GOOD SAMARITAN HOSPITAL: Form 990, tax year 2013

View the entire original 990 at ProPublica ↗

Organization: GOOD SAMARITAN HOSPITAL (EIN 47-0379755)
Tax period: 2013-07-01 to 2014-06-30
Filed: 2015-05-14
IRS object ID: 201521349349307407
Schema version: 2013v4.0
Source: Download XML · Original 990 at ProPublica

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

Return header
Form 990
Schedule A
Schedule B
Schedule C
Schedule D
Schedule H
Schedule I
Schedule J
Schedule O
Schedule R

Return header ReturnHeader

Field	Value	IRS element (for citing)
Return	2015-05-14T16:00:05-05:00	ReturnTs
Tax Period End	2014-06-30	TaxPeriodEndDt

Preparer Firm PreparerFirmGrp

Field	Value	IRS element (for citing)
Preparer Firm EIN	470617373	PreparerFirmEIN

Preparer Firm Name PreparerFirmName

Field	Value	IRS element (for citing)
Business Name Line1	CATHOLIC HEALTH INITIATIVES	BusinessNameLine1

Preparer US Address PreparerUSAddress

Field	Value	IRS element (for citing)
Address Line1	198 INVERNESS DRIVE WEST	AddressLine1
City	ENGLEWOOD	City
State	CO	State
ZIP Code	80112	ZIPCode

Field	Value	IRS element (for citing)
Return Type	990	ReturnTypeCd
Tax Period Begin	2013-07-01	TaxPeriodBeginDt

Filer Filer

Field	Value	IRS element (for citing)
EIN	470379755	EIN

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	GOOD SAMARITAN HOSPITAL	BusinessNameLine1

Field	Value	IRS element (for citing)
Business Name Control	GOOD	BusinessNameControlTxt
Phone	3088657900	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	PO Box 1990	AddressLine1
City	Kearney	City
State	NE	State
ZIP Code	68848	ZIPCode

Business Officer BusinessOfficerGrp

Field	Value	IRS element (for citing)
Person	JEANETTE WOJTALEWICZ	PersonNm
Person Title	CFO CHI HEALTH	PersonTitleTxt
Signature	2014-05-13	SignatureDt
Discuss With Paid Preparer	Yes (true)	DiscussWithPaidPreparerInd

Preparer Person PreparerPersonGrp

Field	Value	IRS element (for citing)
Preparer Person	ANGELA LEA	PreparerPersonNm
PTIN	P01051055	PTIN
Phone	3032989100	PhoneNum

Field	Value	IRS element (for citing)
Tax	2013	TaxYr
Build TS	2016-03-07 17:11:31Z	BuildTS

Form 990 IRS990

Doing Business As Name DoingBusinessAsName

Field	Value	IRS element (for citing)
Business Name Line1	CHI GOOD SAMARITAN	BusinessNameLine1

Principal Ofcr Business Address PrincipalOfcrBusinessAddress

Field	Value	IRS element (for citing)
Business Name Line1	CLIFF ROBERTSON	BusinessNameLine1

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	12809 West Dodge Road	AddressLine1
City	Omaha	City
State	NE	State
ZIP Code	68154	ZIPCode

Field	Value	IRS element (for citing)
Gross Receipts	$238,117,698	GrossReceiptsAmt
Group Return For Affiliates	false	GroupReturnForAffiliatesInd
Group Exemption	0928	GroupExemptionNum
Organization501c3	Yes (X)	Organization501c3Ind
Website Address	WWW.GSHS.ORG	WebsiteAddressTxt
Type Of Organization Corp	Yes (X)	TypeOfOrganizationCorpInd
Formation	1924	FormationYr
Legal Domicile State	NE	LegalDomicileStateCd
Activity Or Mission	THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH.	ActivityOrMissionDesc
Voting Members Governing Body	11	VotingMembersGoverningBodyCnt
Voting Members Independent	8	VotingMembersIndependentCnt
Total Employee	1731	TotalEmployeeCnt
Total Volunteers	200	TotalVolunteersCnt
Total Gross UBI	$106,288	TotalGrossUBIAmt
Net Unrelated Bus Txbl Incm	$55,893	NetUnrelatedBusTxblIncmAmt
PY Contributions Grants	$3,037,646	PYContributionsGrantsAmt
CY Contributions Grants	$1,573,697	CYContributionsGrantsAmt
PY Program Service Revenue	$210,414,933	PYProgramServiceRevenueAmt
CY Program Service Revenue	$225,923,071	CYProgramServiceRevenueAmt
PY Investment Income	$10,339,862	PYInvestmentIncomeAmt
CY Investment Income	$7,294,212	CYInvestmentIncomeAmt
PY Other Revenue	$3,934,031	PYOtherRevenueAmt
CY Other Revenue	$3,294,449	CYOtherRevenueAmt
PY Total Revenue	$227,726,472	PYTotalRevenueAmt
CY Total Revenue	$238,085,429	CYTotalRevenueAmt
PY Grants And Similar Paid	$553,988	PYGrantsAndSimilarPaidAmt
CY Grants And Similar Paid	$763,350	CYGrantsAndSimilarPaidAmt
PY Benefits Paid To Members	$0	PYBenefitsPaidToMembersAmt
CY Benefits Paid To Members	$0	CYBenefitsPaidToMembersAmt
PY Salaries Comp Emp Bnft Paid	$75,045,752	PYSalariesCompEmpBnftPaidAmt
CY Salaries Comp Emp Bnft Paid	$73,105,351	CYSalariesCompEmpBnftPaidAmt
PY Total Prof Fndrsng Expns	$0	PYTotalProfFndrsngExpnsAmt
CY Total Prof Fndrsng Expns	$0	CYTotalProfFndrsngExpnsAmt
CY Total Fundraising Expense	$0	CYTotalFundraisingExpenseAmt
PY Other Expenses	$132,117,856	PYOtherExpensesAmt
CY Other Expenses	$139,500,619	CYOtherExpensesAmt
PY Total Expenses	$207,717,596	PYTotalExpensesAmt
CY Total Expenses	$213,369,320	CYTotalExpensesAmt
PY Revenues Less Expenses	$20,008,876	PYRevenuesLessExpensesAmt
CY Revenues Less Expenses	$24,716,109	CYRevenuesLessExpensesAmt
Total Assets BOY	$368,225,432	TotalAssetsBOYAmt
Total Assets EOY	$408,846,427	TotalAssetsEOYAmt
Total Liabilities BOY	$43,638,201	TotalLiabilitiesBOYAmt
Total Liabilities EOY	$42,046,369	TotalLiabilitiesEOYAmt
Net Assets Or Fund Balances BOY	$324,587,231	NetAssetsOrFundBalancesBOYAmt
Net Assets Or Fund Balances EOY	$366,800,058	NetAssetsOrFundBalancesEOYAmt
Info In Schedule O Part III	Yes (X)	InfoInScheduleOPartIIIInd
Mission	SEE SCHEDULE O	MissionDesc
Significant New Program Srvc	false	SignificantNewProgramSrvcInd
Significant Change	false	SignificantChangeInd
Expense	$183,367,173	ExpenseAmt
Grant	$763,350	GrantAmt
Revenue	$225,873,793	RevenueAmt
Desc	SEE SCHEDULE H	Desc
Total Program Service Expenses	$183,367,173	TotalProgramServiceExpensesAmt
Described In Section501c3	Yes (true)	DescribedInSection501c3Ind
Schedule B Required	Yes (true)	ScheduleBRequiredInd
Political Campaign Acty	false	PoliticalCampaignActyInd
Lobbying Activities	Yes (true)	LobbyingActivitiesInd
Donor Advised Fund	false	DonorAdvisedFundInd
Conservation Easements	false	ConservationEasementsInd
Collections Of Art	false	CollectionsOfArtInd
Credit Counseling	false	CreditCounselingInd
Temp Or Permanent Endowments	false	TempOrPermanentEndowmentsInd
Report Land Building Equipment	Yes (true)	ReportLandBuildingEquipmentInd
Report Investments Other Sec	Yes (true)	ReportInvestmentsOtherSecInd
Report Program Related Invst	false	ReportProgramRelatedInvstInd
Report Other Assets	false	ReportOtherAssetsInd
Report Other Liabilities	Yes (true)	ReportOtherLiabilitiesInd
Include FIN48 Footnote	Yes (true)	IncludeFIN48FootnoteInd
Independent Audit Fincl Stmt	false	IndependentAuditFinclStmtInd
Consolidated Audit Fincl Stmt	Yes (true)	ConsolidatedAuditFinclStmtInd
School Operating	false	SchoolOperatingInd
Foreign Office	false	ForeignOfficeInd
Foreign Activities	false	ForeignActivitiesInd
More Than5000 K To Org	false	MoreThan5000KToOrgInd
More Than5000 K To Individuals	false	MoreThan5000KToIndividualsInd
Professional Fundraising	false	ProfessionalFundraisingInd
Fundraising Activities	false	FundraisingActivitiesInd
Gaming Activities	false	GamingActivitiesInd
Operate Hospital	Yes (true)	OperateHospitalInd
Audited Financial Stmt Att	Yes (true)	AuditedFinancialStmtAttInd
Grants To Organizations	Yes (true)	GrantsToOrganizationsInd
Grants To Individuals	Yes (true)	GrantsToIndividualsInd
Schedule J Required	Yes (true)	ScheduleJRequiredInd
Tax Exempt Bonds	false	TaxExemptBondsInd
Engaged In Excess Benefit Trans	false	EngagedInExcessBenefitTransInd
PY Excess Benefit Trans	false	PYExcessBenefitTransInd
Loan Outstanding	false	LoanOutstandingInd
Grant To Related Person	false	GrantToRelatedPersonInd
Business Rln With Org Mem	false	BusinessRlnWithOrgMemInd
Business Rln With Fam Mem	false	BusinessRlnWithFamMemInd
Business Rln With Officer Ent	false	BusinessRlnWithOfficerEntInd
Deductible Non Cash Contri	false	DeductibleNonCashContriInd
Deductible Art Contribution	false	DeductibleArtContributionInd
Terminate Operations	false	TerminateOperationsInd
Partial Liquidation	false	PartialLiquidationInd
Disregarded Entity	false	DisregardedEntityInd
Related Entity	Yes (true)	RelatedEntityInd
Related Organization Ctrl Ent	Yes (true)	RelatedOrganizationCtrlEntInd
Transaction With Control Ent	Yes (true)	TransactionWithControlEntInd
Trnsfr Exmpt Non Chrtbl Rltd Org	false	TrnsfrExmptNonChrtblRltdOrgInd
Activities Conducted Prtshp	false	ActivitiesConductedPrtshpInd
Schedule O Required	Yes (true)	ScheduleORequiredInd
IRP Document	4	IRPDocumentCnt
IRP Document W2 G	0	IRPDocumentW2GCnt
Backup Wthld Compliance	Yes (true)	BackupWthldComplianceInd
Employee	1731	EmployeeCnt
Employment Tax Returns Filed	Yes (true)	EmploymentTaxReturnsFiledInd
Unrelated Bus Incm Over Limit	Yes (true)	UnrelatedBusIncmOverLimitInd
Form990 T Filed	Yes (true)	Form990TFiledInd
Foreign Financial Account	false	ForeignFinancialAccountInd
Prohibited Tax Shelter Trans	false	ProhibitedTaxShelterTransInd
Taxable Party Notification	false	TaxablePartyNotificationInd
Nondeductible Contributions	false	NondeductibleContributionsInd
Quid Pro Quo Contributions	false	QuidProQuoContributionsInd
Form8282 Property Disposed Of	false	Form8282PropertyDisposedOfInd
Rcv Fnds To Pay Prsnl Bnft Cntrct	false	RcvFndsToPayPrsnlBnftCntrctInd
Pay Premiums Prsnl Bnft Cntrct	false	PayPremiumsPrsnlBnftCntrctInd
Indoor Tanning Services	false	IndoorTanningServicesInd
Info In Schedule O Part VI	Yes (X)	InfoInScheduleOPartVIInd
Governing Body Voting Members	11	GoverningBodyVotingMembersCnt
Independent Voting Member	8	IndependentVotingMemberCnt
Family Or Business Rln	false	FamilyOrBusinessRlnInd
Delegation Of Mgmt Duties	false	DelegationOfMgmtDutiesInd
Change To Org Documents	Yes (true)	ChangeToOrgDocumentsInd
Material Diversion Or Misuse	false	MaterialDiversionOrMisuseInd
Members Or Stockholders	Yes (true)	MembersOrStockholdersInd
Election Of Board Members	Yes (true)	ElectionOfBoardMembersInd
Decisions Subject To Approva	Yes (true)	DecisionsSubjectToApprovaInd
Minutes Of Governing Body	Yes (true)	MinutesOfGoverningBodyInd
Minutes Of Committees	Yes (true)	MinutesOfCommitteesInd
Officer Mailing Address	false	OfficerMailingAddressInd
Local Chapters	false	LocalChaptersInd
Form990 Provided To Gvrn Body	Yes (true)	Form990ProvidedToGvrnBodyInd
Conflict Of Interest Policy	Yes (true)	ConflictOfInterestPolicyInd
Annual Disclosure Covered Prsn	Yes (true)	AnnualDisclosureCoveredPrsnInd
Regular Monitoring Enfrc	Yes (true)	RegularMonitoringEnfrcInd
Whistleblower Policy	Yes (true)	WhistleblowerPolicyInd
Document Retention Policy	Yes (true)	DocumentRetentionPolicyInd
Compensation Process CEO	false	CompensationProcessCEOInd
Compensation Process Other	Yes (true)	CompensationProcessOtherInd
Investment In Joint Venture	Yes (true)	InvestmentInJointVentureInd
Written Policy Or Procedure	false	WrittenPolicyOrProcedureInd
States Where Copy Of Return Is Fld	NE	StatesWhereCopyOfReturnIsFldCd
Upon Request	Yes (X)	UponRequestInd

Books In Care Of Detail BooksInCareOfDetail

Business Name BusinessName

Field	Value	IRS element (for citing)
Business Name Line1	Jeanette Wojtalewicz	BusinessNameLine1

Field	Value	IRS element (for citing)
Phone	4023434671	PhoneNum

US Address USAddress

Field	Value	IRS element (for citing)
Address Line1	12809 West Dodge Road	AddressLine1
City	Omaha	City
State	NE	State
ZIP Code	68154	ZIPCode

Form990 Part VII Section A Form990PartVIISectionAGrp (36 entries)

TitleTitleTxt	Average Hours Per WeekAverageHoursPerWeekRt	Average Hours Per Week Rltd OrgAverageHoursPerWeekRltdOrgRt	Individual Trustee Or DirectorIndividualTrusteeOrDirectorInd	OfficerOfficerInd	Reportable Comp From OrgReportableCompFromOrgAmt	Reportable Comp From Rltd OrgReportableCompFromRltdOrgAmt	Other CompensationOtherCompensationAmt	Key EmployeeKeyEmployeeInd	Highest Compensated EmployeeHighestCompensatedEmployeeInd	Former Ofcr Director TrusteeFormerOfcrDirectorTrusteeInd
CLIFF ROBERTSON
Board Member/CEO CHI Health	1.00	59.00	Yes (X)	Yes (X)	$0	$761,591	$100,446
MICHAEL DEFREECE
Secretary/Treasurer	1.00	11.00	Yes (X)	Yes (X)	$0	$0	$0
RICHARD HACHTEN II
Chair/ACH President & CEO	1.00	48.00	Yes (X)	Yes (X)	$0	$4,316,298	$67,124
RICHARD HERINK
BOARD CHAIR	1.00	11.00	Yes (X)	Yes (X)	$0	$0	$0
RICHARD J VIERK
Vice Chair	1.00	11.00	Yes (X)	Yes (X)	$0	$0	$0
BARRY SANDSTROM
Board Member	1.00	12.00	Yes (X)		$0	$0	$0
DR MARYANNE STEVENS RSM
Board Member	1.00	11.00	Yes (X)		$0	$0	$0
FR JAMES CLIFTON SJ
Board Member	1.00	11.00	Yes (X)		$0	$0	$0
GREGORY HEIDRICK
Board Member	1.00	12.00	Yes (X)		$0	$0	$0
H KEITH SCHMODE
Board Member	1.00	11.00	Yes (X)		$0	$0	$0
LARRY BUTLER
Board Member	1.00	11.00	Yes (X)		$0	$0	$0
MARTIN M MANCUSO MD
Board Member	1.00	59.00	Yes (X)		$0	$416,092	$25,222
MICHAEL ROWAN FACHE
Board member/CHI EVP & COO	1.00	59.00	Yes (X)		$0	$2,769,716	$258,055
PAUL EDGETT III
Board Member/CHI SVP	1.00	59.00	Yes (X)		$0	$1,126,594	$94,198
ROBERT LANIK
BOARD MEMBER/CHI NE President/CEO	2.00	58.00	Yes (X)		$0	$1,314,093	$48,200
SISTER NADINE HEIMANN
Board Member	1.00	11.00	Yes (X)		$0	$0	$0
GEORGE HARMS
VICE PRESIDENT OF FINANCE	55.00	5.00		Yes (X)	$240,572	$0	$42,504
JEANETTE WOJTALEWICZ
CFO, CHI HEALTH	1.00	59.00		Yes (X)	$0	$499,985	$59,878
MICHAEL SCHNIEDERS
PRESIDENT GSH	55.00	5.00		Yes (X)	$0	$495,769	$75,511
AMY HATCHER
VP Divisional Finance	1.00	0			$0	$0	$0	Yes (X)
CAROL WAHL
VP PATIENT SERVICES	60.00	0			$237,918	$0	$36,771	Yes (X)
DENNIS EDWARDS
VP MEDICAL AFFAIRS	40.00	10.00			$0	$391,777	$41,950	Yes (X)
LISA WEBB
VP of Finance	1.00	46.00			$17,044	$218,584	$16,004	Yes (X)
ROBERT CUNNINGHAM
VP ANCILLARY SUPPORT	60.00	0			$217,173	$0	$38,252	Yes (X)
DAVID HUEBNER MD
Board Member/PRESIDENT MEDICAL STAFF	55.00	0			$384,598	$0	$0		Yes (X)
MICHAEL BIBLER
Physician	0.00	60.00			$427,296	$456,769	$31,870		Yes (X)
NICKI L BOHL
DIRECTOR PHARMACY	45.00	0			$139,145	$0	$26,855		Yes (X)
RICHARD HRANAC
BOARD MEMBER/Physician	2.00	0.00			$45,157	$117,989	$15,529		Yes (X)
TODD STOVER
DIRECTOR PERFUSION	45.00	0			$144,695	$0	$34,682		Yes (X)
CLARESSA L MILLSAP
DIRECTOR CARDIOVASCULAR	45.00	0.00			$23,827	$102,638	$33,294			Yes (X)
ELIZABETH TAYLOR-TRUJILLO
DIRECTOR BEHAVIORAL HEALTH	45.00	0			$115,458	$0	$13,174			Yes (X)
FISHEL LIBERMAN
FORMER PHYSICIAN	0.00	60.00			$0	$747,024	$44,500			Yes (X)
HUGO GONZALEZ NIETO
FORMER PHYSICIAN	0.00	60.00			$0	$312,689	$38,896			Yes (X)
LAWRENCE A SURMEIER
DIRECTOR FACILITY OPERATIONS	45.00	0			$113,597	$0	$13,123			Yes (X)
LEIGH BERTHOLF
Former VP & CRO	0.00	60.00			$0	$337,725	$49,840			Yes (X)
STEPHEN LEURCK
FORMER INTERIM CAO	0.00	40.00			$0	$298,799	$0			Yes (X)

Field	Value	IRS element (for citing)
Total Reportable Comp From Org	$2,106,480	TotalReportableCompFromOrgAmt
Tot Reportable Comp Rltd Org	$14,684,132	TotReportableCompRltdOrgAmt
Total Other Compensation	$1,205,878	TotalOtherCompensationAmt
Indiv Rcvd Greater Than100 K	30	IndivRcvdGreaterThan100KCnt
Former Ofcr Employees Listed	Yes (true)	FormerOfcrEmployeesListedInd
Total Comp Greater Than150 K	Yes (true)	TotalCompGreaterThan150KInd
Compensation From Other Srcs	false	CompensationFromOtherSrcsInd

Contractor Compensation ContractorCompensationGrp (5 entries)

Address Line1ContractorAddress/USAddress/AddressLine1	CityContractorAddress/USAddress/City	StateContractorAddress/USAddress/State	ZIP CodeContractorAddress/USAddress/ZIPCode	ServicesServicesDesc	CompensationCompensationAmt
WPS TRICARE FOR LIFE
PO BOX 7928	MADISON	WI	537077928	PHYSICIANS SERVICES SUPPORT	$1,435,573
RODGERS HELICOPTER SERVICES
4965 AIRPORT ROAD	KEARNEY	NE	688473372	AIRCARE FLIGHT SERVICES	$782,687
SORENSEN GROUP INC
1400 W 22ND STREET	KEARNEY	NE	68845	GENERAL CONTRACTORS	$568,856
SULLIVAN HEALTHCARE CONSULTING
900VICTORS WAY	ANN ARBOR	MI	48108	CONSULTING	$520,466
ALL ABOUT STAFFING INC
10020 NORTH RODNEY PARHAM RD	LITTLE ROCK	AR	72227	STAFFING SERVICES	$509,661

Field	Value	IRS element (for citing)
Cntrct Rcvd Greater Than100 K	55	CntrctRcvdGreaterThan100KCnt
Related Organizations	$1,036,554	RelatedOrganizationsAmt
Government Grants	$347,831	GovernmentGrantsAmt
All Other Contributions	$189,312	AllOtherContributionsAmt
Total Contributions	$1,573,697	TotalContributionsAmt

Program Service Revenue ProgramServiceRevenueGrp (5 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Related Or Exempt Func IncomeRelatedOrExemptFuncIncomeAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt
PATIENT SERVICES	900099	$223,768,632	$223,768,632
EQUITY CHANGES OF UNCONSOLIDATED ORGS	900099	$1,208,185	$1,158,907	$49,278
RENTAL INCOME	900099	$946,254	$946,254
		$0
		$0

Total Oth Program Service Rev TotalOthProgramServiceRevGrp

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

Field	Value	IRS element (for citing)
Total Program Service Revenue	$225,923,071	TotalProgramServiceRevenueAmt

Investment Income InvestmentIncomeGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,924,997	TotalRevenueColumnAmt
Unrelated Business Revenue	-$11,100	UnrelatedBusinessRevenueAmt
Exclusion	$3,936,097	ExclusionAmt

Incm From Invest Bond Proceeds IncmFromInvestBondProceedsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Royalties Revenue RoyaltiesRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Gross Rents GrossRentsGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt

Rental Income Or Loss RentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Real	$0	RealAmt
Personal	$0	PersonalAmt

Net Rental Income Or Loss NetRentalIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt
Exclusion	$0	ExclusionAmt

Gross Amount Sales Assets GrossAmountSalesAssetsGrp

Field	Value	IRS element (for citing)
Securities	$3,398,593	SecuritiesAmt
Other	$2,891	OtherAmt

Less Cost Oth Basis Sales Expnss LessCostOthBasisSalesExpnssGrp

Field	Value	IRS element (for citing)
Other	$32,269	OtherAmt

Gain Or Loss GainOrLossGrp

Field	Value	IRS element (for citing)
Securities	$3,398,593	SecuritiesAmt
Other	-$29,378	OtherAmt

Net Gain Or Loss Investments NetGainOrLossInvestmentsGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$3,369,215	TotalRevenueColumnAmt
Exclusion	$3,369,215	ExclusionAmt

Net Incm From Fundraising Evt NetIncmFromFundraisingEvtGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Income From Gaming NetIncomeFromGamingGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Net Income Or Loss NetIncomeOrLossGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$0	TotalRevenueColumnAmt

Other Revenue Misc OtherRevenueMiscGrp (3 entries)

DescDesc	BusinessBusinessCd	Total Revenue ColumnTotalRevenueColumnAmt	Unrelated Business RevenueUnrelatedBusinessRevenueAmt	ExclusionExclusionAmt
SERVICES SOLD	900099	$1,228,916	$5,669	$1,223,247
CAFETERIA	722100	$928,010	$1,208	$926,802
CHILD CARE	624410	$447,389		$447,389

Miscellaneous Revenue MiscellaneousRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$690,134	TotalRevenueColumnAmt
Related Or Exempt Func Income	$0	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$61,233	UnrelatedBusinessRevenueAmt
Exclusion	$628,901	ExclusionAmt

Field	Value	IRS element (for citing)
Other Revenue Total	$3,294,449	OtherRevenueTotalAmt

Total Revenue TotalRevenueGrp

Field	Value	IRS element (for citing)
Total Revenue Column	$238,085,429	TotalRevenueColumnAmt
Related Or Exempt Func Income	$225,873,793	RelatedOrExemptFuncIncomeAmt
Unrelated Business Revenue	$106,288	UnrelatedBusinessRevenueAmt
Exclusion	$10,531,651	ExclusionAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part IX	Yes (X)	InfoInScheduleOPartIXInd

Grants To Domestic Orgs GrantsToDomesticOrgsGrp

Field	Value	IRS element (for citing)
Total	$763,350	TotalAmt
Program Services	$763,350	ProgramServicesAmt

Grants To Domestic Individuals GrantsToDomesticIndividualsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Foreign Grants ForeignGrantsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Benefits To Members BenefitsToMembersGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Comp Current Ofcr Directors CompCurrentOfcrDirectorsGrp

Field	Value	IRS element (for citing)
Total	$793,252	TotalAmt
Program Services	$339,303	ProgramServicesAmt
Management And General	$453,949	ManagementAndGeneralAmt

Comp Disqual Persons CompDisqualPersonsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Other Salaries And Wages OtherSalariesAndWagesGrp

Field	Value	IRS element (for citing)
Total	$54,688,048	TotalAmt
Program Services	$53,611,308	ProgramServicesAmt
Management And General	$1,076,740	ManagementAndGeneralAmt

Pension Plan Contributions PensionPlanContributionsGrp

Field	Value	IRS element (for citing)
Total	$2,984,085	TotalAmt
Program Services	$2,765,376	ProgramServicesAmt
Management And General	$218,709	ManagementAndGeneralAmt

Other Employee Benefits OtherEmployeeBenefitsGrp

Field	Value	IRS element (for citing)
Total	$10,673,143	TotalAmt
Program Services	$10,669,298	ProgramServicesAmt
Management And General	$3,845	ManagementAndGeneralAmt

Payroll Taxes PayrollTaxesGrp

Field	Value	IRS element (for citing)
Total	$3,966,823	TotalAmt
Program Services	$3,890,261	ProgramServicesAmt
Management And General	$76,562	ManagementAndGeneralAmt

Fees For Services Management FeesForServicesManagementGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Legal FeesForServicesLegalGrp

Field	Value	IRS element (for citing)
Total	$348,168	TotalAmt
Management And General	$348,168	ManagementAndGeneralAmt

Fees For Services Accounting FeesForServicesAccountingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Lobbying FeesForServicesLobbyingGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Prof Fundraising FeesForServicesProfFundraising

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Srvc Invst Mgmnt Fees FeesForSrvcInvstMgmntFeesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Fees For Services Other FeesForServicesOtherGrp

Field	Value	IRS element (for citing)
Total	$35,420,689	TotalAmt
Program Services	$21,332,159	ProgramServicesAmt
Management And General	$14,088,530	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Advertising AdvertisingGrp

Field	Value	IRS element (for citing)
Total	$588,296	TotalAmt
Program Services	$583,913	ProgramServicesAmt
Management And General	$4,383	ManagementAndGeneralAmt

Office Expenses OfficeExpensesGrp

Field	Value	IRS element (for citing)
Total	$5,553,954	TotalAmt
Program Services	$5,527,560	ProgramServicesAmt
Management And General	$26,394	ManagementAndGeneralAmt

Information Technology InformationTechnologyGrp

Field	Value	IRS element (for citing)
Total	$10,407,913	TotalAmt
Program Services	$9,844,029	ProgramServicesAmt
Management And General	$563,884	ManagementAndGeneralAmt

Royalties RoyaltiesGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Occupancy OccupancyGrp

Field	Value	IRS element (for citing)
Total	$3,149,899	TotalAmt
Program Services	$2,804,839	ProgramServicesAmt
Management And General	$345,060	ManagementAndGeneralAmt

Travel TravelGrp

Field	Value	IRS element (for citing)
Total	$450,609	TotalAmt
Program Services	$428,631	ProgramServicesAmt
Management And General	$21,978	ManagementAndGeneralAmt

Pymt Travel Entrtnmnt Pub Ofcl PymtTravelEntrtnmntPubOfclGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Conferences Meetings ConferencesMeetingsGrp

Field	Value	IRS element (for citing)
Total	$55,088	TotalAmt
Program Services	$54,242	ProgramServicesAmt
Management And General	$846	ManagementAndGeneralAmt

Interest InterestGrp

Field	Value	IRS element (for citing)
Total	$918,482	TotalAmt
Program Services	$918,482	ProgramServicesAmt

Payments To Affiliates PaymentsToAffiliatesGrp

Field	Value	IRS element (for citing)
Total	$16,354,584	TotalAmt
Program Services	$3,841,155	ProgramServicesAmt
Management And General	$12,513,429	ManagementAndGeneralAmt

Depreciation Depletion DepreciationDepletionGrp

Field	Value	IRS element (for citing)
Total	$11,166,862	TotalAmt
Program Services	$11,152,578	ProgramServicesAmt
Management And General	$14,284	ManagementAndGeneralAmt

Insurance InsuranceGrp

Field	Value	IRS element (for citing)
Total	$635,584	TotalAmt
Program Services	$601,149	ProgramServicesAmt
Management And General	$34,435	ManagementAndGeneralAmt

Other Expenses OtherExpensesGrp (4 entries)

DescDesc	TotalTotalAmt	Program ServicesProgramServicesAmt	Management And GeneralManagementAndGeneralAmt
MEDICAL SUPLIES	$37,850,460	$37,850,460
BAD DEBTS	$9,913,454	$9,913,454
REPAIRS AND MAINTENANCE	$3,405,967	$3,400,667	$5,300
UNRELATED BUSINESS TAXES	$13,855		$13,855

All Other Expenses AllOtherExpensesGrp

Field	Value	IRS element (for citing)
Total	$3,266,755	TotalAmt
Program Services	$3,074,959	ProgramServicesAmt
Management And General	$191,796	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Functional Expenses TotalFunctionalExpensesGrp

Field	Value	IRS element (for citing)
Total	$213,369,320	TotalAmt
Program Services	$183,367,173	ProgramServicesAmt
Management And General	$30,002,147	ManagementAndGeneralAmt
Fundraising	$0	FundraisingAmt

Total Joint Costs TotalJointCostsGrp

Field	Value	IRS element (for citing)
Total	$0	TotalAmt

Cash Non Interest Bearing CashNonInterestBearingGrp

Field	Value	IRS element (for citing)
BOY	$4,950	BOYAmt
EOY	$5,050	EOYAmt

Savings And Temp Cash Invst SavingsAndTempCashInvstGrp

Field	Value	IRS element (for citing)
BOY	$17,677,778	BOYAmt
EOY	$27,955,800	EOYAmt

Accounts Receivable AccountsReceivableGrp

Field	Value	IRS element (for citing)
BOY	$29,972,633	BOYAmt
EOY	$39,148,867	EOYAmt

Receivables From Officers Etc ReceivablesFromOfficersEtcGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Rcvbl From Disqualified Prsn RcvblFromDisqualifiedPrsnGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Oth Notes Loans Receivable Net OthNotesLoansReceivableNetGrp

Field	Value	IRS element (for citing)
BOY	$87,755	BOYAmt
EOY	$307,681	EOYAmt

Inventories For Sale Or Use InventoriesForSaleOrUseGrp

Field	Value	IRS element (for citing)
BOY	$7,293,623	BOYAmt
EOY	$7,315,265	EOYAmt

Prepaid Expenses Defrd Charges PrepaidExpensesDefrdChargesGrp

Field	Value	IRS element (for citing)
BOY	$334,670	BOYAmt
EOY	$429,150	EOYAmt

Field	Value	IRS element (for citing)
Land Bldg Equip Cost Or Other Bss	$271,777,684	LandBldgEquipCostOrOtherBssAmt
Land Bldg Equip Accum Deprec	$148,906,765	LandBldgEquipAccumDeprecAmt

Land Bldg Equip Basis Net LandBldgEquipBasisNetGrp

Field	Value	IRS element (for citing)
BOY	$129,982,925	BOYAmt
EOY	$122,870,919	EOYAmt

Investments Pub Traded Sec InvestmentsPubTradedSecGrp

Field	Value	IRS element (for citing)
BOY	$710	BOYAmt
EOY	$611	EOYAmt

Investments Other Securities InvestmentsOtherSecuritiesGrp

Field	Value	IRS element (for citing)
BOY	$173,091,551	BOYAmt
EOY	$202,971,746	EOYAmt

Investments Program Related InvestmentsProgramRelatedGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Intangible Assets IntangibleAssetsGrp

Field	Value	IRS element (for citing)
BOY	$2,301,156	BOYAmt
EOY	$2,301,156	EOYAmt

Other Assets Total OtherAssetsTotalGrp

Field	Value	IRS element (for citing)
BOY	$7,477,681	BOYAmt
EOY	$5,540,182	EOYAmt

Total Assets TotalAssetsGrp

Field	Value	IRS element (for citing)
BOY	$368,225,432	BOYAmt
EOY	$408,846,427	EOYAmt

Accounts Payable Accr Expnss AccountsPayableAccrExpnssGrp

Field	Value	IRS element (for citing)
BOY	$15,006,987	BOYAmt
EOY	$18,823,804	EOYAmt

Deferred Revenue DeferredRevenueGrp

Field	Value	IRS element (for citing)
EOY	$68,445	EOYAmt

Loans From Officers Directors LoansFromOfficersDirectorsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Other Liabilities OtherLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$28,631,214	BOYAmt
EOY	$23,154,120	EOYAmt

Total Liabilities TotalLiabilitiesGrp

Field	Value	IRS element (for citing)
BOY	$43,638,201	BOYAmt
EOY	$42,046,369	EOYAmt

Field	Value	IRS element (for citing)
Organization Follows SFAS117	Yes (X)	OrganizationFollowsSFAS117Ind

Unrestricted Net Assets UnrestrictedNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$324,587,231	BOYAmt
EOY	$366,800,058	EOYAmt

Temporarily Rstr Net Assets TemporarilyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Permanently Rstr Net Assets PermanentlyRstrNetAssetsGrp

Field	Value	IRS element (for citing)
BOY	$0	BOYAmt
EOY	$0	EOYAmt

Total Net Assets Fund Balance TotalNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$324,587,231	BOYAmt
EOY	$366,800,058	EOYAmt

Tot Liab Net Assets Fund Balance TotLiabNetAssetsFundBalanceGrp

Field	Value	IRS element (for citing)
BOY	$368,225,432	BOYAmt
EOY	$408,846,427	EOYAmt

Field	Value	IRS element (for citing)
Info In Schedule O Part XI	Yes (X)	InfoInScheduleOPartXIInd
Reconcilation Revenue Expnss	$24,716,109	ReconcilationRevenueExpnssAmt
Net Unrlzd Gains Losses Invst	$17,178,058	NetUnrlzdGainsLossesInvstAmt
Other Changes In Net Assets	$318,660	OtherChangesInNetAssetsAmt
Method Of Accounting Accrual	Yes (X)	MethodOfAccountingAccrualInd
Accountant Compile Or Review	false	AccountantCompileOrReviewInd
FS Audited	Yes (true)	FSAuditedInd

FS Audited Basis FSAuditedBasisGrp

Field	Value	IRS element (for citing)
Consolidated Basis Fincl Stmt	Yes (X)	ConsolidatedBasisFinclStmtInd

Field	Value	IRS element (for citing)
Audit Committee	Yes (true)	AuditCommitteeInd
Federal Grant Audit Required	Yes (true)	FederalGrantAuditRequiredInd
Federal Grant Audit Performed	Yes (true)	FederalGrantAuditPerformedInd

Schedule A IRS990ScheduleA

Field	Value	IRS element (for citing)
Hospital	Yes (X)	HospitalInd

Schedule B IRS990ScheduleB

Contributor Information ContributorInformationGrp

Field	Value	IRS element (for citing)
Contributor	RESTRICTED	ContributorNum

Contributor Business Name ContributorBusinessName

Field	Value	IRS element (for citing)
Business Name Line1	RESTRICTED	BusinessNameLine1

Contributor US Address ContributorUSAddress

Field	Value	IRS element (for citing)
Address Line1	RESTRICTED	AddressLine1
Address Line2	RESTRICTED	AddressLine2
City	RESTRICTED	City
State	RESTRICTED	State
ZIP Code	RESTRICTED	ZIPCode

Field	Value	IRS element (for citing)
Total Contributions	RESTRICTED	TotalContributionsAmt

Schedule C IRS990ScheduleC

Field	Value	IRS element (for citing)
Volunteers	false	VolunteersInd
Paid Staff Or Management	false	PaidStaffOrManagementInd
Media Advertisements	false	MediaAdvertisementsInd
Mailings Members	false	MailingsMembersInd
Publications Or Broadcast	false	PublicationsOrBroadcastInd
Grants Other Organizations	Yes (true)	GrantsOtherOrganizationsInd
Grants Other Organizations	$9,843	GrantsOtherOrganizationsAmt
Direct Contact Legislators	false	DirectContactLegislatorsInd
Rallies Demonstrations	false	RalliesDemonstrationsInd
Other Activities	false	OtherActivitiesInd
Total Lobbying Expenditures	$9,843	TotalLobbyingExpendituresAmt
Not Described Section501c3	false	NotDescribedSection501c3Ind

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule C, Part II-B, Line 1, Description of the activities reported on Lines 1a through 1i	FormAndLineReferenceDesc
Explanation	LINE 1F: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS; NEBRASKA HOSPITAL ASSOCIATION $6,343, CATHOLIC HEALTH ASSOCIATION $2,601, AND AMERICAN HOSPITAL ASSOCIATION $899.	ExplanationTxt

Schedule D IRS990ScheduleD

Land LandGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$8,318,547	OtherCostOrOtherBasisAmt
Book Value	$8,318,547	BookValueAmt

Buildings BuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$112,502,994	OtherCostOrOtherBasisAmt
Depreciation	$42,708,829	DepreciationAmt
Book Value	$69,794,165	BookValueAmt

Leasehold Improvements LeaseholdImprovementsGrp

Field	Value	IRS element (for citing)
Book Value	$0	BookValueAmt

Equipment EquipmentGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$138,439,670	OtherCostOrOtherBasisAmt
Depreciation	$99,582,747	DepreciationAmt
Book Value	$38,856,923	BookValueAmt

Other Land Buildings OtherLandBuildingsGrp

Field	Value	IRS element (for citing)
Other Cost Or Other Basis	$12,516,473	OtherCostOrOtherBasisAmt
Depreciation	$6,615,189	DepreciationAmt
Book Value	$5,901,284	BookValueAmt

Field	Value	IRS element (for citing)
Total Book Value Land Buildings	$122,870,919	TotalBookValueLandBuildingsAmt

Financial Derivatives FinancialDerivativesGrp

Field	Value	IRS element (for citing)
Book Value	$0	BookValueAmt

Closely Held Equity Interests CloselyHeldEquityInterestsGrp

Field	Value	IRS element (for citing)
Book Value	$0	BookValueAmt

Other Securities OtherSecuritiesGrp (2 entries)

DescDesc	Book ValueBookValueAmt	Method ValuationMethodValuationCd
CHI OIP - FIXED INCOME	$98,876,209	F
CHI OIP - EQUITY SECURITIES	$104,095,537	F

Field	Value	IRS element (for citing)
Total Book Value Securities	$202,971,746	TotalBookValueSecuritiesAmt
Federal Income Tax Liability	$0	FederalIncomeTaxLiabilityAmt

Other Liabilities Org OtherLiabilitiesOrgGrp (3 entries)

DescDesc	AmtAmt
INTERCOMPANY PAYABLES	$22,882,713
UNCLAIMED PROPERTY	$15,994
PHYSICIAN GUARANTEE	$255,413

Field	Value	IRS element (for citing)
Total Liability	$23,154,120	TotalLiabilityAmt
Footnote Text	Yes (X)	FootnoteTextInd

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule D, Part X, Line 2, FIN 48 (ASC 740) footnote	FormAndLineReferenceDesc
Explanation	GOOD SAMARITAN HOSPITAL'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES, A RELATED ORGANIZATION. CHI'S FIN 48 (ASC740) FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2014 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."	ExplanationTxt

Schedule H IRS990ScheduleH

Field	Value	IRS element (for citing)
Financial Assistance Policy	Yes (true)	FinancialAssistancePolicyInd
Written Policy	Yes (true)	WrittenPolicyInd
All Hospitals Policy	Yes (X)	AllHospitalsPolicyInd
FPG Reference Free Care	false	FPGReferenceFreeCareInd
FPG Reference Discounted Care	false	FPGReferenceDiscountedCareInd
Free Care Medically Indigent	Yes (true)	FreeCareMedicallyIndigentInd
Financial Assistance Budget	Yes (true)	FinancialAssistanceBudgetInd
Expenses Exceed Budget	Yes (true)	ExpensesExceedBudgetInd
Unable To Provide Care	false	UnableToProvideCareInd
Annual Community Bnft Report	Yes (true)	AnnualCommunityBnftReportInd
Report Publically Available	Yes (true)	ReportPublicallyAvailableInd

Financial Assistance At Cost Typ FinancialAssistanceAtCostTyp

Field	Value	IRS element (for citing)
Persons Served	3509	PersonsServedCnt
Total Community Benefit Expns	$3,905,132	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$3,905,132	NetCommunityBenefitExpnsAmt
Total Expense	0.01920	TotalExpensePct

Unreimbursed Medicaid UnreimbursedMedicaidGrp

Field	Value	IRS element (for citing)
Persons Served	8559	PersonsServedCnt
Total Community Benefit Expns	$17,301,464	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$12,388,107	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$4,913,357	NetCommunityBenefitExpnsAmt
Total Expense	0.02410	TotalExpensePct

Unreimbursed Costs UnreimbursedCostsGrp

Field	Value	IRS element (for citing)
Total Community Benefit Expns	$196,992	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$523,335	DirectOffsettingRevenueAmt
Net Community Benefit Expns	-$326,343	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Financial Assistance Typ TotalFinancialAssistanceTyp

Field	Value	IRS element (for citing)
Activities Or Programs	0	ActivitiesOrProgramsCnt
Persons Served	12068	PersonsServedCnt
Total Community Benefit Expns	$21,403,588	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$12,911,442	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$8,492,146	NetCommunityBenefitExpnsAmt
Total Expense	0.04330	TotalExpensePct

Community Health Services CommunityHealthServicesGrp

Field	Value	IRS element (for citing)
Activities Or Programs	42	ActivitiesOrProgramsCnt
Persons Served	248408	PersonsServedCnt
Total Community Benefit Expns	$963,548	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$42,302	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$921,246	NetCommunityBenefitExpnsAmt
Total Expense	0.00450	TotalExpensePct

Health Professions Education HealthProfessionsEducationGrp

Field	Value	IRS element (for citing)
Activities Or Programs	29	ActivitiesOrProgramsCnt
Persons Served	2595	PersonsServedCnt
Total Community Benefit Expns	$569,997	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$35,695	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$534,302	NetCommunityBenefitExpnsAmt
Total Expense	0.00260	TotalExpensePct

Subsidized Health Services SubsidizedHealthServicesGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Research ResearchGrp

Field	Value	IRS element (for citing)
Activities Or Programs	3	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$311,534	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$311,534	NetCommunityBenefitExpnsAmt
Total Expense	0.00150	TotalExpensePct

Cash And In Kind Contributions CashAndInKindContributionsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	19	ActivitiesOrProgramsCnt
Persons Served	30502	PersonsServedCnt
Total Community Benefit Expns	$513,519	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$513,519	NetCommunityBenefitExpnsAmt
Total Expense	0.00250	TotalExpensePct

Total Other Benefits TotalOtherBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	93	ActivitiesOrProgramsCnt
Persons Served	281505	PersonsServedCnt
Total Community Benefit Expns	$2,358,598	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$77,997	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$2,280,601	NetCommunityBenefitExpnsAmt
Total Expense	0.01110	TotalExpensePct

Total Community Benefits TotalCommunityBenefitsGrp

Field	Value	IRS element (for citing)
Activities Or Programs	93	ActivitiesOrProgramsCnt
Persons Served	293573	PersonsServedCnt
Total Community Benefit Expns	$23,762,186	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$12,989,439	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$10,772,747	NetCommunityBenefitExpnsAmt
Total Expense	0.05440	TotalExpensePct

Physical Imprv And Housing PhysicalImprvAndHousingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Economic Development EconomicDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Community Support CommunitySupportGrp

Field	Value	IRS element (for citing)
Activities Or Programs	2	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$13,548	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$13,548	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Environmental Improvements EnvironmentalImprovementsGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Leadership Development LeadershipDevelopmentGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Coalition Building CoalitionBuildingGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Health Improvement Advocacy HealthImprovementAdvocacyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$1,076	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$1,076	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Workforce Development WorkforceDevelopmentGrp

Field	Value	IRS element (for citing)
Activities Or Programs	1	ActivitiesOrProgramsCnt
Total Community Benefit Expns	$699,878	TotalCommunityBenefitExpnsAmt
Net Community Benefit Expns	$699,878	NetCommunityBenefitExpnsAmt
Total Expense	0.00320	TotalExpensePct

Other Communtity Building Acty OtherCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Net Community Benefit Expns	$0	NetCommunityBenefitExpnsAmt
Total Expense	0.00000	TotalExpensePct

Total Communtity Building Acty TotalCommuntityBuildingActyGrp

Field	Value	IRS element (for citing)
Activities Or Programs	4	ActivitiesOrProgramsCnt
Persons Served	0	PersonsServedCnt
Total Community Benefit Expns	$714,502	TotalCommunityBenefitExpnsAmt
Direct Offsetting Revenue	$0	DirectOffsettingRevenueAmt
Net Community Benefit Expns	$714,502	NetCommunityBenefitExpnsAmt
Total Expense	0.00330	TotalExpensePct

Field	Value	IRS element (for citing)
Bad Debt Expense Reported	Yes (true)	BadDebtExpenseReportedInd
Bad Debt Expense	$9,913,454	BadDebtExpenseAmt
Bad Debt Expense Attributable	$0	BadDebtExpenseAttributableAmt
Reimbursed By Medicare	$82,444,848	ReimbursedByMedicareAmt
Cost Of Care Reimbursed By Medcr	$107,580,000	CostOfCareReimbursedByMedcrAmt
Medicare Surplus Or Shortfall	-$25,135,152	MedicareSurplusOrShortfallAmt

Costing Methodology Used CostingMethodologyUsedGrp

Field	Value	IRS element (for citing)
Cost To Charge Ratio	Yes (X)	CostToChargeRatioInd

Field	Value	IRS element (for citing)
Written Debt Collection Policy	Yes (true)	WrittenDebtCollectionPolicyInd
Financial Assistance Prvsn	Yes (true)	FinancialAssistancePrvsnInd

Management Co And Jnt Ventures ManagementCoAndJntVenturesGrp

Entity Name EntityName

Field	Value	IRS element (for citing)
Business Name Line1	KEARNEY AMBULATORY SURGICAL CENTER	BusinessNameLine1

Field	Value	IRS element (for citing)
Primary Activities	SURGERY	PrimaryActivitiesTxt
Org Profit Or Ownership	0.2462	OrgProfitOrOwnershipPct
Ofcr Etc Profit Or Ownership	0	OfcrEtcProfitOrOwnershipPct
Physicians Profit Or Ownership	0.7538	PhysiciansProfitOrOwnershipPct

Field	Value	IRS element (for citing)
Hospital Facilities	3	HospitalFacilitiesCnt

Hospital Facilities HospitalFacilitiesGrp (3 entries)

FacilityFacilityNum	Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	Website AddressWebsiteAddressTxt	State LicenseStateLicenseNum	Licensed HospitalLicensedHospitalInd	General Medical And SurgicalGeneralMedicalAndSurgicalInd	Emergency Room24 HrsEmergencyRoom24HrsInd	OtherOtherDesc	Facility Reporting GroupFacilityReportingGroupCd
GOOD SAMARITAN HOSPITAL
1	10 EAST 31ST STREET PO BOX 1990	KEARNEY	NE	68848	WWW.GSHS.ORG	070001	Yes (X)	Yes (X)	Yes (X)	ACUTE HOSPITAL	A
RICHARD YOUNG BEHAVIORAL HEALTH CENTER
2	1755 PRAIRIE VIEW PL	KEARNEY	NE	68847	WWW.GSHS.ORG		Yes (X)			PSYCHIATRIC HOSPITAL	A
GOOD SAMARITAN HOSPITAL LTC
3	10 EAST 31ST STREET PO BOX 1990	KEARNEY	NE	68848	WWW.GSHS.ORG		Yes (X)			LONG TERM CARE	A

Hospital Fclty Policies Prctc HospitalFcltyPoliciesPrctcGrp

Hospital Facility Name HospitalFacilityName

Field	Value	IRS element (for citing)
Business Name Line1	A	BusinessNameLine1

Field	Value	IRS element (for citing)
Facility	1	FacilityNum
CHNA Conducted	Yes (true)	CHNAConductedInd
Community Definition	Yes (X)	CommunityDefinitionInd
Community Demographics	Yes (X)	CommunityDemographicsInd
Existing Resources	Yes (X)	ExistingResourcesInd
How Data Obtained	Yes (X)	HowDataObtainedInd
Community Health Needs	Yes (X)	CommunityHealthNeedsInd
Other Health Issues	Yes (X)	OtherHealthIssuesInd
Community Hlth Needs Id Process	Yes (X)	CommunityHlthNeedsIdProcessInd
Consulting Process	Yes (X)	ConsultingProcessInd
Information Gaps	Yes (X)	InformationGapsInd
CHNA Conducted	12	CHNAConductedYr
Take Into Account Others Input	Yes (true)	TakeIntoAccountOthersInputInd
CHNA Conducted With Other Fclts	false	CHNAConductedWithOtherFcltsInd
CHNA Report Widely Available	Yes (true)	CHNAReportWidelyAvailableInd
Rpt Available On Own Website	Yes (X)	RptAvailableOnOwnWebsiteInd
Own Website URL	www.chihealthgoodsamaritan.org	OwnWebsiteURLTxt
Other Website	Yes (X)	OtherWebsiteInd
Other Website URL	www.whychihealth.org	OtherWebsiteURLTxt
Rpt Available Upon Request	Yes (X)	RptAvailableUponRequestInd
Adopt Implementation Strategy	Yes (X)	AdoptImplementationStrategyInd
Exec Implementation Strategy	Yes (X)	ExecImplementationStrategyInd
Develop Community Wide Plan	Yes (X)	DevelopCommunityWidePlanInd
Exec Community Wide Plan	Yes (X)	ExecCommunityWidePlanInd
Include Operational Plan	Yes (X)	IncludeOperationalPlanInd
Adopt Budget	Yes (X)	AdoptBudgetInd
Prioritize Health Needs	Yes (X)	PrioritizeHealthNeedsInd
Prioritize Services	Yes (X)	PrioritizeServicesInd
All Needs Addressed	Yes (true)	AllNeedsAddressedInd
Organization Incur Excise Tax	false	OrganizationIncurExciseTaxInd
Elig Criteria Explained	Yes (true)	EligCriteriaExplainedInd
FPG Used Deter Elig Free Care	false	FPGUsedDeterEligFreeCareInd
FPG Used Determ Elig Dscnt Care	false	FPGUsedDetermEligDscntCareInd
Explained Basis	Yes (true)	ExplainedBasisInd
Income Level	Yes (X)	IncomeLevelInd
Asset Level	Yes (X)	AssetLevelInd
Medical Indigency	Yes (X)	MedicalIndigencyInd
Uninsured Discount	Yes (X)	UninsuredDiscountInd
App Financial Asst Expln	Yes (true)	AppFinancialAsstExplnInd
Includes Publicity Measures	Yes (true)	IncludesPublicityMeasuresInd
Posted On Website	Yes (X)	PostedOnWebsiteInd
Posted In Emergency Room	Yes (X)	PostedInEmergencyRoomInd
Posted In Admission Office	Yes (X)	PostedInAdmissionOfficeInd
Other Publicity	Yes (X)	OtherPublicityInd
FAP Actions On Nonpayment	Yes (true)	FAPActionsOnNonpaymentInd
Collection Activities	false	CollectionActivitiesInd
Nondis Emergency Care Policy	Yes (true)	NondisEmergencyCarePolicyInd
Other Method Used	Yes (X)	OtherMethodUsedInd
Amounts Generally Billed	false	AmountsGenerallyBilledInd
Gross Charges	false	GrossChargesInd

Supplemental Information SupplementalInformationGrp (5 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part V Sec B, Line 3, Community Served by Needs Assessment	(1) A - GROUP A: GOOD SAMARITAN HOSPITAL HOLDS A PERMANENT SEAT ON THE BOARD OF BUFFALO COUNTY COMMUNITY PARTNERS, PROVIDING SIGNIFICANT FINANCIAL AND IN-KIND SUPPORT, AS WELL AS HOSPITAL STAFF PARTICIPATION ON THE BOARD AND VARIOUS COALITIONS AND COMMITTEES. THIS ASSESSMENT REPORT IS A SUMMARY OF THE CONTINUOUS ASSESSMENTS AND PRIORITIZATION ACTIVITIES THAT ARE CONDUCTED BY BUFFALO COUNTY COMMUNITY PARTNERS SINCE 2009. THE BOARD OF BUFFALO COUNTY COMMUNITY PARTNERS INCLUDES A WIDE RANGE OF INDIVIDUALS REPRESENTING PUBLIC HEALTH, LOCAL GOVERNMENT, EDUCATION, SOCIAL SERVICE AGENCIES, BUSINESS, THE FAITH COMMUNITY, AND HEALTH CARE PROVIDERS. ADDITIONALLY THERE ARE ISSUE SPECIFIC COALITIONS AND COMMITTEES THAT FURTHER EXPAND COMMUNITY INVOLVEMENT IN OUR ONGOING ASSESSMENT ACTIVITIES. ADDITIONALLY, TOWN HALL MEETINGS WERE HELD IN EVERY CITY IN THE COUNTY, FOCUS GROUPS, DOOR TO DOOR SURVEYS, AS WELL AS NUMEROUS OTHER SURVEYS CONDUCTED IN THE SCHOOLS AND WITH THE ADULT POPULATION. COMMUNITY PARTICIPANTS INCLUDED: DENISE ZWIENER, DIRECTOR, BUFFALO COUNTY COMMUNITY PARTNERS SUE REIBER AREA REPRESENTATIVE KATHY GOSCH, PARISH NURSING PROGRAM ADMINISTRATOR, REGION 3, BEHAVIORAL HEALTH SERVICES ISMAEL TORRES, HEALTH, EDUCATION COORDINATOR, UNIVERSITY OF NEBRASKA AT KEARNEY MATHEW MIMS, ASSISTANT PROFESSOR, COUNSELOR EDUCATION, UNIVERSITY OF NEBRASKA AT KEARNEY MICHELLE REED, FAITH UNITED METHODIST CHURCH EPHRAIM VALENZUELA, SERGEANT, BUFFALO COUNTY SHERIFF'S OFFICE LISA REESE PARISH, EXECUTIVE DIRECTOR, UNITED WAY SUZANNE BRODINE, ASSISTANT TO THE CITY MANAGER, CITY OF KEARNEY DAVE GLOVER, OFFICE MANAGER, FAMILY PRACTICE ASSOCIATES JANA PETERSON, FACILITY ADMINISTRATOR, YRTC-K BOB HUDDLESTON, WELLS FARGO SCOTT ANDERSON, NEW YORK LIFE, INSURANCE COMPANY ELNIDA CHANDLER, CROSSROADS CENTER, RESCUE MISSION NIKKI GAUSMAN, EXECUTIVE DIRECTOR, SAFE CENTER CRYSTAL WINFIELD, EXECUTIVE DIRECTOR, SENTINEL HEALTH CARE JULIE WEIR, DIRECTOR OF HEALTH SERVICES COMMUNITY ACTION PARTNERSHIP ROBERT SMOOT, VP OF MISSION INTEGRATION, GOOD SAMARITAN HEALTH SYSTEMS CAROL SCHWARZ, EXTENSION EDUCATOR, BUFFALO COUNTY EXTENSION SERVICE TERRY KROHN, TWO RIVERS PUBLIC HEALTH DEPARTMENT DR. LEANN OBRECHT, DIRECTOR COUNSELING AND HEALTH CARE, UNIVERSITY OF NEBRASKA AT KEARNEY CORTNEY GEISLER, APRN, PLATTE VALLEY MEDICAL GROUP CAROL RENNER, ASSOCIATE SUPERINTENDENT, KEARNEY PUBLIC SCHOOLS *ANDREA RABE, CENTRAL HEALTH CENTER THIS PUBLIC INPUT PROCESS WAS USED TO VALIDATE THE LOCAL HEALTH ISSUE DATA, AND TO SELECT PRIORITY HEALTH NEEDS FOR GOOD SAMARITAN HOSPITAL AND THE GREATER KEARNEY AREA TO ADDRESS TOGETHER.;
Schedule H, Part V Sec B, Line 10, Used federal poverty guidelines (FPG) to determine eligibility	(1) A - GROUP A: HUD LOW INCOME GUIDELINES USED;
Schedule H, Part V Sec B, Line 11, Eligibility for Discounted Care	(1) A - GROUP A: HUD LOW INCOME GUIDELINES USED;
Schedule H, Part V Sec B, Line 14g, Other ways hospital publicized Financial Assistance Policy	(1) A - : INFORMATION FOR OUR FINANCIAL ASSISTANCE PROGRAM, INCLUDING THE APPLICATION PROCESS, IS PROVIDED TO PATIENTS IN VARYING FORMATS AND PROCESSES (E.G. PATIENT BROCHURES, GUEST INFORMATION GUIDE, SIGNAGE, SELF-PAY PACKETS, COMMUNITY BENEFIT TAB ON WEBSITE, ETC).;
Schedule H, Part V Sec B, Line 20d, How amounts charged to FAP-eligible patients were determined	(1) A - : THE AVERAGE MANAGED CARE CONTRACTUAL ALLOWANCES RATE SHALL BE DEVELOPED ANNUALLY BY GOOD SAMARITAN HOSPITAL AND APPLIED TO ALL UNINSURED PATIENTS DEEMED ELIGIBLE FOR THIS DISCOUNT. THE DISCOUNT SHALL BE CALCULATED BY EACH SEPARATE ENTITY WITHIN GOOD SAMARITAN HOSPITAL BY DIVIDING THE TOTAL AMOUNT OF MANAGED CARE CONTRACTUAL ALLOWANCES, FOR THE MOST RECENT FISCAL YEAR, BY THE TOTAL GROSS CHARGES FOR THOSE MANAGED CARE PLANS TO DETERMINE A DISCOUNT RATE THAT SHALL BE USED FOR THE CURRENT FISCAL YEAR, AS FOLLOWS: DISCOUNT PERCENTAGE = TOTAL MANAGED CARE CONTRACTUAL ALLOWANCES / TOTAL MANAGED CARE GROSS CHARGES. FEDERAL, STATE, LOCAL AND COUNTY ENTITLEMENT PROGRAMS SHALL BE EXCLUDED FROM THE ABOVE CALCULATION (I.E., DISREGARD THE DISCOUNTS AND CHARGES FROM SUCH PLANS). ;

Supplemental Information Detail SupplementalInformationDetail (16 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule H, Part I, Line 3c, Eligibility criteria for free or discounted care	WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO GOOD SAMARITAN HOSPITAL) ESTABLISHED ITS CHARITY CARE 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. ELIGIBILITY FOR CHARITY CARE DISCOUNTS SHALL BE DETERMINED BASED ON 130% OF THE ANNUALLY UPDATED HUD GEOGRAPHIC VERY-LOW INCOME GUIDELINES FOR THE APPLICANT'S COUNTY OF RESIDENCE, (REFERENCED LATER IN THIS DOCUMENT), AVAILABLE ASSETS AND ANY EXTENUATING CIRCUMSTANCES. THUS, THE STANDARDS OF ELIGIBILITY FOR THE APPLICATION OF CHARITY DISCOUNTS MUST CONSIDER ASSETS, AS WELL AS INCOME. IN ADDITION, THE NEED FOR FUTURE SERVICES REQUIRING FINANCIAL ASSISTANCE SHALL BE ASSESSED. SEPARATE DETERMINATIONS OF ELIGIBILITY FOR CHARITY CARE DISCOUNTS SHALL BE MADE FOR EACH DATE OF SERVICE. CONFIRMATION OF CONTINUED ELIGIBILITY SHALL BE UPDATED EVERY 90 DAYS FOR PATIENTS WHO REQUIRE ONGOING HEALTH CARE SERVICES. AN INDIVIDUAL'S OCCUPATION MAY BE INDICATIVE OF ELIGIBILITY FOR A CHARITY CARE DISCOUNT. EXAMPLES OF LOW-PAYING JOBS MIGHT INCLUDE DAY LABORER, FARM WORKER, MIGRANT WORKER AND FOOD SERVICE ASSOCIATE.
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 6/30/14 WAS COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE. BASED ON THAT FORMULA, $17,541,578/$39,366,244 RESULTS IN A 37.26% COST-TO-CHARGE RATIO. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO.
Schedule H, Part I, Line 7, col(f), Bad Debt Expense excluded from financial assistance calculation	9,913,454
Schedule H, Part I, Line 7g, Subsidized Health Services	THERE ARE NO PHYSICIAN CLINICS INCLUDED IN SUBSIDIZED HEALTH SERVICES.
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 37.26%. 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	GOOD SAMARITAN HOSPITAL 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	GOOD SAMARITAN HOSPITAL 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 ALLOWANCES 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 PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY. IN ACCORDANCE WITH ACCOUNTING STANDARDS UPDATE (ASU) NO. 2011-07, PRESENTATION AND DISCLOSURE OF PATIENT SERVICES REVENUE, PROVISION FOR BAD DEBTS, AND ALLOWANCES FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH ENTITIES, THE PROVISION FOR BAD DEBTS IS PRESENTED ON THE CONSOLIDATED STATEMENT OF OPERATIONS AS A DEDUCTION FROM PATIENT SERVICES REVENUES (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) SINCE CHI ACCEPTS AND TREATS ALL PATIENTS WITHOUT REGARD TO THE ABILITY TO PAY."
Schedule H, Part III, Line 8, Community benefit & methodology for determining medicare costs	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. GOOD SAMARITAN HOSPITAL'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: $ 82,444,848 TOTAL MEDICARE COSTS: $ 107,580,000 SURPLUS OF SHORTFALL $ (25,135,152) GOOD SAMARITAN 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	GOOD SAMARITAN HOSPITAL'S DEBT COLLECTION POLICY PROVIDES THAT GOOD SAMARITAN HOSPITAL 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 GOOD SAMARITAN HOSPITAL COMMUNITY ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO MEET THE GOOD SAMARITAN HOSPITAL COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO GOOD SAMARITAN HOSPITAL FOR APPROPRIATE FOLLOW-UP. GOOD SAMARITAN HOSPITAL 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 VI, LINES 2, 4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	IN 2010, THE KEARNEY COMMUNITY BEGAN THEIR COMMUNITY HEALTH NEEDS ASSESSMENT BY WORKING PRIMARILY THROUGH OUR COMMUNITY WIDE COALITION, WHICH WAS ESTABLISHED TO IMPROVE THE HEALTH STATUS OF THE RESIDENTS OF BUFFALO COUNTY. THE ASSESSMENT INCLUDED A REVIEW OF PUBLIC HEALTH DATA OVER SEVERAL YEARS, YOUTH RISK AND PROTECTION FACTOR SURVEY IN 2010, THE ADULT BEHAVIORAL RISK FACTOR SURVEY IN 2010, AND THE MINORITY BEHAVIORAL RISK FACTOR SURVEY IN 2009. ADDITIONALLY, IN 2009, TOWN HALL MEETINGS WERE CONDUCTED IN EACH OF THE CITIES IN BUFFALO COUNTY. INSTEAD OF AN INSULATED AND INTERNAL PROCESS OF PRIORITIZATION WITHIN THE HOSPITAL, THE HOSPITAL AND ITS PARTNERS CONDUCT THE PRIORITIZATION OF HEALTH NEEDS IN OUR COMMUNITY COLLABORATIVELY. THROUGH THE COALITION'S. "PLANNING AND MEASUREMENT COMMITTEE" WE CONDUCTED A DETAILED REVIEW OF THE RESULTS OF THE VARIOUS SURVEYS, TOWN HALL MEETINGS AND OTHER FOCUS GROUPS MENTIONED ABOVE. THIS PROCESS OF REVIEW RESULTED IN A SET OF RECOMMENDATIONS TO THE LARGER COALITION BOARD THAT THEN APPROVED THE PRIORITIES. GOOD SAMARITAN HOSPITAL'S EXECUTIVE TEAM AND BOARD OF DIRECTORS REVIEWED THESE PRIORITIES AND AFFIRMED THEM AS THE PRIORITY AREAS THAT WOULD GUIDE OUR OWN COMMUNITY HEALTH STRATEGY. THE ASSESSMENT PROCESS IS A FLUID PROCESS THAT IS COORDINATED BY THE BOARD'S PLANNING AND MEASUREMENT COMMITTEE. THE COMMITTEE HAS OUTLINED STEPS BELOW THAT ARE FOLLOWED TO ENSURE A CONSISTENT AND LIVING ASSESSMENT PROCESS. IN 2008-2010, THE COMMUNITY PARTNERS CONDUCTED A COUNTYWIDE ASSESSMENT TO DETERMINE WHICH PRIORITY HEALTH GOALS SHOULD BE ATTAINED BY 2020. ASSESSMENT TOOLS USED FOR THE COUNTY WIDE ASSESSMENT INCLUDE; BEHAVIORAL RISK FACTOR SURVEYS FOR ADULTS, MINORITY AND YOUTH IN BUFFALO COUNTY (THESE SURVEYS ARE LINKED IN THE SECTION ABOVE). TO SECURE THE QUALITATIVE DATA THE PARTNERS CONDUCTED A FOCUS GROUP PROCESS CALLED MINI-TOWN HALL MEETINGS IN EACH BUFFALO COUNTY COMMUNITY NETWORKING WITH 300 RESIDENTS INCLUDING YOUTH AND MINORITIES. THE MOST RECENT TOWN HALL MEETING REPORT IS LINKED IN THE SECTION ABOVE. FIVE AREAS OF NEED WERE PRIORITIZED AND SELECTED BY GOOD SAMARITAN HOSPITAL AS ALIGNED HEALTH NEEDS AND ARE NOW PART OF THE IMPLEMENTATION PLAN SHARED BY THE HOSPITAL. HIGH IMPACT PREVENTION SERVICES - A REVIEW OF THE DATA SHOWS OUR COMMUNITY HAS OPPORTUNITY TO DECREASE UNDERAGE AND BINGE DRINKING, TOBACCO AND MARIJUANA USE, TO WORK TOWARD EARLIER DETECTION AND BETTER COMMUNITY RESPONSE TO ALZHEIMER'S AND DEMENTIA, AND TO INCREASE THE NUMBER OF TEENS REPORTING THEY ARE NOT SEXUALLY ACTIVE. GOOD SAMARITAN HOSPITAL AFFIRMS THE COMMUNITY'S PRIORITIZATION OF THESE EFFORTS. ELIMINATE HEALTH DISPARITIES -A REVIEW OF THE DATA SHOWS THAT OUR COMMUNITY HAS OPPORTUNITY TO INCREASE THE NUMBER OF ADULTS WITH HEALTH INSURANCE, DECREASE THE NUMBER OF MINORITY RESIDENTS REPORTING BARRIERS TO HEALTH CARE, AND INCREASE THE NUMBER OF ADULTS REPORTING HEALTHY DAYS. GOOD SAMARITAN HOSPITAL AFFIRMS THE COMMUNITY'S PRIORITIZATION OF THESE EFFORTS. HEALTHY EATING & ACTIVE LIVING -A REVIEW OF THE DATA SHOWS THAT OUR COMMUNITY HAS OPPORTUNITY TO INCREASE PHYSICAL ACTIVITY BY ADULTS AND YOUTH, INCREASE CONSUMPTION OF FRUITS AND VEGETABLES BY ADULTS AND YOUTH, AND TO DECREASE THE BMI REPORTED BY ADULTS AND YOUTH. GOOD SAMARITAN HOSPITAL AFFIRMS THE COMMUNITY'S PRIORITIZATION OF THESE EFFORTS INJURY-FREE LIVING -A REVIEW OF THE DATA INDICATES OUR COMMUNITY HAS OPPORTUNITY TO INCREASE SEAT BELT USE AMONG ADULTS AND YOUTH, TO INCREASE REPORTING OF SUBSTANTIATED CASES OF CHILD ABUSE, TO INCREASE REPORTING OF CASES OF DOMESTIC VIOLENCE, AND TO DECREASE YOUTH SUICIDE AND THOUGHTS OF SUICIDE. GOOD SAMARITAN HOSPITAL AFFIRMS THE COMMUNITY'S PRIORITIZATION OF THESE EFFORTS.
SCHEDULE H, PART VI, LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	FOR PURPOSES OF THE CHNA GOOD SAMARITAN DEFINES BUFFALO COUNTY AS THE COMMUNITY WE SERVE. WHILE WE CERTAINLY SERVE PEOPLE IN A BROADER AREA, BUFFALO COUNTY REPRESENTS THE SINGLE LARGEST BLOCK OF PATIENTS WE SERVE. THE SURROUNDING COUNTIES EACH HAVE THEIR CRITICAL ACCESS HOSPITALS WITHIN THEIR BORDERS THAT ARE BETTER SUITED TO ADDRESS LOCAL CONCERNS. THE POPULATION OF BUFFALO COUNTY ACCORDING TO THE 2010 CENSUS IS 46,102, CLASSIFYING BUFFALO COUNTY AS RURAL. ECONOMY - MAJOR INDUSTRIES/EMPLOYERS: MANUFACTURING, WHOLESALE TRADE, RETAIL TRADE, INFORMATION, REAL ESTATE/RENTAL & LEASING, PROFESSIONAL/SCIENTIFIC/TECH. SERVICES , ADMINISTRATIVE/SUPPORT & WASTE MANAGEMENT, EDUCATION SERVICES, HEALTH CARE & SOCIAL ASSISTANCE, ARTS/ENTERTAINMENT/RECREATION, ACCOMMODATION & FOOD SERVICES, OTHER SERVICES (NON-GOVERNMENTAL) MAJOR NON-MANUFACTURING EMPLOYERS INCLUDE: GOOD SAMARITAN HOSPITAL 1,000+, UNIVERSITY OF NE AT KEARNEY 1000+, KEARNEY PUBLIC SCHOOLS 750-1000, THE BUCKLE 500-750, WAL-MART STORES, INC. 500-750, CABELA'S 250-500, CASH-WA 250-500, CITY OF KEARNEY 250-500. MAJOR MANUFACTURING EMPLOYERS INCLUDE: BALDWIN FILTERS OIL, AIR, FUEL FILTERS 750-1000, EATON CORPORATION AUTO VALVES & FORGED GEARS 250-500, WEST PHARM. SERVICES PHARM. STOPPERS & CLOSURES 250-500. INCOME LEVELS: MEDIAN HOUSEHOLD INCOME IS $46,762; PER CAPITA INCOME $22,787 DEMOGRAPHICS: PERSONS UNDER 5 YEARS, PERCENT, 2011 7.1% PERSONS UNDER 18 YEARS, PERCENT, 2011 23.6% PERSONS 65 YEARS AND OVER, PERCENT, 2011 12.1% FEMALE PERSONS, PERCENT, 2011 50.4% WHITE PERSONS, PERCENT, 2011 (A) 96.1% BLACK PERSONS, PERCENT, 2011 (A) 1.0% AMERICAN INDIAN AND ALASKA NATIVE PERSONS, PERCENT, 2011 (A) 0.4% ASIAN PERSONS, PERCENT, 2011 (A) 1.3% NATIVE HAWAIIAN AND OTHER PACIFIC ISLANDER PERSONS, PERCENT, 2011 (A) 0.1% PERSONS REPORTING TWO OR MORE RACES, PERCENT, 2011 1.2% PERSONS OF HISPANIC OR LATINO ORIGIN, PERCENT, 2011 (B) 7.6% WHITE PERSONS NOT HISPANIC, PERCENT, 2011 89.1% LIVING IN SAME HOUSE 1 YEAR & OVER, 2006-2010 79.3% FOREIGN BORN PERSONS, PERCENT, 2006-2010 3.7% LANGUAGE OTHER THAN ENGLISH SPOKEN AT HOME, PCT AGE 5+, 2006-2010 6.5% HIGH SCHOOL GRADUATES, PERCENT OF PERSONS AGE 25+, 2006-2010 92.1% BACHELOR'S DEGREE OR HIGHER, PCT OF PERSONS AGE 25+, 2006-2010 32.0% VETERANS, 2006-2010 3,102 MEAN TRAVEL TIME TO WORK (MINUTES), WORKERS AGE 16+, 2006-2010 14.7
SCHEDULE H, PART VI, LINES 2,4 AND 5 - NEEDS ASSESSMENT AND COMMUNITY INFORMATION	ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE THE MISSION OF GOOD SAMARITAN HOSPITAL IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY. FIDELITY TO THE GOSPEL URGES US TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE MOVE TOWARD THE CREATION OF HEALTHIER COMMUNITIES. HONORING OUR CATHOLIC HERITAGE, GOOD SAMARITAN HOSPITAL IS RECOGNIZED FOR EXCELLENCE IN REGIONAL HEALTHCARE THROUGH VALUES-BASED LEADERSHIP. THE PRIMARY TAX-EXEMPT PURPOSE IS TO SUPPORT THE COMMUNITY BY PROMOTING AND PROVIDING HEALTH CARE SERVICES IN ACCORDANCE WITH THE NEEDS OF A COMMUNITY IN THE ABSENCE OF PRIVATE BENEFIT. GOOD SAMARITAN HOSPITAL SERVES BOTH THE UNDERINSURED AND UNINSURED IN KEARNEY, NE AND THE SURROUNDING COMMUNITIES. GOOD SAMARITAN HOSPITAL (GSH) HAS ALWAYS BEEN INTIMATELY INVOLVED IN COMMUNITY HEALTH COLLABORATION. IN THE EARLY 1990S GOOD SAMARITAN HOSPITAL PROVIDED A GRANT TO HELP ESTABLISH WHAT IS TODAY BUFFALO COUNTY COMMUNITY PARTNERS, WHOSE MISSION IS TO ASSESS, STRENGTHEN AND PROMOTE THE HEALTH OF BUFFALO COUNTY. GSH HOLDS A PERMANENT SEAT ON THE BOARD OF BUFFALO COUNTY COMMUNITY PARTNERS, PROVIDING SIGNIFICANT FINANCIAL AND IN-KIND SUPPORT, AS WELL AS HOSPITAL STAFF PARTICIPATION ON THE BOARD AND VARIOUS COALITIONS AND COMMITTEES. GSH HAS A HISTORY OF TARGETED COMMUNITY BENEFIT INVESTMENTS AND COMMUNITY PARTNERSHIPS THAT ADDRESS COMMUNITY HEALTH NEEDS WHICH INCLUDE COMMUNITY BUILDING SUCH AS: COMMUNITY HEALTH ACCESS TEAM (CHAT) - THE COMMUNITY HEALTH ACCESS TEAM IS A TEAM OF INDIVIDUALS REPRESENTING 14 DIFFERENT ORGANIZATIONS AND AGENCIES WHOSE MISSION IS: EVERYONE WITH A POINT OF ENTRY TO SERVICE IN BUFFALO COUNTY WILL HAVE ACCESS TO, REGULARLY USE, AND BE SATISFIED WITH COMPREHENSIVE, COST EFFECTIVE, HIGH QUALITY, PRIMARY HEALTH SERVICES THAT SUPPORT OPTIMAL QUALITY OF LIFE. CHAT'S GOAL IS TO REACH 100 PERCENT ACCESS TO PRIMARY HEALTHCARE SERVICES FOR ALL WITH ZERO RACIAL AND ETHNIC DISPARITY. DIFFERENCES BETWEEN PEOPLE, SUCH AS CULTURE, CLASS, EDUCATIONAL ATTAINMENT, EMPLOYMENT STATUS AND ABILITY TO PAY, WILL NO LONGER BE ASSOCIATED WITH DIFFERENTIAL HEALTH OUTCOMES. 24-HOUR EMERGENCY ROOM OPEN MEDICAL STAFF PROVIDE CRITICAL SPECIALTY SERVICES AND ADDITIONAL RURAL OUTREACH, WHICH IS OTHERWISE UNAVAILABLE TO SURROUNDING COUNTIES INCLUDING: NEUROLOGY, CARDIOVASCULAR SERVICES, ONCOLOGY, ETC. IN CONCERT WITH GOOD SAMARITAN HOSPITAL, THE MEDICAL STAFF HAS ESTABLISHED CLINICS IN SEVERAL SPECIALTY AREAS ALLOWING RESIDENTS IN RURAL COMMUNITIES TO RECEIVE CARE CLOSE TO HOME. THESE SPECIALTY AREAS INCLUDE: OBSTETRICS AND GYNECOLOGY, HEMATOLOGY AND ONCOLOGY, SPORTS MEDICINE, OPHTHALMOLOGY, UROLOGY, NEUROSURGERY, CARDIOLOGY, PODIATRY, SPINE AND ORTHOPEDICS, NEUROLOGY, NEPHROLOGY, PULMONOLOGY, RHEUMATOLOGY, BEHAVIORAL HEALTH AND VASCULAR SURGERY LIVING WELL CLASS - OFFERED TO THE COMMUNITY THREE TIMES A YEAR, WHICH IS AN EVIDENCE-BASED CHRONIC DISEASE SELF-MANAGEMENT PROGRAM DEVELOPED BY STANFORD UNIVERSITY. MEDICATION ACCESS PROGRAM - FUNDED SENTINEL HEALTH CARE'S MEDICATION ACCESS PROGRAM WHICH PROVIDED AID IN OBTAINING 4,899 PRESCRIPTIONS IN FY14. AMERICAN RED CROSS BLOOD COLLECTION CENTER - COLLABORATED WITH THE AMERICAN RED CROSS TO CONNECT THE FT. KEARNEY CHAPTER OF THE AMERICAN RED CROSS AND THE AMERICAN RED CROSS MIDWEST BLOOD REGION, A NEW BLOOD COLLECTION CENTER TO MAXIMIZE DONATION LOCATION IN THE AREA. ANNUAL SIMPLY PINK BREAST CANCER AWARENESS STYLE SHOW - RAISE AWARENESS AND TO HONOR BREAST CANCER SURVIVORS. THE EVENT IS FREE, HOWEVER; FREE WILL DONATIONS ARE RECEIVED. THIS YEAR THE DONATIONS WILL BE USED TO HELP FUND THE HEALING GARDEN. GOOD SAMARITAN CANCER CENTER - PROVIDES VARIOUS SUPPORT GROUPS TO AID PATIENTS AND FAMILIES DURING DIAGNOSIS, TREATMENT AND RECOVERY. CENTRAL NEBRASKA AREA HEALTH EDUCATION CENTER (CN-AHEC) -PROVIDE SUPPORT FINANCIAL AND IN-KIND SUPPORT TO ELIMINATE DISPARITIES IN HEALTH AND HEALTH CARE, ESPECIALLY IN UNDERSERVED COMMUNITIES. LOW-COST AND WIDELY ACCESSIBLE CANCER SCREENINGS IN-KIND SPACE PROVIDED TO MORE THAN 25,000 PARTICIPANTS VIA THE GSH CONFERENCE CENTER CRITICAL ACCESS HOSPITAL (CAH) NETWORK - VISION OF THE GOOD SAMARITAN CAH NETWORK IS TO UTILIZE A COLLABORATIVE APPROACH TO IMPROVE PROCESSES OF COMMUNICATION, QUALITY ASSURANCE, PEER REVIEW AND CREDENTIALING SO THAT CARE IS OPTIMIZED WITHIN EACH HOSPITAL IN THE NETWORK AS WELL AS WHEN PATIENTS ARE TRANSFERRED FROM CRITICAL ACCESS HOSPITALS TO THE TERTIARY CARE HOSPITAL. AS A NETWORK, WE WILL LOOK FOR WAYS TO SUPPORT THE NETWORK WHILE STRENGTHENING INDIVIDUAL MEMBERS AND THE COMMUNITIES THEY SERVE. EN CARE PROGRAM (EMERGENCY NURSES' CARE)- DELIVERS EN CARE PROGRAMS FOR CHILDREN, TEENS, YOUNG ADULTS AND SENIOR CITIZENS INCLUDING; FALL PREVENTION, ALCOHOL/DRUG/TOBACCO PREVENTION PROGRAM, AND BIKE SAFETY. *ENHANCED ACCESS TO RICHARD YOUNG BEHAVIORAL HEALTH CENTER- PROVIDE FREE INITIAL ASSESSMENTS BY LICENSED MENTAL HEALTH PROFESSIONALS
SCHEDULE H, PART VI, LINES 2,4 AND 5 - NEEDS ASSESMENT AND COMMUNITY INFORMATION	FAMILY ADVOCACY NETWORK (FAN) - IN-KIND OFFICE SPACE FOR THIS ORGANIZATION THAT CONNECTS ALL AGENCIES AND THE FAMILY TO PROVIDE AN EXPERIENCED, MULTIDISCIPLINARY RESPONSE TO ABUSE AND SEXUAL ASSAULT. FEETLOOSE WITH SAM THE MOOSE - GSH LED ACTIVE LIVING CAMPAIGN FOR FAMILIES; NEARLY 1,000 PEOPLE PARTICIPATED IN THE FEETLOOSE ECHALLENGE AND POSTED COMMENTS, PHOTOS AND MORE ON THE DAILY CHALLENGES. HEALTH CARE SCIENCES II CLASS - GOOD SAMARITAN HOSPITAL PARTNERS WITH KEARNEY HIGH SCHOOL TO OFFER THE HEALTH CARE SCIENCES II CLASS. THIS CLASS MEETS AT GOOD SAMARITAN HOSPITAL FOUR DAYS A WEEK AND PROVIDES REAL HANDS-ON LEARNING EXPERIENCES FOR STUDENTS INTERESTED IN HEALTHCARE CAREERS. EXPERTS IN THEIR FIELDS, DIFFERENT HOSPITAL REPRESENTATIVES MEET WITH THE STUDENTS OVER THE COURSE OF 8 WEEKS TO PROVIDE INFORMATION ABOUT THEIR INDUSTRY, THE SPECIFIC ASPECTS OF THE CARE THEY PROVIDE, AND VARIOUS CAREER OPPORTUNITIES WITHIN HEALTHCARE. THE PROGRAM IS DIVIDED INTO FIVE HEALTH SCIENCES CAREER PATHWAYS, MODELED AFTER THE NEBRASKA DEPARTMENT OF EDUCATION'S CAREER FIELDS AND CLUSTER MODEL: DIAGNOSTIC SERVICES, SUPPORT SERVICES, BIOTECHNOLOGY RESEARCH AND DEVELOPMENT, THERAPEUTIC SERVICES AND HEALTH INFORMATICS. MIDWEST TELEHEALTH NETWORK - THE MIDWEST TELEHEALTH NETWORK BECAME OPERATIONAL IN 1995 WITH FIVE RURAL SITES AND GOOD SAMARITAN HOSPITAL AS THE HUB FACILITY. SINCE THEN, THE TELEHEALTH NETWORK HAS GROWN TO NOW INCLUDE TWENTY-THREE RURAL SITES FROM BOTH NEBRASKA AND KANSAS. GOOD SAMARITAN HOSPITAL HAS DEVELOPED AND IMPLEMENTED SEVERAL COLLABORATIVE PROJECTS TO ASSIST FAMILIES, TEENS AND ADULTS. THESE PROJECTS HAVE BEEN DEVELOPED FROM GRANT FUNDS OBTAINED BY THE GOOD SAMARITAN HOSPITAL FOUNDATION. THEY INCLUDE: EARLY DEVELOPMENT NETWORK - PROVIDES SERVICES COORDINATION TO FAMILIES WHO HAVE CHILDREN 0-3 YEARS OF AGE WHO HAVE A VERIFIED DISABILITY PER NE RULE 51 (SPECIAL EDUCATION LAW). THIS MEANS THAT THE PROGRAM IS AN ONGOING CENTRAL ACCESS POINT FOR FAMILIES TO HELP CONNECT THEM WITH SERVICES IN THEIR COMMUNITY THAT WILL HELP THEM CARE FOR THEIR CHILDREN AND ENSURE THE FREE AND APPROPRIATE EDUCATION GUARANTEED TO ALL CHILDREN AGES BIRTH TO 21 IN THE STATE OF NEBRASKA. INJURY PREVENTION - TRAUMA DEPARTMENT: -POISON PREVENTION POSTER CONTEST ENTRY WITH EDUCATIONAL MATERIALS WAS DISTRIBUTED TO ALL ELEMENTARY AGE SCHOOL CHILDREN IN THE KEARNEY PUBLIC SCHOOL SYSTEM. THE WINNING ENTRY WAS PRINTED ON HIGHWAY 30 JUST OUTSIDE OF KEARNEY. -THE FIRST ANNUAL KIDS SAFETY DAY; MORE THAN 200 CHILDREN ATTENDED AND LEARNED SAFETY ADVICE FOR VARIOUS ACTIVITIES, INCLUDING BIKE SAFETY, WATER SAFETY, FIRE SAFETY, ATV SAFETY, AND MUCH MORE. CHILD PASSENGER SAFETY INSPECTION STATIONS WERE SET UP TO PROPERLY FIT CAR SEATS IN VEHICLES. -A "SLOW DOWN IN OUR NEIGHBORHOOD" YARD SIGN CONTEST WAS IMPLEMENTED AT THE BEGINNING OF THE NEW SCHOOL YEAR. -OVER 400 THIRD GRADE STUDENTS HEARD THE MESSAGE "WHY I WON'T USE DRUGS" DURING RED RIBBON WEEK FROM THE INJURY PREVENTION NURSE COORDINATOR AND THE CANCER PREVENTION NURSE. THE EFFECTS OF ALCOHOL, DRUGS AND TOBACCO ON THE BODY, BRAIN AND LUNGS WERE DISCUSSED AND ALSO DEMONSTRATED WITH A BRAIN MODEL, REAL PIG LUNGS AND MR. GROSS MOUTH. -TRAUMA OUTREACH HEADED A NEW PROGRAM FOR CONCUSSION AWARENESS AND PREVENTION IN OUR REGION. GOOD SAMARITAN HOSPITAL PARTNERED WITH NEBRASKA SPORTS CONCUSSION NETWORK AND AREA SPORTS TRAINERS TO PROVIDE CONCUSSION TRAINING TO OVER 100 AREA COACHES; REACHING 2000 STUDENTS IN 30 AREA HIGH SCHOOLS. TRAINING AND PRECONCUSSION NEUROCOGNITIVE TESTING WERE COMPLETED AT THE EXPENSE OF GOOD SAMARITAN HOSPITAL. -THE SAFE TEEN DRIVING SCHOLARSHIP PROGRAM AWARDED SEVERAL KIDS SCHOLARSHIPS RANGING FROM $50-$150 FOR A TOTAL OF $2000 TO ASSIST WITH THE COST OF DRIVER'S EDUCATION CLASSES. -SAFE KIDS PLATTE VALLEY - GSH IS THE LEAD AGENCY FOR THIS INJURY PREVENTION COALITION -MONTHLY CHILD PASSENGER SAFETY FITTING STATIONS IN KEARNEY AND NORTH PLATTE. ASSISTING NEBRASKA OFFICE OF HIGHWAY SAFETY AND SAFE KIDS NEBRASKA WITH NEBRASKA CHILD PASSENGER SAFETY TECHNICAL UPDATE -TEEN NET (PRENATAL AND PARENTING PROGRAM FOR TEENS) - TEEN PARENTING PROGRAM; FUNDING THROUGH GOOD SAMARITAN HOSPITAL AND KEARNEY PUBLIC SCHOOLS -PROJECT SEARCH - HIGH SCHOOL TRANSITION PROGRAM THAT ASSISTS STUDENTS WITH DISABILITIES WITH A CONNECTION TO EMPLOYMENT. GSH HOSTS THE PROGRAM ON-SITE AT NO COST TO THE PROGRAM. MEDICAL EDUCATION - GOOD SAMARITAN HOSPITAL SUPPORTS THE EDUCATION OF MEDICAL STUDENTS BY PROVIDING SPECIALTY SPECIFIC PHYSICIAN-SUPERVISED ROTATIONS IN CONJUNCTION WITH MEDICAL SCHOOLS. OTHER STUDENTS FROM VARIOUS PROGRAMS AND COLLEGES ARE PROVIDED EDUCATIONAL EXPERIENCES AT GOOD SAMARITAN HOSPITAL. APRNS, RNS, LPNS, PSYCH STUDENTS, MASTER'S LEVEL COUNSELING STUDENTS, AND RECREATIONAL THERAPISTS ARE PROVIDED A BROAD RANGE OF EDUCATIONAL EXPERIENCES FROM FIELD EXPERIENCES TO INTERNSHIPS.
Schedule H, Part VI, Line 3, Patient education of eligibility for assistance.	GOOD SAMARITAN HOSPITAL INCLUDES INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, GOOD SAMARITAN HOSPITAL 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 GOOD SAMARITAN HOSPITAL OUTPATIENT FACILITIES. IN ADDITION, GOOD SAMARITAN HOSPITAL REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR FINANCIAL ASSISTANCE UNDER GOOD SAMARITAN HOSPITAL'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. GOOD SAMARITAN HOSPITAL REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON-ENGLISH-SPEAKING INDIVIDUALS. GOOD SAMARITAN HOSPITAL'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 6, Affiliated health care system	GOOD SAMARITAN HOSPITAL 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 92 HOSPITALS, INCLUDING FOUR ACADEMIC MEDICAL CENTERS, AND 24 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 $910 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN THE 2014 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. GOOD SAMARITAN HOSPITAL OPERATES WITH ITS WHOLLY OWNED AFFILIATES AND COMMUNITY PARTNERS, ALONG WITH ITS FUNDRAISING ARM, THE [GOOD SAMARITAN HOSPITAL FOUNDATION, TO SERVE THE HEALTH CARE NEEDS OF THE KEARNEY, NEBRASKA COMMUNITIES.
Schedule H, Part VI, Line 7, State filing of community benefit report	NE

Schedule I IRS990ScheduleI

Field	Value	IRS element (for citing)
Grant Records Maintained	Yes (true)	GrantRecordsMaintainedInd

Recipient Table RecipientTable (6 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	Recipient EINRecipientEIN	IRC SectionIRCSectionDesc	Cash GrantCashGrantAmt	Purpose Of GrantPurposeOfGrantTxt
KEARNEY PUBLIC SCHOOLS
310 W 24TH STREET	KEARNEY	NE	68845	476001393	N/A	$50,000	PROGRAM SUPPORT
BUFFALO COUNTY COMMUNITY HEALTH PARTNERS INC
1755 PRAIRIE VIEW PLACE	KEARNEY	NE	68845	205852415	501(C)(3)	$35,000	PROGRAM SUPPORT
UNIVERSITY OF NEBRASKA FOUNDATION
1010 LINCOLN MALL SUITE 300	LINCOLN	NE	68501	470049123	501(C)(3)	$250,000	PROGRAM SUPPORT
KEARNEY CATHOLIC FOUNDATION
PO BOX 1261	KEARNEY	NE	68848	363157461	501(C)(3)	$20,000	PROGRAM SUPPORT
AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVE	DALLAS	TX	75231	135613797	501(C)(3)	$12,500	PROGRAM SUPPORT
GOOD SAMARITAN HOSPITAL FOUNDATION
111 WEST 31ST STREET	KEARNEY	NE	68847	476059443	501(C)(3)	$350,000	PROGRAM SUPPORT

Field	Value	IRS element (for citing)
Total501c3 Org	5	Total501c3OrgCnt
Total Other Org	1	TotalOtherOrgCnt

Supplemental Information Detail SupplementalInformationDetail

Field	Value	IRS element (for citing)
Form And Line Reference	Schedule I, Part I, Line 2, Procedures for monitoring use of grant funds	FormAndLineReferenceDesc
Explanation	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.	ExplanationTxt

Schedule J IRS990ScheduleJ

Field	Value	IRS element (for citing)
Travel For Companions	Yes (X)	TravelForCompanionsInd
Idemnification Gross Up Pmts	Yes (X)	IdemnificationGrossUpPmtsInd
Written Policy Ref T And E Expnss	Yes (true)	WrittenPolicyRefTAndEExpnssInd
Substantiation Required	Yes (true)	SubstantiationRequiredInd
Severance Payment	false	SeverancePaymentInd
Supplemental Nonqual Rtr Plan	Yes (true)	SupplementalNonqualRtrPlanInd
Equity Based Comp Arrngm	false	EquityBasedCompArrngmInd
Comp Based On Revenue Of Flng Org	false	CompBasedOnRevenueOfFlngOrgInd
Comp Bsd On Rev Related Orgs	false	CompBsdOnRevRelatedOrgsInd
Comp Bsd Net Earns Flng Org	false	CompBsdNetEarnsFlngOrgInd
Comp Bsd Net Earns Rltd Orgs	false	CompBsdNetEarnsRltdOrgsInd
Any Non Fixed Payments	false	AnyNonFixedPaymentsInd
Initial Contract Exception	false	InitialContractExceptionInd

Rltd Org Officer Trst Key Empl RltdOrgOfficerTrstKeyEmplGrp (25 entries)

TitleTitleTxt	Base Compensation Filing OrgBaseCompensationFilingOrgAmt	Compensation Based On Rltd OrgsCompensationBasedOnRltdOrgsAmt	Bonus Filing OrganizationBonusFilingOrganizationAmount	Bonus Related OrganizationsBonusRelatedOrganizationsAmt	Other Compensation Filing OrgOtherCompensationFilingOrgAmt	Other Compensation Rltd OrgsOtherCompensationRltdOrgsAmt	Deferred Compensation Flng OrgDeferredCompensationFlngOrgAmt	Deferred Comp Rltd OrgsDeferredCompRltdOrgsAmt	Nontaxable Benefits Filing OrgNontaxableBenefitsFilingOrgAmt	Nontaxable Benefits Rltd OrgsNontaxableBenefitsRltdOrgsAmt	Total Compensation Filing OrgTotalCompensationFilingOrgAmt	Total Compensation Rltd OrgsTotalCompensationRltdOrgsAmt	Comp Report Prior990 Filing OrgCompReportPrior990FilingOrgAmt	Comp Report Prior990 Rltd OrgsCompReportPrior990RltdOrgsAmt
RICHARD HACHTEN II
CHAIR/ACH PRESIDENT & CEO	$0	$1,002,940	$0	$3,138,518	$0	$174,840	$0	$53,071	$0	$14,053	$0	$4,383,422	$0	$155,803
CLIFF ROBERTSON
BOARD MEMBER/CEO CHI HEALTH	$0	$575,759	$0	$114,665	$0	$71,167	$0	$77,744	$0	$22,702	$0	$862,037	$0	$48,435
PAUL EDGETT III
BOARD MEMBER/CHI SVP	$0	$496,880	$0	$515,695	$0	$114,019	$0	$72,192	$0	$22,006	$0	$1,220,792	$0	$92,265
ROBERT LANIK
BOARD MEMBER/CHI NE PRESIDENT/CEO	$0	$650,100	$0	$502,592	$0	$161,401	$0	$33,702	$0	$14,498	$0	$1,362,293	$0	$28,040
MARTIN M MANCUSO MD
BOARD MEMBER	$0	$368,040	$0	$0	$0	$48,052	$0	$7,500	$0	$17,722	$0	$441,314	$0	$0
MICHAEL ROWAN FACHE
BOARD MEMBER/CHI EVP & COO	$0	$1,098,277	$0	$1,471,311	$0	$200,128	$0	$238,353	$0	$19,702	$0	$3,027,771	$0	$175,028
LEIGH BERTHOLF
FORMER VP & CRO	$0	$232,348	$0	$18,808	$0	$86,569	$0	$31,152	$0	$18,688	$0	$387,565	$0	$0
STEPHEN LEURCK
FORMER INTERIM CAO	$0	$298,799	$0	$0	$0	$0	$0	$0	$0	$0	$0	$298,799	$0	$0
JEANETTE WOJTALEWICZ
CFO, CHI HEALTH	$0	$426,811	$0	$51,596	$0	$21,578	$0	$39,641	$0	$20,237	$0	$559,863	$0	$0
MICHAEL SCHNIEDERS
PRESIDENT GSH	$0	$377,773	$0	$68,850	$0	$49,146	$0	$55,377	$0	$20,134	$0	$571,280	$0	$18,011
GEORGE HARMS
VICE PRESIDENT OF FINANCE	$215,002	$0	$16,263	$0	$9,307	$0	$22,736	$0	$19,768	$0	$283,076	$0	$0	$0
LISA WEBB
VP OF FINANCE	$17,044	$193,775	$0	$15,980	$0	$8,829	$0	$0	$0	$16,004	$17,044	$234,588	$0	$0
ROBERT CUNNINGHAM
VP ANCILLARY SUPPORT	$194,175	$0	$14,389	$0	$8,609	$0	$19,846	$0	$18,406	$0	$255,425	$0	$0	$0
CAROL WAHL
VP PATIENT SERVICES	$212,594	$0	$15,579	$0	$9,745	$0	$28,969	$0	$7,802	$0	$274,689	$0	$0	$0
DENNIS EDWARDS
VP MEDICAL AFFAIRS	$0	$384,900	$0	$1,500	$0	$5,377	$0	$20,952	$0	$20,998	$0	$433,727	$0	$0
CLARESSA L MILLSAP
DIRECTOR CARDIOVASCULAR	$23,827	$100,070	$0	$2,353	$0	$215	$0	$13,761	$1,845	$17,688	$25,672	$134,087	$0	$0
ELIZABETH TAYLOR-TRUJILLO
DIRECTOR BEHAVIORAL HEALTH	$98,884	$0	$1,869	$0	$14,705	$0	$0	$0	$13,174	$0	$128,632	$0	$0	$0
LAWRENCE A SURMEIER
DIRECTOR FACILITY OPERATIONS	$111,712	$0	$1,738	$0	$147	$0	$0	$0	$13,123	$0	$126,720	$0	$0	$0
HUGO GONZALEZ NIETO
FORMER PHYSICIAN	$0	$234,138	$0	$75,530	$0	$3,021	$0	$23,502	$0	$15,394	$0	$351,585	$0	$0
FISHEL LIBERMAN
FORMER PHYSICIAN	$0	$589,697	$0	$150,290	$0	$7,037	$0	$23,502	$0	$20,998	$0	$791,524	$0	$0
RICHARD HRANAC
BOARD MEMBER/PHYSICIAN	$45,157	$107,856	$0	$0	$0	$10,133	$0	$6,549	$0	$8,980	$45,157	$133,518	$0	$0
DAVID HUEBNER MD
BOARD MEMBER/PRESIDENT MEDICAL STAFF	$384,598	$0	$0	$0	$0	$0	$0	$0	$0	$0	$384,598	$0	$0	$0
MICHAEL BIBLER
PHYSICIAN	$427,296	$444,384	$0	$0	$0	$12,385	$0	$23,502	$0	$8,368	$427,296	$488,639	$0	$0
TODD STOVER
DIRECTOR PERFUSION	$136,617	$0	$2,264	$0	$5,814	$0	$15,138	$0	$19,544	$0	$179,377	$0	$0	$0
NICKI L BOHL
DIRECTOR PHARMACY	$136,882	$0	$2,125	$0	$138	$0	$12,667	$0	$14,188	$0	$166,000	$0	$0	$0

Supplemental Information Detail SupplementalInformationDetail (6 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
Schedule J, Part I, Line 1a, Travel for companions	GOOD SAMARITAN HOSPITAL PROVIDES FOR COMPANION TRAVEL FOR ITS BOARD MEMBERS WHEN DEEMED APPROPRIATE. THESE BENEFITS ARE PAID AND GROSSED-UP PURSUANT TO A WRITTEN POLICY. ALL SUCH BENEFITS ARE INCLUDED IN THE INDIVIDUAL'S FORM W-2.
Schedule J, Part I, Line 1a, Tax indemnification and gross-up payments	GOOD SAMARITAN HOSPITAL PROVIDES FOR COMPANION TRAVEL FOR ITS BOARD MEMBERS WHEN DEEMED APPROPRIATE. THESE BENEFITS ARE PAID AND GROSSED-UP PURSUANT TO A WRITTEN POLICY. ALL SUCH BENEFITS ARE INCLUDED IN THE INDIVIDUAL'S FORM W-2.
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 CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE.
SCHEDULE J, PART I, LINE 4A, SEVERANCE	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. NO REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS IN CALENDAR YEAR 2013.
Schedule J, Part I, Line 4b, Supplemental nonqualified retirement plan	DURING THE 2013 CALENDAR YEAR CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: MICHAEL SCHNIEDERS, ROBERT LANIK, PAUL EDGETT, CLIFF ROBERTSON, MICHAEL ROWAN, RICHARD HACHTEN, JEANETTE WOJTALEWICZ DURING 2013 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: MICHAEL SCHNIEDERS $34,425 PAUL EDGETT $43,590 CLIFF ROBERTSON $49,142 MICHAEL ROWAN $214,851 JEANETTE WOJTALEWICZ $13,589 DURING 2013 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: MICHAEL SCHNIEDERS $18,011 ROBERT LANIK $28,040 PAUL EDGETT $92,265 CLIFF ROBERTSON $48,435 MICHAEL ROWAN $175,028 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 ARE ELIGIBLE TO RECEIVE THEIR 2013 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 2013, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: ROBERT LANIK $101,293 RICHARCD HACHTEN $133,616
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.

Schedule O IRS990ScheduleO

Supplemental Information Detail SupplementalInformationDetail (14 entries)

Form And Line ReferenceFormAndLineReferenceDesc	ExplanationExplanationTxt
FORM 990, PART III, LINE 1, ORGANIZATION'S MISSION	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 VI, Sec A, 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 THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION.
Form 990, Part VI, Sec A, Line 4, Significant changes to organizational documents	GOOD SAMRITAN HOSPITAL AMENDED ITS BYLAWS ON OCTOBER 1, 2013. SIGNIFICANT CHANGES INCLUDE AN INCREASE IN THE MINIMUM NUMBER OF BOARD MEMBER FROM 9 TO 11 AND A DECREASE IN THE MAXIMUM NUMBER OF BOARD MEMBERS FROM 21 TO 15. FURTHERMORE, THE CHIEF EXECUTIVE OFFICER AND THE EXECUTIVE VICE PRESIDENT AND CHIEF OPERATING OFFICER OR OTHER DESIGNEE SHALL EACH SERVE AS AN EX OFFICIO VOTING MEMBER OF THE BOARD. ADDITIONAL CHANGES MADE INCLUDE REMOVING THE REQUIREMENTS THAT THE PRESIDENT OF THE MEDICAL STAFF SHALL REPORT TO THE BOARD ON MATTERS RELATING TO THE MEDICAL STAFF AND THE CHAIRPERSON OF THE FOUNDATION SHALL NO LONGER BE REQUESTED TO ATTEND MEETINGS AT LEAST QUARTERLY.
Form 990, Part VI, Sec A, Line 6, Classes of members or stockholders	THE SOLE MEMBER OF THE CORPORATION IS CHI NEBRASKA, A NEBRASKA NONPROFIT CORPORATION.
Form 990, Part VI, Sec A, Line 7a, Members or stockholders electing members of governing body	CHI NEBRASKA HAS THE POWER TO APPOINT, REMOVE OR REPLACE THE MEMBERS OF THE BOARD OF DIRECTORS.
Form 990, Part VI, Sec A, Line 7b, Decisions requiring approval by members or stockholders	THE ORGANIZATION'S CORPORATE MEMBER IS CHI NEBRASKA. PURSUANT TO SECTION 5.1 OF THE ORGANIZATION'S BYLAWS, THE CORPORATE MEMBER SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE CHI NEBRASKA BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE CHI NEBRASKA CHIEF EXECUTIVE OFFICER: -APPROVE MEMBERS OF THE GOOD SAMARITAN HOSPITAL BOARD -AMENDMENT OF THE CORPORATE DOCUMENTS OF THE GOOD SAMARITAN HOSPITAL -APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE GOOD SAMARITAN HOSPITAL -ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE GOOD SAMARITAN HOSPITAL -SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE GOOD SAMARITAN HOSPITAL -REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE GOOD SAMARITAN HOSPITAL -APPROVAL OF ISSUANCE OF DEBT BY GOOD SAMARITAN HOSPITAL -APPROVAL OF PARTICIPATION OF GOOD SAMARITAN HOSPITAL IN A JOINT VENTURE -APPROVAL OF FORMATION OF A NEW CORPORATION BY GOOD SAMARITAN HOSPITAL -APPROVAL OF A MERGER INVOLVING THE GOOD SAMARITAN HOSPITAL -APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE GOOD SAMARITAN HOSPITAL -TO REQUIRE THE TRANSFER OF ASSETS BY THE GOOD SAMARITAN HOSPITAL TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION 5.2 OF THE ORGANIZATION'S BYLAWS, GOOD SAMARITAN HOSPITAL OR CHI NEBRASKA 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, Sec B, 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 DIRECTOR 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, Sec B, Line 12c, Conflict of interest policy	GOOD SAMARITAN HOSPITAL 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 CONFLIC T OF INTEREST POLICY. ADDITIONALLY, ALL OFFICERS, TRUSTEES AND EMPLOYEES ARE REQUIRED TO ACT IN ACCORDANCE WITH CHI'S STATNDARDS OF CONDUCT, WHICH INCLUDE THE AVOIDANCE OF CONFLICTS OF INTEREST OR THE APPEARANCE OF CONFLICTS. THE CHI CONFLICT OF INTEREST POLICY PROVIDES THAT ALL MEMBERS OF THE BOARD OF DIRECTORS AND OF ANY BOARD COMMITTEE ARE REQUIRED TO PROMPTLY AND FULLY DISCLOSE TO THE BOARD CHAIR SITUATIONS THAT MAY CREATE A CONFLICT OF INTEREST WHEN THEY BECOME AWARE OF THE SITUATION. IN ADDITIONAL, ALL MEMBERS OF THE BOARD ARE REQUIRED TO ANNUALLY DISCLOSE ANY CONFLICTS OF INTEREST VIA COMPLETION OF THE CONFLICT OF INTEREST DISCLOSURE FORM WHICH IS REVIEWED BY THE SENIOR VICE PRESIDENT LEGAL SERVICES AND GENERAL COUNSEL. ANY IDENTIFIED POTENTIAL CONFLICTS ARE REPORTED TO THE BOARD CHARE, WHO IS CHARGED WITH FURTHER INVESTIGATION OF THE CONFLICT(S). AS HE OR SHE DEEMS APPROPRIATE: DOCUMENTATION OF CONCLUSIONS WITH RESPECT TO THE EXISTENCE OF A CONFLICT (INCLUDING RELEVANT FACTS AND CIRCUMSTANCES); AND REPORTING TO THE BOARD EXECUTIVE COMMITTEE CONCERNING THE REVIEW, EVALUATION AND CONFLICT DETERMINATION. TO THE EXTENT THAT THE BOARD CHAIR AND ANY OTHER TRUSTEE DISAGREE AS TO WHETHER A CIRCUMSTANCE GIVES RISE TO A CONFLICT, THE BOARD EXECUTIVE COMMITTEE MAKES THE FINAL DETERMINATION AS TO THE EXISTENCE OF A CONFLICT. THE CONFLICTED TRUSTEE IS EXCLUDED FROM VOTING AS TO THE EXISTENCE OF A CONFLICT, AND IS EXCUSED FROM THE ROOM WHILE VOTING CONCERNING THE MATTER IS CONDUCTED. IN ANY CIRCUMSTANCE WHERE A TRUSTEE HAS BEEN IDENTIFIED AS HAVING A CONFLICT OF INTEREST WITH RESPECT TO A PARTICULAR TRANSACTION, THAT TRUSTEE IS ALSO EXCLUDED FROM VOTING WITH RESPECT THAT PARTICULAR TRANSACTION. THE CONFLICT OF INTEREST POLICY WITH RESPECT TO EMPLOYEES REQUIRES THAT ALL EMPLOYEES COMPLETE AND SIGN A CONFLICT OF INTEREST DISCLOSURE FORM AT THE TIME OF HIRING. THEREAFTER, DIRECTOR LEVEL AND ABOVE EMPLOYEES MYST ANNUALLY CERTIFY AS PART OF THE PERFORMANCE EVALUATION PROCESS THAT THEY HAVE NO CONFLICTS OF INTEREST. FURTHER, ALL EMPLOYEES, REGARDLESS OF EMPLOYMENT LEVEL, ARE SUBJECT TO A GENERAL OBLIGATION TO DISCLOSE TO THEIR SUPERVISOR ANY CONFLICTS THAT ARISE DURING THE YEAR. FAILURE TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS MAY RESULT IN DISCIPLINARY ACTION.
FORM 990, PART VI, LINE 15A, PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL	CERTAIN EXECUTIVES AND MEMBERS OF MANAGEMENT WERE PAID BY CHI, A RELATED ORGANIZATION, DURING CALENDAR YEAR 2013. FOR THOSE PAID BY CHI, COMPENSATION WAS DETERMINED UNDER THE COMPENSATION PHILOSOPHY OF CHI. UNDER CHI'S 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 DELIVEREC BY THE 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. IN ADDITION, THE HAY GROUP COMPLETES A COMPREHENSIVE ANNUAL REVIEW OF ALL CHI POSITIONS AT THE LEVEL OF VICE PRESIDENT AND ABOVE. THESE COMPENSATION LEVELS ARE REVISED ANNUALLY BASED ON MARKET DATA, WHERE APPLICABLE. FOR OTHER MEMBERS OF MANAGEMENT WHO WERE PAID UNDER ALEGENT CREIGHTON HEALTH FOR CALENDAR YEAR 2013, ALEGENT CREIGHTON HEALTH HUMAN RESOURCES COMPLETES A COMPENSATION MARKET STUDY TO DETERMINE SALARY.
Form 990, Part VI, Sec B, Line 15b, Process to establish compensation of other employees	HR ADVANTAGE HAS SERVED AS THE INDEPENDENT COMPENSATION CONSULTANT FOR THE NEBRASKA FACILITIES IN 2012-2014. HR ADVANTAGE REVIEWED ALL NEBRASKA MINISTRIES' VP AND EXECUTIVE DIRECTORS COMPENSATION LEVELS AND PROVIDED A REPORT WITH COMPARABILITY DATA TO CHI NEBRASKA HR LEADERS TO REVIEW WITH LOCAL CEOS, CONFIRMING THE REASONABLENESS OF MBO EXECUTIVE'S COMPENSATION AND PHILOSOPHY. COMPENSATION PACKAGE AND BONUS POTENTIAL FOR EXECUTIVE LEADERS IS APPROVED BY EACH MINISTRIES LOCAL BOARDS. THE HIGHEST PAID EMPLOYEES ARE DIRECTORS.
FORM 990, PART VI, LINE 16B, FORMAL POLICIES CONCERNING PARTICIPATION IN JOINT VENTURES	GOOD SAMARITAN HOSPITAL 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, Sec C, 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 (IOWA) SCRETARY OF STATE WEBSITE (HTTP://WWW.SOS.NE.GOV/BUSINESS OR IOWA'S WEBSITE FROM PRIOR YEAR) 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 IX, Line 11g, Other Expenses	CONTRACT SERVICES - TOTAL EXPENSE: 21542853, PROGRAM SERVICE EXPENSE: 10081211, MANAGEMENT AND GENERAL EXPENSES: 11461642, FUNDRAISING EXPENSES: ; CONTRACT LABOR - TOTAL EXPENSE: 3174024, PROGRAM SERVICE EXPENSE: 2825832, MANAGEMENT AND GENERAL EXPENSES: 348192, FUNDRAISING EXPENSES: ; CONTRACTED PROFESSIONALS - TOTAL EXPENSE: 4425933, PROGRAM SERVICE EXPENSE: 3783413, MANAGEMENT AND GENERAL EXPENSES: 642520, FUNDRAISING EXPENSES: ; OTHER FEES FOR SERVICES - TOTAL EXPENSE: 6277879, PROGRAM SERVICE EXPENSE: 4641703, MANAGEMENT AND GENERAL EXPENSES: 1636176, FUNDRAISING EXPENSES: ;
Form 990 , Part XI, Line 9, Other changes in net assets or fund balances	DONATED EQUIPMENT - 318660;

Schedule R IRS990ScheduleR

Id Related Tax Exempt Org IdRelatedTaxExemptOrgGrp (158 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Exempt Code SectionExemptCodeSectionTxt	Public Charity StatusPublicCharityStatusTxt	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Controlled OrganizationControlledOrganizationInd
ALEGENT CREIGHTON CLINIC
12809 W DODGE RD	OMAHA	NE	68154	470765154	HEALTHCARE	NE	501(C)(3)	3	ACH	Yes (true)
ALEGENT CREIGHTON HEALTH
12809 W DODGE RD	OMAHA	NE	68154	470757164	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (true)
ALEGENT CREIGHTON HEALTH FOUNDATION
12809 W DODGE RD	OMAHA	NE	68154	470648586	FUNDRAISING	NE	501(C)(3)	7	ACH	Yes (true)
ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM
7500 MERCY RD	OMAHA	NE	68124	470484764	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (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	Yes (true)
ALEGENT HEALTH - IMMANUEL MEDICAL CENTER
6901 N 72ND ST	OMAHA	NE	68122	470376615	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (true)
ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER
104 W 17TH ST	SCHUYLER	NE	68661	470399853	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (true)
ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA
PO BOX 368	CORNING	IA	50841	420782518	HEALTHCARE	IA	501(C)(3)	3	CHI NEBRASKA	Yes (true)
ALVERNA APARTMENTS
300 SE 8TH AVE	LITTLE FALLS	MN	56345	411351177	LTERM CARE	MN	501(C)(3)	9	CHI	Yes (true)
APPLETREE COURT
601 OAK ST	BRECKENRIDGE	MN	56520	411850500	SENIOR LIVING	MN	501(C)(3)	9	SFH	Yes (true)
BISHOP DRUMM RETIREMENT CENTER
1111 6TH AVE	DES MOINES	IA	50314	420725196	LTERM CARE	IA	501(C)(3)	9	CHI-IA CORP	Yes (true)
BORNEMANN HEALTHCARE CORPORATION
2500 BERNVILLE RD PO BOX 316	READING	PA	19603	232187242	HEALTHCARE	PA	501(C)(3)	11 - Type I	CHI	Yes (true)
CARRINGTON HEALTH CENTER
800 N 4TH ST	CARRINGTON	ND	58421	450227311	HEALTHCARE	ND	501(C)(3)	3	CHI	Yes (true)
CATHOLIC HEALTH INITIATIVES
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	470617373	HEALTHCARE	CO	501(C)(3)	9	NA	Yes (true)
CATHOLIC HEALTH INITIATIVES - COLORADO
188 INVERNESS DRIVE WEST STE 500	ENGLEWOOD	CO	80112	840405257	HEALTHCARE	CO	501(C)(3)	3	CHI	Yes (true)
CATHOLIC HEALTH INITIATIVES - IOWA CORP
1111 6TH AVE	DES MOINES	IA	50314	420680448	HEALTHCARE	IA	501(C)(3)	3	CHI	Yes (true)
CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION
6385 CORPORATE DR STE 301	COLORADO SPRINGS	CO	80919	840902211	FUNDRAISING	CO	501(C)(3)	7	CHIC	Yes (true)
CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION
6385 CORPORATE DR	COLORADO SPRINGS	CO	80919	270930004	FUNDRAISING	CO	501(C)(3)	11 - Type I	CHI	Yes (true)
CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	460992796	HEALTHCARE	CO	501(C)(3)	11 - Type I	CHINS	Yes (true)
CENTENNIAL MEDICAL GROUP INC
2700 STEWART PKWY	ROSEBURG	OR	97471	263946191	PHYSICIANS	OR	501(C)(3)	9	MMC	Yes (true)
CENTRAL KANSAS MEDICAL CENTER
3515 BROADWAY	GREAT BEND	KS	67530	480543724	SURGERY CENTER	KS	501(C)(3)	3	CHI	Yes (true)
CHI HEALTH CONNECT AT HOME - FARGO
4816 AMBER VALLEY PKWY S	FARGO	ND	58104	271966847	HEALTHCARE	MN	501(C)(3)	9	CHI	Yes (true)
CHI INSTITUTE FOR RESEARCH AND INNOVATION
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	271050565	HEALTHCARE	CO	501(C)(3)	11 - Type I	CHI	Yes (true)
CHI KENTUCKY INC
3900 OLYMPIC BLVD STE 400	ERLANGER	KY	41018	202741651	HEALTHCARE	KY	501(C)(3)	11 - Type I	CHI	Yes (true)
CHI NATIONAL HOME CARE
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	451261716	HEALTHCARE	CO	501(C)(3)	9	CHI NS	Yes (true)
CHI NATIONAL SERVICES
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	452532084	HEALTHCARE	CO	501(C)(3)	11 - Type I	CHI	Yes (true)
CHI NEBRASKA
6940 O ST STE 200	LINCOLN	NE	68510	363233121	HEALTHCARE	NE	501(C)(3)	11 - Type III - FI	CHI	Yes (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	Yes (true)
CHI ST VINCENT HOSPITAL HOT SPRINGS
300 WERNER ST	HOT SPRINGS	AR	71913	710236913	HEALTHCARE	AR	501(C)(3)	3	CHISVHS	Yes (true)
CHI ST VINCENT HOT SPRINGS
300 WERNER ST	HOT SPRINGS	AR	71913	261125064	HOLDING CO	AR	501(C)(3)	11 - Type II	SVIMC	Yes (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	Yes (true)
COMMUNITY LIMITED CARE DIALYSIS CENTER
619 OAK ST ACCOUNTING-3 W	CINCINNATI	OH	45206	237419853	HOLDING CO	OH	501(C)(2)	N/A	GSH	Yes (true)
COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION
631 N 8TH ST	MISSOURI VALLEY	IA	51555	421294399	FUNDRAISING	IA	501(C)(3)	11 - Type I	AH-CMHMV	Yes (true)
CONTINUING CARE HOSPITAL
150 NORTH EAGLE CREEK DR	LEXINGTON	KY	40509	611400619	LT ACH	KY	501(C)(3)	3	SJHS	Yes (true)
COVENANT HOME CARE
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	232028429	HOME HEALTH	PA	501(C)(3)	11 - Type II	CHI NHC	Yes (true)
ENUMCLAW REGIONAL HOSPITAL ASSOCIATION
1450 BATTERSBY AVE	ENUMCLAW	WA	98022	910715805	HEALTHCARE	WA	501(C)(3)	3	FHS	Yes (true)
FLAGET HEALTHCARE INC
4305 NEW SHEPHERDSVILLE RD	BARDSTOWN	KY	40004	611345363	HEALTHCARE	KY	501(C)(3)	3	KOH	Yes (true)
FLAGET MEMORIAL HOSPITAL FOUNDATION INC
4305 NEW SHEPHERDSVILLE RD	BARDSTOWN	KY	40004	562351341	FUNDRAISING	KY	501(C)(3)	11 - Type I	FH	Yes (true)
FRANCISCAN FOUNDATION
1717 SOUTH J ST	TACOMA	WA	98405	911145592	FUNDRAISING	WA	501(C)(3)	9	FHS	Yes (true)
FRANCISCAN HEALTH SYSTEM
1717 SOUTH J ST	TACOMA	WA	98405	910564491	HEALTHCARE	WA	501(C)(3)	3	CHI	Yes (true)
FRANCISCAN HEALTH VENTURES FKA SJMGROUP
TACOMA FNC CTR BLDG 1145 BROADWAY	TACOMA	WA	98402	431882377	PHYSICIANS	MO	501(C)(3)	9	CHI	Yes (true)
FRANCISCAN MEDICAL GROUP
1313 BROADWAY STE 200	TACOMA	WA	98402	911939739	HEALTHCARE	WA	501(C)(3)	9	FHS	Yes (true)
FRANCISCAN VILLA OF SOUTH MILWAUKEE INC
3601 S CHICAGO AVE	SOUTH MILWAUKEE	WI	53172	391093829	HEALTHCARE	WI	501(C)(3)	9	CHI	Yes (true)
GLOBAL HEALTH INITIATIVES
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	201536108	MINISTRIES	CO	501(C)(3)	11 - Type I	CHI	Yes (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	Yes (true)
GOOD SAMARITAN FOUNDATION OF CINCINNATI INC
619 OAK ST ACCOUNTING-3 W	CINCINNATI	OH	45206	311206047	FUNDRAISING	OH	501(C)(3)	11 - Type I	GSH	Yes (true)
GOOD SAMARITAN HOSPITAL
PO BOX 1990	KEARNEY	NE	68848	470379755	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (true)
GOOD SAMARITAN HOSPITAL FOUNDATION
111 W 31ST ST	KEARNEY	NE	68847	470659443	FUNDRAISING	NE	501(C)(3)	7	GSH	Yes (true)
GOOD SAMARITAN HOSPITAL FOUNDATION - DAYTON
110 N MAIN ST STE 500	DAYTON	OH	45402	237296923	FUNDRAISING	OH	501(C)(3)	7	SHP	Yes (true)
HARRISON MEDICAL CENTER
2520 CHERRY AVE	BREMERTON	WA	98310	910565546	HEALTHCARE	WA	501(C)(3)	3	FHS	Yes (true)
HARRISON MEDICAL CENTER FOUNDATION
2520 CHERRY AVE	BREMERTON	WA	98310	911197626	FUNDRAISING	WA	501(C)(3)	7	HMC	Yes (true)
HEALTH SET
2420 W 26TH AVE STE 460D	DENVER	CO	80211	841102943	LOW INC CARE	CO	501(C)(3)	7	CHIC	Yes (true)
HEALTHCARE AND WELLNESS FOUNDATION
2400 ST FRANCIS DR	BRECKENRIDGE	MN	56520	760761782	FUNDRAISING	MN	501(C)(3)	11 - Type I	SFMC	Yes (true)
HIGHLINE MEDICAL CENTER
16251 SYLVESTER RD SW	BURIEN	WA	98166	910712166	HEALTHCARE	WA	501(C)(3)	3	FHS	Yes (true)
HOUSE OF MERCY
1111 6TH AVE	DES MOINES	IA	50314	421323808	SHELTER	IA	501(C)(3)	7	CHI-IA CORP	Yes (true)
JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC
539 S 4TH ST	LOUISVILLE	KY	40202	611029768	HEALTHCARE	KY	501(C)(3)	3	KOH	Yes (true)
KENTUCKYONE HEALTH MEDICAL GROUP INC
539 S 4TH ST	LOUISVILLE	KY	40202	611352729	HEALTHCARE	KY	501(C)(3)	9	JHSMH	Yes (true)
KENTUCKYONE HEALTH INC
200 ABRAHAM FLEXNER WAY	LOUISVILLE	KY	40202	611029769	HEALTHCARE	KY	501(C)(3)	9	CHI	Yes (true)
LAKEWOOD HEALTH CENTER
600 MAIN AVE S	BAUDETTE	MN	56623	410758434	HEALTHCARE	MN	501(C)(3)	3	CHI	Yes (true)
LINUS OAKES INC
2700 STEWART PKWY	ROSEBURG	OR	97471	930821381	SENIOR LIVING	OR	501(C)(3)	9	MMC	Yes (true)
LISBON AREA HEALTH SERVICES
905 MAIN ST	LISBON	ND	58054	820558836	HEALTHCARE	ND	501(C)(3)	3	CHI	Yes (true)
LUFKIN VISION ACQUISITIONS
PO BOX 1447	LUFKIN	TX	75901	820563768	PROPERTY MGMT	TX	501(C)(3)	11 - Type III - FI	MHSET	Yes (true)
MEMORIAL HEALTH CARE SYSTEM FOUNDATION INC
2525 DE SALES AVE	CHATTANOOGA	TN	37404	621839548	FUNDRAISING	TN	501(C)(3)	7	MHCS	Yes (true)
MEMORIAL HEALTH CARE SYSTEM INC
2525 DE SALES AVE	CHATTANOOGA	TN	37404	620532345	HEALTHCARE	TN	501(C)(3)	3	CHI	Yes (true)
MEMORIAL HEALTH PARTNERS FOUNDATION INC
5600 BRAINERD RD STE 500	CHATTANOOGA	TN	37411	030417049	HEALTHCARE	TN	501(C)(3)	9	MHCS	Yes (true)
MEMORIAL HEALTH SYSTEM OF EAST TEXAS
PO BOX 1447	LUFKIN	TX	75902	750755367	HEALTHCARE	TX	501(C)(3)	3	CHI	Yes (true)
MEMORIAL MEDICAL CENTER - LIVINGSTON
PO BOX 1447	LUFKIN	TX	75902	760436439	HEALTHCARE	TX	501(C)(3)	3	MHSET	Yes (true)
MEMORIAL MEDICAL CENTER - SAN AUGUSTINE
PO BOX 1447	LUFKIN	TX	75902	752663904	HEALTHCARE	TX	501(C)(3)	3	MHSET	Yes (true)
MEMORIAL MULTISPECIALTY ASSOCIATES
1201 FRANK AVE	LUFKIN	TX	95904	752721155	PHYSICIANS	TX	501(C)(3)	11 - Type III - FI	MHSET	Yes (true)
MEMORIAL SPECIALTY HOSPITAL
PO BOX 1447	LUFKIN	TX	95902	752492741	HEALTHCARE	TX	501(C)(3)	3	MHSET	Yes (true)
MERCY AUXILIARY OF CENTRAL IOWA
1111 6TH AVE	DES MOINES	IA	50314	426076069	AUXILIARY	IA	501(C)(3)	11 - Type I	MF-DM IA	Yes (true)
MERCY CLINICS INC
1111 6TH AVE	DES MOINES	IA	50314	421193699	PHYSICIANS	IA	501(C)(3)	9	CHI-IA CORP	Yes (true)
MERCY COLLEGE OF HEALTH SCIENCES
1111 6TH AVE	DES MOINES	IA	50314	421511682	EDUCATION	IA	501(C)(3)	2	CHI-IA CORP	Yes (true)
MERCY FOUNDATION OF DES MOINES IA
1111 6TH AVE	DES MOINES	IA	50314	237358794	FUNDRAISING	IA	501(C)(3)	7	CHI-IA CORP	Yes (true)
MERCY FOUNDATION INC
2700 STEWART PKWY	ROSEBURG	OR	97471	936088946	FUNDRAISING	OR	501(C)(3)	7	MMC	Yes (true)
MERCY HEALTH CARE FOUNDATION
PO BOX 368	CORNING	IA	50841	421461064	FUNDRAISING	IA	501(C)(3)	11 - Type I	AHMH-CORNING	Yes (true)
MERCY HEALTHCARE FOUNDATION
570 CHAUTAUQUA BLVD	VALLEY CITY	ND	58072	450435338	FUNDRAISING	ND	501(C)(3)	11 - Type III - FI	MHVC	Yes (true)
MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS
800 MERCY DR	COUNCIL BLUFFS	IA	51503	421178204	FUNDRAISING	IA	501(C)(3)	11 - Type I	AHBMHS	Yes (true)
MERCY HOSPITAL OF DEVILS LAKE
1031 7TH ST NE	DEVILS LAKE	ND	58301	450227012	HEALTHCARE	ND	501(C)(3)	3	CHI	Yes (true)
MERCY HOSPITAL OF DEVILS LAKE FOUNDATION
1031 7TH ST NE	DEVILS LAKE	ND	58301	352367360	FUNDRAISING	ND	501(C)(3)	7	MHDL	Yes (true)
MERCY HOSPITAL OF VALLEY CITY
570 CHAUTAUQUA BLVD	VALLEY CITY	ND	58072	450226553	HEALTHCARE	ND	501(C)(3)	3	CHI	Yes (true)
MERCY MEDICAL CENTER
1301 15TH AVE WEST	WILLISTON	ND	58801	450231183	HEALTHCARE	ND	501(C)(3)	3	CHI	Yes (true)
MERCY MEDICAL CENTER - CENTERVILLE
ONE ST JOSEPHS DRIVE	CENTERVILLE	IA	52544	420680308	HEALTHCARE	IA	501(C)(3)	3	CHI-IA CORP	Yes (true)
MERCY MEDICAL CENTER INC
2700 STEWART PKWY	ROSEBURG	OR	97471	930386868	HEALTHCARE	OR	501(C)(3)	3	CHI	Yes (true)
MERCY MEDICAL FOUNDATION
1301 15TH AVE WEST	WILLISTON	ND	58801	450381803	FUNDRAISING	ND	501(C)(3)	11 - Type I	MMC	Yes (true)
MERCY PROFESSIONAL PRACTICE ASSOCIATES INC
1111 6TH AVE	DES MOINES	IA	50314	421470935	PHYSICIANS	IA	501(C)(3)	9	CHI-IA CORP	Yes (true)
NEBRASKA HEART HOSPITAL
7500 S 91ST ST	LINCOLN	NE	68526	392031968	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (true)
OAKES COMMUNITY HOSPITAL
1200 N 7TH ST	OAKES	ND	58474	450231675	HEALTHCARE	ND	501(C)(3)	3	CHI	Yes (true)
OAKES COMMUNITY HOSPITAL FOUNDATION
1200 N 7TH ST	OAKES	ND	58474	710966606	FUNDRAISING	ND	501(C)(3)	11 - Type I	OCH	Yes (true)
PINEYWOODS MEDICAL DEVELOPMENT CORP
PO BOX 1447	LUFKIN	TX	75902	752493116	PROPERTY MGMT	TX	501(C)(3)	11 - Type III - FI	MHSET	Yes (true)
PUEBLO STEPUP
1925 E ORMAN AVE STE G52	PUEBLO	CO	81004	841234295	COMMUNITY	CO	501(C)(3)	7	CHIC	Yes (true)
REGIONAL HOSPITAL FOR RESPIRATORY AND COMPLEX CARE
12844 MILITARY RD S	TUKWILA	WA	98168	911170040	HEALTHCARE	WA	501(C)(3)	3	FHS	Yes (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	Yes (true)
SAINT CLARE'S COMMUNITY CARE INC
25 POCONO RD	DENVILLE	NJ	07834	222876836	HEALTHCARE	NJ	501(C)(3)	11 - Type II	SCHS	Yes (true)
SAINT CLARE'S FOUNDATION INC
25 POCONO RD	DENVILLE	NJ	07834	222502997	FUNDRAISING	NJ	501(C)(3)	7	SCHS	Yes (true)
SAINT CLARE'S HEALTH SERVICES INC
25 POCONO RD	DENVILLE	NJ	07834	223639733	MANAGEMENT	NJ	501(C)(3)	11 - Type II	CHI	Yes (true)
SAINT CLARE'S HOSPITAL INC
25 POCONO RD	DENVILLE	NJ	07834	223319886	HEALTHCARE	NJ	501(C)(3)	3	SCHS	Yes (true)
SAINT ELIZABETH FOUNDATION
555 S 70TH ST	LINCOLN	NE	68510	470625523	FUNDRAISING	NE	501(C)(3)	7	SERMC	Yes (true)
SAINT ELIZABETH HEALTH SERVICES
555 S 70TH ST	LINCOLN	NE	68510	363233120	HEALTHCARE	NE	501(C)(3)	3	SERMC	Yes (true)
SAINT ELIZABETH REGIONAL MEDICAL CENTER
555 S 70TH ST	LINCOLN	NE	68510	470379836	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (true)
SAINT FRANCIS MEDICAL CENTER
2620 W FAIDLEY	GRAND ISLAND	NE	68803	470376601	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (true)
SAINT FRANCIS MEDICAL CENTER FOUNDATION
PO BOX 9804	GRAND ISLAND	NE	68802	470630267	FUNDRAISING	NE	501(C)(3)	7	SFMC	Yes (true)
SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC
305 ESTILL ST	BEREA	KY	40403	260152877	FUNDRAISING	KY	501(C)(3)	7	SJHS	Yes (true)
SAINT JOSEPH HEALTH SYSTEM INC
424 LEWIS HARGETT CIRCLE STE 160	LEXINGTON	KY	40503	611334601	HEALTHCARE	KY	501(C)(3)	3	KOH	Yes (true)
SAINT JOSEPH HOSPITAL FOUNDATION INC
ONE SAINT JOSEPH DRIVE	LEXINGTON	KY	40504	611159649	FUNDRAISING	KY	501(C)(3)	11 - Type I	SJHS	Yes (true)
SAINT JOSEPH LONDON FOUNDATION INC
1001 SAINT JOSEPH LANE	LONDON	KY	40741	260438748	FUNDRAISING	KY	501(C)(3)	7	SJHS	Yes (true)
SAINT JOSEPH MEDICAL FOUNDATION INC
200 ABRAHAM FLEXNER WAY	LOUISVILLE	KY	40202	311539059	PHYSICIANS	KY	501(C)(3)	3	SJHS	Yes (true)
SAINT JOSEPH MOUNT STERLING FOUNDATION INC
225 FALCON DR	MOUNT STERLING	KY	40353	272884584	FUNDRAISING	KY	501(C)(3)	7	SJHS	Yes (true)
SAINT JOSEPH'S HOSPITAL FOUNDATION
30 WEST 7TH ST	DICKINSON	ND	58601	363418207	FUNDRAISING	ND	501(C)(3)	11 - Type I	SJHHC	Yes (true)
SAMARITAN BEHAVIORAL HEALTH INC
601 S EDWIN C MOSES BLVD	DAYTON	OH	45417	020633634	HEALTHCARE	OH	501(C)(3)	7	SHP	Yes (true)
SAMARITAN HEALTH PARTNERS
110 N MAIN ST STE 500	DAYTON	OH	45402	311107411	HEALTHCARE	OH	501(C)(3)	11 - Type I	CHI	Yes (true)
SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC
104 W 17TH ST	SCHUYLER	NE	68661	363630014	FUNDRAISING	NE	501(C)(3)	11 - Type I	AHMHS	Yes (true)
SJRMC JOPLIN MISSOURI
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	440545809	HEALTHCARE	MO	501(C)(3)	3	CHI	Yes (true)
SL AUGUSTA CORP
PO BOX 20269	HOUSTON	TX	77225	760226623	TITLE HOLDING	TX	501(C)(2)	N/A	SLPC	Yes (true)
ST ANTHONY HOSPITAL
1601 SE COURT AVE	PENDLETON	OR	97801	930391614	HEALTHCARE	OR	501(C)(3)	3	CHI	Yes (true)
ST ANTHONY HOSPITAL FOUNDATION
1601 SE COURT AVE	PENDLETON	OR	97801	930992727	FUNDRAISING	OR	501(C)(3)	11 - Type I	SAH	Yes (true)
ST ANTHONY'S HOSPITAL ASSOCIATION
FOUR HOSPITAL DR	MORRILTON	AR	72110	710245507	HEALTHCARE	AR	501(C)(3)	3	SVIMC	Yes (true)
ST CATHERINE HOSPITAL
401 EAST SPRUCE ST	GARDEN CITY	KS	67846	480543721	HEALTHCARE	KS	501(C)(3)	3	CHI	Yes (true)
ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION
401 EAST SPRUCE ST	GARDEN CITY	KS	67846	200598702	FUNDRAISING	KS	501(C)(3)	11 - Type I	SCH	Yes (true)
ST DOMINIC OF ONTARIO OREGON
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	930433692	HEALTHCARE	OR	501(C)(4)	N/A	CHI	Yes (true)
ST FRANCIS HOME
2400 ST FRANCIS DR	BRECKENRIDGE	MN	56520	410729978	LTERM CARE	MN	501(C)(3)	9	CHI	Yes (true)
ST FRANCIS LIFE CARE CORPORATION
19 POCONO RD	DENVILLE	NJ	07834	222536017	ELDERLY CARE	NJ	501(C)(3)	9	SCHS	Yes (true)
ST FRANCIS MEDICAL CENTER
2400 ST FRANCIS DR	BRECKENRIDGE	MN	56520	410695598	HEALTHCARE	MN	501(C)(3)	3	CHI	Yes (true)
ST FRANCIS OF BAKER CITY
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	930412495	HEALTHCARE	OR	501(C)(3)	3	CHI	Yes (true)
ST JOSEPH COMMUNITY HEALTH
1516 5TH ST NW	ALBUQUERQUE	NM	87102	710897107	COMMUNITY	NM	501(C)(3)	11 - Type I	CHI	Yes (true)
ST JOSEPH HEALTH MINISTRIES
1929 LINCOLN HWY E STE 150	LANCASTER	PA	17602	232342997	HEALTHCARE	PA	501(C)(3)	11 - Type I	CHI	Yes (true)
ST JOSEPH MEDICAL CENTER FOUNDATION
2500 BERNVILLE RD PO BOX 316	READING	PA	19603	232649362	FUNDRAISING	PA	501(C)(3)	11 - Type I	SJRHN	Yes (true)
ST JOSEPH MEDICAL CENTER INC
201 INTERNATIONAL CIRCLE STE 212	HUNT VALLEY	MD	21030	520591461	HEALTHCARE	MD	501(C)(3)	3	CHI	Yes (true)
ST JOSEPH MEDICAL GROUP
2500 BERNVILLE RD PO BOX 316	READING	PA	19603	208544021	HEALTHCARE	PA	501(C)(3)	9	BHC	Yes (true)
ST JOSEPH PHYSICIAN ENTERPRISE INC
201 INTERNATIONAL CIRCLE STE 212	HUNT VALLEY	MD	21030	521311775	PHYSICIANS	MD	501(C)(3)	11 - Type I	SJMC	Yes (true)
ST JOSEPH REGIONAL HEALTH NETWORK
2500 BERNVILLE RD PO BOX 316	READING	PA	19603	231352211	HEALTHCARE	PA	501(C)(3)	3	CHI	Yes (true)
ST JOSEPH'S AREA HEALTH SERVICES
600 PLEASANT AVE	PARK RAPIDS	MN	56470	410695603	HEALTHCARE	MN	501(C)(3)	3	CHI	Yes (true)
ST JOSEPH'S HOSPITAL AND HEALTH CENTER
30 WEST 7TH ST	DICKINSON	ND	58601	450226429	HEALTHCARE	ND	501(C)(3)	3	CHI	Yes (true)
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	260274448	MANAGEMENT	TX	501(C)(3)	11 - Type I	SLHS	Yes (true)
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - PMC
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	273733278	HEALTHCARE	TX	501(C)(3)	3	SLCDC	Yes (true)
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	261947374	HEALTHCARE	TX	501(C)(3)	3	SLHS	Yes (true)
ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	260335902	HEALTHCARE	TX	501(C)(3)	3	SLCDC	Yes (true)
ST LUKE'S COMMUNITY HEALTH SERVICES
6624 FANNIN ST STE 1100	HOUSTON	TX	77030	760536234	HEALTHCARE	TX	501(C)(3)	3	SLHS	Yes (true)
ST LUKE'S FOUNDATION
1213 HERMANN DRIVE STE 855	HOUSTON	TX	77004	453811485	FUNDRAISING	TX	501(C)(3)	7	SLHS	Yes (true)
ST LUKE'S HEALTH SYSTEM CORPORATION
6624 FANNIN ST STE 1100	HOUSTON	TX	77030	760536232	MANAGEMENT	TX	501(C)(3)	11 - Type I	CHI	Yes (true)
ST LUKE'S HEALTH SYSTEM FOUNDATION
6624 FANNIN ST STE 1100	HOUSTON	TX	77030	760127715	INVESTMENT MGMT	TX	501(C)(3)	11 - Type I	SLHS	Yes (true)
ST LUKE'S HOSPITAL AT THE VINTAGE
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	263734606	HEALTHCARE	TX	501(C)(3)	3	SLHS	Yes (true)
ST LUKE'S MEDICAL GROUP
6624 FANNIN ST	HOUSTON	TX	77030	760458535	PHYSICIANS	TX	501(C)(3)	3	SLHS	Yes (true)
ST LUKE'S MEDICAL TOWER CORPORATION
6624 FANNIN ST STE 1100	HOUSTON	TX	77030	760531713	PROPERTY MGMT	TX	501(C)(3)	11 - Type I	CHI-SLH	Yes (true)
ST LUKE'S PROPERTIES CORPORATION
6624 FANNIN ST STE 1100	HOUSTON	TX	77030	760531716	PROPERTY MGMT	TX	501(C)(3)	11 - Type I	SLHS	Yes (true)
ST LUKE'S SUGAR LAND PROPERTIES CORPORATION
6624 FANNIN ST STE 2505	HOUSTON	TX	77030	454120549	PROPERTY MGMT	TX	501(C)(3)	11 - Type I	SLCDC-SL	Yes (true)
ST MARY'S COMMUNITY HOSPITAL
1314 3RD AVE	NEBRASKA CITY	NE	68410	470443636	HEALTHCARE	NE	501(C)(3)	3	CHI NEBRASKA	Yes (true)
ST MARY'S HOSPITAL FOUNDATION
1314 3RD AVE	NEBRASKA CITY	NE	68410	470707604	FUNDRAISING	NE	501(C)(3)	7	SMCH	Yes (true)
ST VINCENT FOUNDATION
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	510169537	FUNDRAISING	AR	501(C)(3)	11 - Type I	SVIMC	Yes (true)
ST VINCENT INFIRMARY MEDICAL CENTER
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710236917	HEALTHCARE	AR	501(C)(3)	3	CHI	Yes (true)
ST VINCENT MEDICAL GROUP
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710830696	HEALTHCARE	AR	501(C)(3)	9	SVIMC	Yes (true)
THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH
619 OAK ST ACCOUNTING-3 W	CINCINNATI	OH	45206	310537486	HEALTHCARE	OH	501(C)(3)	3	CHI	Yes (true)
THE PHYSICIAN NETWORK
2000 Q ST STE 500	LINCOLN	NE	68503	470780857	PHYSICIANS	NE	501(C)(3)	11 - Type I	CHI NEBRASKA	Yes (true)
TOTAL HEALTHCARE
188 INVERNESS DRIVE WEST STE 500	ENGLEWOOD	CO	80112	840927232	HEALTHCARE	CO	501(C)(3)	3	CHIC	Yes (true)
UNITY FAMILY HEALTHCARE
815 SE 2ND ST	LITTLE FALLS	MN	56345	410721642	HEALTHCARE	MN	501(C)(3)	3	CHI	Yes (true)
VILLA NAZARETH INC
801 PAGE DR	FARGO	ND	58103	450226714	LTERM CARE	ND	501(C)(3)	9	CHI	Yes (true)
VISITING NURSE ASSOCIATION OF ST CLARE'S INC
191 WOODPORT RD	SPARTA	NJ	07871	221768334	HOME HEALTH	NJ	501(C)(3)	9	SCHS	Yes (true)
WOODLANDS DOCTOR GROUP
17200 ST LUKES WAY STE 170	THE WOODLANDS	TX	77384	274499340	PHYSICIANS	TX	501(C)(3)	9	SLCHS	Yes (true)

Id Related Org Txbl Partnership IdRelatedOrgTxblPartnershipGrp (41 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Predominant Income TypePredominantIncomeTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	Disproportionate AllocationsDisproportionateAllocationsInd	UBI Code VUBICodeVAmt	General Or Managing PartnerGeneralOrManagingPartnerInd	OwnershipOwnershipPct
ALEGENT HEALTH NORTHWEST IMAGING CENTER LLC
3606 N 156TH ST	OMAHA	NE	68116	061786985	OP DIAGNOSTICS	NE	ACH	RELATED	$116,752	$776,649	false	$0	Yes (true)	0.51
AUDUBON LAND COMPANY LLC
5390 N ACADEMY BLVD STE 300	COLORADO SPRINGS	CO	80918	841513085	REAL ESTATE	CO	CHIC	RELATED	$34,991	$8,665,388	false	$0	false	0.501
AVANTAS LLC
11128 JOHN GALT BLVD STE 400	OMAHA	NE	68137	392045003	STAFFING OF NURSES	NE	AHBMHS	RELATED	-$319,683	$4,762,246	false	-$439,535	false	0.95
BERGAN MERCY SURGERY CENTER LLC
7710 MERCY RD STE 200	OMAHA	NE	68124	208671994	AMBUL SURG CTR	NE	ACH	RELATED	$142,085	$3,294,472	false	$0	false	0.6394
BERYWOOD OFFICE PROPERTIES LLC
400 BERYWOOD TRAIL	CLEVELAND	TN	37312	621875199	PHYS OFFICE	TN	MHCS	RELATED	$57,545	$1,013,237	false	$0	Yes (true)	0.63
BLUEGRASS REGIONAL IMAGING CENTER
1218 SOUTH BRDWAY STE 310	LEXINGTON	KY	40504	611386736	DIAGNOSTIC IMAGING	KY	SJHS	RELATED	$308,428	$3,317,191	false	$0	false	0.65
CATHOLIC HEALTH INITIATIVES PHYSICIAN SERVICES LLC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	462945938	PRACTICE MGMT SRVC	DE	CHI	RELATED	$2,478	$4,571,498	false	$0	Yes (true)	0.8
CENTRAL NEBRASKA HOME CARE SERVICES
PO BOX 1146 4502 N SECOND AVE	KEARNEY	NE	68848	470692112	HEALTHCARE SRVC	NE	NA	RELATED	-$195,425	$216,945	false	-$77,269	Yes (true)	1
CENTRAL NEBRASKA REHAB SERVICE
620 DIERS AVE STE 300	GRAND ISLAND	NE	68803	810653461	PHYSICAL THERAPY	NE	SFMC	RELATED	$2,132,606	$3,494,427	false	$0	false	0.51
CHI OPERATING INVESTMENT PROGRAM LP
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	470727942	INVESTMENTS	CO	CHI	UNRELATED	$344,962,532	$4,617,413,792	false	$0	Yes (true)	0.928
CHICAMSURG SURGERY CENTERS LLC
188 INVERNESS DRIVE WEST 500	ENGLEWOOD	CO	80112	111222333	SURGERY CENTER	CO	CHIC	RELATED	$0	$0	false	$0	false	0.51
HC SL VINTAGE I LLC
18000 W SARAH LANE STE 250	BROOKFIELD	WI	53045	270453767	PROPERTY HOLDING	WI	SL CDC-V	RELATED	$1,027,057	$105,658,490	false	$0	false	0.51
HEALTHCARE SUPPORT SERVICES
PO BOX 9804	GRAND ISLAND	NE	68802	721546196	LAUNDRY	NE	NA	RELATED	$98,584	$3,190,678	false	$97,006	false	1
HEARTLAND ONCOLOGY LLC
2337 E CRAWFORD ST	SALINA	KS	67401	222333444	ONCOLOGY	KS	SCH	RELATED	$0	$0	false	$0	false	0.51
HIGHLINE IMAGING LLC
275 SW 160TH ST	BURIEN	WA	98166	200460005	DIAGNOSTIC IMAGING	WA	HMC	RELATED	$375,761	$1,784,057	false	$0	false	0.8
LAKESIDE AMBULATORY SURGICAL CENTER LLC
17031 LAKESIDE HILLS DR	OMAHA	NE	68130	204267902	AMBUL SURG CTR	NE	ACH	RELATED	$3,465,880	$1,951,221	false	$0	false	0.51
LAKESIDE ENDOSCOPY CENTER LLC
17001 LAKESIDE HILLS PLZ STE 201	OMAHA	NE	68130	205544496	ENDOSCOPY SRVC	NE	ACH	RELATED	$1,455,294	$1,013,126	false	$0	false	0.5228
LINCOLN CK LEASING LLC
6003 OLD CHENEY RD	LINCOLN	NE	68516	262496856	REAL ESTATE	NE	SERMC	RELATED	$574,064	$425,034	false	$0	false	0.5376
LOUISVILLE SC LTD
3000 RIVERCHASE GALLERIA STE 500	BIRMINGHAM	AL	35244	062119566	SURGERY CENTER	AL	SCOFL	RELATED	$417,359	$478,373	false	$0	Yes (true)	0.611
NEBRASKA SPINE HOSPITAL LLC
6901 N 72ND ST	OMAHA	NE	68122	270263191	SPINE HOSPITAL	NE	ACH	RELATED	$10,501,730	$17,301,869	false	$0	false	0.51
NORTH RIVER SURGERY CENTER LLC
2209 WILDWOOD AVE	SHERWOOD	AR	72120	710799771	AMBUL SURG CTR	AR	SVIMC	RELATED	$81,071	$1,077,536	false	$0	false	0.5745
ORTHOCOLORADO LLC
11650 WEST 2ND PLACE	LAKEWOOD	CO	80255	371577105	ORTHO HOSPITAL	CO	THC	RELATED	$1,846,183	$8,411,844	false	$0	false	0.6
PENINSULA RADIATION ONCOLOGY LLC
315 MLK JR WAY STE 111	TACOMA	WA	98405	870808610	HEALTHCARE SRVC	WA	FHS	RELATED	$256,567	$3,262,002	false	$0	false	0.6
PENRAD IMAGING
1390 KELLY JOHNSON BLVD	COLORADO SPRINGS	CO	80920	841072619	MEDICAL IMAGING	CO	CHIC	RELATED	$715,094	$3,489,436	false	$0	false	0.7
PMC HOSPITAL LLC
4600 E SAM HOUSTON PKWY	SOUTH PASADENA	TX	77505	273280598	HOSPITAL	TX	SL CDC-PMC	RELATED	$1,092,540	$20,751,174	false	$0	Yes (true)	0.51
PRAIRIE HEALTH VENTURES LLC
421 S 9TH ST STE 102	LINCOLN	NE	68508	204962103	TECH SRVC	NE	AH-IMC	RELATED	$1,011,804	$5,564,586	false	$68,565	Yes (true)	0.6575
PREMIER SURGERY CENTER OF LOUISVILLE LP
3000 RIVERCHASE GALLERIA STE 500	BIRMINGHAM	AL	35244	721378216	SURGERY CENTER	AL	SCA	RELATED	$88,900	$254,399	false	$0	Yes (true)	0.51
PUEBLO AMBULATORY SURGERY CENTER LLC
188 INVERNESS DRIVE WEST 500	ENGLEWOOD	CO	80112	621488737	SURGERY CENTER	CO	CHIC	RELATED	$0	$0	false	$0	false	0.51
SAINT JOSEPH - PAML LLC
424 LEWIS HARGETT CIRCLE STE 160	LEXINGTON	KY	40503	452116736	MGMT SVCS	KY	SJHS	RELATED	-$52,573	$93,769	false	$0	Yes (true)	0.625
SAINT JOSEPH - SCA HOLDINGS LLC
1451 HARRODSBURG RD	LEXINGTON	KY	40503	453801157	OP SURGERY	DE	SJHS	RELATED	$0	$0	false	$0	Yes (true)	0.51
SAINT JOSEPH-ANC HOME CARE SERVICES
1700 EDISON DR	MILFORD	OH	45150	263330545	HOME HEALTH	KY	JH	RELATED	$88,608	$256,606	false	$0	false	1
SCA PREMIER SURGERY CENTER OF LOUISVILLE LLC
200 ABRAHAM FLEXNER WAY	LOUISVILLE	KY	40202	721386840	SURGERY CENTER	KY	JH	RELATED	$42,319	$631,595	false	$0	Yes (true)	0.51
ST FRANCIS LAND COMPANY
5390 N ACADEMY BLVD STE 300	COLORADO SPRINGS	CO	80918	263134100	REAL ESTATE	CO	CHIC	RELATED	-$130,967	$13,823,763	false	$0	false	0.51
ST FRANCIS MEDICAL CENTER ASSOCIATES
1717 SOUTH J ST	TACOMA	WA	98405	911352698	MED OFFICE	WA	FHS	RELATED	$238,717	$19,017,063	false	$0	false	0.5421
ST LUKE'S DIAGNOSTIC CATH LAB LLP
6620 MAIN ST STE 1520	HOUSTON	TX	77030	710959365	DIAGNOSTICS	TX	SLHS HOLDINGS	RELATED	$273,448	$868,814	false	$0	false	0.573
ST LUKE'S HOSPITAL AT THE VINTAGE LLC
6624 FANNIN STE 2505	HOUSTON	TX	77030	263734516	HOSPITAL	TX	SLHS	RELATED	-$19,253,743	$69,158,748	false	$0	Yes (true)	0.51
ST LUKE'S LAKESIDE HOSPITAL LLC
6624 FANNIN STE 2505	HOUSTON	TX	77030	300427437	HOSPITAL	TX	SL CDC-W	RELATED	$1,106,628	$25,874,619	false	$0	Yes (true)	0.51
ST LUKE'S THE WOODLANDS SLEEP CENTER LLC
6624 FANNIN STE 800	HOUSTON	TX	77030	462795726	DIAGNOSTICS	TX	SLHSH	RELATED	$0	$0	false	$0	Yes (true)	0.5
SUPERIOR MEDICAL IMAGING LLC
5000 NORTH 26TH ST	LINCOLN	NE	68521	262884555	OP DIAGNOSTICS	NE	SERMC	RELATED	-$200,323	$821,112	false	$0	Yes (true)	0.51
SURGERY CENTER OF LEXINGTON LLC
424 LEWIS HARGETT CIRCLE STE 160	LEXINGTON	KY	40503	621179539	SURGERY CENTER	DE	SJHS	RELATED	-$200,318	$4,079,584	false	$0	Yes (true)	0.51
SURGERY CENTER OF LOUISVILLE LLC
200 ABRAHAM FLEXNER WAY	LOUISVILLE	KY	40202	621179537	SURGERY CENTER	KY	JH	RELATED	-$15,452	$396,101	false	$0	Yes (true)	0.51

Id Related Org Txbl Corp Tr IdRelatedOrgTxblCorpTrGrp (59 entries)

Address Line1USAddress/AddressLine1	CityUSAddress/City	StateUSAddress/State	ZIP CodeUSAddress/ZIPCode	EINEIN	Primary ActivitiesPrimaryActivitiesTxt	Legal Domicile StateLegalDomicileStateCd	Business Name Line1DirectControllingEntityName/BusinessNameLine1	Entity TypeEntityTypeTxt	Share Of Total IncomeShareOfTotalIncomeAmt	Share Of EOY AssetsShareOfEOYAssetsAmt	OwnershipOwnershipPct	Controlled OrganizationControlledOrganizationInd	Legal Domicile Foreign CountryLegalDomicileForeignCountryCd	Address Line1ForeignAddress/AddressLine1	CityForeignAddress/City	Province Or StateForeignAddress/ProvinceOrState	CountryForeignAddress/Country	Postal CodeForeignAddress/PostalCode	Business Name Line2RelatedOrganizationName/BusinessNameLine2
ALEGENT HEALTHCREIGHTON ST JOSEPH MANAGED CARE SERVICES INC
12809 WEST DODGE RD	OMAHA	NE	68154	470802396	MANAGED CARE	NE	CHI NEBRASKA	C CORPORATION	$5,312,313	$4,520,865	1	Yes (true)
ALL SAINTS INSURANCE COMPANY SPC LTD
					INSURANCE		CHI	C CORPORATION	$0	$43,866,961	1	Yes (true)	CJ
ALTERNATIVE INSURANCE MANAGEMENT SERVICE
3900 OLYMPIC BLVD STE 400	ERLANGER	KY	41018	841112049	MANAGEMENT SERVICES	CO	CHI	C CORPORATION	$0	$6,272,746	1	Yes (true)
AMERICAN NURSING CARE INC
1700 EDISON DR	MILFORD	OH	45150	311085414	HOME HEALTH	OH	CHS	C CORPORATION	$5,118,606	$51,920,207	1	Yes (true)
AMERIMED INC
1700 EDISON DR	MILFORD	OH	45150	311158699	HOME HEALTH	OH	ANC	C CORPORATION	$2,134,392	$14,669,219	1	Yes (true)
BC HOLDING COMPANY INC
1850 BLUEGRASS AVE	LOUISVILLE	KY	40215	311542851	FITNESS CLUB	KY	JHSMH	C CORPORATION	$0	$0	1	Yes (true)
CADUCEUS MEDICAL ASSOCIATES INC
2525 DE SALES AVE	CHATTANOOGA	TN	37404	621570736	HEALTHCARE	TN	MHCS	C CORPORATION	$0	$1,008	1	Yes (true)
CAPTIVE MANAGEMENT INITIATIVES LTD
				980663022	CAPTIVE MANAGEMENT		CHI	C CORPORATION	$0	$0	1	Yes (true)	CJ	PO BOX 10073 APO	GEORGETOWN	GRAND CAYMAN	CJ	KY1-1001
CARMONA-DESOTO BUILDING HORIZONTAL PROPERTY REGIME INC
300 WERNER ST	HOT SPRINGS	AR	71913	710771076	HEALTHCARE	AR	CHI-SVHS	C CORPORATION	$0	$0	1	Yes (true)
CATHOLIC HEALTH INITIATIVES CENTER FOR TRANSLATIONAL RESEARCH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	272269511	RESEARCH	CO	CIRI	TRUST	-$2,286,538	$1,241,259	1	Yes (true)
CGH REALTY COMPANY INC
2500 BERNVILLE RD	READING	PA	19603	232326801	REAL ESTATE	PA	SJHM	C CORPORATION	$0	$0	1	Yes (true)
CHI ST LUKE'S HEALTH BAYLOR COLLEGE OF MEDICINE MEDICAL CENTER CONDO ASSOC
6624 FANNIN STE 2505	HOUSTON	TX	77030	455079545	CONDO ASSOC	TX	CHI-SLHBCM	C CORPORATION	$0	$0	1	Yes (true)
CLEARRIVER HEALTH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	464495960	INSURANCE	TN	PHPSI	C CORPORATION	$0	$0	1	Yes (true)
COMCARE SERVICES INC
5570 DTC PARKWAY	ENGLEWOOD	CO	80111	840904813	INACTIVE	CO	CHIC	C CORPORATION	$0	$0	1	Yes (true)
CONSOLIDATED HEALTH SERVICES
1700 EDISON DR	MILFORD	OH	45150	311378212	HOME HEALTH	OH	CHI	C CORPORATION	-$879,467	$52,379,487	1	Yes (true)
DES MOINES MEDICAL CENTER INC
1111 6TH AVE	DES MOINES	IA	50314	420837382	REAL ESTATE	IA	CHI-IA CORP	C CORPORATION	$67,314	$1,064,032	0.9298	Yes (true)
EAST TEXAS CLINICAL SERVICES INC
2801 VIA FORTUNA 500	AUSTIN	TX	78746	454736213	HEALTHCARE	TX	MHSET	C CORPORATION	$632,545	$16,782	1	Yes (true)
FIRST INITIATIVES INSURANCE LTD
				980203038	INSURANCE		CHI	C CORPORATION	$0	$0	1	Yes (true)	CJ	PO BOX 10073 APO	GEORGETOWN	GRAND CAYMAN	CJ	KY1-1001
FRANCISCAN SERVICES INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	232487967	HEALTHCARE	CO	CHI	C CORPORATION	$434,854	$718,254	1	Yes (true)
GOOD SAMARITAN OUTREACH SERVICES
PO BOX 1990	KEARNEY	NE	68848	470659440	MEDICAL CLINIC	NE	CHI NEBRASKA	C CORPORATION	-$7,280	$180,468	1	Yes (true)
HEALTH SYSTEMS ENTERPRISES INC
PO BOX 1990	KEARNEY	NE	68848	470664558	MGMT	NE	GSH	C CORPORATION	$87,278	$1,377,820	1	Yes (true)
HEALTHCARE MGMT SERVICES ORGANIZATION INC
1717 SOUTH J ST	TACOMA	WA	98405	911865474	HEALTH ORG.	WA	FHS	C CORPORATION	$0	$0	1	Yes (true)
HEARTLANDPLAINS HEALTH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	464368223	INSURANCE	NE	PHPSI	C CORPORATION	$0	$0	1	Yes (true)
HIGHLINE MEDICAL GROUP
15811 AMBAUM BLVD SW STE 170	BURIEN	WA	98166	911586438	MEDICAL SERVICES	WA	HMC	C CORPORATION	-$6,049,147	$5,689,139	1	Yes (true)
MEDQUEST
1602 WEST 11TH ST	WILLISTON	ND	58801	450392137	SALE OF DME	ND	MMC WILLISTON	C CORPORATION		$1,152,715	1	Yes (true)
MERCY PARK APARTMENTS LTD
1111 6TH AVE	DES MOINES	IA	50314	421202422	HOUSING	IA	CHI-IA CORP	C CORPORATION	$273,525	$1,937,218	1	Yes (true)
MERCY SERVICES CORP
2700 STEWART PARKWAY	ROSEBURG	OR	97471	930824308	RETAIL SALES	OR	MMC	C CORPORATION	$0	$142,337	1	Yes (true)
MHI CLINICAL SERVICES
1201 W FRANK AVE	LUFKIN	TX	75904	461967952	HEALTHCARE	TX	MHSET	C CORPORATION	$0	$0	1	Yes (true)
MOUNTAIN MANAGEMENT SERVICES INC
6028 SHALLOWFORD RD	CHATTANOOGA	TN	37421	621570739	MGMT SVC ORG	TN	MHCS	C CORPORATION	$96,044	$6,465,179	1	Yes (true)
NAZARETH ASSURANCE COMPANY
				030304831	INSURANCE		CHI	C CORPORATION	$0	$0	1	Yes (true)	CJ	PO BOX 10073 APO	GEORGETOWN	GRAND CAYMAN	CJ	KY1-1001
PATIENT TRANSPORT SERVICES INC
1700 EDISON DR	MILFORD	OH	45150	311100798	HOME HEALTH	OH	ANC	C CORPORATION	-$164,340	$5,488,275	1	Yes (true)
PHYSICIANHEALTH SYSTEM NETWORK
1149 MARKET ST	TACOMA	WA	98402	911746721	HEALTH ORG.	WA	FHS	C CORPORATION	$0	$0	1	Yes (true)
PROMINENCE HEALTH PLAN SERVICES INC (FKA COLLABHEALTH PLAN SERVICES INC)
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	461224037	ADMIN SERVICES	CO	PHI	C CORPORATION	-$5,339,325	$38,272,608	1	Yes (true)
PROMINENCE HEALTH INC (FKA COLLABHEALTH MANAGED SOLUTIONS INC)
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	461222808	HOLDING CO	CO	CHI	C CORPORATION	$0	$23,806,707	1	Yes (true)
QCA HEALTH PLAN INC
12615 CHENAL PARKWAY STE 300	LITTLE ROCK	AR	72211	710794605	INSURANCE	AR	QCHI	C CORPORATION	$0	$0	1	Yes (true)
QUALCHOICE HOLDINGS INC
12615 CHENAL PARKWAY STE 300	LITTLE ROCK	AR	72211	274075520	HOLDING CO	AR	PHPS	C CORPORATION	$0	$0	1	Yes (true)
QUALCHOICE LIFE AND HEALTH INSURANCE COMPANY INC
12615 CHENAL PARKWAY STE 300	LITTLE ROCK	AR	72211	710386640	INSURANCE	AR	QCH	C CORPORATION	$0	$0	1	Yes (true)
RIVERLINK HEALTH
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	464380824	INSURANCE	OH	PHPS	C CORPORATION	$0	$0	1	Yes (true)
RIVERLINK HEALTH OF KENTUCKY INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	464828332	INSURANCE	KY	PHPS	C CORPORATION	$0	$0	1	Yes (true)
SAINT CLARE'S PRIMARY CARE INC
66 FORD RD	DENVILLE	NJ	07834	222441202	BILLING SERVICES	NJ	SCCC	C CORPORATION	-$235,604	$1,361,242	1	Yes (true)
SAMARITAN FAMILY CARE INC
40 W FOURTH ST STE 1700	DAYTON	OH	45402	311299450	HEALTHCARE	OH	SHP	C CORPORATION	$0	$0	1	Yes (true)
SJH SERVICES CORPORATION
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	232307408	HEALTHCARE	CO	FSI	C CORPORATION	-$197,039	$3,331,737	1	Yes (true)
SJL PHYSICIAN MANAGEMENT SERVICES INC
424 LEWIS HARGETT CR STE 160	LEXINGTON	KY	40503	270164198	MGMT	KY	SJHS	C CORPORATION	$0	$0	1	Yes (true)
SLMT PARKING INC
6624 FANNIN STE 800	HOUSTON	TX	77030	760637140	PARKING	TX	SLHS	C CORPORATION	$1,117,934	$13,768,221	1	Yes (true)
SOUNDPATH HEALTH INC
32129 WEYERHAEUSER WAY S STE 201	FEDERAL WAY	WA	98001	421720801	INSURANCE	WA	PHPS	C CORPORATION	-$154,741	$10,976,973	0.626	Yes (true)
ST ANTHONY DEVELOPMENT COMPANY
1415 SOUTHGATE	PENDLETON	OR	97801	931216943	ATHLETIC CLUB	OR	SAH	C CORPORATION	$114,663	$2,936,102	1	Yes (true)
ST JOSEPH DEVELOPMENT COMPANY INC
1717 SOUTH J ST	TACOMA	WA	98405	911480569	RENTAL	WA	FSI	C CORPORATION	$63,164	$11,845,439	1	Yes (true)
ST JOSEPH OFFICE PARK ASSOCIATION
1401 HARRODSBURG RD BLDG B70	LEXINGTON	KY	40504	611079899	MGMT	KY	SJHS	C CORPORATION	$0	$882,139	0.85	Yes (true)
ST LUKE'S 6620 MAIN CONDOMINIUM ASSOCIATION
6624 FANNIN STE 2505	HOUSTON	TX	77030	300355517	CONDO ASSOC	TX	SLPC	C CORPORATION	$0	$0	1	Yes (true)
ST LUKE'S ANESTHESIOLOGY ASSOCIATES
6624 FANNIN STE 1100	HOUSTON	TX	77030	461517163	MEDICAL CLINIC	TX	CHI-SLH	C CORPORATION	$0	$0	1	Yes (true)
ST LUKE'S EPISCOPAL HOSPITAL PHYSICIAN HOSPITAL ORGANIZATION INC
6720 BERTNER MC4-262	HOUSTON	TX	77030	760377932	PHO	TX	CHI-SLH	C CORPORATION	$6	$0	0.6	Yes (true)
ST LUKE'S HEALTH SYSTEM HOLDINGS INC (FKA SLEHS HOLDINGS INC)
6624 FANNIN STE 800	HOUSTON	TX	77030	760637138	HOLDING CO	TX	SLHS	C CORPORATION	$1,425,313	$33,114,103	1	Yes (true)
ST LUKE'S MEDICAL ARTS CENTER I CONDOMINIUM ASSOCIATION
6624 FANNIN STE 2505	HOUSTON	TX	77030	300355518	CONDO ASSOC	TX	SLPC	C CORPORATION	$0	$0	1	Yes (true)
ST LUKE'S MEDICAL TOWER CONDOMINIUM ASSOCIATION
6624 FANNIN STE 2505	HOUSTON	TX	77030	760298751	CONDO ASSOC	TX	SLMTC	C CORPORATION	$0	$0	1	Yes (true)
ST VINCENT COMMUNITY HEALTH SERVICES INC
TWO ST VINCENT CIRCLE	LITTLE ROCK	AR	72205	710710785	HEALTHCARE	AR	SVIMC	C CORPORATION	$2,408,638	$15,225,732	1	Yes (true)
STABLEVIEW HEALTH INC
198 INVERNESS DRIVE WEST	ENGLEWOOD	CO	80112	464373713	INSURANCE	KY	PHPS	C CORPORATION	$0	$0	1	Yes (true)
SUGAR LAND DOCTOR GROUP
1317 LAKE POINTE PARKWAY	SUGAR LAND	TX	77478	454270163	MEDICAL CLINIC	TX	SLCDC-SL	C CORPORATION	$0	$0	1	Yes (true)
THE TEXAS HEART INSTITUTE AT ST LUKE'S EPISCOPAL HOSPITAL DENTON A COOLEY B
6624 FANNIN STE 2505	HOUSTON	TX	77030	900064009	CONDO ASSOC	TX	CHI-SLH	C CORPORATION	$0	$0	1	Yes (true)							UILDING COMDOMINIUM ASSOCIATION
TOWSON MANAGEMENT INC
7601 OSLER DR	TOWSON	MD	21204	521710750	MGMT SERVICES	MD	FSI	C CORPORATION	$516,457	$197,196	1	Yes (true)

Field	Value	IRS element (for citing)
Receipt Of Int Annts Rnts Rylts	false	ReceiptOfIntAnntsRntsRyltsInd
Gift Grnt Or Cap Contri To Oth Org	Yes (true)	GiftGrntOrCapContriToOthOrgInd
Gift Grnt Cap Contri From Oth Org	Yes (true)	GiftGrntCapContriFromOthOrgInd
Loans Or Guarantees To Other Org	false	LoansOrGuaranteesToOtherOrgInd
Loans Or Guarantees From Oth Org	Yes (true)	LoansOrGuaranteesFromOthOrgInd
Div Related Organization	false	DivRelatedOrganizationInd
Asset Sale To Other Org	false	AssetSaleToOtherOrgInd
Asset Purchase From Other Org	false	AssetPurchaseFromOtherOrgInd
Asset Exchange	false	AssetExchangeInd
Rental Of Facilities To Oth Org	Yes (true)	RentalOfFacilitiesToOthOrgInd
Rental Of Fclts From Oth Org	false	RentalOfFcltsFromOthOrgInd
Perform Of Services For Oth Org	false	PerformOfServicesForOthOrgInd
Perform Of Services By Other Org	Yes (true)	PerformOfServicesByOtherOrgInd
Sharing Of Facilities	false	SharingOfFacilitiesInd
Paid Employees Sharing	false	PaidEmployeesSharingInd
Reimbursement Paid To Other Org	false	ReimbursementPaidToOtherOrgInd
Reimbursement Paid By Other Org	false	ReimbursementPaidByOtherOrgInd
Transfer To Other Org	Yes (true)	TransferToOtherOrgInd
Transfer From Other Org	false	TransferFromOtherOrgInd

Transactions Related Org TransactionsRelatedOrgGrp (2 entries)

Transaction TypeTransactionTypeTxt	InvolvedInvolvedAmt
GOOD SAMARITAN HOSPITAL FOUNDATION
C	$1,036,554
GOOD SAMARITAN HOSPITAL FOUNDATION
B	$350,000