2016-05-13T13:03:37-05:00 2015-06-30 470617373 Catholic Health Initiatives 198 Inverness Drive West Englewood CO 80112 990 2014-07-01 470379836 Saint Elizabeth Regional Medical Center SAIN 4022198000 555 South 70th Street Lincoln NE 68510 Jeanette Wojtalewicz CFO CHI Health 2016-05-08 true DONALD NEAL JR P00798244 3032989100 2014 2016-08-17 19:52:53Z Cliff Robertson 555 South 70th Street Lincoln NE 68510 212482640 false 0928 X http://www.chihealthstelizabeth.com/ X 1889 NE Community service is a core activity for Saint Elizabeth. Essential inpatient and outpatient services are provided as well as specialties in Neonatal, Burn, Cancer and Emergency. 13 10 1814 734 1721464 243953 3156509 433581 237011045 196701753 10270330 11358181 3839151 3989125 254277035 212482640 476543 23331182 0 0 80514807 73092418 0 0 0 154152448 125363469 235143798 221787069 19133237 -9304429 458668207 436875547 90274978 81058291 368393229 355817256 See Schedule O false false 8540691 6399359 81914943 At Saint Elizabeth, our team works to provide you and your referring physician with the information needed for fast and effective treatment. We have met the rigorous requirements of accreditation from the American College of Radiology in CT, MRI, Mammography, Nuclear Medicine and PET/CT imaging. 6784126 2823560 36142963 Our emergency room is staffed 24 hours a day by physicians and nurses who are specially trained in emergency care. We have state-of-the-art technology that assists our expert staff in evaluating, diagnosing and treating any type of illness or injury. We have an accredited Stroke Center and a verified Burn Center, which means that our staff is specially trained to be ready at a moment's notice to treat stroke and burn patients as quickly as possible. We are also recognized as one of the nation's top hospitals for quickest response times to heart attacks. Our cardiac procedure and surgery success rates exceed state and national averages. 5679925 4042223 51742446 We are recognized for being one of the nation's top hospitals for quickest response times to heart attacks. Our cardiac procedure and surgery success rates exceed state and national averages. We are committed to offering the highest standards of care and expertise from skilled medical professionals specially trained to care for your heart. Our services include: Diagnostic Tests & Procedures Our cardiac team performs the latest procedures for diagnosis and treatment of heart disease, including diagnostic and interventional cardiac catheterization, electrophysiology, non-invasive diagnostic studies and medical cardiac care. Cardiac Rehabilitation Our cardiac rehabilitation program offers medically-monitored exercise and education tailored to your needs for recovery and prevention of future heart issues. Prevention We offer preventive programs including screening, lifestyle management and a smoking cessation program. We encourage you to reduce our risk of heart disease by developing a heart-healthy lifestyle. 192982381 10066040 26901401 Other programs 192982381 10066040 26901401 213987123 true true false true false false false false false false true true false false true true false true false false true false false false false false true true true true true false false false false false false false false false false false false false true true true false false true 0 0 1814 true true true false false false false false false false false false X 13 10 false false false false true true true true true false false true true true true true true false true true false X Jeanette Wojtalewicz 4023434671 12809 West Dodge Road Omaha NE 68154 MICHAEL DEFREECE Secretary/Treasurer 1.00 11.00 X X 0 0 0 RICHARD HERINK Board Chair 1.00 11.00 X X 0 0 0 CLIFF ROBERTSON Board Member/CEO CHI Health 1.00 59.00 X X 0 1023504 178123 DR Maryanne Stevens RSM VICE CHAIR 1.00 11.00 X X 0 0 0 LARRY BUTLER Board Member 1.00 11.00 X 0 0 0 FR JAMES CLIFTON SJ Board Member 1.00 11.00 X 0 0 0 GREGORY HEIDRICK Board Member 1.00 59.00 X 0 2329 0 Sister Nadine Heimann Board Member 1.00 11.00 X 0 0 0 MARTIN M MANCUSO MD Board Member 1.00 59.00 X 0 391484 25633 MICHAEL ROWAN FACHE Board member/CHI EVP & COO 1.00 59.00 X 0 2500443 53656 BARRY SANDSTROM Board Member 1.00 11.00 X 0 0 0 NATHANIEL BRACKETT MD BOARD MEMBER 1.00 11.00 X 0 0 0 SUSANNE L HRUZA BOARD MEMBER 1.00 11.00 X 0 0 0 AMY L MCGAHA BOARD MEMBER 1.00 11.00 X 0 234004 9616 NANCY WALLACE SVP HR CHI HEALTH 8.00 52.00 X 0 506487 0 CARY WARD MD CHIEF MEDICAL OFFICER 24.00 36.00 X 223975 270028 76501 JEANETTE WOJTALEWICZ CFO CHI Health 5.00 55.00 X 0 696172 98208 STEVE HOUSTON SVP STRATEGY 8.00 52.00 X 0 281209 22650 KIM MOORE PRESIDENT 58.00 3.00 X 0 454810 85469 MIKE WATTERS VP-SENIOR COUNSEL 3.00 57.00 X 0 312583 41629 MICHAEL GERMAN DIRECTOR OF PHARMACY 50.00 0 X 145931 0 23046 PATRICK GILLES VP CLINICAL SUPPORT 60.00 0.00 X 154519 0 35415 NANCY GONDRINGER DIRECTOR PERIOPERATIVE SERVICE 50.00 0 X 155567 0 26351 DONNA HAMMACK CHIEF DEVELOPMENT OFFICER-FOUNDATION 1.00 50.00 X 169326 0 40462 ELIZABETH RAETZ VP NURSING 60.00 0.00 X 222898 0 52309 GREGORY GILLESPIE VP HUMAN RESOURCES 0.00 60.00 X 0 331318 49173 CHARLOTTE LIGGETT VP STRATEGY & PLANNING 0.00 60.00 X 0 458336 43109 DAN SCHONLAU VP Operational Finance NHH, St. Elizabeth 1.00 50.00 X 3731 197122 30967 AMY HATCHER VP Divisional Finance 0.00 60.00 X 0 205947 10194 DOUGLAS KUCERA VP FINANCE 59.00 1.00 X 115461 0 33771 MICHAEL FERRIS MD BOARD MEMBER/CHIEF OF STAFF 10.00 50.00 X 74727 52925 18824 ROBERT LANIK Former Board Member/CHI NE President/CEO 0.00 0.00 X 0 1396479 58032 1266135 9315180 1013138 36 true true false LINCOLN ANESTHESIOLOGY GRP PC 555 S 70th St Lincoln NE 68510 anesthesiology services 1513552 ARAMARK HEALTHCARE 1101 Market St Philadelphia PA 19107 healthcare support services 1306928 lincoln medical education partnership 4600 Valley Rd 225 Lincoln NE 68510 healthcare education services 564676 NEBRASKA PULMONARY SPECIALTIES 1500 South 48th St Suite 800 Lincoln NE 68506 Healtcare services 498780 PATHOLOGY MEDICAL SERVICES PC 5440 South St 200 Lincoln NE 68506 Laboratory services 471941 91 X 0 0 0 433581 0 0 0 433581 Patient Services 900099 194786440 194786440 0 0 Equity changes of unconsolidated orgs 900099 639090 639090 0 0 Rental Income 900099 712505 712505 0 0 Medical Services 621300 383209 383209 0 0 Rehab Services Revenue 621400 98025 98025 0 0 82484 82484 0 0 196701753 5864279 0 -12931 5877210 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 5493902 0 0 0 5493902 0 5493902 0 0 5493902 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 Durable Medical Equipment 446199 1383674 0 1269980 113694 Cafeteria 722100 973600 0 0 973600 Services Sold 900099 1306555 0 402863 903692 325296 0 61552 263744 3989125 212482640 196701753 1721464 13625842 X 8238046 8238046 15093136 15093136 48377 4838 43539 55042762 52328250 2714512 2907305 2761940 145365 11022086 10474476 547610 4071888 3868294 203594 396 396 11135 11135 33545205 31867387 1677818 0 1072632 1019000 53632 5388574 5119145 269429 17089674 16235190 854484 5424876 5153632 271244 161343 153276 8067 27220 25859 1361 3087037 3087037 4631812 4400221 231591 8284367 7870149 414218 894575 849846 44729 Unrelated Business Taxes 97200 97200 Bad debts 6671724 6671724 Medical Supplies 35257725 35222467 35258 Repairs and maintenance 1233339 1171672 61667 2484635 2360403 124232 0 221787069 213987123 7799946 0 2203 1009403 14076603 7539794 0 35352366 28569549 0 0 0 6839 5534060 5487391 250747 359677 221899972 130269634 94908527 91630338 0 289079681 288396984 0 0 19464020 13875572 458668207 436875547 18220375 13356883 0 0 0 0 0 0 72054603 67701408 90274978 81058291 X 368393229 355817256 0 0 368393229 355817256 458668207 436875547 X -9304429 -3048723 -222821 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 11135 false false false 11135 false Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY The portion of organization dues that are related to lobbying are as follows: American Hospital Association - $2,658 Catholic Health Association - $830 Nebraska Hospital Association - $7,647 179532 179532 117091117 50922370 66168747 1641818 1282768 359050 91851046 73322042 18529004 11136459 4742454 6394005 91630338 CHI OIP 288396984 F 288396984 CHI Debt Management Program 63621851 Environmental Remediation Liability 3105555 Accrued Capital 429254 Pension Liability 529949 Unclaimed Property 14799 67701408 X Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Saint Elizabeth Regional Medical Center's 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, 2015, 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." 0 0 0 0 0 0 0 0 0 true false false false false false true true X false false true true false true true 3841 7362263 7362263 0.0342 7197 26873071 6661701 20211370 0.0940 0 0.0 0 11038 34235334 6661701 27573633 0.1282 13 62726 1386062 489974 896088 0.0042 4 804 722525 722525 0.0034 0 0.0 0 0.0 10 454 668708 668708 0.0031 27 63984 2777295 489974 2287321 0.0106 27 75022 37012629 7151675 29860954 0.1388 0 0.0 0 0.0 1 22 663 663 0.0000 0 0.0 0 0.0 1 566 566 0.0000 0 0.0 1 68 2221 2221 0.0000 0 0.0 3 90 3450 0 3450 0.0000 true 6671724 0 58882366 76678400 -17796034 X true true LINCOLN CK LEASING LLC ONCOLOGY EQUIPMENT 0.5376 0.0 0.3226 SUPERIOR MEDICAL IMAGING LLC OUTPATIENT IMAGING CENTER 0.51 0.0 0.49 NEBRASKA SURGERY CENTER LLC AMBULATORY SURGERY CENTER 0.369 0.0 0.631 1 1 Saint Elizabeth Regional Medical Center http://www.chihealthstelizabeth.com/ 500007 X X X X Saint Elizabeth Regional Medical Center 1 false false true X X X X X X X X 12 true true true true X http://www.chihealthstelizabeth.com/images/images/downloads/communityneedsassessment.pdf X SEE SUPPLEMENTAL INFORMATION X true 12 true http://www.chihealthstelizabeth.com/images/images/downloads/communityneedsassessment.pdf false false true X X X X X X X true true X X X true X http://www.chihealthstelizabeth.com/images/downloads/financialassistancepolicy.pdf X SEE SUPPLEMENTAL INFORMATION true X false X X X true X false false Schedule H, Part V, Section B, Line 5 Facility , 1 Facility , 1 - Saint Elizabeth Regional Medical Center. REPRESENTATIVES FROM SAINT ELIZABETH PARTICIPATED IN THE MOBILIZING FOR ACTION THROUGH PLANNING AND PARTNERSHIP (MAPP) PROCESS IN COOPERATION WITH THE LINCOLN-LANCASTER COUNTY HEALTH DEPARTMENT. THE RESULT OF THE MAPP PROCESS IS THE DEVELOPMENT OF A COMMUNITY HEALTH IMPROVEMENT PLAN FOR THE CITY OF LINCOLN AND LANCASTER COUNTY. AS PART OF THE MAPP PROCESS, THE LINCOLN-LANCASTER COUNTY HEALTH DEPARTMENT FORMED A STEERING COMMITTEE. THE 25 MEMBER COMMITTEE IS A BROAD-BASED REPRESENTATION OF THE HEALTH DEPARTMENT'S COMMUNITY PARTNERS AND STAKEHOLDERS. THEIR ROLE IS TO ASSIST THE HEALTH DEPARTMENT IN THE FACILIATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, THE IDENTIFICATION OF COMMUNITY PRIORITY HEALTH NEEDS, AND IN THE DEVELOPMENT OF THE COMMUNITY HEALTH IMPROVEMENT PLAN. The following organizations were engaged in the process: - CHI Saint Elizabeth Regional Medical Center - Nebraska Heart Hospital - Lincoln Lancaster County Health Department - Aging Partners - Asian Community & Cultural Center - AARP - Bryan Health - Bryan Medical Center - CEDARS Youth Services - CenterPointe - Clinic with a Heart - Community Action Partnership - Community Mental Health Center - E.D. Connections - El Centro de las Americas - Family Health Services - Homestead Rehabilitation - Houses of Hope - Human Services Federation - Indian Center Inc. - Lincoln Council on Alcoholism and Drugs - Lancaster County Emergency Management - Lancaster County Medical Society - Lincoln Community Foundation - Lincoln Police Department - Lincoln Public Schools - Lutheran Family Services - Mothers Against Drunk Drivers - Malone Community Center - Medical Reserve Corps/American Red Cross - Medical Reserve Corps - Nebraska Department of Health & Human Services - Nebraska Hospital Association - Partnership for a Healthy Lincoln - People's City Mission - People's Health Center - Safe Kids of Lincoln Lancaster County - Seniors Foundation - Firespring - Substance Abuse Action Coalition - The Salvation Army - University of Nebraska Lincoln - United Way - Community Action Partnership Schedule H, Part V, Section B, Line 6a Facility , 1 Facility , 1 - Saint Elizabeth Regional Medical Center. Alegent Creighton Health - NHH and Saint Elizabeth Community Benefits report are part of the consolidated report done by Alegent Creighton Health. Schedule H, Part V, Section B, Line 6b Facility , 1 Facility , 1 - Saint Elizabeth Regional Medical Center. Saint Elizabeth Regional Medical Center conducted the CHNA with the Lincoln-Lancaster County Health Department, Bryan Medical Center and the MAPP Steering Committee. Schedule H, Part V, Section B, Line 11 Facility , 1 Facility , 1 - Saint Elizabeth Regional Medical Center. The MAPP Steering Committee utilized the priority scoring list and results of the state sponsored survey of Lancaster County residents, 2011 Nebraska Community Themes and Strengths Assessments Survey Results to determine the top priority community health needs. Based on the scoring results, the MAPP Steering Committee identified five priority community health needs to be acted on as part of the CHIP. These five issues combined a number of conditions, behaviors, and issues all considered during the community health needs assessment process. As a result, the MAPP Steering Committee made the commitment to focus implementation strategies on the following four priority community health needs. 1. Access to Care 2. Behavioral Health Care 3. Chronic Disease Prevention 4. Injury Prevention 5. Violence Prevention After additional consideration, the MAPP Steering Committee determined that the Violence Prevention priority health issue would be best addressed within both the Behavioral Health Care and Injury Prevention priority health issues. As a result, the MAPP Steering Committee made the commitment to focus implementation strategies on the remaining four priority community health needs. For each of the areas of opportunity identified by the CHNA, Saint Elizabeth's leadership will partner with the community to address the health needs as follows: Access to Care a. Saint Elizabeth Regional Medical Center in partnership with Bryan Health administers the Lincoln ED Connections Program. b. Provide financial support to Health360- a new partnership between Lutheran Family Services of Nebraska and People's Health Center providing affordable behavioral health services, primary health care and an on-site pharmacy. This new clinic helps alleviate appointment wait time and other health concerns that result from limited access to care for Lincoln's underserved c. Saint Elizabeth funds a mid-level practitioner to help build revenue streams for Lincoln's Community Health Center. d. Provided financial assistance to assist with the operation of community health clinics serving the homeless and near homeless population (Saint Monica's, Clinic With a Heart, Peoples Health Center) e. Provided financial support for 7 individuals with Saint Elizabeth's Medication Assistance Program f. Health Hub, which is funded in part by Catholic Health Initiatives, is an innovative holistic program for connecting uninsured patients with health care and other assistance. g. Saint Elizabeth continues to administer patient hardship fund ensures that all individuals are able to receive medically necessary care regardless of their ability to pay. h. Saint Elizabeth Regional Medical Center provided transportation home for patients without any other means. i. Saint Elizabeth Regional Medical Center serves in a leadership capacity as board members for Clinic with a Heart and People's Health Center. j. Partnered/contributed in the Missions of Mercy providing individuals with dental care for a three day weekend. Behavioral Health Care a. Contracts with Blue Valley Behavioral Health, a private organization for behavioral health care referrals. b. Employs a mental health nurse in Saint Elizabeth Emergency Department and developed a screening tool for suicide prevention screenings. c. St. Elizabeth placed several health navigators in many TPN offices to navigate the underserved and patients with chronic conditions d. Saint Elizabeth contributes to Peoples Health Center and Lutheran Family Services in Health 360- an integrated clinic to build to assure that behavioral health is integrated with primary care, specialty care, pharmacy and dentistry. Chronic Disease Prevention a. Support of 25 events serving over 1000 individuals for health screenings. b. Developed a partnership with the Healthy Lincoln Organization. c. Provided 107 mammograms for uninsured women who do not qualify for Nebraska's Every Woman Matters program. d. Provided financial support to Partnership for a Healthy Lincoln, non-profit organization whose mission to implement district-wide wellness policies to decrease obesity and increase fitness in the schools through programs that promote physical activity, good nutrition, and the forming of healthy habits. - Increased the percentage of adults in Lancaster County who reported participating in any leisure time physical activity to 80.3%. - Increased the percentage of 4-8th grade Lincoln Public Schools students passing the district aerobic fitness test to 77.37%. - Increased the percentage of adults in Lancaster County reported consuming fruits and vegetables 5+ per day. - Increased the percent of WIC infants and children who were fully breastfed - Decreased the percentage of adults in Lancaster County that are overweight or obese from 59.3% to 57%. - Decreased the percentage of K-8 grade Lincoln Public Schools students who are obese from 16.8% to 14% by September 1, 2017. - Decreased the prevalence of tobacco use among Lancaster County adults from 21.9% to 18.3%. - Increase the number of adults reporting that they have had their cholesterol checked within the previous 5 years from 69.6% to 74.6%. e. In association with the Partnership for a Healthy Lincoln, Saint Elizabeth Regional Medical Center is one of four large businesses in the community implementing the Lincoln Healthy Beverage Vending Goals. f. The cafeteria at Saint Elizabeth Regional Medical Center offers patients and families healthy eating choices. Injury Prevention a. Partnering with Lincoln Public Schools and Lincoln Fire and Rescue in educating kindergartners about the risks of injury from scalds. The leading causes of burn injuries in young children are hot liquids and steam. - Opened the first and only permanent child passenger safety seat station in Lancaster County. This project was originated to fill a community need to provide car seat checks for young children in our community in which 85-90% of parents incorrectly used safety seats. b. Supports the Nebraska Regional Poison Center, a free, 24-hour emergency telephone service. Violence Prevention a. Saint Elizabeth Foundation secured a 3-year, $315,000 grant from Catholic Health Initiatives Mission and Ministry Fund to support Saint Gianna Homes, a transitional housing program of Catholic Social Services. b. Funds to support a position of an RN health and wellness life coach at Saint Gianna Homes. c. Saint Elizabeth has also provided in-kind support to Saint Gianna Homes such as staff time, office space, project management, medical supplies and equipment, and toys for the children in residence. Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - SAINT ELIZABETH REGIONAL MEDICAL CENTER. HUD LOW INCOME GUIDELINES USED Schedule H, Part V, Section B, Line 13 Facility , 1 Facility , 1 - SAINT ELIZABETH REGIONAL MEDICAL CENTER. The eligibility criteria for financial assistance also includes the size of the family Schedule H, Part V, Section B, Line 22 Facility , 1 Facility , 1 - SAINT ELIZABETH REGIONAL MEDICAL CENTER. A 40% discount is provided based on the average of Managed Care Discounts. 2 Nebraska Surgery Center LLC 625 South 70th Street Lincoln NE 68510 Ambulatory surgical center Superior Medical Imaging LLC 5000 North 26th Street Lincoln NE 68521 Outpatient diagnostic imaging center Schedule H, Part I, Line 6a How the organization made its community benefit report available Saint Elizabeth Regional Medical Center produces an annual public community benefit report that is mailed to a core constituency, placed in key places throughout the organization and distributed in community meetings. Schedule H, Part VI, Line 7 STATE FILING OF COMMUNITY BENEFIT REPORT THE COMMUNITY BENEFIT REPORT IS NOT REQUIRED TO BE FILED WITH THE STATE OF NEBRASKA; HOWEVER, SAINT ELIZABETH REGIONAL MEDICAL CENTER VOLUNTARILY PARTICIPATES WITH THE NEBRASKA HOSPITAL HOSPITAL ASSOCIATION'S ANNUAL COMPILATION OF COMMUNITY BENEFIT REPORTS, WHICH ARE PROVIDED TO FEDERAL AND STATE OFFICIALS, LEGISLATORS, AND OTHER INTERESTED PARTIES. Schedule H, Part V, Section B, Line 7 Other website (List URL) http://www.chihealthstelizabeth.com/index.php?option=com_content&view=article&id=845:community-health-needs-assessment-&catid=13:about-us&Itemid=757 Schedule H, Part V, Section B, Line 16b FAP Application form website http://www.chihealthstelizabeth.com/images/images/downloads/financial_assistance_application_form.pdf Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care Saint Elizabeth Regional Medical Center provides free and discounted care to patients with a financial need. The amount of any such free or discounted care provided by Saint Elizabeth Regional Medical Center takes into consideration the medical necessity of the care, the patient's household size, income, liquid assets, as well as other medical liabilities. When Catholic Health Initiatives (the ultimate parent organization to Saint Elizabeth Regional Medical Center) 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 17 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. Saint Elizabeth Regional Medical Center 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 may be seriously detrimental to the patients basic financial well being and survival. Such patients may be extended discounted or free care based upon these extenuating facts and circumstances. Saint Elizabeth Regional Medical Center's eligibility criterion for the application of discounts is based upon 130% of the annually updated HUD Very-Low Income guidelines. The HUD Guidelines take into consideration family incomes that do not exceed 50% of the median family income for a geographic area and utilize a sliding scale approach based upon family income and size. Schedule H, Part I, Line 7g Subsidized Health Services There are no physician clinics included in subsidized health services in Part I, Line 7g. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 6671724 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using the organization's cost-to-charge ratio. The cost-to-charge ratio covers all patient segments. The cost-to-charge ratio for the year ended 6/30/15 was computed using the following formula: Operating expense (before restructuring, impairment and other losses) divided by gross patient revenue. Based on that formula, $191,004,000/512,098,000 results in a 37.30% cost-to-charge ratio. Schedule H, Part II Community Building Activities CHI Saint Elizabeth Medical Center has a history of centralized community benefit investments, as well as hospital specific investments that address community health needs which include community building such as: - Community and economic development including support of local Chambers of Commerce - Sponsorship of community not for profits and fundraising events - Support of the federally qualified healthcare centers - Parish nursing program - Community health fairs, support groups and community education - School based healthcare services - Leadership in and funding of health coalitions including- - DIVERSITY AMBASSADORS and Leadership Committee - Two efforts implemented to ensure patient care is culturally relevant and responsive to diverse patient needs. - PEOPLES HEALTH CENTER - SAINT ELIZABETH REGIONAL MEDICAL CENTER IS A SUPPORTER OF THE PEOPLE'S HEALTH CENTER (PHC) is a Federally Qualified Health Care Center IN LINCOLN, NEBRASKA serving the behavioral, dental and medical care needs of the community's most economically vulnerable. Saint Elizabeth Regional Medical Center funded and arranged PHYSICIAN CALL COVERAGE to support uninterrupted care. - CLINIC WITH A HEART - Funded a portion of operations to ensure more individuals are connected to human service agencies, helping them find a medical home. - NEBRASKA MISSION OF MERCY - PROVIDED funding TO THE NEBRASKA MISSION OF MERCY DENTAL CARE PROGRAM to open free access to CRITICAL DENTAL CARE WHILE PLACING A HIGH PRIORITY ON PATIENTS SUFFERING FROM DENTAL INFECTIONS OR PAIN. IT ALSO PROVIDES BASIC DENTAL EDUCATION AND AWARENESS TO PATIENTS. - PARTNERSHIP FOR A HEALTHY LINCOLN - Provided significant funding of operations to support THE PARTNERSHIP FOR A HEALTHY LINCOLN IN FISCAL YEAR 2013 WITH A $50,000 CONTRIBUTION. THE PARTNERSHIP WORKS ON COMMUNITY WIDE EDUCATION AND POLICY CHANGE TO PROMOTE HEALTH AND FITNESS IN LINCOLN'S SCHOOLS AND AMONG THE CITIZENS OF LINCOLN. - LINCOLN MEDICAL EDUCATION PARTNERSHIP (LMEP) - PROVIDED funding IN SUPPORT TO THE LINCOLN MEDICAL EDUCATION PARTNERSHIP, a COMMUNITYBASED RESIDENCY PROGRAM FOR MEDICAL SCHOOL GRADUATES INTERESTED IN FAMILY PRACTICE AND IS SUPPORTED BY 250 COMMUNITY PHYSICIANS WHO VOLUNTEER MORE THAN 40,000 HOURS PER YEAR AS FACULTY MEMBERS. LINCOLN MEDICAL EDUCATION PARTNERSHIP HELPS THE LINCOLN COMMUNITY ATTRACT, TRAIN AND RETAIN NEW PHYSICIANS. - Community Classes - Free or low cost programs are offered to the community as part of the aligned health needs including examples such as; GRIEF SUPPORT CLASSES, WOMEN'S HEALTH CLASSES, Prevention and coping with DIABETES, ARTHRITIS, SKIN CANCER, SMOKING CESSATION, etc. - HEALTH PROFESSIONAL EDUCATION - TRAINs STUDENTS of PHARMACY, NURSING, AND OTHER MEDICAL PROFESSIONS, AS WELL AS SUPPORTING LINCOLN MEDICAL EDUCATION PARTNERSHIP. SAINT ELIZABETH REGIONAL MEDICAL CENTER BELIEVES HIGHLY TRAINED PERSONNEL PROVIDE QUALITY CARE. In addition, the hospital supports ongoing training and communication of area emergency units. Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount Costing methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 37.30%. When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Saint Elizabeth Regional Medical Center does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Saint Elizabeth Regional Medical Center 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 costs Using essentially the same Medicare cost report principles as to the allocation of general services costs and "apportionment" methods, the "CHI Workbook" calculates a payers' gross allowable costs by service (so as to facilitate a corresponding comparison between gross allowable costs and ultimate payments received). The term "gross allowable costs" means costs before any deductibles or co-insurance are subtracted. Saint Elizabeth Regional Medical Center's ultimate reimbursement will be reduced by any applicable copayment/ deductible. Where Medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from Medicare allowable costs because the amounts are typically immaterial. 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: $58,882,366 Total Medicare costs: $76,678,400 Surplus or Shortfall ($17,796,034) Saint Elizabeth Regional Medical Center believes that excluding Medicare losses from community benefit makes the overall community benefit report more credible for these reasons: Unlike subsidized areas such as burn units or behavioral-health services, Medicare is not a differentiating feature of tax-exempt health care organizations. In fact, for-profit hospitals focus on attracting patients with Medicare coverage, especially in the case of well-paid services that include cardiac and orthopedics. Significant effort and resources are devoted to ensuring that hospitals are reimbursed appropriately by the Medicare program. The Medicare Payment Advisory Commission (MedPAC), an independent Congressional agency, carefully studies Medicare payment and the access to care that Medicare beneficiaries receive. The commission recommends payment adjustments to Congress accordingly. Though Medicare losses are not included by Catholic hospitals as community benefit, the Catholic Health Association guidelines allow hospitals to count as community benefit some programs that specifically serve the Medicare population. For instance, if hospitals operate programs for patients with Medicare benefits that respond to identified community needs, generate losses for the hospital, and meet other criteria, these programs can be included in the CHA framework in Category C as "subsidized health services." Medicare losses are different from Medicaid losses, which are counted in the CHA community benefit framework, because Medicaid reimbursements generally do not receive the level of attention paid to Medicare reimbursement. Medicaid payment is largely driven by what states can afford to pay, and is typically substantially less than what Medicare pays. Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance Saint Elizabeth Regional Medical Center's debt collection policy provides that Saint Elizabeth Regional Medical Center will perform a reasonable review of each inpatient account prior to turning an account for 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 Saint Elizabeth Regional Medical Center's community assistance policy. After having been turned over to a third-party collection agent, any patient account that is subsequently determined to meet the Saint Elizabeth Regional Medical Center community assistance policy is required to be returned immediately by the third-party collection agent to Saint Elizabeth Regional Medical Center for appropriate follow-up. Saint Elizabeth Regional Medical Center 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 - Saint Elizabeth Regional Medical Center: Line 16a URL: http://www.chihealthstelizabeth.com/images/downloads/financialassistancepolicy.pdf; Schedule H, Part V, Section B, Line 16b FAP Application website - Saint Elizabeth Regional Medical Center: Line 16b URL: SEE SUPPLEMENTAL INFORMATION; Schedule H, Part VI, Line 2 Needs assessment SERMC was a participant in the COLLABORATIVE CHNA PROCESS COORDINATED THROUGH THE LINCOLN-LANCASTER COUNTY HEALTH DEPARTMENT. A STEERING COMMITTEE WAS FORMED BY THE HEALTH DEPARTMENT TO ASSIST THEM IN THE FACILITATION OF THE COMMUNITY HEALTH NEEDS ASSESSMENT, IDENTIFICATION OF COMMUNITY PRIORITY HEALTH NEEDS, AND IN THE DEVELOPMENT AND IMPLEMENTATION OF STRATEGIES TO MEET THE IDENTIFIED PRIORITY HEALTH NEEDS. THE STEERING COMMITTEE FOCUSED THEIR EFFORTS ON ACCESS TO CARE, BEHAVIORAL HEALTH CARE, CHRONIC DISEASE PREVENTION, AND INJURY PREVENTION. WORKING COMMITTEES WERE ESTABLISHED TO FURTHER DEFINE THE NEEDS AND IDENTIFY STRATEGIES TO ADDRESS THOSE NEEDS. SERMC CONTINUES TO WORK CLOSELY WITH COMMUNITY LEADERS ON AN ONGOING BASIS TO DEVELOP MORE IMMEDIATE RESPONSES TO COMMUNITY HEALTH NEEDS. Saint Elizabeth Regional Medical Center has collaborated on this body of work since the beginning of Fiscal Year 2012. The Community Health Needs Assessment Report and the Community Health Needs Assessment Implementation Strategy Report were collectively placed into the Catholic Health Initiatives Nebraska Strategic Plan, as mandated by the Accountable Care Act. These strategies were presented to the Catholic Health Initiatives Nebraska Board and approved in April 2013. The demographic, socioeconomic, and health information included in this Community Health Needs Assessment Report has been obtained from three needs assessments (listed below) recently conducted for the City of Lincoln and Lancaster County, Nebraska. 1. 2012 Community Health Status Assessment conducted by the Lincoln-Lancaster County Health Department. 2. 2011 Nebraska Community Themes and Strengths Assessments Survey conducted by the Nebraska Department of Health and Human Services. 3. 2012 Comprehensive Plan to address appropriate effective and sustainable health care services for the uninsured and Medicaid Populations in Lincoln, Nebraska conducted by Health Management Associations for the Community Health Endowment of Lincoln. Community Survey Results The MAPP Steering Committee made the commitment to focus implementation strategies on the following four priority community health needs. 1. Access to Care 2. Behavioral Health Care 3. Chronic Disease Prevention 4. Injury Prevention Schedule H, Part VI, Line 3 Patient education of eligibility for assistance Saint Elizabeth Regional Medical Center includes information concerning its financial assistance policy on its website. In addition, Saint Elizabeth Regional Medical Center 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 Saint Elizabeth Regional Medical Center outpatient facilities. In addition, Saint Elizabeth Regional Medical Center 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 Saint Elizabeth Regional Medical Center's 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. Saint Elizabeth Regional Medical Center 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. Saint Elizabeth Regional Medical Center's 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 4 Community information The community served by Saint Elizabeth Regional Medical Center includes the City of Lincoln and Lancaster County, Nebraska. Lancaster County (289,800 population) includes the City of Lincoln (262,341 population) and the City of Waverly (3,133 population). Difference in population (24,326) includes residents living in the towns of Bennet, Davey, Denton, Firth, Hallam, Hickman, Malcolm, Panama, Raymond, Roca, Sprague and in rural areas of the county. From 2000 to 2010, Lancaster County's population increased by 14.8 percent. The county's population aged 62 or older increased by 27 percent. Year 2010 estimates indicated that 14.8 percent of the population had family incomes below the poverty level. For children under 18, the poverty rate estimate is even higher, at 17.6 percent. Also, 2012 estimates the county's median income as $50,197 in 2010, which is higher than the Nebraska median income estimate of $48,415 and only slightly above the national median income estimate of $50,046. Nearly 93% of Lincoln's adult population has at least a high school education, and 34% of Lincoln residents have a bachelor's degree or higher; compared to the U.S. average of 27%. Lincoln is the home to the University of Nebraska-Lincoln. Lincoln offers a highly educated and motivated labor force. The work ethic and productivity of the Lincoln employees are cited by local employers as two key advantages of doing business in Lincoln. Lancaster County ranks 20th out of 79 ranked counties in the County Health Rankings. Only 12 % of adults in Lancaster County are uninsured. 36% of the county's children qualify for free & reduced lunch. Lincoln was ranked as a five star community for healthcare by Expansion Management. Lincoln was also recently ranked No. 9 by Forbes as one of the top 10 most livable cities in America. Schedule H, Part VI, Line 5 Promotion of community health SAINT ELIZABETH REGIONAL MEDICAL CENTER PROVIDES ESSENTIAL HEALTH CARE SERVICES BY MAINTAINING A 260 BED MEDICAL CENTER WITH 44 OUTPATIENT BEDS DESIGNED TO PROVIDE THE HIGHEST QUALITY MEDICAL CARE WHILE EMBRACING TRADITIONS RICH IN SPIRITUALITY. THE REGIONS' MOST INNOVATIVE AND HOLISTIC CARE IS AVAILABLE THROUGH ASSOCIATION WITH MORE THAN 500 PHYSICIANS, MANY OF WHOM WHO ARE BOARD CERTIFIED, AS WELL AS A PHYSICIAN NETWORK OF FAMILY AND SPECIALTY CLINICS IN LINCOLN AND THE SURROUNDING AREAS. IN ADDITION TO THE SERVICES PROVIDED LOCALLY, SAINT ELIZABETH REGIONAL MEDICAL CENTER HAS COMMITTED ITS EXPERTISE IN WOUND CARE TO OTHER COMMUNITIES AND PROVIDERS. A FOCUS ON DELIVERING EXCEPTIONAL PATIENT CARE IN A STATE-OF-THE-ART ENVIRONMENT WITH EXPERIENCED MEDICAL PROFESSIONALS HAS DRIVEN SERMC TO GO BEYOND THE BASICS AND PROVIDE SERVICE LINES DESIGNED TO PROVIDE SPECIALTY CARE IN THE LOCAL COMMUNITY. SAINT ELIZABETH REGIONAL MEDICAL CENTER IS GOVERNED BY A BOARD OF DIRECTORS THAT IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES. SAINT ELIZABETH REGIONAL MEDICAL CENTER IS ACCREDITED BY THE JOINT COMMISSION - A SEAL OF APPROVAL THAT INDICATES THAT SERMC MEETS STRICT PERFORMANCE STANDARDS, PROVIDES HIGH QUALITY PATIENT CARE, AND DEMONSTRATES ACCOUNTABILITY IN THE RAPIDLY CHANGING FIELD OF HEALTHCARE. IT HAS also BEEN RANKED AS A 100 TOP HOSPITAL IN THE NATION FOUR TIMES IN THE "OVERALL" CATEGORY BY THOMPSON REUTERS. SAINT ELIZABETH REGIONAL MEDICAL CENTER ALSO HOLDS THE PRESTIGIOUS DESIGNATION AS A MAGNET HOSPITAL, THE HIGHEST AWARD IN NURSING, BY THE AMERICAN NURSES CREDENTIALING CENTER. SAINT ELIZABETH REGIONAL MEDICAL CENTER EXCELS IN THE TREATMENT AREAS OF NEWBORN AND PEDIATRIC CARE, WOMEN'S HEALTH, CARDIOLOGY, EMERGENCY MEDICINE, ORTHOPEDICS, NEUROSCIENCE, ONCOLOGY, REHABILITATION, AND BURN AND WOUND CARE, AND IS LEADING THE WAY IN PREVENTION AND WELLNESS. NEONATAL INTENSIVE CARE UNIT AND MATERNAL TRANSPORT & OUTREACH EDUCATION PROGRAM extends neonatal services to area rural communities. SAINT ELIZABETH REGIONAL MEDICAL CENTER'S SERVICES ARE PROVIDED TO THE COMMUNITY ON A NON-DISCRIMINATORY BASIS. THE HOSPITAL OPERATES A 24-HOUR EMERGENCY DEPARTMENT ("ED") 365 DAYS A YEAR. THE EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. SAINT ELIZABETH REGIONAL MEDICAL CENTER HAS AN OPEN MEDICAL STAFF AND PARTICIPATES IN A VARIETY OF PROGRAMS INTENDED TO BENEFIT THE POPULATIONS WITHIN ITS SERVICE AREA, AS WELL AS THE INDIVIDUALS ENTERING INTO THE SERVICE AREA. THESE PROGRAMS INCLUDE MEDICARE, MEDICAID, TRICARE (FORMERLY KNOWN AS THE CIVILIAN HEALTH AND MEDICAL PROGRAM OF THE UNIFORMED SERVICES), WORKERS COMPENSATION, AND OTHER DISCOUNTED HEALTH INSURANCE PROGRAMS. THIS PARTICIPATION PROVIDES ACCESS TO A LOCAL HEALTH CARE PROVIDER FOR THE COMMUNITY. DIVERSITY AT SAINT ELIZABETH REGIONAL MEDICAL CENTER: LINCOLN RANKS AMONG THE TOP 15 SITES FOR REFUGEE RELOCATION IN THE UNITED STATES. THE U.S. OFFICE OF REFUGEE RESETTLEMENT HAS DESIGNATED LINCOLN AS A PREFERRED COMMUNITY FOR NEWLY-ARRIVED REFUGEES. IN ADDITION TO REFUGEES, LINCOLN IS ALSO HOME TO EXISTING ETHNIC MINORITY POPULATIONS. FOR THESE REASONS, LINCOLN IS RICH IN CULTURAL AND ETHNIC DIVERSITY. THIS DIVERSITY POSES NOT ONLY CHALLENGES---MULTIPLE LANGUAGES, CULTURAL DIFFERENCES, ETC--- BUT ALSO EXCITINGOPPORTUNITIES FOR THOSE WILLING TO EMBRACE IT. SAINT ELIZABETH REGIONAL MEDICAL CENTER CHOOSES TO EMBRACE THIS DIVERSITY IN NUMEROUS WAYS. SOME OF THESE WAYS INCLUDE: Financial Assistance - Provide care to the uninsured and underinsured via generous policy, which provides a safety net for vulnerable populations in our community. Interpretive Services - Provided for patients in-person and via using video remote or telephonic tools. The most prevalent languages include: 1) SPANISH; 2) ARABIC; 3) VIETNAMESE; 4) RUSSIAN; 5) SIGN LANGUAGE; 6) KURDISH. INTERPRETERS OF MANY OTHER FOREIGN LANGUAGES WERE ALSO USED INTERMITTENTLY DURING THE YEAR AS NEEDED. DIVERSITY AMBASSADORS and Leadership Committee - Two efforts implemented to ensure patient care is culturally relevant and responsive to diverse patient needs. COMMUNITY BENEFIT APPROACH: PEOPLES HEALTH CENTER - SAINT ELIZABETH REGIONAL MEDICAL CENTER IS A SUPPORTER OF THE PEOPLE'S HEALTH CENTER (PHC) is a Federally Qualified Health Care Center IN LINCOLN, NEBRASKA serving the behavioral, dental and medical care needs of the community's most economically vulnerable. Saint Elizabeth Regional Medical Center funded and arranged PHYSICIAN CALL COVERAGE to support uninterrupted care. CLINIC WITH A HEART - Funded a portion of operations to ensure more individuals are connected to human service agencies, helping them find a medical home. NEBRASKA MISSION OF MERCY - PROVIDED funding TO THE NEBRASKA MISSION OF MERCY DENTAL CARE PROGRAM to open free access to CRITICAL DENTAL CARE WHILE PLACING A HIGH PRIORITY ON PATIENTS SUFFERING FROM DENTAL INFECTIONS OR PAIN. IT ALSO PROVIDES BASIC DENTAL EDUCATION AND AWARENESS TO PATIENTS. PARTNERSHIP FOR A HEALTHY LINCOLN - Provided significant funding of operations to support THE PARTNERSHIP FOR A HEALTHY LINCOLN IN FISCAL YEAR 2013 WITH A $50,000 CONTRIBUTION. THE PARTNERSHIP WORKS ON COMMUNITY WIDE EDUCATION AND POLICY CHANGE TO PROMOTE HEALTH AND FITNESS IN LINCOLN'S SCHOOLS AND AMONG THE CITIZENS OF LINCOLN. LINCOLN MEDICAL EDUCATION PARTNERSHIP (LMEP) - PROVIDED funding IN SUPPORT TO THE LINCOLN MEDICAL EDUCATION PARTNERSHIP, a COMMUNITYBASED RESIDENCY PROGRAM FOR MEDICAL SCHOOL GRADUATES INTERESTED IN FAMILY PRACTICE AND IS SUPPORTED BY 250 COMMUNITY PHYSICIANS WHO VOLUNTEER MORE THAN 40,000 HOURS PER YEAR AS FACULTY MEMBERS. LINCOLN MEDICAL EDUCATION PARTNERSHIP HELPS THE LINCOLN COMMUNITY ATTRACT, TRAIN AND RETAIN NEW PHYSICIANS. Community Classes - Free or low cost programs are offered to the community as part of the aligned health needs including examples such as; GRIEF SUPPORT CLASSES, WOMEN'S HEALTH CLASSES, Prevention and coping with DIABETES, ARTHRITIS, SKIN CANCER, SMOKING CESSATION, etc. HEALTH PROFESSIONAL EDUCATION - TRAINs STUDENTS of PHARMACY, NURSING, AND OTHER MEDICAL PROFESSIONS, AS WELL AS SUPPORTING LINCOLN MEDICAL EDUCATION PARTNERSHIP. SAINT ELIZABETH REGIONAL MEDICAL CENTER BELIEVES HIGHLY TRAINED PERSONNEL PROVIDE QUALITY CARE. In addition, the hospital supports ongoing training and communication of area emergency units. Schedule H, Part VI, Line 6 Affiliated health care system Saint Elizabeth Regional Medical Center, 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 101 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 $981 million in charity care and community benefit in the 2015 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. Saint Elizabeth Regional Medical Center operates with its wholly owned affiliates and community partners, along with its fundraising arm, Saint Elizabeth Foundation, to serve the health care needs of the Lincoln, NE communities. true HEALTH PARTNERS INITIATI 4600 Valley Rd Suite 200 Lincoln NE 68510 363832796 501(c)(3) 55000 Program support NEBRASKA SPORTS COUNCIL PO BOX 29366 Lincoln NE 68529 363354207 501(c)(3) 50000 Program support CLINIC WITH A HEART 1701 S 17th St 4g Lincoln NE 68502 202850139 501(c)(3) 24000 Program support AMERICAN HEART ASSOCIATION 7272 Greenville Ave Dallas TX 75231 135613797 501(c)(3) 20000 Program support AMERICAN CANCER SOCIETY HIGH PLAINS DIV 1100 PENNSYLVANIA AVE KANSAS CITY MO 64105 741185665 501(c)(3) 14500 Program support CATHOLIC SOCIAL SERVICES 3700 Sheridan Boulevard Suite 1 Lincoln NE 68506 470751554 501(c)(3) 11000 Program support PIUS X HIGH SCHOOL 6000 A St Lincoln NE 68501 470426529 501(c)(3) 10411 Program support MADONNA FOUNDATION 5401 South Street Lincoln NE 68506 237159940 501(c)(3) 10000 Program support TRI-CITIES MISSION OF ME 908 N HOWARD STE 106 Grand Island NE 68803 273385904 501(c)(3) 10000 Program support LINCOLN PARKS FDTN 2740 A Street Suite 201 Lincoln NE 68502 363853746 501(c)(3) 8834 Program support TeamMates Mentoring Program 6801 O Street Lincoln NE 68510 470840990 501(c)(3) 8500 Program support GOOD SAMARITAN HOSPITAL foundation 111 W 31ST STREET KEARNEY NE 68847 470659443 501(c)(3) 7168 Program support THE PHYSICIAN NETWORK 2000 Q STREET 500 LINCOLN NE 685033610 470780857 501(c)93) 7964448 One Care Contribution 13 0 Charity Care and Financial Assistance 3841 0 15093136 book reduction or write off of patient services Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds Grants included in Part II are to community organizations that engage in activities that benefit the community at large. No consideration is received in exchange for these contributions, as they are considered to be a gift to be used by the recipients in accordance with their charitable purposes. As such, use of the funds given to the grantees is not monitored beyond distribution. Grants included in Part III are to individuals needing financial assistance. Patient hardship charges are billed directly to SERMC, and employees are required to provide copies of invoices, etc. for employee assistance payment eligibility; these procedures ensure proper use of the funds. Scholarship recipients are required to submit a letter certifying his/her admission to a health care career program with the application. The funds are paid directly to the recipients and can be used for tuition, books, supplies, or other expenses that may be incurred with their schooling. Schedule I, Part III Assistance to Individuals Saint Elizabeth Regional Medical Center 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 I, Line 2 Procedures for monitoring use of grant funds. Grants included in Part II are to community organizations that engage in activities that benefit the community at large. No consideration is received in exchange for these contributions, as they are considered to be a gift to be used by the recipients in accordance with their charitable purposes. As such, use of the funds given to the grantees is not monitored beyond distribution. Grants included in Part III are to individuals needing financial assistance. Patient hardship charges are billed directly to SERMC, and employees are required to provide copies of invoices, etc. for employee assistance payment eligibility; these procedures ensure proper use of the funds. Scholarship recipients are required to submit a letter certifying his/her admission to a health care career program with the application. The funds are paid directly to the recipients and can be used for tuition, books, supplies, or other expenses that may be incurred with their schooling. true true false false false false false true false CLIFF ROBERTSON Board Member/CEO CHI Health 0 772865 0 115809 0 134830 0 151369 0 26754 0 1201627 0 54120 MICHAEL FERRIS MD BOARD MEMBER/CHIEF OF STAFF 74219 52723 0 0 508 202 5122 0 0 13702 79849 66627 0 0 ROBERT LANIK Former Board Member/CHI NE President/CEO 0 337316 0 525382 0 533781 0 42666 0 15366 0 1454511 0 127815 MARTIN M MANCUSO MD Board Member 0 388633 0 0 0 2851 0 9079 0 16554 0 417117 0 0 MICHAEL ROWAN FACHE Board member/CHI EVP & COO 0 1195620 0 788897 0 515926 0 32602 0 21054 0 2554099 0 224413 AMY L MCGAHA BOARD MEMBER 0 233848 0 0 0 156 0 8002 0 1614 0 243620 0 0 DOUGLAS KUCERA VP FINANCE 0 0 0 0 115461 0 23502 0 10269 0 149232 0 0 0 NANCY WALLACE SVP HR CHI HEALTH 0 309173 0 173948 0 23366 0 0 0 0 0 506487 0 0 CARY WARD MD CHIEF MEDICAL OFFICER 218588 188938 0 29075 5387 52015 35152 19350 11922 10077 271049 299455 0 0 JEANETTE WOJTALEWICZ CFO CHI Health 0 464487 0 208308 0 23377 0 75918 0 22290 0 794380 0 0 STEVE HOUSTON SVP STRATEGY 0 236114 0 39730 0 5365 0 8433 0 14217 0 303859 0 0 CHARLOTTE LIGGETT VP STRATEGY & PLANNING 0 253922 0 65596 0 138818 0 36501 0 6608 0 501445 0 0 DAN SCHONLAU VP Operational Finance NHH, St. Elizabeth 3731 182760 0 14153 0 209 19857 0 0 11110 23588 208232 0 0 AMY HATCHER VP Divisional Finance 0 144291 0 48584 0 13072 0 5618 0 4576 0 216141 0 0 KIM MOORE PRESIDENT 0 325683 0 79246 0 49881 0 69082 0 16387 0 540279 0 13586 MIKE WATTERS VP-SENIOR COUNSEL 0 229154 0 39598 0 43831 0 22685 0 18944 0 354212 0 0 GREGORY GILLESPIE VP HUMAN RESOURCES 0 215945 0 106136 0 9237 0 33713 0 15460 0 380491 0 0 MICHAEL GERMAN DIRECTOR OF PHARMACY 143017 0 2403 0 511 0 21818 0 1228 0 168977 0 0 0 PATRICK GILLES VP CLINICAL SUPPORT 85690 0 14634 0 54195 0 26052 0 9363 0 189934 0 0 0 NANCY GONDRINGER DIRECTOR PERIOPERATIVE SERVICE 150707 0 4016 0 844 0 18732 0 7619 0 181918 0 0 0 DONNA HAMMACK CHIEF DEVELOPMENT OFFICER-FOUNDATION 159606 0 4353 0 5367 0 25867 0 14595 0 209788 0 0 0 ELIZABETH RAETZ VP NURSING 193189 0 20507 0 9202 0 32539 0 19770 0 275207 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Compensation for the top management official was established and paid by the following related organizations: Catholic Health Initiatives (CHI) and Franciscan Health System (FHS). CHI and FHS used the following to establish the top management official's compensation: (1) Compensation Committee; (2) Independent Compensation Consultant; (3) Written Employment Contracts; (4) Compensation Survey or Study; (5) Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4a Severance or change-of-control payment Post-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. The following reportable individuals received severance payments from Catholic Health Initiatives (a Related Organization) during the 2014 calendar year, and these severance payments were included in the individual's W-2 income and reportable compensation on Schedule J: DOUGLAS KUCERA - $117,692 ROBERT LANIK - $312,137 CHARLOTTE LIGGETT - $100,917 Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan During the 2014 calendar year Catholic Health Initiatives (CHI), a related organization, maintained a supplemental non-qualified deferred compensation plan for MBO CEOs/Presidents and other CHI employees at the level of Senior Vice President and above. The following reportable individuals were eligible to participate in that plan: ROBERT LANIK KIM MOORE CLIFF ROBERTSON MICHAEL ROWAN CARY WARD JEANETTE WOJTALEWICZ During 2014 the following contributions were made by CHI to the deferred compensation plan: KIM MOORE - $29,736 CLIFF ROBERTSON - $113,667 CARY WARD - $19,350 JEANETTE WOJTALEWICZ - $40,766 During 2014 the following distributions were made by CHI from the deferred compensation plan: ROBERT LANIK - $127,815 KIM MOORE - $13,586 CLIFF ROBERTSON - $54,120 MICHAEL ROWAN - $224,413 Due to the "super" vesting rules under the CHI deferred compensation plan, participants who have met certain requirements such as age, years of service or more than 5 years of plan participation are eligible to receive their 2014 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 2014, the following contributions that would have been made by CHI to the deferred compensation plan were paid in cash: ROBERT LANIK - $49,415 MICHAEL ROWAN - $266,409 Schedule J, Part I, Line 7 Non-fixed payments CATHOLIC HEALTH INITIATIVES (CHI) MAINTAINS A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES, QUALITY IMPROVEMENT, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON HITTING MINIMUM LEVELS OF OPERATING MARGIN AND CHARITY CARE LEVELS, UNLESS THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES USES THEIR DISCRETION TO APPROVE AN EXCEPTION. Form 990, Part III, Line 1 MISSION STATEMENT THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. FIDELITY TO THE GOSPEL URGES THE CORPORATION TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS IT CREATES HEALTHIER COMMUNITIES. THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION. Form 990, Part III, Line 4d Description of other program services (Expenses $ 192,982,381 including grants of $ 10,066,040)(Revenue $ 26,901,401) Other programs Form 990, Part V, Line 1c number reported in Box 3 of Form 1096 PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF CATHOLIC HEALTH INITIATIVES (CHI) ARE MADE BY CHI. THEREFORE NO FORM 1099S ARE ISSUED BY St. Elizabeth Medical Center. CHI FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY CHI ON BEHALF OF St. Elizabeth Medical Center ARE REPORTED TO THE IRS. Form 990, Part VI, Line 16b JOINT VENTURE POLICY SAINT ELIZABETH REGIONAL MEDICAL CENTER HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER CHI'S SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S-LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. ANY JOINT VENTURE AGREEMENTS THAT DO NOT CONFORM TO THE MODEL AGREEMENT ARE GENERALLY REVIEWED BY COUNSEL. Form 990, Part VI, Line 15a COMPENSATION OF ORGANIZATION'S CEO Compensation for the top management official was established and paid by the following related organizations: Catholic Health Initiatives (CHI) and Franciscan Health System (FHS) CHI 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 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 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 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 14, 2015. In addition, 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. FHS USES AN EXTERNAL COMPENSATION FIRM WHO UTILIZES ACTUAL MARKET DATA COMPENSATION FROM SIMILAR INSTITUTIONS WITH COMPARABLE POSITIONS AND COMPENSATION LEVELS AND CONSIDERING THE ORGANIZATION'S GEOGRAPHIC LOCATION. THE EXECUTIVE COMMITTEE OF THE BOARD ANNUALLY EVALUATES AND APPROVES THE EXECUTIVE COMPENSATION ARRANGEMENT FOR EACH EXECUTIVE FOR FAIR MARKET VALUE ALONG WITH OTHER APPLICABLE FACTORS RELIED ON BY THE BOARD'S DETERMINATION. THE SUPPORTING DOCUMENTATION BECOMES PART OF THE MINUTES OF THE MEETING. THIS PROCESS IS COMPLETED YEARLY. Form 990, Part VI, Line 1a Delegate broad authority to a committee Pursuant to Section 8.1 of the corporation's bylaws, committees, such as the Executive Committee, that are granted authority to act on behalf of the board of directors may include only directors of the corporation. Form 990, Part VI, Line 6 Classes of members or stockholders According to the organization's bylaws of Saint Elizabeth Regional Medical Center, the entity's sole corporate member is CHI Nebraska, a Nebraska non-profit corporation. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body According to the organization's bylaws, directors shall be appointed or refused by the corporate member. The corporate member may appoint one or more individuals to the board of directors, and may at any time remove, with or without cause, any member of the board of directors. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The organization's corporate member is CHI Nebraska. Pursuant to Section 5.4.1 of the organization's bylaws, both CHI Nebraska and Catholic Health Initiatives ("CHI") have reserved powers as outlined in the CHI governance matrix. Pursuant to the governance matrix the following rights are held by the CHI Nebraska's Board: * Approve members of the Saint Elizabeth Regional Medical Center board. * Amendment of the corporate documents of the Saint Elizabeth Regional Medical Center. *Approve removal of a member of the governing body of the Saint Elizabeth Regional Medical Center. * Adoption of long range and strategic plans for the Saint Elizabeth Regional Medical Center. 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 Saint Elizabeth Regional Medical Center. * Removal of a member of the governing body of the Saint Elizabeth Regional Medical Center. * Approval of issuance of debt by Saint Elizabeth Regional Medical Center. * Approval of participation of Saint Elizabeth Regional Medical Center in a joint venture. *Approval of formation of a new corporation by Saint Elizabeth Regional Medical Center. * Approval of a merger involving the Saint Elizabeth Regional Medical Center. * Approval of the sale of all or substantially all of the assets of the Saint Elizabeth Regional Medical Center. * To require the transfer of assets by the Saint Elizabeth Regional Medical Center to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. Pursuant to Section 5.5.2 of the organization's bylaws, CHI Nebraska or CHI may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and its President and the Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate Form 990, Part VI, Line 11b Review of form 990 by governing body CHI NEBRASKA'S (THE ORGANIZATION'S CORPORATE MEMBER) CFO IS RESPONSIBLE FOR REVIEWING THE FINAL TAX RETURN PREPARED BY THE CHI TAX DEPARTMENT FOR ANY POTENTIAL ERRORS, OMISSIONS, OR CLARIFICATIONS NEEDED FOR PROPER PRESENTATION. AFTER THE FINAL CHANGES ARE MADE TO THE FORM 990, THE RETURNS ARE POSTED TO A SECURED BOARD COLLABORATION SITE FOR REVIEW BY THE BOARD MEMBERS. SUBSEQUENT TO DISTRIBUTION 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 policy Catholic 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 15b Process to establish compensation of other employees Compensation for other officers is compared to a study completed by HR Advantage and is approved by the President/CEO. Compensation for key employees is compared to a study completed by MSA and is approved by the individual's supervising Vice President. The board of directors also oversees and approves the compensation setting process to ensure reasonableness and compliance with the organization's compensation philosophy. Form 990, Part VI, Line 19 Required documents available to the public The Organization's governing documents and conflict of interest policy are available upon request from the administration department. In addition, the Articles of Incorporation are available from the Nebraska Secretary of State website (http://www.sos.ne.gov/business). 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. Form 990, Part VIII, Line 2f Other Program Service Revenue Other Program Service Revenue - Total Revenue: 82484, Related or Exempt Function Revenue: 82484, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue Other Miscellaneous Revenue - Total Revenue: 325296, Related or Exempt Function Revenue: , Unrelated Business Revenue: 61552, Revenue Excluded from Tax Under Sections 512, 513, or 514: 263744; Form 990, Part IX, Line 11g Other Fees Medical Professionals - Total Expense: 11212573, Program Service Expense: 10651944, Management and General Expenses: 560629, Fundraising Expenses: ; Clinical Engineering - Total Expense: 3789237, Program Service Expense: 3599775, Management and General Expenses: 189462, Fundraising Expenses: ; Laboratory Serivces - Total Expense: 1075702, Program Service Expense: 1021917, Management and General Expenses: 53785, Fundraising Expenses: ; Cafeteria Services - Total Expense: 717129, Program Service Expense: 681273, Management and General Expenses: 35856, Fundraising Expenses: ; Contracted Services - Total Expense: 1997271, Program Service Expense: 1897407, Management and General Expenses: 99864, Fundraising Expenses: ; Revenue Recovery Center - Total Expense: 7838033, Program Service Expense: 7446131, Management and General Expenses: 391902, Fundraising Expenses: ; Intercompany - Total Expense: 1404684, Program Service Expense: 1334450, Management and General Expenses: 70234, Fundraising Expenses: ; Other - Total Expense: 5510576, Program Service Expense: 5234490, Management and General Expenses: 276086, Fundraising Expenses: ; Form 990, Part XI, Line 9 Other changes in net assets or fund balances Lincoln CK Leasing Non-controlling Interest - -85874; TN Retirement Loss - -136947; ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HEALTHCARE NE 501(c)(3 3 ACH true ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT CREIGHTON HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING NE 501(c)(3 7 ACH true ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HEALTHCARE IA 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HEALTHCARE IA 501(c)(3 3 CHI NEBRASKA true ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(c)(3 9 CHI true APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(c)(3 9 SFH true BELLEVILLE ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 274005511 HEALTHCARE TX 501(c)(3 3 SHSC true BISHOP DRUMM RETIREMENT CENTER 1111 6TH AVE DES MOINES IA 50314 420725196 LTERM CARE IA 501(c)(3 9 CHI-IA CORP true BORNEMANN HEALTHCARE CORPORATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 232187242 HEALTHCARE PA 501(c)(3 Type I CHI true BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HEALTHCARE TX 501(c)(3 3 SJSC true BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 HEALTHCARE TX 501(c)(3 9 SJSC true CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HEALTHCARE ND 501(c)(3 3 CHI true CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(c)(3 Type I NA true CATHOLIC HEALTH INITIATIVES - COLORADO 188 INVERNESS DRIVE WEST STE 500 ENGLEWOOD CO 80112 840405257 HEALTHCARE CO 501(c)(3 3 CHI true CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES IA 50314 420680448 HEALTHCARE IA 501(c)(3 3 CHI true CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 6385 CORPORATE DR STE 301 COLORADO SPRINGS CO 80919 840902211 FUNDRAISING CO 501(c)(3 7 CHIC true CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 6385 CORPORATE DR COLORADO SPRINGS CO 80919 270930004 FUNDRAISING CO 501(c)(3 Type I CHI true CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 HEALTHCARE CO 501(c)(3 Type I CHINS true CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 PHYSICIANS OR 501(c)(3 9 MMC true CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 480543724 SURGERY CENTER KS 501(c)(3 3 CHI true CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 HEALTHCARE MN 501(c)(3 9 CHI true CHI INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(c)(3 Type I CHI true CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(c)(3 Type I CHI true CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(c)(3 9 CHI NS true CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(c)(3 Type I CHI true CHI NEBRASKA 6940 O ST STE 200 LINCOLN NE 68510 363233121 HEALTHCARE NE 501(c)(3 Type I CHI true CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(c)(3 Type I CHI true CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER 6624 FANNIN ST HOUSTON TX 77030 741161938 HEALTHCARE TX 501(c)(3 3 SLHS true CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 710236913 HEALTHCARE AR 501(c)(3 3 CHISVHS true CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125064 HOLDING CO AR 501(c)(3 Type II SVIMC true CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 1 MERCY LANE STE 201 HOT SPRINGS AR 71913 261125131 HEALTHCARE AR 501(c)(3 3 CHISVHS true COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 237419853 HOLDING CO OH 501(c)(2 GSH true COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION 631 N 8TH ST MISSOURI VALLEY IA 51555 421294399 FUNDRAISING IA 501(c)(3 Type I AH-CMHMV true CONTINUING CARE HOSPITAL 150 NORTH EAGLE CREEK DR LEXINGTON KY 40509 611400619 LT ACH KY 501(c)(3 3 SJHS true COVENANT HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232028429 HOME HEALTH PA 501(c)(3 Type II CHI NHC true ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1450 BATTERSBY AVE ENUMCLAW WA 98022 910715805 HEALTHCARE WA 501(c)(3 3 FHS true FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 611345363 HEALTHCARE KY 501(c)(3 3 KOH true FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 562351341 FUNDRAISING KY 501(c)(3 Type I FH true FRANCISCAN CARE CENTER 4111 N HOLLAND-SYLVANIA RD TOLEDO OH 43623 341931806 HEALTHCARE OH 501(c)(3 9 FLC true FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA WA 98405 911145592 FUNDRAISING WA 501(c)(3 9 FHS true FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA WA 98405 910564491 HEALTHCARE WA 501(c)(3 3 CHI true FRANCISCAN HEALTH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BROADWAY TACOMA WA 98402 431882377 PHYSICIANS MO 501(c)(3 9 CHI true FRANCISCAN LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE OH 501(c)(3 Type I SFH true FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA WA 98402 911939739 HEALTHCARE WA 501(c)(3 9 FHS true FRANCISCAN VILLA OF SOUTH MILWAUKEE INC 3601 S CHICAGO AVE SOUTH MILWAUKEE WI 53172 391093829 HEALTHCARE WI 501(c)(3 9 CHI true GARRISON MEMORIAL HOSPITAL 407 THIRD AVENUE SOUTHEAST GARRISON ND 58540 450227752 HEALTHCARE ND 501(c)(3 3 SAMC true GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 201536108 MINISTRIES CO 501(c)(3 Type I CHI true GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311778403 EDUCATION OH 501(c)(3 2 GSH true GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK ST ACCOUNTING-3 W CINCINNATI OH 45206 311206047 FUNDRAISING OH 501(c)(3 Type I GSH true GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 470379755 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST ST KEARNEY NE 68847 470659443 FUNDRAISING NE 501(c)(3 7 GSH true GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON 110 N MAIN ST STE 500 DAYTON OH 45402 237296923 FUNDRAISING OH 501(c)(3 7 SHP true HARRISON MEDICAL CENTER 2520 CHERRY AVE BREMERTON WA 98310 910565546 HEALTHCARE WA 501(c)(3 3 FHS true HARRISON MEDICAL CENTER FOUNDATION 2520 CHERRY AVE BREMERTON WA 98310 911197626 FUNDRAISING WA 501(c)(3 7 HMC true HEALTH SET 2420 W 26TH AVE STE 460D DENVER CO 80211 841102943 LOW INC CARE CO 501(c)(3 7 CHIC true HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 760761782 FUNDRAISING MN 501(c)(3 Type I SFMC true HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN WA 98166 910712166 HEALTHCARE WA 501(c)(3 3 FHS true HOUSE OF MERCY 1111 6TH AVE DES MOINES IA 50314 421323808 SHELTER IA 501(c)(3 7 CHI-IA CORP true JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029768 HEALTHCARE KY 501(c)(3 3 KOH true KENTUCKYONE HEALTH MEDICAL GROUP INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611352729 HEALTHCARE KY 501(c)(3 9 JHSMH true KENTUCKYONE HEALTH INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611029769 HEALTHCARE KY 501(c)(3 9 CHI true LAKEWOOD HEALTH CENTER 600 MAIN AVE S BAUDETTE MN 56623 410758434 HEALTHCARE MN 501(c)(3 3 CHI true LAKEWOOD REGIONAL HEALTHCARE FOUNDATION 600 MAIN AVE S BAUDETTE MN 56623 411893795 FUNDRAISING ND 501(c)(3 7 LHC true LINUS OAKES INC 2700 STEWART PKWY ROSEBURG OR 97471 930821381 SENIOR LIVING OR 501(c)(3 9 MMC true LISBON AREA HEALTH SERVICES 905 MAIN ST LISBON ND 58054 820558836 HEALTHCARE ND 501(c)(3 3 CHI true LUFKIN VISION ACQUISITIONS PO BOX 1447 LUFKIN TX 75901 820563768 PROPERTY MGMT TX 501(c)(3 Type III-FI MHSET true MADISON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742761145 HEALTHCARE TX 501(c)(3 3 SJSC true MADONNA MANOR INC 2344 AMSTERDAM ROAD VILLA HILLS KY 51017 610654635 LIVING ASSIST KY 501(c)(3 1 FLC true MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC 2525 DE SALES AVE CHATTANOOGA TN 37404 621839548 FUNDRAISING TN 501(c)(3 7 MHCS true MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVE CHATTANOOGA TN 37404 620532345 HEALTHCARE TN 501(c)(3 3 CHI true MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD RD STE 500 CHATTANOOGA TN 37411 030417049 HEALTHCARE TN 501(c)(3 9 MHCS true MEMORIAL HEALTH SYSTEM OF EAST TEXAS PO BOX 1447 LUFKIN TX 75902 750755367 HEALTHCARE TX 501(c)(3 3 CHI true MEMORIAL MEDICAL CENTER - LIVINGSTON PO BOX 1447 LUFKIN TX 75902 760436439 HEALTHCARE TX 501(c)(3 3 MHSET true MEMORIAL MEDICAL CENTER - SAN AUGUSTINE PO BOX 1447 LUFKIN TX 75902 752663904 HEALTHCARE TX 501(c)(3 3 MHSET true MEMORIAL MULTISPECIALTY ASSOCIATES 1201 FRANK AVE LUFKIN TX 95904 752721155 PHYSICIANS TX 501(c)(3 Type III-FI MHSET true MEMORIAL SPECIALTY HOSPITAL PO BOX 1447 LUFKIN TX 95902 752492741 HEALTHCARE TX 501(c)(3 3 MHSET true MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVE DES MOINES IA 50314 426076069 AUXILIARY IA 501(c)(3 Type I MF-DM IA true MERCY CLINICS INC 1111 6TH AVE DES MOINES IA 50314 421193699 PHYSICIANS IA 501(c)(3 9 CHI-IA CORP true MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVE DES MOINES IA 50314 421511682 EDUCATION IA 501(c)(3 2 CHI-IA CORP true MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVE DES MOINES IA 50314 237358794 FUNDRAISING IA 501(c)(3 7 CHI-IA CORP true MERCY FOUNDATION INC 2700 STEWART PKWY ROSEBURG OR 97471 936088946 FUNDRAISING OR 501(c)(3 7 MMC true MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 421461064 FUNDRAISING IA 501(c)(3 Type I AHMH-Corning true MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450435338 FUNDRAISING ND 501(c)(3 Type I MHVC true MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DR COUNCIL BLUFFS IA 51503 421178204 FUNDRAISING IA 501(c)(3 Type I AHBMHS true MERCY HOSPITAL OF DEVILS LAKE 1031 7TH ST NE DEVILS LAKE ND 58301 450227012 HEALTHCARE ND 501(c)(3 3 CHI true MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 7TH ST NE DEVILS LAKE ND 58301 352367360 FUNDRAISING ND 501(c)(3 7 MHDL true MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BLVD VALLEY CITY ND 58072 450226553 HEALTHCARE ND 501(c)(3 3 CHI true MERCY MEDICAL CENTER 1301 15TH AVE WEST WILLISTON ND 58801 450231183 HEALTHCARE ND 501(c)(3 3 CHI true MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 420680308 HEALTHCARE IA 501(c)(3 3 CHI-IA CORP true MERCY MEDICAL CENTER INC 2700 STEWART PKWY ROSEBURG OR 97471 930386868 HEALTHCARE OR 501(c)(3 3 CHI true MERCY MEDICAL FOUNDATION 1301 15TH AVE WEST WILLISTON ND 58801 450381803 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