2016-05-16T10:01:05-05:00 2015-06-30 470617373 Catholic Health Initiatives 12809 WEST DODGE ROAD OMAHA NE 68154 990 2014-07-01 420776568 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEYIOWA ALEG 4023434323 631 N 8TH ST MISSOURI VALLEY IA 515551102 Jeanette Wojtalewicz CFO 2016-05-15 true ANGELA LEA P01051055 4023434323 2014 2016-12-15 16:53:06Z Cliff A Robertson 631 N 8TH ST MISSOURI VALLEY IA 515551102 27382290 false X www.chihealth.com X 1955 IA THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. 13 10 198 17 0 0 40175 14050 22648307 26981728 119521 111251 76323 267322 22884326 27374351 948591 1373288 0 0 12983981 12083422 0 0 0 8377515 12072956 22310087 25529666 574239 1844685 30010683 33207906 3521023 4873700 26489660 28334206 THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. FIDELITY TO THE GOSPEL URGES THE CORPORATION TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS IT CREATES HEALTHIER COMMUNITIES. THE CORPORATION, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION, AS A VALUES-BASED ORGANIZATION, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT AND FORMATION FOR MINISTRY THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION. false false 2195457 899032 17663757 ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IS PROUD TO OFFER DIAGNOSTIC IMAGING SERVICES - CLOSE TO HOME - WITHIN THE COMMUNITY. THE DIAGNOSTIC IMAGING SERVICES PROVIDED INCLUDE THE FOLLOWING: CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND. 1947470 179136 3519580 AS A COMMUNITY HOSPITAL, ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY HAS STAYED COMMITTED TO KEEPING RESIDENTS OF HARRISON COUNTY IN GOOD HEALTH. THROUGH THE YEARS, ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL HAS STRIVED TO IMPROVE THE HEALTH STATUS OF SOUTHWEST IOWA RESIDENT CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS THROUGH THE FOLLOWING SERVICES: 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS AND CARDIOVASCULAR SERVICES. CARDIOVASCULAR SERVICES INCLUDE THE FOLLOWING: NON-INVASIVE DIAGNOSTIC STUDIES SUCH AS EKG, TELEMETRY MONITORING, TREADMILL STRESS TESTING, ECHO CARDIOGRAM, AND STRESS ECHO CARDIOGRAM. 1381397 171631 3372128 ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL PROVIDES A VARIETY OF SPECIALTY CLINICS LOCATED IN THE FOLLOWING CITIES: MISSOURI VALLEY, LOGAN, WOODBINE AND DUNLAP. THE FOCUS OF EACH SPECIALTY CLINIC AREAS ARE THE FOLLOWING: CARDIOLOGY NON-INVASIVE STUDIES, EAR, NOSE AND THROAT, GASTROENTEROLOGY INCLUDING VIDEOSCOPE EQUIPMENT, GENERAL SURGERY/WOUND CARE, EDICAL/SURGICAL CONSULTATION, OB/GYN, ONCOLOGY, OPHTHALMOLOGY, ORTHOPAEDICS, PAIN MANAGEMENT, PODIATRY AND UROLOGY. THE HOSPITAL HEALTH CLINICS IN THE SMALL VILLAGES OF LOGAN, WOODBINE AND DUNLAP, IOWA ARE A TREMENDOUS BENEFIT TO THOSE COMMUNITIES, WHICH SERVE A DISPROPORTIONATELY LARGE ELDERLY AND RURAL POPULATION, AND ARE PROVIDED AS A CONVENIENCE TO THESE COMMUNITIES WHICH WOULD OTHERWISE HAVE NO CLOSE ACCESS TO MEDICAL SERVICES. 18982472 123489 2426263 OTHER PROGRAMS 18982472 123489 2426263 24506796 true true false true false false false false false true true false false false false true false true false false false false false false false false true true false true true false false false false false false false false false false false false false true true true false false true 0 0 198 true false false false false false false false false false false X 13 10 false false true false true true true true true false false true true true true true true 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 11.00 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 59.00 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 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 5.00 55.00 X 0 696172 98208 RODNEY TRIPLETT NETWORK EXECUTIVE 20.00 40.00 X 0 197534 19345 ROBERT VALENTINE President, REGIONAL HOSPITAL 59.00 1.00 X 148164 0 6838 JASON YUNGTUM VP/REG GENERAL COUNSEL 2.00 58.00 X 0 422347 29415 MIKE WATTERS VP-SENIOR COUNSEL 1.00 59.00 X 0 312583 41629 AHMAD ALCHOMMALI MD PHYSICIAN 60.00 0.00 X 502448 1552 24765 ENRIQUE COHEN MD PHYSICIAN 60.00 0.00 X 345652 0 32192 ROBERT CUNARD MD PHYSICIAN 60.00 0.00 X 470435 0 30660 MARY LOB MD PHYSICIAN 60.00 0.00 X 478176 0 33124 NATHANIEL ALVIS PHYSICIAN 60.00 0.00 X 399429 0 29220 Tim Schnack VP OPERATIONAL FINANCE 9.00 51.00 X 0 290543 24118 AMY HATCHER VP DIVISIONAL FINANCE 7/1/14 - 7/13/14 5.00 55.00 X 0 205947 10194 NANCY WALLACE SVP HR CHIEF OFFICER 5.00 55.00 X 0 506487 0 SCOTT WOOTEN FORMER ACH SVP/CFO 0.00 0.00 X 0 1454576 0 RICHARD HACHTEN II Former Board Member/ACH President & CEO 0.00 0.00 X 0 492165 35534 MARIE KNEDLER FORMER VICE-CHAIR 0.00 60.00 X 0 481692 26638 2344304 9213362 708908 13 true true false THOMAS RICE CRNA INC 1154 SOUTH 96TH STREET OMAHA NE 68124 ANESTHESIOLOGY SERVICES 258640 SHARED MEDICAL SERVICES 209 LIMESTONE PASS COTTAGE GROVE WI 53527 DIAGNOSTIC IMAGING 103040 2 X 0 0 0 11382 2668 0 3632 14050 Net patient services 900099 24534572 24534572 0 0 Pharmacy Services 446110 2309529 2309529 0 0 Intercompany Transactions 900099 30227 30227 0 0 0 0 0 0 0 0 0 0 107400 107400 0 0 26981728 0 0 0 0 0 0 0 0 0 0 0 0 90916 0 0 0 90916 0 90916 0 0 90916 111251 0 0 0 111251 0 111251 0 0 111251 6191 0 840 5351 0 5351 0 0 0 0 0 0 10086 7099 2987 0 0 2987 Cafeteria 722100 25809 0 0 25809 Laboratory Services 621500 139577 0 0 139577 0 0 0 0 2682 0 0 2682 168068 27374351 26981728 0 378573 X 5634 5634 1367654 1367654 155002 147252 7750 9543991 9059041 484950 451044 428492 22552 1323378 1257209 66169 610007 579507 30500 142103 134624 7479 8305 8305 3094 3094 6199397 5884542 314855 0 44208 41998 2210 510056 484553 25503 344702 327467 17235 36486 34662 1824 986 937 49 15571 15571 454194 431484 22710 81668 77585 4083 Bad debts 1178758 1178758 Medical Supplies 2927447 2927447 0 Other Expenses 125981 119285 6696 0 25529666 24506796 1022870 0 9471676 7528645 10018270 13901435 3665625 5215690 0 0 0 418301 410093 7306335 1652834 5938269 5653501 0 0 498542 498542 30010683 33207906 3085956 4583949 0 41773 81747 247978 353320 0 3521023 4873700 X 26489660 28334206 26489660 28334206 30010683 33207906 1844685 -139 X false true X true true true X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 3094 false false false 3094 false Schedule C, Part II-B, Line 1 Description of the activities reported on lines 1A through 1J The portion of organization dues that are related to lobbying are as follows: Iowa Hospital Association - $3,094 358693 26846 15771 38435 362875 335621 39603 32444 48975 358693 369561 50991 12902 97833 335621 328728 44542 18879 22588 369561 353265 46478 21280 92295 328728 0.0 0.86 0.14 false true true 861370 861370 4293353 787899 3505454 1853306 761216 1092090 298306 103719 194587 5653501 Environmental Remediation Liability Intercompany Payables Long Term Debt - CHI 0 X Schedule D, Part V, Line 4 Intended uses of endowment funds ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICES FOUNDATION AND ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IA. Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa'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." true true X false false true true false true true 301 832444 0 832444 0.0342 2968 4325885 2528089 1797796 0.0738 0 6850 4219 2631 0.0001 0 3269 5165179 2532308 2632871 0.1081 10 15582 64555 9008 55547 0.0023 3 164 564 0 564 0.0000 2 0 4273584 3678585 594999 0.0244 1 0 2129 0 2129 0.0001 4 55 17931 2914 15017 0.0006 20 15801 4358763 3690507 668256 0.0274 20 19070 9523942 6222815 3301127 0.1356 0 0 0 0 0 0.0 0 0 0 0 0 0.0 0 0 0 0 0 0.0 1 0 63 0 63 0.0000 1 1 3412 0 3412 0.0001 2 3000 9415 0 9415 0.0004 0 0 0 0 0 0.0 2 121 264 0 264 0.0000 0 0 0 0 0 0.0 6 3122 13154 0 13154 0.0005 true 1178758 0 14961125 13960712 1000413 X true true 1 1 AH-COM MEM HOSPITAL OF MISSOURI VALLEY 631 N 8TH ST MISSOURI VALLEY IA 51555 www.chihealth.com 430030H X X X A A 1 false false true X X X X X X X X X 12 true false true true X http://www.chihealth.com/chna X http://www.harrisoncountyhealth.org/ X true 12 true http://www.chihealth.com/documents/CHNA/implementation_plan_Missouri_valley.pdf false false true X X X X X X true true X X X true X http://www.chihealth.com/financial-assistance X http://www.chihealth.com/documents/Financial_Assistance_Application.pdf X X true X false X X X X true X false false Schedule H, Part V, Section B, Line 5 Facility A, 1 Facility A, 1 - AH-COM Mem Hospital of Missouri Valley. Community Memorial Hospital and the Harrison County Health Department engaged diverse stakeholders in their CHNA and planning processes over a period of several months. The members of the Steering Committee were chosen based on their professional roles and expertise and knowledge of the health of the County. Additional patients, families and community members were engaged in the series of meetings to select priorities and create implementation plans. The following individuals representing the following organizations participated in the CHNA: * Nicole Carritt - Administrator Harrison County Home & Public Health (replaced by Brent Saron) * Bob Valentine - Administrator Alegent Health Community Memorial Hospital * Dr. Carrie Grady - Family Practice Physician Alegent Health Logan Clinic * Lynne Tremel - West Central Community Action, Matt Pitt - Harrison County Environmental Health * Larry Oliver - Harrison County Emergency Management Administrator, * Julie Florian - Harrison County Home & Public Health (tobacco control) * Diane Foss - HMS Decat & ECI * Jim Poehlman - MOSAIC * Mary Arndt - MOSAIC * Melissa Meeker - Logan Magnolia School Nurse * Renee Forest - Woodbine School Nurse * Rich Pope - Harrison County ISU Extension Director * Pat Hart - Pisgah resident Schedule H, Part V, Section B, Line 6b Facility A, 1 Facility A, 1 - Alegent Health-Community Memorial Hospital of Missouri Valley. Harrison County Health Department Schedule H, Part V, Section B, Line 7 Facility A, 1 Facility A, 1 - AH-COM Mem Hospital of Missouri Valley. CHNA was also posted on the Health Department's website and distributed to participating individuals and organizations. Schedule H, Part V, Section B, Line 11 Facility A, 1 Facility A, 1 - AH-COM Mem Hospital of Missouri Valley. The CHNA was conducted with The Harrison County Home and Public Health agency assuming the primary leadership role and Community Memorial Hospital assuming the role of key advisor. The top 5 health issues were identified as part of this CHNA process: 1. Overweight/Obese Population 2. Child Abuse and Neglect Prevention 3. Achieved Educational Levels 4. Lung Health - Tobacco/Radon. 5. Alcohol Use Community Memorial Hospital's Priorities In addition to system-wide community benefit investments in which Lakeside shares on a net service revenue basis, Community Memorial's Implementation Plan focuses on the following priorities and related strategies, aligning with the Harrison County Health Improvement Plan: Hospital Leadership co-leads the Healthy Harrison Coalition to engage county with resources, structure and leadership around identified community health needs. 1. GOAL: Decrease the population of overweight and obese children in grades pre-K through 6th grade in Harrison County by 10% by January 2015. * Partners with local school nurses to establish BMI baseline data for grades 3-8 in Logan, Woodbine & Dunlap schools. This information was initially collected from schools but in past year the hospital has been able to use hospital EPIC system to compare data. * Established coalition of school nurses and school district leaders (currently 46 members) from Missouri Valley, Woodbine, and Dunlap with monthly meetings. * Provided healthy eating education in Logan & Dow City schools. * Engaged 7 students in HOSA Student Mentorship program. * Assessed healthy food choices in Harrison County through a Nutrition Environment Measurement Survey with gas station/convenience stores to find 6 of 16 stores offering healthy choices. * Worked with a farm and farmers market to expand location and a drop off location in Missouri Valley. * Increased availability of farmer's markets in Logan, Dunlap and promoted to members of the Chamber Challenge 5K. * Developing strategies to implement a community garden. * Promoted "Live Healthy Iowa" and the 10-Week Wellness Challenge among Harrison County Residents with participation from 45 children & 138 adults. * Held a "Hot Cocoa Hike" and expanded knowledge of available trails from the Welcome Center. o This eventwas repeated and expanded to include dental health representatives. * Partnered with Iowa State University Extension "Loving Your Family" Nutrition Trainers. * Breastfeeding grant allowed for hire of a Certified Lactation Consultant. * Lead and facilitated monthly meetings with the Healthy Harrison Coalition. * Connected with City Council and Chamber to engage in the Healthy Harrison Coalition: 3 chambers and 2 city councils have joined the coalition from the Harrison County communities. * Partnered in schools to promote healthy lifestyle messages and implement a Healthy snack school policy 2. Decrease the rate of confirmed child abuse and neglect cases in Harrison County by 10% by January 2015. * Supported the Diaper Bank, which is located at the Public Health Department, and collected 7,952 diapers. Community Memorial Hospital employees contributed over 60% of diapers collected. * Promoted parenting classes through Learning for Life a parenting program through the local Public health Department * Provided promotional materials around "Protecting Children is Everyone's Business". Using a pinwheel event to spread awareness and to generate a little revenue to support partner programs. * Distributed teddy bears that provided an outreach number to call for parenting support. * Implemented the First Five program to allow for medical providers to screen for children at risk and refer for support. * Hosted a pinwheel coloring contest for 3rd graders to raise awareness among children. * Held a "Darkness to Light" event with speakers for the community. * Held a "Growing Up a Girl" - a webinar hosted with question and answer session for parents and children. 3. Expand technology, locations and capacity to provide access to health care services. * Expanded clinic hours to 9pm (instead of 5pm) and make clinic available from 9a-3p on Saturdays. * Planning the addition of a clinic in Mondamin, IA to better serve the residents of Pisgah, Modale, Little Sioux and Mondamin. * Financial assistance - In FY15, Community Memorial provided $671,000 part of CHI Health's $154.7 million in unpaid care through the ACH financial assistance policy and unpaid costs of Medicaid. * Currently working on a capital campaign for funding to build a new hospital and convert the current Community Memorial site into a behavioral health unit. * Currently piloting telemedicine for rural hospitals. A Nephrology clinic is currently in place and doing well. * Purchased telehealth cart for Behavioral health and working on adding a cart for Pulmonology. * Partnered with Foundation to fund the SWITA Bus to provide patient transportation to care. Although the following community needs were not identified as a top priority for the Hospital, Community Memorial addresses the following health needs in the following ways: * Smoking- Provides smoking cessation programs. Outpatient treatment is available by referral through Community Memorial's Respiratory and Pulmonary Rehabilitation departments and inpatient treatment is offered to all hospital inpatients. * Unintended injury-Treatment of injuries is provided 24/7 through Community Memorial's Level 4 Trauma Emergency Department, or for less serious conditions through its after-hours or primary care clinics. Injuries can also be followed up on by a local provider or a specialist that comes to thespecialty clinic. * Sexually Transmitted Diseases- Screening and treatment is completed through Community Memorial's clinics and Emergency Department and is monitored by Community Memorial's Infection Prevention Specialist working closely with Harrison County Public Health, local providers and the Iowa Department of Public Health as warranted. Hospital sponsorship precludes leadership and active participation in addressing STDs, given our faith based moral principles. * Radon- Community Memorial partnered with Iowa State Extension to acquire Radon kits at $5/kit to make available through the Extension offices in Logan as part of the Healthy Harrison Coalition. * Communication - As part of the Healthy Harrison Coalition, the hospital coordinates messaging in its quarterly newsletter related to monthly Coalition newsletters and topics. Community Priorities not addressed by the Hospital: * High School Degree-This is a priority of the public schools. Community Memorial is a major supporter of the Hospital Occupation Student Association (HOSA). HOSA students shadow various healthcare professionals throughout the school year. Community Memorial also sponsors students to attend an annual conference. Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - AH-COM Mem Hospital of Missouri Valley. Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa 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. Schedule H, Part V, Section B, Line 13 Facility A, 1 Facility A, 1 - AH-Com MEM Hospital. Size of Family Schedule H, Part V, Section B, Line 22 Facility A, 1 Facility A, 1 - AH-COM MEM Hospital. PATIENTS WHO ARE CONSIDERED SELF PAY PATIENTS ARE PROVIDED AN UPFRONT DISCOUNT BASED ON THE AVERAGE MANAGED CARE CONTRACTS OF THE GEOGRAPHICAL AREA OF 33% 5 AH LOGAN RURAL HEALTH CLINIC 122 WEST 8TH STREET LOGAN IA 51546 RURAL HEALTH CLINIC AH WOODBINE RURAL HEALTH CLINIC 410 ELY WOODBINE IA 51579 RURAL HEALTH CLINIC AH MISSOURI VALLEY RURAL HEALTH CLINIC 809 EAST ELM STREET MISSOURI VALLEY IA 51555 RURAL HEALTH CLINIC AH DUNLAP RURAL HEALTH CLINIC 707 IOWA AVENUE DUNLAP IA 51529 RURAL HEALTH CLINIC AH CMH SKILLED NURSING FACILITY 631 N 8TH STREET MISSOURI VALLEY IA 51555 SKILLED NURSING FACILITY Schedule H, Part I, Line 6a Community Benefit Report Available to the public Yes, the Alegent Creighton Health system 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. It is also available on the company's intranet site, and on its public website at http://www.chihealth.com/community-benefit. Schedule H, Part I, Line 3c Eligibility criteria for free or discounted care When Catholic Health Initiatives (the ultimate parent organization to Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa) 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. Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa 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 6a Community benefit report prepared by related organization Alegent Creighton Health Schedule H, Part I, Line 7g Subsidized Health Services Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa provides subsidized health to the broader community through its rural health clinic. The amount included as a subsidized health service is $594,999. Schedule H, Part I, Line 7 Bad Debt Expense excluded from financial assistance calculation 1178758 Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance The costing methodology used to calculate the amounts reported in the table were worksheets 1-8 provided with the schedule H instructions. The cost to charge ratio derived from worksheet 2 was used to calculate total community benefit expense for charity care, Medicaid and other means tested. Schedule H, Part II Community Building Activities Alegent Creighton Health 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: - Live Well Omaha Kids. As a result of community health needs assessment conducted in 2006 which pointed to childhood obesity as a serious health needs issue across all Omaha Metropolitan Service Areas (MSA) counties served, the Alegent Creighton Health system partnered with the community to make a multi-year commitment to impact childhood obesity through community based best practice interventions. This initiative has had a primary focus of impact in Douglas County, Nebraska, but the funding to underwrite has come from the fiscal performance of all Alegent Creighton Health hospitals. The community coalition known as Live Well Omaha Kids (LWOK) is staffed and funded by Alegent Creighton Health. An Executive Committee consisting of community leaders and policy makers have directed an ecological approach to improve programs, policies and built the environment to promote physical activity and healthy eating and build capacity for healthy choices at the individual and organizational level. More than 200 volunteers and 90 organizations have participated in the planning and implementation of LWOK initiatives. A portion of this investment in LWOK is allocated to the Community Memorial Hospital of Missouri Valley on a net service revenue basis. - Community and economic development including support of local Chambers of Commerce - Strategic planning and consulting services for community - Sponsorship of community not for profits and fundraising events - Support of international health ministries in Tanzania and Dominican Republic - 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 Leaders of Alegent Health Community Memorial Hospital of Missouri Valley, IA, are involved in leadership roles as both the Vice President and Director of Economic Development on the Missouri Valley Chamber of Commerce. The hospital also promotes community building and safe physical activity through its support of the Missouri Valley Schools backpack program to provide meals to children who might otherwise go without and through its bicycle helmet safety program. Hospital leaders work with the Southwest Iowa Planning Council to develop a short and long range economic growth plan, which centered on a flood prevention/elimination plan. The hospital also supports the Teammates Mentoring Program and various other student programs throughout Harrison County. 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 55.67%. When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. Schedule H, Part III, Line 3 Bad Debt Expense Methodology Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care. Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa 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. Alegent Health-Community Memorial Hospital 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: $14,961,125 Total Medicare costs: $13,960,712 Surplus or Shortfall $1,000,413 Alegent Health-Community Memorial Hospital 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 Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa's debt collection policy provides that Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa 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 Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa' community assistance policy. After having been turned over to a third-party collection agent, any patient account that is subsequently determined to meet the Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa' community assistance policy is required to be returned immediately by the third-party collection agent to Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa for appropriate follow-up. Alegent Health-Community Memorial Hospital of Missouri Valley, Iowa 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 A - AH-COM MEM HOSPITAL OF MISSOURI VALLEY: Line 16a URL: http://www.chihealth.com/financial-assistance; Schedule H, Part V, Section B, Line 16b FAP Application website A - AH-COM MEM HOSPITAL OF MISSOURI VALLEY: Line 16b URL: http://www.chihealth.com/documents/Financial_Assistance_Application.pdf; Schedule H, Part VI, Line 2 Needs assessment The process to develop assessments of the CHNA is collaborative in nature and involves health departments, existing health coalitions, community members and hospital leadership, and is supported by the Alegent Creighton Health's Community Benefit and Healthier Communities Department staff. Each Alegent Creighton Health hospital participates in the CHNA process for the county in which the facility is located at least every 3 years in partnership with the local health departments. The assessment varies in each community but includes review of primary data (such as surveys, key informant interviews, focus groups) and secondary data (such as County Health Rankings, BRFRSS, YRBS, census data etc.) Leadership from Alegent Creighton Health participate in multiple internal and external venues to garner community input, prioritize community health needs and develop community health improvement plans. The CHNA report for each community is made available to the public by posting the report on the Alegent Creighton Health external website and by making it available in community venues. The CHNAs are integrated into the governance and planning for Alegent Creighton Health on two levels: * Reporting to the Board of Directors * Reporting into the annual strategic planning and budgeting processes of Alegent Creighton Health. * Implementation plans approved by Board of Directors. Particular to Community Memorial Hospital of Missouri Valley, IA, leaders from the hospital are on the Harrison County Home and Public Health Department committee to develop a CHNA and a Community Health Improvement Plan. This partnership results in a community health needs assessment every 2 years as required by state law. This local effort is supported by the Alegent Creighton Health system. Schedule H, Part VI, Line 3 Patient education of eligibility for assistance There are several financial assistance access points throughout a patient's care cycle. Bills contain financial assistance verbiage; signs are posted in clinics and hospital, and there is information on financial assistance posted at registration points throughout clinics and hospitals. Information on The Alegent Creighton Health System's financial assistance policies are located several places on the system's website- www.chihealth.com All efforts are made to establish whether patients are eligible for financial assistance prior to service if possible, otherwise as soon as possible following service. Alegent Creighton Health representatives help patients seek reimbursement from local, state and federal programs at no charge to the patient. After these efforts and resources have been exhausted, patients are assisted in the application process for financial assistance consistent with Alegent Creighton Health's Financial Assistance Policy. The application process requires that the patient complete a personal financial application and provide verification documents. Verification includes employment verification and obtaining documentation of the applicant's financial condition such as federal tax return, pay stub, net worth and/or liquid assets and reasonable household or business expenses. Financial assistance may still be granted in certain circumstances involving a catastrophic occurrence resulting in medical bills grossly exceeding the patient's ability to pay, and in these situations, the patient's responsibility will be limited to 20% of the family's gross annual income. Schedule H, Part VI, Line 4 Community information Alegent Creighton Health Community Memorial Hospital of Missouri Valley, IA (population-2,838), serves Harrison County, Iowa with an estimated population of 14,548, a two-year decrease of 2.6 percent from 2010. Harrison County is one of the 3 Iowa counties included in the Greater Omaha CSA. It is nestled in the scenic Loess Hills, near the Missouri River. Harrison County encompasses approximately 696 square miles and is composed of 10 incorporated towns, 6 unincorporated towns and 20 townships. The racial and ethnic makeup is predominantly white (98.3%). The median household income is $53,939, compared to $51,129 for the state of Iowa. Harrison County contains 10 public school districts and approximately one third of the students in each of these school districts receive free or reduced lunch. Schedule H, Part VI, Line 5 Promotion of community health Alegent Creighton Health has a history of centralized community benefit and hospital specific community benefit investments to address community health needs of the particular service area. Examples of how Alegent Creighton Health furthers its exempt purpose by promoting the health of the community include: * Financial Assistance and Unpaid costs of Medicaid * Community health improvement services- o Community education, classes and programs (childbirth, diabetes, oncology, physical activity, healthy eating and cooking, health careers, cancer, sports medicine etc) o Support groups (cancer, bereavement, youth etc) o Community health fairs and screenings o Immunization clinics o Parish nursing program and faith community outreach o School based healthcare services * Health professional education- o Clinical preceptorships for healthcare professionals o Scholarships and mentorships o Affiliation with and support of Creighton University School of Medicine o Physician residency and fellowship programs training more than 200 residents and fellows annually * Research-Participation in the Missouri Valley Cancer Consortium * Financial and in-kind contributions o Support of the Federally Qualified Healthcare Centers (and Hope Medical Coalition which provides access to medical services specifically for the underserved o Corporate sponsorships o Tanzania and Dominican Republic health ministries o Staff service on health related board and coalitions * Subsidized healthcare service including behavioral health, NICU, home health and hospice * Community building activities- o Community and economic development including support of local Chambers of Commerce o Strategic planning and consulting services for community o Health coalitions * The primary care physician clinics that are part of the parent corporation provide access to care through the system's Financial Assistance Policy and participate in medical student preceptorships that advance the healthcare provider education process. * Alegent Creighton Health has Open Medical staffs * Alegent Creighton Health is one of three health systems that fund the operations of a coalition that exists to provide access for the patients of three area federally qualified healthcares to specialty physician services and hospital based diagnostics and treatment * Alegent Creighton Health is the sole comprehensive mental health provider in the Omaha MSA area * Alegent Creighton Health is a joint venture partner in a not-for-profit Hospice inpatient hospital and provides the management support contract. Community Memorial Hospital-Missouri Valley, IA promotes the health of its community through financial and in-kind donations to support community needs. The hospital provides staff, leadership, administrative support and financial backing to a number of community health and economic development coalitions, including-Harrison County Home Care Providers, Healthy Harrison County and Harrison County Board of Public Health and local Chamber of Commerce organization. In addition, the hospital provides sports physicals, mental health first aid training and mental health medication vouchers, scholarships for future healthcare professionals, and general health promotion through Public Health Awareness Days. Community input is sought through the hospital's Community Advisory Board. Community Memorial Hospital-Missouri Valley, IA is governed by a Board of Directors primarily comprised of volunteer members of our local community who are leaders in the fields of business, healthcare, accounting and medicine and understand their role in providing strong corporate governance. The hospital has full-time emergency department that is open to the public and provides medical screening examinations and stabilizing treatment within the capabilities and capacities of the hospitals regardless of but not limited to the patient's race, color, sex, age, and/or ability to pay. The hospitals are in compliance with the federal EMTALA regulations. In addition, together with unrelated hospitals in the area, work closely with local fire and rescue departments to ensure that ambulances take patients to the appropriate hospital. This is generally the hospital that is closest geographically with exceptions based on patient preference, patient's physician preference, and capacity or the availability of specialized facilities or programs related to the patient's condition. Finally, the hospital maintains detailed procedures regarding when and under what circumstances a patient can be transferred. Under this policy, no patient will be transferred based on race, creed, religion or ability to pay. Schedule H, Part VI, Line 6 Affiliated health care system Alegent Creighton Health Community Memorial Hospital of Missouri Valley 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. Alegent Health Community Memorial Hospital of Missouri Valley operates with its wholly owned affiliates and community partners, along with its fundraising arm, the Community Memorial Hospital Medical Services Foundation to serve the health care needs of the Harrison County community. Schedule H, Part VI, Line 7 State filing of community benefit report IA, NE true CHARITY CARE/FINANCIAL ASSISTANCE 301 1365154 Book Reduction or write off of patient services AUXILIARY SCHOLARSHIP 3 2500 Schedule I, Part I, Line 2 Description Of Procedure For Monitoring Use Of Grant Funds MOST DISBURSEMENTS IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PROGRAMS ARE MADE DIRECTLY IN THE ACTIVE CONDUCT OF THE ACTIVITIES CONSTITUTING THE EXEMPT PURPOSE OR FUNCTION OF THE ORGANIZATION. OTHERWISE, DISTRIBUTIONS IN FURTHERANCE OF THE INSTITUTION'S EXEMPT PROGRAMS ARE MADE IN ACCORDANCE WITH PROCEDURES SUBJECT TO CONDITIONS ESTABLISHED BY THE INSTITUTION'S GOVERNING BOARD OR MANAGEMENT DESIGNED TO ENSURE THAT RECIPIENTS OF SUCH DISBURSEMENTS FROM THE ORGANIZATION ARE ADEQUATELY INVESTIGATED AND GRANTED TO QUALIFIED RECIPIENTS. Schedule I, Part III CHARITY CARE/FINANCIAL ASSISTANCE ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA 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. MOST DISBURSEMENTS IN FURTHERANCE OF THE ORGANIZATION'S EXEMPT PROGRAMS ARE MADE DIRECTLY IN THE ACTIVE CONDUCT OF THE ACTIVITIES CONSTITUTING THE EXEMPT PURPOSE OR FUNCTION OF THE ORGANIZATION. OTHERWISE, DISTRIBUTIONS IN FURTHERANCE OF THE INSTITUTION'S EXEMPT PROGRAMS ARE MADE IN ACCORDANCE WITH PROCEDURES SUBJECT TO CONDITIONS ESTABLISHED BY THE INSTITUTION'S GOVERNING BOARD OR MANAGEMENT DESIGNED TO ENSURE THAT RECIPIENTS OF SUCH DISBURSEMENTS FROM THE ORGANIZATION ARE ADEQUATELY INVESTIGATED AND GRANTED TO QUALIFIED RECIPIENTS. false true false false false false false true false RICHARD HACHTEN II Former Board Member/ACH President & CEO 0 159899 0 112521 0 219745 0 31152 0 4382 0 527699 0 0 MARIE KNEDLER FORMER VICE-CHAIR 0 384762 0 90753 0 6177 0 12084 0 14554 0 508330 0 0 CLIFF ROBERTSON Board Member/CEO CHI Health 0 772865 0 115809 0 134830 0 151369 0 26754 0 1201627 0 54120 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 NANCY WALLACE SVP HR CHIEF OFFICER 0 309173 0 173948 0 23366 0 0 0 0 0 506487 0 0 SCOTT WOOTEN FORMER ACH SVP/CFO 0 0 0 1454576 0 0 0 0 0 0 0 1454576 0 0 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 0 464487 0 208308 0 23377 0 75918 0 22290 0 794380 0 0 Tim Schnack VP OPERATIONAL FINANCE 0 240321 0 49241 0 981 0 9100 0 15018 0 314661 0 0 AMY HATCHER VP DIVISIONAL FINANCE 7/1/14 - 7/13/14 0 144291 0 48584 0 13072 0 5618 0 4576 0 216141 0 0 RODNEY TRIPLETT NETWORK EXECUTIVE 0 168252 0 28938 0 344 0 5150 0 14195 0 216879 0 0 ROBERT VALENTINE President, REGIONAL HOSPITAL 126168 0 21251 0 745 0 5198 0 1640 0 155002 0 0 0 JASON YUNGTUM VP/REG GENERAL COUNSEL 0 232111 0 170543 0 19693 0 7717 0 21698 0 451762 0 0 MIKE WATTERS VP-SENIOR COUNSEL 0 229154 0 39598 0 43831 0 22685 0 18944 0 354212 0 0 AHMAD ALCHOMMALI MD PHYSICIAN 501821 1552 0 0 627 0 1158 0 23607 0 527213 1552 0 0 ENRIQUE COHEN MD PHYSICIAN 342642 0 0 0 3010 0 7980 0 24212 0 377844 0 0 0 ROBERT CUNARD MD PHYSICIAN 469427 0 0 0 1008 0 9100 0 21560 0 501095 0 0 0 MARY LOB MD PHYSICIAN 464655 0 0 0 13521 0 9100 0 24024 0 511300 0 0 0 NATHANIEL ALVIS PHYSICIAN 386785 0 12500 0 144 0 7742 0 21478 0 428649 0 0 0 Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation Compensation for the top management official was established and paid by the following related organizations: Catholic Health Initiatives (CHI) and Franciscan Health System (FHS). CHI and FHS used the following to establish the top management official's compensation: (1) Compensation Committee; (2) Independent Compensation Consultant; (3) Written Employment Contracts; (4) Compensation Survey or Study; (5) Approval by the Board or Compensation Committee. Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan DURING THE 2014 CALENDAR YEAR, CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MARKET BASED ORGANIZATION CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN CHI'S SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON MICHAEL ROWAN JEANETTE WOJTALEWICZ DURING 2014 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON - $113,667 JEANETTE WOJTALEWICZ - $40,766 DURING 2014 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: 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 TERMINATION, AGE, OR YEARS OF SERVICE WERE 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: MICHAEL ROWAN - $266,409 RICHARD HACHTEN II - $22,269 Schedule J, Part I, Line 7 Non-fixed payments CATHOLIC HEALTH INITIATIVES (CHI) MAINTAINS A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES, QUALITY IMPROVEMENT, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON HITTING MINIMUM LEVELS OF OPERATING MARGIN AND CHARITY CARE LEVELS, UNLESS THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES USES THEIR DISCRETION TO APPROVE AN EXCEPTION. Form 990, Part III, Line 4d Description of other program services (Expenses $ 18,982,472 including grants of $ 123,489)(Revenue $ 2,426,263) OTHER PROGRAMS Form 990, Part V, Line 1c PAYMENTS TO VENDORS PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF Catholic Health Initiatives (CHI) ARE MADE BY CHI, THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA. 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 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA ARE REPORTED TO THE IRS. Form 990, Part VI, Line 4 Significant changes to organizational documents Alegent Health-Community Memorial Hospital of Missouri Valley AMENDED its BYLAWS on October 1, 2013. The amendment made CHI Nebraska, a Nebraska nonprofit corporation, the sole member of the corporation. Form 990, Part VI, Line 6 Classes of members or stockholders ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL MISSOURI VALLEY, IOWA HAS ONE MEMBER, WHICH CHI Nebraska. Form 990, Part VI, Line 7a Members or stockholders electing members of governing body According to the organization's bylaws, directors shall be appointed or refused by the corporate member. The corporate member may appoint one or more individuals to the board of directors, and may at any time remove, with or without cause, any member of the board of directors. According to the organization's bylaws, directors of the corporation shall be appointed by the corporate member no later than June 30 of each year. The names and qualifications of each individual accepted by the board of directors shall be submitted to the corporate member, who shall appoint or refuse each nominee in accordance with the corporate member's bylaws and with endorsement of the senior vice president of operations. The corporate member may unilaterally appoint one or more individuals to the board of directors should the board fail to furnish the corporate member with a list of individuals qualified to serve on the board of directors of the corporation. Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders The organization's corporate member is CHI Nebraska. Pursuant to Section 5.4.1 of the organization's bylaws, both CHI Nebraska and Catholic Health Initiatives ("CHI") have reserved powers as outlined in the CHI governance matrix. Pursuant to the governance matrix the following rights are held by the CHI Nebraska's Board: * Approve members of the Alegent Health- Community Memorial Hospital board. * Amendment of the corporate documents of the Alegent Health- Community Memorial Hospital. *Approve removal of a member of the governing body of the Alegent Health- Community Memorial Hospital. * Adoption of long range and strategic plans for the Alegent Health- Community Memorial Hospital. The following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: * Substantial change in the mission or philosophy of the Alegent Health- Community Memorial Hospital. * Removal of a member of the governing body of the Alegent Health- Community Memorial Hospital. * Approval of issuance of debt by Alegent Health- Community Memorial Hospital. * Approval of participation of Alegent Health- Community Memorial Hospital in a joint venture. *Approval of formation of a new corporation by Alegent Health- Community Memorial Hospital. * Approval of a merger involving the Alegent Health- Community Memorial Hospital. * Approval of the sale of all or substantially all of the assets of the Alegent Health- Community Memorial Hospital. * To require the transfer of assets by the Saint Alegent Health- Community Memorial Hospital to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts. Pursuant to Section 5.5.2 of the organization's bylaws, CHI Nebraska or CHI may, in exercise of their approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and its President and the Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. Form 990, Part VI, Line 11b Review of form 990 by governing body FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE CHI TAX DIRECTOR AND THE LOCAL CHIEF FINANCIAL OFFICER. AFTER INCORPORATION OF ANY CHANGES RESULTING FROM THIS REVIEW, THE FORM 990 IS PROVIDED TO THE BOARD OF DIRECTORS AND MEMBERS OF THE FINANCE COMMITTEE OF THE BOARD A WEEK IN ADVANCE OF THE FINANCE COMMITTEE MEETING. THE FORM 990 IS REVIEWED AT THE FINANCE COMMITTEE MEETING AND THE CHIEF FINANCIAL OFFICER AND CHI TAX DIRECTOR ARE PRESENT AT THE MEETING TO ANSWER QUESTIONS. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW AND ARE ABLE TO ASK THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR QUESTIONS PRIOR TO FILING WITH THE IRS. UPON CHIEF FINANCIAL OFFICER APPROVAL AND SIGNATURE, THE TAX Analyst FILES THE FINAL FORM 990 AS PRESENTED TO THE BOARD AND FINANCE COMMITTEE, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. Form 990, Part VI, Line 12c Conflict of interest policy ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA HAS ADOPTED THE CONFLICT OF INTEREST POLICY AND CONFLICT INVESTIGATION PROCESS OF CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION. ALL OFFICERS, TRUSTEES AND EMPLOYEES ARE COVERED BY A CONFLICT OF INTEREST POLICY. ADDITIONALLY, ALL OFFICERS, TRUSTEES AND EMPLOYEES ARE REQUIRED TO ACT IN ACCORDANCE WITH CHI'S STANDARDS OF CONDUCT, WHICH INCLUDE THE AVOIDANCE OF CONFLICTS OF INTEREST OR THE APPEARANCE OF CONFLICTS. 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 15a Process to establish compensation of top management official 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 15b Process to establish compensation of other employees SEE DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15A. Form 990, Part VI, Line 19 Required documents available to the public THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT. IN ADDITION, THE ARTICLES OF INCORPORATION ARE AVAILABLE FROM THE IOWA SECRETARY OF STATE WEBSITE. 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: 107400, Related or Exempt Function Revenue: 107400, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Form 990, Part VIII, Line 11d Other Miscellaneous Revenue - Total Revenue: 2682, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 2682; Form 990, Part IX, Line 11g Other Fees Other Fees for Services - Total Expense: 6199397, Program Service Expense: 5884542, Management and General Expenses: 314855, Fundraising Expenses: ; Form 990, Part XII, Line 2c AUDITED FINANCIAL STATEMENTS FOR FISCAL YEAR ENDING JUNE 30, 2015, THE FINANCIAL STATEMENTS OF ALEGENT HEALTH - COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA ARE INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES (CHI). THE CHI FINANCE COMMITTEE OVERSEES THE INDEPENDENT AUDIT PROCESS AND SELECT THE INDEPENDENT AUDITOR TO CONDUCT THE CONSOLIDATED FINANCIAL STATEMENT AUDIT. 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 FUNDRAISING ND 501(c)(3 Type I MMC true MERCY PROFESSIONAL PRACTICE ASSOCIATES INC 1111 6TH AVE DES MOINES IA 50314 421470935 PHYSICIANS IA 501(c)(3 9 CHI-IA CORP true NEBRASKA HEART HOSPITAL 7500 S 91ST ST LINCOLN NE 68526 392031968 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true NORTH CENTRAL HEALTH CARE ALLIANCE DBA PRIMECARE HEALTH GROUP 401 N 9th St BISMARCK ND 585014507 450439894 HEALTHCARE ND 501(c)(3 9 NHCA true OAKES COMMUNITY HOSPITAL 1200 N 7TH ST OAKES ND 58474 450231675 HEALTHCARE ND 501(c)(3 3 CHI true OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH ST OAKES ND 58474 710966606 FUNDRAISING ND 501(c)(3 Type I OCH true PINEYWOODS MEDICAL DEVELOPMENT CORP PO BOX 1447 LUFKIN TX 75902 752493116 PROPERTY MGMT TX 501(c)(3 Type III-FI MHSET true PROVIDENCE CARE CENTER 2025 HAYES AVENUE SANDUSKY OH 44870 341658625 HEALTHCARE OH 501(c)(3 9 FLC true PROVIDENCE CARE CENTERS 2025 HAYES AVENUE SANDUSKY OH 44870 341826099 HOLDING CO OH 501(c)(3 Type II FLC true PROVIDENCE RESIDENTIAL COMMUNITY CORPORATION 5055 PROVIDENCE DRIVE SANDUSKY OH 44870 341896807 LIVING COMM OH 501(c)(3 9 FLC true PUEBLO STEPUP 1925 E ORMAN AVE STE G52 PUEBLO CO 81004 841234295 COMMUNITY CO 501(c)(3 7 CHIC true REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE 12844 MILITARY RD S TUKWILA WA 98168 911170040 HEALTHCARE WA 501(c)(3 3 FHS true SET OF COLORADO SPRINGS INC 2864 S CIRCLE DR STE 450 COLORADO SPRINGS CO 80906 841183335 LTERM CARE CO 501(c)(3 7 CHIC true SAINT CLARE'S COMMUNITY CARE INC 25 POCONO RD DENVILLE NJ 07834 222876836 HEALTHCARE NJ 501(c)(3 Type II SCHS true SAINT CLARE'S FOUNDATION INC 25 POCONO RD DENVILLE NJ 07834 222502997 FUNDRAISING NJ 501(c)(3 7 SCHS true SAINT CLARE'S HEALTH SERVICES INC 25 POCONO RD DENVILLE NJ 07834 223639733 MANAGEMENT NJ 501(c)(3 Type II CHI true SAINT CLARE'S HOSPITAL INC 25 POCONO RD DENVILLE NJ 07834 223319886 HEALTHCARE NJ 501(c)(3 3 SCHS true SAINT ELIZABETH FOUNDATION 555 S 70TH ST LINCOLN NE 68510 470625523 FUNDRAISING NE 501(c)(3 7 SERMC true SAINT ELIZABETH HEALTH SERVICES 555 S 70TH ST LINCOLN NE 68510 363233120 HEALTHCARE NE 501(c)(3 3 SERMC true SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 S 70TH ST LINCOLN NE 68510 470379836 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER 2620 W FAIDLEY GRAND ISLAND NE 68803 470376601 HEALTHCARE NE 501(c)(3 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND NE 68802 470630267 FUNDRAISING NE 501(c)(3 7 SFMC true SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL ST BEREA KY 40403 260152877 FUNDRAISING KY 501(c)(3 7 SJHS true SAINT JOSEPH HEALTH SYSTEM INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 611334601 HEALTHCARE KY 501(c)(3 3 KOH true SAINT JOSEPH HOSPITAL FOUNDATION INC ONE SAINT JOSEPH DRIVE LEXINGTON KY 40504 611159649 FUNDRAISING KY 501(c)(3 Type I SJHS true SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON KY 40741 260438748 FUNDRAISING KY 501(c)(3 7 SJHS true SAINT JOSEPH MOUNT STERLING FOUNDATION INC 225 FALCON DR MOUNT STERLING KY 40353 272884584 FUNDRAISING KY 501(c)(3 7 SJHS true SAINT JOSEPH'S HOSPITAL FOUNDATION 30 WEST 7TH ST DICKINSON ND 58601 363418207 FUNDRAISING ND 501(c)(3 Type I SJHHC true SAMARITAN BEHAVIORAL HEALTH INC 601 S EDWIN C MOSES BLVD DAYTON OH 45417 020633634 HEALTHCARE OH 501(c)(3 7 SHP true SAMARITAN HEALTH PARTNERS 110 N MAIN ST STE 500 DAYTON OH 45402 311107411 HEALTHCARE OH 501(c)(3 Type I CHI true SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC 104 W 17TH ST SCHUYLER NE 68661 363630014 FUNDRAISING NE 501(c)(3 Type I AHMHS true SJRMC JOPLIN MISSOURI 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 440545809 HEALTHCARE MO 501(c)(3 3 CHI true SL AUGUSTA CORP PO BOX 20269 HOUSTON TX 77225 760226623 TITLE HOLDING TX 501(c)(2 SLPC true ST ALEXIUS MEDICAL CENTER 900 EAST BROADWAY AVENUE BISMARCK ND 58501 450226711 HEALTHCARE ND 501(c)(3 3 CHI true ST ANTHONY HOSPITAL 1601 SE COURT AVE PENDLETON OR 97801 930391614 HEALTHCARE OR 501(c)(3 3 CHI true ST ANTHONY HOSPITAL FOUNDATION 1601 SE COURT AVE PENDLETON OR 97801 930992727 FUNDRAISING OR 501(c)(3 Type I SAH true ST ANTHONY'S HOSPITAL ASSOCIATION FOUR HOSPITAL DR MORRILTON AR 72110 710245507 HEALTHCARE AR 501(c)(3 3 SVIMC true ST CATHERINE HOSPITAL 401 EAST SPRUCE ST GARDEN CITY KS 67846 480543721 HEALTHCARE KS 501(c)(3 3 CHI true ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION 401 EAST SPRUCE ST GARDEN CITY KS 67846 200598702 FUNDRAISING KS 501(c)(3 Type I SCH true ST CLARE COMMONS 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 270163752 LIVING COMM OH 501(c)(3 9 FLC true ST DOMINIC OF ONTARIO OREGON 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 930433692 HEALTHCARE OR 501(c)(4 CHI true ST FRANCIS HOME 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 410729978 LTERM CARE MN 501(c)(3 9 CHI true ST FRANCIS LIFE CARE CORPORATION 19 POCONO RD DENVILLE NJ 07834 222536017 ELDERLY CARE NJ 501(c)(3 9 SCHS true ST FRANCIS MEDICAL CENTER 2400 ST FRANCIS DR BRECKENRIDGE MN 56520 410695598 HEALTHCARE MN 501(c)(3 3 CHI true ST FRANCIS OF BAKER CITY 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 930412495 HEALTHCARE OR 501(c)(3 3 CHI true ST JOSEPH FOUNDATION OF BRYAN TEXAS 2801 FRANCISCAN DRIVE BRYAN TX 77802 742351158 FUNDRAISING TX 501(c)(3 Type I SJSC true ST JOSEPH HEALTH MINISTRIES 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232342997 HEALTHCARE PA 501(c)(3 Type I CHI true ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742847594 HEALTHCARE TX 501(c)(3 9 SJSC true ST JOSEPH MEDICAL CENTER FOUNDATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 232649362 FUNDRAISING PA 501(c)(3 Type I SJRHN true ST JOSEPH MEDICAL CENTER INC 201 INTERNATIONAL CIRCLE STE 212 HUNT VALLEY MD 21030 520591461 HEALTHCARE MD 501(c)(3 3 CHI true ST JOSEPH MEDICAL GROUP 2500 BERNVILLE RD PO BOX 316 READING PA 19603 208544021 HEALTHCARE PA 501(c)(3 9 BHC true ST JOSEPH 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