (true)
MERCY MEDICAL CENTER
1301 15TH AVE WESTWILLISTONND58801450231183HEALTHCAREND501(c)(33CHIYes (true)
MERCY MEDICAL CENTER - CENTERVILLE
ONE ST JOSEPHS DRIVECENTERVILLEIA52544420680308HEALTHCAREIA501(c)(33CHI-IA CORPYes (true)
MERCY MEDICAL CENTER - NEWTON DBA SKIFF MEDICAL CENTER
1111 6TH AVEDES MOINESIA50314421470935PHYSICIANSIA501(c)(39CHI-IA CORPYes (true)
MERCY MEDICAL CENTER INC
2700 STEWART PKWYROSEBURGOR97471930386868HEALTHCAREOR501(c)(33CHIYes (true)
MERCY MEDICAL FOUNDATION
1301 15TH AVE WESTWILLISTONND58801450381803FUNDRAISINGND501(c)(3Type IMMCYes (true)
NEBRASKA HEART HOSPITAL
7500 S 91ST STLINCOLNNE68526392031968HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
North Central Health Care Alliance dba PrimeCare Health Group
401 N 9th StBISMARCKND585014507450439894HEALTHCAREND501(c)(39NHCAYes (true)
OAKES COMMUNITY HOSPITAL
1200 N 7TH STOAKESND58474450231675HEALTHCAREND501(c)(33CHIYes (true)
OAKES COMMUNITY HOSPITAL FOUNDATION
1200 N 7TH STOAKESND58474710966606FUNDRAISINGND501(c)(3Type IOCHYes (true)
PINEYWOODS MEDICAL DEVELOPMENT CORP
PO BOX 1447LUFKINTX75902752493116PROPERTY MGMTTX501(c)(3Type III-FIMHSETYes (true)
PROVIDENCE CARE CENTER
2025 HAYES AVENUESANDUSKYOH44870341658625HEALTHCAREOH501(c)(39FLCYes (true)
PROVIDENCE CARE CENTERS
2025 HAYES AVENUESANDUSKYOH44870341826099HOLDING COOH501(c)(3Type IIFLCYes (true)
PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION
5055 PROVIDENCE DRIVESANDUSKYOH44870341896807LIVING COMMOH501(c)(39FLCYes (true)
PUEBLO STEPUP
1925 E ORMAN AVE STE G52PUEBLOCO81004841234295COMMUNITYCO501(c)(37CHICYes (true)
REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE
12844 MILITARY RD STUKWILAWA98168911170040HEALTHCAREWA501(c)(33FHSYes (true)
SET OF COLORADO SPRINGS INC
2864 S CIRCLE DR STE 450COLORADO SPRINGSCO80906841183335LTERM CARECO501(c)(37CHICYes (true)
SAINT CLARE'S COMMUNITY CARE INC
25 POCONO RDDENVILLENJ07834222876836HEALTHCARENJ501(c)(3Type IISCHSYes (true)
SAINT CLARE'S FOUNDATION INC
25 POCONO RDDENVILLENJ07834222502997FUNDRAISINGNJ501(c)(37SCHSYes (true)
SAINT CLARE'S HEALTH SERVICES INC
25 POCONO RDDENVILLENJ07834223639733MANAGEMENTNJ501(c)(3Type IICHIYes (true)
SAINT CLARE'S HOSPITAL INC
25 POCONO RDDENVILLENJ07834223319886HEALTHCARENJ501(c)(33SCHSYes (true)
SAINT ELIZABETH FOUNDATION
555 S 70TH STLINCOLNNE68510470625523FUNDRAISINGNE501(c)(37SERMCYes (true)
SAINT ELIZABETH HEALTH SERVICES
555 S 70TH STLINCOLNNE68510363233120HEALTHCARENE501(c)(33SERMCYes (true)
SAINT ELIZABETH REGIONAL MEDICAL CENTER
555 S 70TH STLINCOLNNE68510470379836HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
SAINT FRANCIS MEDICAL CENTER
2620 W FAIDLEYGRAND ISLANDNE68803470376601HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
SAINT FRANCIS MEDICAL CENTER FOUNDATION
PO BOX 9804GRAND ISLANDNE68802470630267FUNDRAISINGNE501(c)(37SFMCYes (true)
SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC
305 ESTILL STBEREAKY40403260152877FUNDRAISINGKY501(c)(37SJHSYes (true)
SAINT JOSEPH HEALTH SYSTEM INC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202611334601HEALTHCAREKY501(c)(33KOHYes (true)
SAINT JOSEPH HOSPITAL FOUNDATION INC
ONE SAINT JOSEPH DRIVELEXINGTONKY40504611159649FUNDRAISINGKY501(c)(3Type ISJHSYes (true)
SAINT JOSEPH LONDON FOUNDATION INC
1001 SAINT JOSEPH LANELONDONKY40741260438748FUNDRAISINGKY501(c)(37SJHSYes (true)
SAINT JOSEPH MOUNT STERLING FOUNDATION INC
225 FALCON DRMOUNT STERLINGKY40353272884584FUNDRAISINGKY501(c)(37SJHSYes (true)
SAINT JOSEPH'S HOSPITAL FOUNDATION
30 WEST 7TH STDICKINSONND58601363418207FUNDRAISINGND501(c)(3Type ISJHHCYes (true)
SAMARITAN BEHAVIORAL HEALTH INC
601 S EDWIN C MOSES BLVDDAYTONOH45417020633634HEALTHCAREOH501(c)(37SHPYes (true)
SAMARITAN HEALTH PARTNERS
110 N MAIN ST STE 500DAYTONOH45402311107411HEALTHCAREOH501(c)(3Type ICHIYes (true)
SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC
104 W 17TH STSCHUYLERNE68661363630014FUNDRAISINGNE501(c)(3Type IAHMHSYes (true)
SJRMC JOPLIN MISSOURI
198 INVERNESS DRIVE WESTENGLEWOODCO80112440545809HEALTHCAREMO501(c)(33CHIYes (true)
SL AUGUSTA CORP
PO BOX 20269HOUSTONTX77225760226623TITLE HOLDINGTX501(c)(2SLPCYes (true)
ST ALEXIUS MEDICAL CENTER
900 EAST BROADWAY AVENUEBISMARCKND58501450226711HEALTHCAREND501(c)(33CHIYes (true)
ST ANTHONY HOSPITAL
1601 SE COURT AVEPENDLETONOR97801930391614HEALTHCAREOR501(c)(33CHIYes (true)
ST ANTHONY HOSPITAL FOUNDATION
1601 SE COURT AVEPENDLETONOR97801930992727FUNDRAISINGOR501(c)(3Type ISAHYes (true)
ST ANTHONY'S HOSPITAL ASSOCIATION
FOUR HOSPITAL DRMORRILTONAR72110710245507HEALTHCAREAR501(c)(33SVIMCYes (true)
ST CATHERINE HOSPITAL
401 EAST SPRUCE STGARDEN CITYKS67846480543721HEALTHCAREKS501(c)(33CHIYes (true)
ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION
401 EAST SPRUCE STGARDEN CITYKS67846200598702FUNDRAISINGKS501(c)(3Type ISCHYes (true)
ST CLARE COMMONS
5942 RENAISSANCE PLACE STE ATOLEDOOH43623270163752LIVING COMMOH501(c)(39FLCYes (true)
ST DOMINIC OF ONTARIO OREGON
198 INVERNESS DRIVE WESTENGLEWOODCO80112930433692HEALTHCAREOR501(c)(4CHIYes (true)
ST FRANCIS HOME
2400 ST FRANCIS DRBRECKENRIDGEMN56520410729978LTERM CAREMN501(c)(39CHIYes (true)
ST FRANCIS LIFE CARE CORPORATION
19 POCONO RDDENVILLENJ07834222536017ELDERLY CARENJ501(c)(39SCHSYes (true)
ST FRANCIS MEDICAL CENTER
2400 ST FRANCIS DRBRECKENRIDGEMN56520410695598HEALTHCAREMN501(c)(33CHIYes (true)
ST FRANCIS OF BAKER CITY
198 INVERNESS DRIVE WESTENGLEWOODCO80112930412495HEALTHCAREOR501(c)(33CHIYes (true)
ST JOSEPH FOUNDATION OF BRYAN TEXAS
2801 FRANCISCAN DRIVEBRYANTX77802742351158FUNDRAISINGTX501(c)(3Type ISJSCYes (true)
ST JOSEPH MANOR
2801 FRANCISCAN DRIVEBRYANTX77802742847594HEALTHCARETX501(c)(39SJSCYes (true)
ST JOSEPH MEDICAL CENTER INC
201 INTERNATIONAL CIRCLE STE 212HUNT VALLEYMD21030520591461HEALTHCAREMD501(c)(33CHIYes (true)
ST JOSEPH PHYSICIAN ASSOCIATES
2801 FRANCISCAN DRIVEBRYANTX77802203159302HEALTHCARETX501(c)(33SJSCYes (true)
ST JOSEPH PHYSICIAN ENTERPRISE INC
201 INTERNATIONAL CIRCLE STE 212HUNT VALLEYMD21030521311775PHYSICIANSMD501(c)(3Type ISJMCYes (true)
ST JOSEPH REGIONAL HEALTH CENTER
2801 FRANCISCAN DRIVEBRYANTX77802741282696HEALTHCARETX501(c)(33SJSCYes (true)
ST JOSEPH REGIONAL HEALTH PARTNERS
2801 FRANCISCAN DRIVEBRYANTX77802454088170HEALTHCARETX501(c)(33SJSCYes (true)
ST JOSEPH REGIONAL HEALTH PARTNERS ACO
2801 FRANCISCAN DRIVEBRYANTX77802463265423HEALTHCARETX501(c)(33SJSCYes (true)
ST JOSEPH SERVICES CORPORATION
2801 FRANCISCAN DRIVEBRYANTX77802742455161MANAGEMENTTX501(c)(3Type ISFHYes (true)
ST JOSEPH'S AREA HEALTH SERVICES
600 PLEASANT AVEPARK RAPIDSMN56470410695603HEALTHCAREMN501(c)(33CHIYes (true)
ST JOSEPH'S HOSPITAL AND HEALTH CENTER
30 WEST 7TH STDICKINSONND58601450226429HEALTHCAREND501(c)(33CHIYes (true)
ST LEONARD
8100 CLYO ROADCENTERVILLEOH45458341940863LIVING COMMOH501(c)(39FLCYes (true)
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION
6624 FANNIN ST STE 2505HOUSTONTX77030260274448MANAGEMENTTX501(c)(3Type ISLHSYes (true)
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - PMC
6624 FANNIN ST STE 2505HOUSTONTX77030273733278HEALTHCARETX501(c)(33SLCDCYes (true)
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND
6624 FANNIN ST STE 2505HOUSTONTX77030261947374HEALTHCARETX501(c)(33SLHSYes (true)
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS
6624 FANNIN ST STE 2505HOUSTONTX77030260335902HEALTHCARETX501(c)(33SLCDCYes (true)
ST LUKE'S COMMUNITY HEALTH SERVICES
6624 FANNIN ST STE 1100HOUSTONTX77030760536234HEALTHCARETX501(c)(33SLHSYes (true)
ST LUKE'S FOUNDATION
1213 HERMANN DRIVE STE 855HOUSTONTX77004453811485FUNDRAISINGTX501(c)(37SLHSYes (true)
ST LUKE'S HEALTH SYSTEM CORPORATION
6624 FANNIN ST STE 1100HOUSTONTX77030760536232MANAGEMENTTX501(c)(3Type ICHIYes (true)
ST LUKE'S HOSPITAL AT THE VINTAGE
6624 FANNIN ST STE 2505HOUSTONTX77030263734606HEALTHCARETX501(c)(33SLHSYes (true)
ST LUKE'S MEDICAL GROUP
6624 FANNIN STHOUSTONTX77030760458535PHYSICIANSTX501(c)(33SLHSYes (true)
ST LUKE'S MEDICAL TOWER CORPORATION
6624 FANNIN ST STE 1100HOUSTONTX77030760531713PROPERTY MGMTTX501(c)(3Type ICHI-SLHYes (true)
ST LUKE'S PROPERTIES CORPORATION
6624 FANNIN ST STE 1100HOUSTONTX77030760531716PROPERTY MGMTTX501(c)(3Type ISLHSYes (true)
ST LUKE'S SUGAR LAND PROPERTIES CORPORATION
6624 FANNIN ST STE 2505HOUSTONTX77030454120549PROPERTY MGMTTX501(c)(3Type ISLCDC-SLYes (true)
ST MARY'S COMMUNITY HOSPITAL
1314 3RD AVENEBRASKA CITYNE68410470443636HEALTHCARENE501(c)(33CHI NEBRASKAYes (true)
ST MARY'S HOSPITAL FOUNDATION
1314 3RD AVENEBRASKA CITYNE68410470707604FUNDRAISINGNE501(c)(37SMCHYes (true)
ST VINCENT FOUNDATION
TWO ST VINCENT CIRCLELITTLE ROCKAR72205510169537FUNDRAISINGAR501(c)(3Type ISVIMCYes (true)
ST VINCENT INFIRMARY MEDICAL CENTER
TWO ST VINCENT CIRCLELITTLE ROCKAR72205710236917HEALTHCAREAR501(c)(33CHIYes (true)
ST VINCENT MEDICAL GROUP
TWO ST VINCENT CIRCLELITTLE ROCKAR72205710830696HEALTHCAREAR501(c)(39SVIMCYes (true)
SYLVANIA FRANCISCAN HEALTH
1715 INDIAN WOOD CIR 200MAUMEEOH43537341412964HEALTHCAREOH501(c)(3Type ICHIYes (true)
SYLVANIA FRANCISCAN HEALTH FOUNDATION
1715 INDIAN WOOD CIR 200MAUMEEOH43537455357161FUNDRAISINGOH501(c)(3Type IFLCYes (true)
THE COMMONS OF PROVIDENCE
5000 PROVIDENCE DRIVESANDUSKYOH44870341826097ASSIST LIVINGOH501(c)(39FLCYes (true)
THE COMMUNITY HOSPITAL OF BRAZOSPORT
100 MEDICAL DRIVELAKE JACKSONTX77566741385192HEALTHCARETX501(c)(33SLHSYes (true)
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH
619 OAK ST ACCOUNTING-3 WCINCINNATIOH45206310537486HEALTHCAREOH501(c)(33CHIYes (true)
THE PHYSICIAN NETWORK
2000 Q ST STE 500LINCOLNNE68503470780857PHYSICIANSNE501(c)(3Type ICHI NEBRASKAYes (true)
TOTAL HEALTHCARE
188 INVERNESS DRIVE WEST STE 500ENGLEWOODCO80112840927232HEALTHCARECO501(c)(33CHICYes (true)
TRINITY HEALTH FOUNDATION
380 SUMMIT AVENUESTEUBENVILLEOH43952311329423FUNDRAISINGOH501(c)(3Type ITHSYes (true)
TRINITY HEALTH SYSTEM
380 SUMMIT AVENUESTEUBENVILLEOH43952341818681HEALTHCAREOH501(c)(3Type ISFHYes (true)
TRINITY HEALTH SYSTEM GROUP
380 SUMMIT AVENUESTEUBENVILLEOH43952300752920HEALTHCAREOH501(c)(33THSYes (true)
TRINITY HOSPITAL HOLDING COMPANY
380 SUMMIT AVENUESTEUBENVILLEOH43952341842025HEALTHCAREOH501(c)(33THSYes (true)
TRINITY HOSPITAL TWIN CITY
819 NORTH FIRST STREETDENNISONOH44621275401105HEALTHCAREOH501(c)(33CHIYes (true)
TRI-STATE HEALTH SERVICES INC
ONE ROSS PARK BLVDSTEUBENVILLEOH43952341522484ASSIST LIVINGOH501(c)(3THSYes (true)
UNITY FAMILY HEALTHCARE
815 SE 2ND STLITTLE FALLSMN56345410721642HEALTHCAREMN501(c)(33CHIYes (true)
VILLA NAZARETH INC
801 PAGE DRFARGOND58103450226714LTERM CAREND501(c)(39CHIYes (true)
VISITING NURSE ASSOCIATION OF ST CLARE'S INC
191 WOODPORT RDSPARTANJ07871221768334HOME HEALTHNJ501(c)(39SCHSYes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (43 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtPredominant Income TypePredominantIncomeTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtDisproportionate AllocationsDisproportionateAllocationsIndUBI Code VUBICodeVAmtGeneral Or Managing PartnerGeneralOrManagingPartnerIndOwnershipOwnershipPct
Alegent Health Northwest Imaging Center LLC
3606 N 156th StOMAHANE68116061786985OP DiagnosticsNEACHRelated-$7,263$485,853false$0Yes (true)0.51
Audubon Land Company LLC
5390 N Academy Blvd STE 300COLORADO SPRINGSCO80918841513085Real EstateCOCHICRelated$250,214$23,193,712false$0false0.5
AVON EMERGENCY AND URGENT CARE CENTER LLC
188 INVERNESS DRIVE WEST 500ENGLEWOODCO80112811727282HEALTHCARE SRVCCOCHICRelated$0$0false$0Yes (true)0.77
BAYLOR CHI ST LUKES HEALTH SERVICES LLC
6624 Fannin St Ste 1100HOUSTONTX77030472079184HEALTHCARE SRVCTXSLHSRelated$0$0false$0Yes (true)0.65
BERGAN MERCY SURGERY CENTER LLC
7710 Mercy Rd Ste 200OMAHANE68124208671994AMBUL SURG CTRNEACHRelated$709,407$1,953,385false$0false0.58
BERYWOOD OFFICE PROPERTIES LLC
400 BERYWOOD TRAILCLEVELANDTN37312621875199PHYS OFFICETNMHCSRelated$127,778$958,445false$0Yes (true)0.63
BLUEGRASS REGIONAL IMAGING CENTER
1218 SOUTH BROADWAY STE 310LEXINGTONKY40504611386736DIAGNOSTIC IMAGINGKYSJHSRelated$312,944$3,261,145false$0false0.65
CATHOLIC HEALTH INITIATIVES PHYSICIAN SERVICES LLC
198 INVERNESS DRIVE WESTENGLEWOODCO80112462945938PRACTICE MGMT SRVCDECHIRelated-$572,758$28,961,482false$0Yes (true)0.8
CENTRAL NEBRASKA HOME CARE SERVICES
PO BOX 1146 4502 N SECOND AVEKEARNEYNE68848470692112HEALTHCARE SRVCNEnaRelated-$33,398$156,208false$0Yes (true)1.0
CENTRAL NEBRASKA REHABILITATION SERVICES LLC
3004 W FAIDLEY AVENUEGRAND ISLANDNE68803810653461Physical TherapyNESFMCRelated$2,441,607$3,412,341false$0false0.51
CENTURA-SCA HOLDINGS LLC
569 BROOK VILLAGE STE 901BIRMINGHAMAL35209474823023OP SURGERY CENTERALCHICRelated$525,814$1,305,299false$0Yes (true)0.65
CHI OPERATING INVESTMENT PROGRAM LP
198 INVERNESS DRIVE WESTENGLEWOODCO80112470727942INVESTMENTSCOCHIUnrelated$332,023,271$6,703,637,716false$515,470Yes (true)1.0
CHI ST LUKE'S HEALTH EMERGENCY CENTER LLC
6624 Fannin St Ste 1100HOUSTONTX77030810743412URGENT CARETXSLHSRelated$0$0false$0Yes (true)0.65
CHICAMSURG Surgery Centers LLC
188 INVERNESS DRIVE WEST 500ENGLEWOODCO80112465683027SURGERY CENTERCOCHICRelated$0$0false$0false0.51
CHICLARKIN VENTURES LLC
188 INVERNESS DRIVE WEST 500ENGLEWOODCO80112474210888URGENT CARECOCHICRelated$0$0false$0Yes (true)0.87
Colorado Springs CK Leasing LLC
8770 W Bryn Mawr Ste 1370CHICAGOIL60631262982714REAL ESTATECOCHICRelated$599,151$425,148false$0Yes (true)0.4
HC SL VINTAGE I LLC
18000 W SARAH LANE STE 250BROOKFIELDWI53045270453767PROPERTY HOLDINGWISL HOSP-VINTAGERelated$1,365,254$375,590,761false$0false0.51
HEALTHCARE SUPPORT SERVICES LLC
PO BOX 9804GRAND ISLANDNE68802721546196LAUNDRYNEnaRelated$256,166$3,371,484false$0false1.0
Heartland Oncology LLC
2337 E Crawford StSALINAKS67401464265403ONCOLOGYKSSCHRelated-$457,809$1,985,911false$0false0.51
HIGHLINE IMAGING LLC
PO BOX 184BRUSH PRAIRIEWA98606200460005DIAGNOSTIC IMAGINGWAHMCRelated$65,074$1,408,012false$0false0.8
LAKESIDE AMBULATORY SURGICAL CENTER LLC
17031 LAKESIDE HILLS DROMAHANE68130204267902AMBUL SURG CTRNEACHRelated$4,111,597$2,474,455false$0false0.54
LAKESIDE ENDOSCOPY CENTER LLC
17001 LAKESIDE HILLS PLZ STE 201OMAHANE68130205544496ENDOSCOPY SRVCNEACHRelated$670,348$721,021false$0false0.51
LINCOLN CK LEASING LLC
6003 Old Cheney RdLincolnNE68516262496856Real EstateNESERMCRelated$488,450$230,998false$0false0.54
NEBRASKA SPINE HOSPITAL LLC
6901 N 72ND STOMAHANE68122270263191SPINE HOSPITALNEACHRelated$10,386,143$19,795,974false$0false0.51
NORTH RIVER SURGERY CENTER LLC
2209 WILDWOOD AVESHERWOODAR72120710799771AMBUL SURG CTRARSVIMCRelated$163,900$1,280,229false$0false0.57
ORTHOCOLORADO LLC
11650 WEST 2ND PLACELAKEWOODCO80255371577105ORTHO HOSPITALCOTHCRelated$9,902,290$2,561,198false$0false0.6
PENINSULA RADIATION ONCOLOGY LLC
314 MLK JR WAY STE 11TACOMAWA98405870808610HEALTHCARE SRVCWAFHSRelated$343,465$2,173,284false$0false0.6
Penrad Imaging
1390 Kelly Johnson BlvdCOLORADO SPRINGSCO80920841072619Medical ImagingCOCHICRelated$1,160,221$2,168,695false$0false0.7
PMC HOSPITAL LLC
3100 MAIN ST STE 500HOUSTONTX77002273280598HOSPITALTXSL CDC-PMCRelated$5,287,747$67,411,280false$0Yes (true)0.51
PRAIRIE HEALTH VENTURES LLC
421 S 9TH ST STE 102LINCOLNNE68508204962103TECH SRVCNEAH-IMCRelated$1,126,606$2,905,862false$0Yes (true)0.66
Pueblo Ambulatory Surgery Center LLC
188 INVERNESS DRIVE WEST 500ENGLEWOODCO80112621488737SURGERY CENTERCOCHICRelated-$155,230$107,312false$0false0.51
Saint JOSEPH - PAML LLC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202452116736MGMT SVCSKYSJHSRelated$57,681$589,808false$0Yes (true)0.63
SAINT JOSEPH - SCA HOLDINGS LLC
1451 Harrodsburg RDLEXINGTONKY40503453801157OP SURGERYDESJHSRelated$0$0false$0Yes (true)0.51
SAINT JOSEPH-ANC HOME CARE SERVICES
1700 EDISON DRMILFORDOH45150263330545HOME HEALTHKYJHSMHRelated$5,517,685$7,112,135false$0false1.0
SCA Premier Surgery Center of Louisville LLC
200 Abraham Flexner WayLOUISVILLEKY40202721386840SURGERY CENTERKYJHSMHRelated-$177,796$2,205,015false$0false0.51
ST FRANCIS LAND COMPANY
5390 N ACADEMY BLVD STE 300COLORADO SPRINGSCO80918263134100REAL ESTATECOCHICRelated-$82,977$14,572,659false$0false0.51
ST FRANCIS MEDICAL CENTER ASSOCIATES
1717 SOUTH J STTACOMAWA98405911352698MED OFFICEWAFHSRelated$265,442$1,984,098false$0false0.61
ST LUKE'S DIAGNOSTIC CATH LAB LLP
6624 FANNIN ST STE 800HOUSTONTX77030710959365DIAGNOSTICSTXSLHS HOLDINGSRelated$611,532$1,117,217false$0false0.57
ST LUKE'S LAKESIDE HOSPITAL LLC
6624 FANNIN STE 2505HOUSTONTX77030300427437HOSPITALTXSL CDC-WRelated$277,867$42,485,184false$0Yes (true)0.51
ST LUKE'S THE WOODLANDS SLEEP CENTER LLC
6624 FANNIN STE 800HOUSTONTX77030462795726DIAGNOSTICSTXSLHSHRelated-$76,879$1,171,971false$0Yes (true)0.51
Superior Medical Imaging LLC
5000 North 26th STLINCOLNNE68521262884555OP DiagnosticsNESERMCRelated$9,528$402,804false$0Yes (true)0.51
SURGERY CENTER OF LEXINGTON LLC
200 ABRAHAM FLEXNER WAYLOUISVILLEKY40202621179539SURGERY CENTERKYSJHSRelated$187,315$2,777,419false$0Yes (true)0.51
SURGERY CENTER OF LOUISVILLE LLC
200 Abraham Flexner WayLOUISVILLEKY40202621179537SURGERY CENTERKYJHSMHRelated$11,207$803,899false$0Yes (true)0.51

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (69 entries)

Address Line1USAddress/AddressLine1TxtCityUSAddress/CityNmState AbbreviationUSAddress/StateAbbreviationCdZIPUSAddress/ZIPCdEINEINPrimary ActivitiesPrimaryActivitiesTxtLegal Domicile StateLegalDomicileStateCdBusiness Name Line1DirectControllingEntityName/BusinessNameLine1TxtEntity TypeEntityTypeTxtShare Of Total IncomeShareOfTotalIncomeAmtShare Of EOY AssetsShareOfEOYAssetsAmtOwnershipOwnershipPctControlled OrganizationControlledOrganizationIndAddress Line1ForeignAddress/AddressLine1TxtCityForeignAddress/CityNmProvince Or StateForeignAddress/ProvinceOrStateNmCountryForeignAddress/CountryCdForeign PostalForeignAddress/ForeignPostalCdLegal Domicile Foreign CountryLegalDomicileForeignCountryCdBusiness Name Line2RelatedOrganizationName/BusinessNameLine2Txt
Alegent HealthCreighton St Joseph Managed Care Services Inc
12809 West Dodge RdOmahaNE68154470802396Managed CareNECHI NebraskaC Corporation$8,129,445$5,108,8221Yes (true)
All Saints Insurance Company SPC Ltd
980556913InsuranceCHIC Corporation$0$01Yes (true)PO BOX 10073 APOGeorgetownGRAND CAYMANCJKY11001CJ
ALLIANCE HEALTH PROVIDERS OF BRAZOS Valley Inc
2801 FRACNISCAN DRIVEBRYANTX77802742466914HealthcareTXSJSCC Corporation$204,115$535,1651Yes (true)
Alternative Insurance Management Service Inc
3900 OLYMPIC BLVD STE 400ErlangerKY41018841112049Management ServicesCOCHIC Corporation$0$6,056,3381Yes (true)
AMERICAN NURSING CARE Inc
1700 EDISON DRMILFORDOH45150311085414HOME HEALTHOHCHSC Corporation$91,903,143$55,758,0441Yes (true)
AMERIMED INC
1700 EDISON DRMILFORDOH45150311158699HOME HEALTHOHANCC Corporation$21,464,273$12,744,1981Yes (true)
BC HOLDING COMPANY INC
1850 BLUEGRASS AVELOUISVILLEKY40215311542851Fitness ClubKYJHSMHC Corporation$0$01Yes (true)
BrazoSport Health Alliance
1 WEST WAY COURTLAKE JACKSONTX77566760518376Health CareTXBRHSC Corporation$0$01Yes (true)
Caduceus Medical Associates INC
5600 Brainerd Road Ste 500ChattanoogaTN37411621570736HealthcareTNMHCSC Corporation$0$1,0081Yes (true)
Captive Management Initiatives Ltd
980663022Captive ManagementCHIC Corporation$29,750$112,4611Yes (true)PO BOX 10073 APOGeorgetownGRAND CAYMANCJKY11001CJ
Carmona-DeSoto Building Horizontal Property Regime Inc
300 Werner StHot SpringsAR71913710771076HealthcareARCHI-SVHSC Corporation$0$01Yes (true)
Catholic Health Initiatives Center for Translational Research
198 INVERNESS DRIVE WESTEnglewoodCO80112272269511ResearchCOCIRIC Corporation$510,763$3,054,9891Yes (true)
CHI St Luke's Health Baylor College of Medicine Medical Center Condominium
6624 Fannin STE 1100HoustonTX77030465079545Condo AssocTXCHI-SLHBCMC Corporation$0$01Yes (true)Assoc
ClearRiver Health
198 INVERNESS DRIVE WESTEnglewoodCO80112464495960InsuranceTNPHPSIC Corporation-$186,666$6,973,9841Yes (true)
Comcare Services Inc
5570 DTC ParkwayEnglewoodCO80111840904813InactiveCOCHICC Corporation$0$01Yes (true)
CONSOLIDATED HEALTH SERVICES
1700 EDISON DRMILFORDOH45150311378212HOME HEALTHOHCHIC Corporation$247,400$51,845,0301Yes (true)
Des Moines Medical Center Inc
1111 6TH AVEDes MoinesIA50314420837382Real EstateIACHI-IA CorpC Corporation$71,628$1,151,0780.93Yes (true)
Diversified Health Resources Inc
100 MEDICAL DRIVELAKE JACKSONTX77566760222679Health CareTXBRHSC Corporation$0$01Yes (true)
East Texas Clinical Services Inc
2801 Via Fortuna 500AustinTX78746454736213HealthcareTXMHSETC Corporation$0$16,7821Yes (true)
First Initiatives Insurance LTD
980203038InsuranceCHIC Corporation$0$01Yes (true)PO BOX 10073 APOGeorgetownGRAND CAYMANCJKY11001CJ
Franciscan Services Inc
198 INVERNESS DRIVE WESTEnglewoodCO80112232487967HealthcareCOCHIC Corporation$318,497$11,891,6451Yes (true)
Good Samaritan Outreach Services
PO Box 1990KearneyNE68848470659440Medical ClinicNECHI NebraskaC Corporation$0$01Yes (true)
HarvestPlains Health of Iowa
32129 Weyerhaeuser Way S STE 201FEDERAL WAYWA98001473451750InsuranceWAQCHPSC Corporation$2,182$3,002,1821Yes (true)
Health Systems Enterprises Inc
1700 EDISON DRMILFORDOH45150470664558MGMTNEGSHC Corporation$84,269$1,115,2101Yes (true)
Healthcare MGMT Services Organization INC
1149 MARKET STTacomaWA98402911865474Health Org.WAFHSC Corporation$0$01Yes (true)
HeartlandPlains Health
198 INVERNESS DRIVE WESTEnglewoodCO80112464368223InsuranceNEPHPSIC Corporation$1,755,860$3,679,1331Yes (true)
Highline Medical Group
15811 AMBUAN Blvd SW STE ABurienWA98166911407026Medical ServicesWAHMCC Corporation$0$01Yes (true)
Medquest
1301 15TH AVENUE WESTWillistonND58801450392137Sale of DMENDMMC WillistonC Corporation$677,839$1,583,3251Yes (true)
Memorial CV Service Line Management Company LLC
1201 W Frank AveLufkinTX75904463622849Heath CareTXMHSETC Corporation$0$01Yes (true)
Mercy Park Apartments LTD
1111 6th AVEDes MoinesIA50314421202422HousingIACHI-IA CorpC Corporation$1,888,173$2,376,8121Yes (true)
Mercy Services Corp
2700 STEWART PARKWAYRoseburgOR97471930824308Retail SalesORMMCC Corporation$2,502,051$1,446,1081Yes (true)
MHI Clinical Services
1201 W Frank AveLufkinTX75904461967952HealthcareTXMHSETC Corporation$10,063,699$1,339,6191Yes (true)
Mountain Management Services Inc
6028 Shallowford RdChattanoogaTN37421621570739MGMT SVC ORGTNMHCSC Corporation$31,344,101$6,237,9321Yes (true)
Nazareth Assurance Company
030304831InsuranceCHIC Corporation$0$01Yes (true)PO BOX 10073 APOGeorgetownGRAND CAYMANCJKY11001CJ
PATIENT TRANSPORT SERVICES INC
1700 EDISON DRMILFORDOH45150311100798HOME HEALTHOHANCC Corporation$9,010,987$6,688,7831Yes (true)
PhysicianHealth System Network
1149 MARKET STTacomaWA98402911746721Health Org.WAFHSC Corporation$0$01Yes (true)
QCA Health Plan Inc
12615 Chenal Parkway STE 300Little RockAR72211710794605InsuranceARQCHIC Corporation$104,106,960$86,204,0291Yes (true)
QualChoice Advantage
32129 WEYERHAEUSER WAY S STE 201FEDERAL WAYWA98001473433912InsuranceWAQCPSC Corporation$2,767$3,502,7671Yes (true)
QualChoice Health Plan Services Inc (fka CollabHealth Plan Services Inc)
198 INVERNESS DRIVE WESTEnglewoodCO80112461224037Admin ServicesCOQCHIC Corporation$17,917,443$64,152,8981Yes (true)
QualChoice Health Inc (fka CollabHealth Managed Solutions Inc)
198 INVERNESS DRIVE WESTEnglewoodCO80112461222808Holding CoCOCHIC Corporation$2,010,400-$2,237,6561Yes (true)
QualChoice Holdings Inc
12615 Chenal Parkway STE 300Little RockAR72211274075520Holding CoARPHPSC Corporation$0$10,1901Yes (true)
QualChoice Life and Health Insurance Company Inc
12615 Chenal Parkway STE 300Little RockAR72211710386640InsuranceARQCHC Corporation$19,949,469$19,444,6331Yes (true)
QualChoice of Nebraska
2401 S 73rd StOmahaNE68124810738827InsuranceNEQCHC Corporation$0$01Yes (true)
RiverLink Health
198 INVERNESS DRIVE WESTEnglewoodCO80112464380824InsuranceOHPHPSC Corporation$2,069,874$3,679,8791Yes (true)
RiverLink Health of Kentucky Inc
198 INVERNESS DRIVE WESTEnglewoodCO80112464828332InsuranceKYPHPSC Corporation$1,590,037$5,958,7861Yes (true)
Ross Park Pharmacy Inc
380 SUMMIT AVESTEUBENVILLEOH43952341832654PharmacyOHTHSC Corporation$1,104,611$2,024,4311Yes (true)
Saint Clare's Primary Care Inc
66 FORD RDDenvilleNJ07834222441202Billing ServicesNJSCCCC Corporation$499,042$1,183,2471Yes (true)
SAMARITAN FAMILY CARE INC
40 W FOURTH ST STE 1700DaytonOH45402311299450HealthcareOHSHPC Corporation$0$01Yes (true)
SJH Services Corporation
198 INVERNESS DRIVE WESTEnglewoodCO80112232307408HealthcareCOFSIC Corporation$2,007,370$2,441,2861Yes (true)
SJL PHYSICIAN MANAGEMENT SERVICES INC
424 LEWIS HARGETT CR STE 160LexingtonKY40503270164198MgmtKYSJHSC Corporation$41$01Yes (true)
SLMT Parking Inc
6624 Fannin STE 800HoustonTX77030760637140ParkingTXSLHSC Corporation$3,345,698$205,2001Yes (true)
SoundPath Health Inc
32129 Weyerhaeuser Way S STE 201Federal WayWA98001421720801InsuranceWAPHPSC Corporation$138,106,211$32,840,9091Yes (true)
St Alexius Health Services Inc
900 East Broadway AvenueBismarckND58501450402812HealthcareNDSAMCC Corporation$0$01Yes (true)
St Anthony Development Company
1415 SouthgatePendletonOR97801931216943Athletic ClubORSAHC Corporation$1,541,465$2,192,2871Yes (true)
St Joseph Development Company Inc
1717 SOUTH J STTacomaWA98405911480569RentalWAFSIC Corporation$3,758,845$12,828,4931Yes (true)
ST JOSEPH OFFICE PARK ASSOCIATION
1401 HARRODSBURG RD BLDG B70LexingtonKY40504611079899MgmtKYSJHSC Corporation$200,108$1,137,6600.85Yes (true)
St Luke's 6620 Main Condominium Association
6624 Fannin STE 1100HoustonTX77030300355517Condo AssocTXSLPCC Corporation$0$01Yes (true)
St Luke's Anesthesiology Associates
6624 Fannin STE 1100HoustonTX77030461517163Medical ClinicTXCHI-SLHC Corporation$0$01Yes (true)
St Luke's Episcopal Hospital Physician Hospital Organization Inc
6720 Bertner MC4-262HoustonTX77030760377932PHOTXCHI-SLHC Corporation$0$00.6Yes (true)
St Luke's Health System Holdings Inc
6624 Fannin STE 800HoustonTX77030760637138Holding CoTXSLHSC Corporation$2,163,924$4,389,0841Yes (true)
St Luke's Medical Arts Center I Condominium Association
6624 Fannin STE 1100HoustonTX77030300355518Condo AssocTXSLPCC Corporation$0$01Yes (true)
St Luke's Medical Tower Condominium Association
6624 Fannin STE 1100HoustonTX77030760298751Condo AssocTXSLMTCC Corporation$0$01Yes (true)
St Vincent Community Health Services Inc
TWO ST VINCENT CIRCLELittle RockAR72205710710785HealthcareARSVIMCC Corporation$4,033,444$16,764,1501Yes (true)
StableView Health Inc
198 INVERNESS DRIVE WESTEnglewoodCO80112464373713InsuranceKYPHPSC Corporation$301,615$5,787,2961Yes (true)
Sugar Land Doctor Group
1317 Lake Point ParkwaySugar LandTX77478454270163Medical ClinicTXSLCDC-SLC Corporation$0$01Yes (true)
The Texas Heart Institute at St Luke's Episcopal Hospital Denton A Cooley B
6624 Fannin STE 1100HoustonTX77030900064009Condo AssocTXCHI-SLHC Corporation$0$01Yes (true)uilding Comdominium Association
Towson Management Inc
7601 OSLER DRTowsonMD21204521710750Mgmt ServicesMDFSIC Corporation$0$01Yes (true)
TRINITY MANAGEMENT SERVICES ORGANIZATION
380 SUMMIT AVESTEUBENVILLEOH43952341471026Mgmt ServicesOHTHSC Corporation-$76,969$259,9911Yes (true)
Vintage Doctor Group
6624 Fannin STE 1100HoustonTX77030Medical ClinicTXCHI-SLHC Corporation$0$01Yes (true)
FieldValueIRS element (for citing)
Receipt Of Int Annts Rnts RyltsfalseReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth OrgfalseGiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth OrgfalseGiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other OrgfalseLoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth OrgYes (true)LoansOrGuaranteesFromOthOrgInd
Div Related OrganizationfalseDivRelatedOrganizationInd
Asset Sale To Other OrgfalseAssetSaleToOtherOrgInd
Asset Purchase From Other OrgfalseAssetPurchaseFromOtherOrgInd
Asset ExchangefalseAssetExchangeInd
Rental Of Facilities To Oth OrgfalseRentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth OrgfalseRentalOfFcltsFromOthOrgInd
Perform Of Services For Oth OrgfalsePerformOfServicesForOthOrgInd
Perform Of Services By Other OrgfalsePerformOfServicesByOtherOrgInd
Sharing Of FacilitiesfalseSharingOfFacilitiesInd
Paid Employees SharingYes (true)PaidEmployeesSharingInd
Reimbursement Paid To Other OrgYes (true)ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other OrgfalseReimbursementPaidByOtherOrgInd
Transfer To Other OrgfalseTransferToOtherOrgInd
Transfer From Other OrgfalseTransferFromOtherOrgInd