2014-05-12T09:35:09-05:00 2013-06-30 990 2012-07-01 271789847 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INC SAIN 5418817295 351 SW 9TH STREET ONTARIO OR 979142639 BLAINE PETERSEN 5418817295 2014-05-08 2012 2015-11-30 17:44:51Z SEE SCHEDULE O KARL KEELER 351 SW 9TH STREET ONTARIO OR 979142639 63671616 0 0928 X WWW.SAINTALPHONSUS.ORG/ONTARIO X 2010 OR HEALTHCARE SERVICES 13 10 651 72 7644 4635 57462 138848 59730267 60562772 772911 868301 1550547 2100243 62111187 63670164 204942 167324 0 0 30683012 32628952 0 0 26593 29838288 33072707 60726242 65868983 1384945 -2198819 63498111 59901421 35156565 33180308 28341546 26721113 HEALTHCARE SERVICES - SEE LINE 4 AND SCHEDULE H FOR ADDITIONAL INFORMATION 0 0 57000262 167324 61856922 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS A 49-BED, ACUTE CARE HOSPITAL SERVING ONTARIO AND THE SURROUNDING COMMUNITIES IN EASTERN OREGON AND SOUTHWESTERN IDAHO. THE MISSION STATEMENT OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS AS FOLLOWS:WE, CHE TRINITY HEALTH, SERVE TOGETHER IN THE SPIRIT OF THE GOSPEL AS A COMPASSIONATE AND TRANSFORMING HEALING PRESENCE WITHIN OUR COMMUNITIES. 57000262 1 1 0 1 0 0 0 0 0 0 1 1 0 0 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 1 0 0 1 1 0 0 0 0 1 1 1 1 0 0 1 174 0 1 651 1 1 1 0 0 0 0 0 0 0 0 0 X 13 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 OR X BRENT CHERNE CONTROLLER 2083677192 6301 EMERALD ST BOISE ID 83706 BRENT LLOYD 1.00 4.00 X 0 0 0 GEORGE JUETTEN 1.00 4.00 X X 0 0 0 SALLY JEFFCOAT 1.00 49.00 X X 0 750004 99876 SR SHARON FORD RSM 1.00 4.00 X 0 0 0 RONALD GRAVES 1.00 4.00 X X 0 0 0 LYNN HARRIS 1.00 4.00 X 0 0 0 KENNETH HART 1.00 44.00 X 0 0 0 J RICHARD O'CONNELL 1.00 54.00 X 0 1036410 130423 KAYE O'RIORDAN 1.00 4.00 X 0 0 0 SR SHARLET WAGNER CSC 1.00 4.00 X 0 0 0 JON WAGNILD MD 1.00 4.00 X 0 0 0 VICTOR YAMAMOTO 1.00 4.00 X 0 0 0 MATTHEW SHIRTCLIFF 1.00 4.00 X 0 0 0 MIKE REULING 1.00 4.00 X X 0 0 0 DARREL ANDERSON 1.00 4.00 X 0 0 0 ANDREW BENTZ 1.00 4.00 X 0 0 0 STEPHANIE WESTERMEIER 1.00 49.00 X 0 279328 39462 BLAINE PETERSEN 1.00 49.00 X 0 424173 43193 RICHARD PALAGI 48.00 2.00 X 0 339285 57407 PAUL VACHEK 48.00 2.00 X 142317 0 29189 JOSEPH SWEDISH 2.00 53.00 X 0 3233500 601476 KEDRICK ADKINS 2.00 53.00 X 0 1821619 126167 JAMES POLK 1.00 49.00 X 0 367761 52061 RODNEY REIDER 1.00 49.00 X 0 412725 62588 JEAN BASOM 1.00 49.00 X 0 165122 69608 GLEN ZAUSMER DO 50.00 0.00 X 402663 0 40968 ANDREW ALLEN DO 50.00 0.00 X 348290 0 36845 FRANK SPOKAS MD 50.00 0.00 X 334836 0 44222 JOHN HANSIL MD 50.00 0.00 X 317539 0 15169 PAMELA BRUCE MD 50.00 0.00 X 309662 0 37967 MICHAEL MURPHY 0.00 0.00 X 0 180882 16630 1855307 9010809 1503251 21 1 1 0 BENITON CONSTRUCTION CO 366 SW 5TH AVE MERIDIAN ID 83642 CONSTRUCTION SERVICES 5225800 ONTARIO EMERGENCY SPECIALISTS 351 SW 9TH STREET ONTARIO OR 97914 EMERGENCY ROOM PHYSICIAN STAFFING 1758176 TREASURE VALLEY LABORATORY PO BOX 2693 SPOKANE WA 99220 LABORATORY SERVICES 735751 APOGEE MEDICAL MANAGEMENT 2525 E CAMELBACK RD PHOENIX AZ 85016 PHYSICIAN SERVICES 365605 STRATEGIC STAFFING SOLUTIONS 645 GRISWOLD STE 2900 ONTARIO OR 97914 STAFFING SERVICES 285377 13 12035 126813 138848 NET PATIENT SVC REV 900099 60141003 60141003 OTHER REVENUE 900099 421769 421769 60562772 576364 576364 260544 0 260544 260544 260544 284889 8500 0 1452 284889 7048 291937 291937 MEDICAID HIT REV 900099 616027 616027 PHARMACY REVENUE 446110 270525 270525 CAFETERIA REVENUE 722100 267380 267380 685767 678123 7644 1839699 63670164 61856922 7644 1666750 162152 162152 5172 5172 673288 673288 53204 53204 24614203 24158903 435725 19575 1079233 1058257 20119 857 4378251 4237137 137681 3433 1830773 1646699 182616 1458 116943 116943 31670 31670 5367963 4671935 695428 600 180465 2582 177883 1222189 1154720 67449 20 58319 44692 13627 1663967 1548756 115211 191300 176125 14940 235 12221 8479 3742 753176 753176 2243793 1758819 484974 404724 171295 233429 MEDICAL SUPPLIES 7835053 7835053 INTERCO. PURCHASED SVCS 5900934 1098053 4802881 BAD DEBT 3852881 3852881 CONTRACT LABOR 2051683 1566305 485378 1185426 1035867 149144 415 65868983 57000262 8842128 26593 213227 134622 74009 100228 9248635 9707905 49726 536562 186555 1348945 1449912 179561 171497 35358159 5190473 23545808 30167686 10115922 8835966 16504926 8489456 127280 1603236 607868 63498111 59901421 10553447 9399604 19177 22336 305508 24583941 23452860 35156565 33180308 X 28267537 26620885 74009 100228 28341546 26721113 63498111 59901421 X -2198819 575694 149 2543 X X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 6955 0 0 0 6955 0 EXPLANATION OF LOBBYING ACTIVITIES: PART II-B, LINE 1: SAINT ALPHONSUS MEDICAL CENTER-ONTARIO, INC. (SAMC-ONT) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS, WHERE THE ORGANIZATIONS HAVE PROVIDED SAMC-ONT WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SAMC-ONT MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 1158775 1158775 22033732 2619610 19414122 9214845 2570863 6643982 225 2950582 2950807 30167686 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 2598813 F EQUITY METHOD INVESTMENTS 3118576 C HEDGE FUNDS 2772067 F 8489456 INTERCOMPANY NOTES PAYABLE 22318776 INTERCOMPANY ACCOUNTS PAYABLE 810544 ASSET RETIREMENT OBLIGATION (FIN 47) 323540 23452860 1 1 X 1 X 1 X 1 1 1 0 1 1 1 2750 2611463 2611463 0.04210 11 19565 12188228 11860197 328031 0.00530 12 22315 14799691 11860197 2939494 0.04740 3 14958 73041 73041 0.00120 1 82 10118 10118 0.00020 4 1521 43763 1235 42528 0.00070 8 16561 126922 1235 125687 0.00210 20 38876 14926613 11861432 3065181 0.04950 1 1100 252858 252858 0.00410 1 1100 252858 252858 0.00410 0 1737826 888203 15945290 20529061 -4583771 X 1 1 1 1 ST ALPHONSUS MEDICAL CENTER - ONTARIO

351 SW 9TH ST ONTARIO OR 97914

HTTP://WWW.SAINTALPHONSUS.ORG/ONTARIO X X X ST ALPHONSUS MEDICAL CENTER - ONTARIO 1 1 X X X X X X X X X 10 1 0 1 X X X X X X X X X 0 0 1 1 200.000000000000 1 300.000000000000 1 X X X X X X 1 1 X X X 1 0 X X X X 1 X 0 0 PART I, LINE 3C: IN ADDITION TO LOOKING AT A MULTIPLE OF THE FEDERAL POVERTY GUIDELINES, OTHER FACTORS ARE CONSIDERED SUCH AS THE PATIENT'S FINANCIAL STATUS AND/OR ABILITY TO PAY AS DETERMINED THROUGH THE ASSESSMENT PROCESS. PART I, LINE 6A: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO PREPARES AN ANNUAL COMMUNITY BENEFIT REPORT, WHICH IT SUBMITS TO THE STATE OF OREGON. IN ADDITION, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO REPORTS ITS COMMUNITY BENEFIT INFORMATION AS PART OF THE CONSOLIDATED COMMUNITY BENEFIT INFORMATION REPORTED BY TRINITY HEALTH IN ITS ANNUAL REPORT, AVAILABLE AT WWW.TRINITY-HEALTH.ORG.IN ADDITION, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. PART I, LINE 7: THE BEST AVAILABLE DATA WAS USED TO CALCULATE THE COST AMOUNTS REPORTED IN ITEM 7. FOR CERTAIN CATEGORIES, PRIMARILY TOTAL CHARITY CARE AND MEANS-TESTED GOVERNMENT PROGRAMS, SPECIFIC COST-TO-CHARGE RATIOS WERE CALCULATED AND APPLIED TO THOSE CATEGORIES. THE COST-TO-CHARGE RATIO WAS DERIVED FROM WORKSHEET 2, RATIO OF PATIENT CARE COST-TO-CHARGES. IN OTHER CATEGORIES, THE BEST AVAILABLE DATA WAS DERIVED FROM THE HOSPITAL'S COST ACCOUNTING SYSTEM. PART I, L7 COL(F): THE FOLLOWING NUMBER, $3,852,881, REPRESENTS THE AMOUNT OF BAD DEBT EXPENSE INCLUDED IN TOTAL FUNCTIONAL EXPENSES IN FORM 990, PART IX, LINE 25. PER IRS INSTRUCTIONS, THIS AMOUNT WAS EXCLUDED FROM THE DENOMINATOR WHEN CALCULATING THE PERCENT OF TOTAL EXPENSE FOR SCHEDULE H, PART I, LINE 7, COLUMN (F). PART II: COMMUNITY BUILDING ACTIVITIES - AS A MEDICALLY UNDERSERVED AREA, SAINT ALPHONSUS MEDICAL CENTER-ONTARIO HAS ALSO BEEN VERY AGGRESSIVE IN RECRUITING PHYSICIANS TO THIS AREA. THE RECRUITMENT STRATEGY IS IN RESPONSE TO NEEDS IDENTIFIED DURING OUR CHNA PROCESS. PART III, LINE 4: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM PAGE 17 OF THOSE STATEMENTS: "THE CORPORATION RECOGNIZES A SIGNIFICANT AMOUNT OF PATIENT SERVICE REVENUE AT THE TIME THE SERVICES ARE RENDERED EVEN THOUGH THE CORPORATION DOES NOT ASSESS THE PATIENT'S ABILITY TO PAY AT THAT TIME. AS A RESULT, THE PROVISION FOR BAD DEBTS IS PRESENTED AS A DEDUCTION FROM PATIENT SERVICE REVENUE (NET OF CONTRACTUAL PROVISIONS AND DISCOUNTS). FOR UNINSURED PATIENTS THAT DO NOT QUALIFY FOR CHARITY CARE, THE CORPORATION ESTABLISHES AN ALLOWANCE TO REDUCE THE CARRYING VALUE OF SUCH RECEIVABLES TO THEIR ESTIMATED NET REALIZABLE VALUE. THIS ALLOWANCE IS ESTABLISHED BASED ON THE AGING OF ACCOUNTS RECEIVABLE AND THE HISTORICAL COLLECTION EXPERIENCE BY MINISTRY ORGANIZATION AND FOR EACH TYPE OF PAYOR. A SIGNIFICANT PORTION OF THE CORPORATION'S PROVISION FOR DOUBTFUL ACCOUNTS RELATES TO SELF-PAY PATIENTS, AS WELL AS CO-PAYMENTS AND DEDUCTIBLES OWED TO THE CORPORATION BY PATIENTS WITH INSURANCE."PART III, LINE 2: METHODOLOGY USED FOR LINE 2- BAD DEBT EXPENSE REPORTED ON LINE 2 IS SHOWN AT COST AND WAS CALCULATED USING A COST TO CHARGE RATIO METHODOLOGY.ANY DISCOUNTS PROVIDED OR PAYMENTS MADE TO A PARTICULAR PATIENT ACCOUNT ARE APPLIED TO THAT PATIENT ACCOUNT PRIOR TO ANY BAD DEBT WRITE-OFF AND ARE THUS NOT INCLUDED IN BAD DEBT EXPENSE. AS A RESULT OF THE PAYMENT AND ADJUSTMENT ACTIVITY BEING POSTED TO BAD DEBT ACCOUNTS, WE ARE ABLE TO REPORT BAD DEBT EXPENSE NET OF THESE TRANSACTIONS.PART III, LINE 3: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO USES A PREDICTIVE MODEL THAT INCORPORATES THREE DISTINCT VARIABLES IN COMBINATION TO PREDICT WHETHER A PATIENT QUALIFIES FOR CHARITY: (1) SOCIO-ECONOMIC SCORE, (2) ESTIMATED FEDERAL POVERTY LEVEL (FPL), AND (3) HOMEOWNERSHIP. BASED ON THE MODEL, CHARITY CARE CAN STILL BE EXTENDED TO PATIENTS EVEN IF THEY HAVE NOT RESPONDED TO FINANCIAL COUNSELING EFFORTS AND ALL OTHER FUNDING SOURCES HAVE BEEN EXHAUSTED. FY13 WAS THE FIRST YEAR SAINT ALPHONSUS MEDICAL CENTER - ONTARIO UTILIZED THE PREDICTIVE MODEL WITH RESULTS USED FOR ANALYSIS ONLY. STARTING IN FY14, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS RECORDING AMOUNTS AS CHARITY CARE (INSTEAD OF BAD DEBT EXPENSE) BASED ON THE RESULTS OF THE PREDICTIVE MODEL. PART III, LINE 8: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO DOES NOT BELIEVE ANY MEDICARE SHORTFALL SHOULD BE TREATED AS COMMUNITY BENEFIT. THIS IS SIMILAR TO CHA RECOMMENDATIONS, WHICH STATE THAT SERVING MEDICARE PATIENTS IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTHCARE ORGANIZATIONS AND THAT THE EXISTING COMMUNITY BENEFIT FRAMEWORK ALLOWS COMMUNITY BENEFIT PROGRAMS THAT SERVE THE MEDICARE POPULATION TO BE COUNTED IN OTHER COMMUNITY BENEFIT CATEGORIES.PART III, LINE 8: COSTING METHODOLOGY FOR LINE 6 - MEDICARE COSTS WERE OBTAINED FROM THE FILED MEDICARE COST REPORT. THE COSTS ARE BASED ON MEDICARE ALLOWABLE COSTS AS REPORTED ON WORKSHEET B, COLUMN 27, WHICH EXCLUDE DIRECT MEDICAL EDUCATION COSTS. INPATIENT MEDICARE COSTS ARE CALCULATED BASED ON A COMBINATION OF ALLOWABLE COST PER DAY TIMES MEDICARE DAYS FOR ROUTINE SERVICES AND COST TO CHARGE RATIO TIMES MEDICARE CHARGES FOR ANCILLARY SERVICES. OUTPATIENT MEDICARE COSTS ARE CALCULATED BASED ON COST TO CHARGE RATIO TIMES MEDICARE CHARGES BY ANCILLARY DEPARTMENT. PART III, LINE 9B: THE HOSPITAL'S COLLECTION POLICY CONTAINS PROVISIONS ON THE COLLECTION PRACTICES TO BE FOLLOWED FOR PATIENTS WHO ARE KNOWN TO QUALIFY FOR FINANCIAL ASSISTANCE. CHARITY DISCOUNTS ARE APPLIED TO THE AMOUNTS THAT QUALIFY FOR FINANCIAL ASSISTANCE. COLLECTION PRACTICES FOR THE REMAINING BALANCES ARE CLEARLY OUTLINED IN THE ORGANIZATION'S COLLECTION POLICY. THE HOSPITAL HAS IMPLEMENTED BILLING AND COLLECTION PRACTICES FOR PATIENT PAYMENT OBLIGATIONS THAT ARE FAIR, CONSISTENT AND COMPLIANT WITH STATE AND FEDERAL REGULATIONS. ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 3: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO SENT THE QUESTIONNAIRES OUT TO LOCAL STAKEHOLDERS AS WELL AS CREATED A PARTNERSHIP WITH THE MALHEUR COUNTY HEALTH DEPARTMENT AND FOUR RIVERS HEALTH COMMUNITY COALITION IN AN EFFORT TO RECEIVE FEEDBACK FROM THEIR INTEREST GROUPS. OTHER ORGANIZATIONS INCLUDING VETERAN ADVOCATES, BOYS AND GIRLS CLUB, LOCAL FOOD BANK, AND MORE WERE REPRESENTED AS WELL. ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 5C: LINE 5A:HTTP://WWW.SAINTALPHONSUS.ORG/DOCUMENTS/ONTARIO/COMMUNITY_NEEDS_ASSESSMENT.PDF ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 7: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO (SAMC - ONTARIO) TOOK AN EXTENSIVE LOOK AT THE RESULTS OF THE CHNA AND THE RESOURCES AVAILABLE IN ORDER TO DEVELOP AND IMPLEMENT APPROPRIATE PROGRAMMING TO MEET THE IDENTIFIED NEEDS. CERTAIN AREAS IDENTIFIED IN THE CHNA WERE OUTSIDE OF THE SCOPE OF WHAT THE FACILITY COULD REASONABLY IMPACT (SUCH AS THE HIGH RATE OF UNEMPLOYMENT, HOUSING ISSUES, AND THE POVERTY RATE IN EACH COUNTY). ADDITIONALLY, THERE WERE OTHER IDENTIFIED NEEDS AND SERVICES THAT SAMC-ONTARIO DID NOT HAVE THE RESOURCES AVAILABLE TO ADDRESS, SUCH AS MENTAL HEALTH AND SUBSTANCE ABUSE WHICH ARE BEING ADDRESSED BY LOCAL COMMUNITY PARTNERS. WE TAKE ANY OPPORTUNITY TO SUPPORT OTHER ORGANIZATIONS WHICH ARE WORKING ON TARGETED NEEDS WHEN WE ARE UNABLE TO ADDRESS THEM DIRECTLY. ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 12H: THE HOSPITAL RECOGNIZES THAT NOT ALL PATIENTS ARE ABLE TO PROVIDE COMPLETE FINANCIAL AND/OR SOCIAL INFORMATION. THEREFORE, APPROVAL FOR FINANCIAL SUPPORT MAY BE DETERMINED BASED ON AVAILABLE INFORMATION. EXAMPLES OF PRESUMPTIVE CASES INCLUDE: DECEASED PATIENTS WITH NO KNOWN ESTATE, THE HOMELESS, UNEMPLOYED PATIENTS, NON-COVERED MEDICALLY NECESSARY SERVICES PROVIDED TO PATIENTS QUALIFYING FOR PUBLIC ASSISTANCE PROGRAMS, PATIENT BANKRUPTCIES, AND MEMBERS OF RELIGIOUS ORGANIZATIONS WHO HAVE TAKEN A VOW OF POVERTY AND HAVE NO RESOURCES INDIVIDUALLY OR THROUGH THE RELIGIOUS ORDER.FOR THE PURPOSE OF HELPING FINANCIALLY NEEDY PATIENTS, A THIRD PARTY IS UTILIZED TO CONDUCT A REVIEW OF PATIENT INFORMATION TO ASSESS FINANCIAL NEED. THIS REVIEW UTILIZES A HEALTHCARE INDUSTRY-RECOGNIZED, PREDICTIVE MODEL THAT IS BASED ON PUBLIC RECORD DATABASES. THESE PUBLIC RECORDS ENABLE THE HOSPITAL TO ASSESS WHETHER THE PATIENT IS CHARACTERISTIC OF OTHER PATIENTS WHO HAVE HISTORICALLY QUALIFIED FOR FINANCIAL ASSISTANCE UNDER THE TRADITIONAL APPLICATION PROCESS. IN CASES WHERE THERE IS AN ABSENCE OF INFORMATION PROVIDED DIRECTLY BY THE PATIENT, AND AFTER EFFORTS TO CONFIRM COVERAGE AVAILABILITY, THE PREDICTIVE MODEL PROVIDES A SYSTEMATIC METHOD TO GRANT PRESUMPTIVE ELIGIBILITY TO FINANCIALLY NEEDY PATIENTS. ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 14G: BROCHURES AVAILABLE AT ALL REGISTRATION AREAS, WAITING ROOMS, CUSTOMER SERVICE AND FINANCIAL COUNSELING.POLICY AND FORMS AVAILABLE FROM FINANCIAL ADVOCATE OFFICE, ALL REGISTRATION AREAS, REGIONAL SHARED SERVICES CENTER.INFORMATION ABOUT FINANCIAL ASSISTANCE PROVIDED DURING ENCOUNTERS WITH FINANCIAL ADVOCATES AND UPON REQUEST TO REGISTRARS, CUSTOMER SERVICE REPRESENTATIVES AT THE REGIONAL SHARED SERVICES CENTER AND THE BILLING COMPANY.SUMMARY INFORMATION AND APPLICATION AVAILABLE ON WEBSITE: HTTP://WWW.SAINTALPHONSUS.ORG/FINANCIAL-SERVICES-2133 BILLING STATEMENTS REFERENCE THE AVAILABILITY OF THE POLICY FOR THOSE UNABLE TO PAY. ST. ALPHONSUS MEDICAL CENTER - ONTARIO PART V, SECTION B, LINE 20D: PATIENTS WITH INCOME AT OR BELOW 200% OF THE FEDERAL POVERTY GUIDELINES (FPG) ARE ELIGIBLE FOR 100% CHARITY CARE WRITE OFF OF THE CHARGES FOR MEDICALLY NECESSARY SERVICES. PATIENTS WITH INCOME BETWEEN 201% AND 300% OF THE FPG RECEIVE A WRITE OFF OF HOSPITAL CHARGES FOR MEDICALLY NECESSARY SERVICES EQUAL TO THE HOSPITAL'S AVERAGE COMMERCIAL CONTRACTUAL ADJUSTMENT FOR ALL COMMERCIAL PAYERS. PART VI, LINE 2: NEEDS ASSESSMENT - SAMC-ONTARIO ASSESSES THE HEALTH STATUS OF ITS COMMUNITY IN THE NORMAL COURSE OF OPERATIONS AND IN THE CONTINUOUS EFFORTS TO IMPROVE PATIENT CARE AND THE HEALTH OF THE OVERALL COMMUNITY. THE HOSPITAL MAY USE PATIENT DATA, PUBLIC HEALTH DATA, ANNUAL COUNTY HEALTH RANKINGS, MARKET STUDIES AND GEOGRAPHICAL MAPS SHOWING AREAS OF HIGH UTILIZATION FOR EMERGENCY SERVICES AND INPATIENT CARE, WHICH MAY INDICATE POPULATIONS OF INDIVIDUALS WHO DO NOT HAVE ACCESS TO PREVENTATIVE SERVICES OR ARE UNINSURED, IN THE ASSESSMENT OF THE COMMUNITY. SAMC-ONTARIO HAS ALSO CONDUCTED COMMUNITY SURVEYS AND FOCUS GROUPS WITH STAKEHOLDERS. THESE SURVEYS, IN ADDITION TO SOLICITING COMMENTS FROM THE COMMUNITY MEMBERS, HAVE HELPED THE ORGANIZATION TO STAY CURRENT WITH THE PERCEIVED NEEDS OF THE COMMUNITY. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SAINT ALPHONSUS MEDICAL CENTER-ONTARIO IS COMMITTED TO:- PROVIDING ACCESS TO QUALITY HEALTHCARE SERVICES WITH COMPASSION, DIGNITY AND RESPECT FOR THOSE WE SERVE, PARTICULARLY THE POOR AND THE UNDERSERVED IN OUR COMMUNITIES- CARING FOR ALL PERSONS, REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES- ASSISTING PATIENTS WHO CANNOT PAY FOR PART OR ALL OF THE CARE THEY RECEIVE - BALANCING NEEDED FINANCIAL ASSISTANCE FOR SOME PATIENTS WITH BROADER FISCAL RESPONSIBILITIES IN ORDER TO SUSTAIN VIABILITY AND PROVIDE THE QUALITY AND QUANTITY OF SERVICES FOR ALL WHO MAY NEED CARE IN A COMMUNITYIN ACCORDANCE WITH AHA RECOMMENDATIONS, SAINT ALPHONSUS MEDICAL CENTER-ONTARIO HAS ADOPTED THE FOLLOWING GUIDING PRINCIPLES WHEN HANDLING THE BILLING, COLLECTION AND FINANCIAL SUPPORT FUNCTIONS FOR OUR PATIENTS:- PROVIDE EFFECTIVE COMMUNICATIONS WITH PATIENTS REGARDING HOSPITAL BILLS- MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE FINANCIAL SUPPORT PROGRAMS- OFFER FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS- IMPLEMENT POLICIES FOR ASSISTING LOW-INCOME PATIENTS IN A CONSISTENT MANNER- IMPLEMENT FAIR AND CONSISTENT BILLING AND COLLECTION PRACTICES FOR ALL PATIENTS WITH PATIENT PAYMENT OBLIGATIONSSAINT ALPHONSUS MEDICAL CENTER-ONTARIO COMMUNICATES EFFECTIVELY WITH PATIENTS REGARDING PATIENT PAYMENT OBLIGATIONS. FINANCIAL COUNSELING IS PROVIDED TO PATIENTS ABOUT THEIR PAYMENT OBLIGATIONS AND HOSPITAL BILLS. INFORMATION ON HOSPITAL-BASED FINANCIAL SUPPORT POLICIES AND EXTERNAL PROGRAMS THAT PROVIDE COVERAGE FOR SERVICES ARE MADE AVAILABLE TO PATIENTS DURING THE PRE-REGISTRATION AND REGISTRATION PROCESSES AND/OR THROUGH COMMUNICATIONS WITH PATIENTS SEEKING FINANCIAL ASSISTANCE. ALL SELF-PAY PATIENTS ARE OFFERED FINANCIAL ASSISTANCE FORMS. EACH PATIENT RECEIVES INFORMATION ABOUT PAYMENT OPTIONS AND HOW TO APPLY FOR CHARITY CARE. PATIENTS ALSO ARE SCREENED FOR MEDICAID ELIGIBILITY, UTILIZING FINANCIAL ASSISTANCE FORMS. FINANCIAL COUNSELORS MAKE AFFIRMATIVE EFFORTS TO HELP PATIENTS APPLY FOR PUBLIC AND PRIVATE PROGRAMS FOR WHICH THEY MAY QUALIFY AND THAT MAY HELP THEM OBTAIN AND PAY FOR HEALTHCARE SERVICES. EVERY EFFORT IS MADE TO DETERMINE A PATIENT'S ELIGIBILITY PRIOR TO OR AT THE TIME OF ADMISSION OR SERVICE. HOWEVER, DETERMINATION FOR FINANCIAL SUPPORT CAN BE MADE DURING ANY STAGE OF THE PATIENT'S STAY AFTER STABILIZATION OR COLLECTION CYCLE.SAINT ALPHONSUS MEDICAL CENTER-ONTARIO OFFERS FINANCIAL SUPPORT TO PATIENTS WITH LIMITED MEANS. THIS SUPPORT IS AVAILABLE TO UNINSURED AND UNDERINSURED PATIENTS WHO DO NOT QUALIFY FOR PUBLIC PROGRAMS OR OTHER ASSISTANCE. NOTIFICATION ABOUT FINANCIAL ASSISTANCE, INCLUDING CONTACT INFORMATION, IS AVAILABLE. SELF-PAY INPATIENTS AND SURGERY PATIENTS ARE VISITED BY AN ASSOCIATE FROM PATIENT FINANCIAL SERVICES WHO ASSISTS THEM IN COMPLETING FINANCIAL ASSISTANCE FORMS FOR COUNTY INDIGENT ASSISTANCE, MEDICAID, SOCIAL SECURITY AND HOSPITAL CHARITY CARE. SAINT ALPHONSUS MEDICAL CENTER-ONTARIO HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SAINT ALPHONSUS MEDICAL CENTER-ONTARIO MAKES EVERY EFFORT TO ADHERE TO THE POLICY AND IS COMMITTED TO IMPLEMENTING AND APPLYING THE POLICY FOR ASSISTING PATIENTS WITH LIMITED MEANS IN A PROFESSIONAL, CONSISTENT MANNER. THE MEDICAL CENTER EDUCATES STAFF MEMBERS WHO WORK CLOSELY WITH PATIENTS (INCLUDING THOSE WORKING IN PATIENT REGISTRATION AND ADMITTING, FINANCIAL ASSISTANCE, CUSTOMER SERVICE, BILLING AND COLLECTIONS) ABOUT THESE POLICIES WITH AN EMPHASIS ON TREATING ALL PATIENTS WITH DIGNITY AND RESPECT REGARDLESS OF THEIR INSURANCE STATUS OR THEIR ABILITY TO PAY FOR SERVICES. PART VI, LINE 4: COMMUNITY INFORMATION - THE PRIMARY SERVICE AREA OF SAINT ALPHONSUS MEDICAL CENTER-ONTARIO ENCOMPASSES A FOUR COUNTY REGION OF SOUTHWESTERN IDAHO AND EASTERN OREGON, INCLUDING WASHINGTON, PAYETTE, MALHEUR AND BAKER COUNTIES. SAINT ALPHONSUS' SERVICE AREA IS PRIMARILY COMPOSED OF SMALL RURAL COMMUNITIES WITHIN THE WEST END OF THE TREASURE VALLEY, BORDERED BY EXTENSIVE FARMLANDS, RUGGED MOUNTAINOUS TERRAIN AND DESERT. THE REGION DIRECTLY EAST HAS EXPERIENCED RAPID POPULATION GROWTH SINCE 2000, WITH GROWTH OF 25.5% BETWEEN 2000 AND 2006. CLOSER TO ONTARIO THE GROWTH HAS BEEN MUCH LOWER, WITH PAYETTE COUNTY IN IDAHO SEEING THE BIGGEST GROWTH. THE ONTARIO REGION IS A DIVERSE COMMUNITY ENJOYING JAPANESE, LATINO, BASQUE, AND WESTERN AMERICAN CULTURES. WITH MEDIAN HOUSEHOLD INCOMES OF $35,788 IN MALHEUR COUNTY AND $43,559 IN PAYETTE COUNTY, AREA RESIDENTS FALL BELOW THE STATE MEDIANS OF $48,325 (OR), AND $46,423 (ID). THE POVERTY LEVEL STANDS AT 23.3% IN MALHEUR COUNTY AND 16.5% IN PAYETTE, COMPARED TO STATE AVERAGES OF 14% (OR) AND 14.3% (ID) AND A NATIONAL AVERAGE OF 13.8%. ANECDOTALLY, CURRENT UNEMPLOYMENT APPEARS TO BE HIGHER THAN IT HAS BEEN IN MANY YEARS.MEDICALLY UNDERSERVED POPULATIONS AND HEALTH PROFESSIONAL SHORTAGE AREAS WITHIN OUR SERVICE AREA INCLUDE A SHORTAGE OF PRIMARY CARE, SPECIALTY PHYSICIANS, ADDICTION TREATMENT, AND MENTAL HEALTH SERVICES.AREA HOSPITAL FACILITIES INCLUDE SAINT ALPHONSUS REGIONAL MEDICAL CENTER (BOISE, IDAHO), ST. LUKE'S, IDAHO ELKS REHABILITATION CENTER, TREASURE VALLEY HOSPITAL, SAINT ALPHONSUS MEDICAL CENTER-NAMPA, WEST VALLEY MEDICAL CENTER, WEISER MEMORIAL HOSPITAL, AND WALTER KNOX MEMORIAL HOSPITAL. PART VI, LINE 5: OTHER INFORMATION - SAINT ALPHONSUS MEDICAL CENTER-ONTARIO STRONGLY SUPPORTS HEALTHCARE WORKFORCE DEVELOPMENT EFFORTS, INCLUDING ANNUAL FINANCIAL SUPPORT TO THE TREASURE VALLEY COMMUNITY COLLEGE NURSING PROGRAM. IN ADDITION, SAINT ALPHONSUS SERVES AS A KEY CLINICAL TRAINING SITE FOR NURSES AND OTHER ALLIED HEALTH PROFESSIONALS.WE PROVIDE THE MAJORITY OF THE FUNDING, SPACE AND SUPPLIES TO STAFF A MATERNITY CARE CLINIC TO SERVE LOW INCOME WOMEN WHO OTHERWISE COULD NOT AFFORD PRE-NATAL CARE.WE OFFER A VARIETY OF HEALTH EDUCATION AND SCREENING OPPORTUNITIES FREE OF CHARGE INCLUDING CARDIAC & STROKE SCREENINGS, FREE LIPID PROFILES, MAMMOGRAMS AND MORE. WE USE THESE SCREENINGS AS AN OPPORTUNITY TO CONNECT PARTICIPANTS WITH A PRIMARY CARE PROVIDER FOR FURTHER HEALTH GUIDANCE.WE HOST A VERY SUCCESSFUL WORKSHOP FOR ASTHMATIC CHILDREN AND THEIR CAREGIVERS. THE BREATHE EASY, NOT WHEEZY EVENT PROVIDES VALUABLE INFORMATION TO ALLOW ASTHMA MANAGEMENT AND CREATE AN UNDERSTANDING OF HOW TO LIVE AN ACTIVE, HEALTHY, LIFE EVEN WITH ASTHMA.THIS PAST YEAR, AMONG MANY OTHERS, THE HOSPITAL WORKED TO ADDRESS THE ISSUES RANKED HIGHEST AMONG THE MANY NEEDS IDENTIFIED IN THE COMMUNITY HEALTH NEEDS ASSESSMENT (CHNA) PROCESS WHICH INCLUDED A VARIETY OF DISCUSSIONS AND FOCUS GROUPS WITH COMMUNITY MEMBERS, AND KEY PARTNERS AND STAKEHOLDERS. THROUGH COLLABORATIONS WITH THE SOUTHEAST OREGON FOOD BANK, BOYS AND GIRLS CLUB AND SAINT ALPHONSUS REGISTERED DIETICIANS, WE WORK TO ELIMINATE BOTH OBESITY AND FOOD INSECURITY. THROUGH THE MATERNITY CARE CLINIC WE HAVE WORKED TO DECREASE THE NUMBER OF PREGNANT WOMEN WHO WAIT TO SEEK PRENATAL CARE OR DON'T AT ALL- IN RETURN IMPROVING BIRTH OUTCOMES. ADDITIONALLY, SAINT ALPHONSUS HAS GREATLY INCREASED THEIR OPPORTUNITIES FOR THE POOR AND UNDERSERVED POPULATIONS TO RECEIVE FREE AND REDUCED COST SCREENINGS AND WELLNESS EXAMS INCLUDING MAMMOGRAMS, LIPID PANELS, A1C, CARDIAC RISK ASSESSMENTS, AND MORE WITH THE GOAL OF REDUCING THE NUMBER OF CHRONIC CONDITIONS AND LIFE-THREATENING CANCERS. PART VI, LINE 6: SAINT ALPHONSUS MEDICAL CENTER-ONTARIO IS A MEMBER OF CHE TRINITY HEALTH, THE SECOND-LARGEST CATHOLIC HEALTH CARE SYSTEM IN THE COUNTRY. CHE TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEFINE - AND ACHIEVE - COMMUNITY BENEFIT GOALS THAT INCLUDE IMPLEMENTING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, CHE TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS SERVING THOSE WHO ARE POOR AND UNINSURED, HELPING MANAGE CHRONIC CONDITIONS LIKE DIABETES, PROVIDING HEALTH EDUCATION, PROMOTING WELLNESS AND REACHING OUT TO UNDERSERVED POPULATIONS. OVERALL, THE ORGANIZATION INVESTS MORE THAN $800 MILLION IN SUCH COMMUNITY BENEFITS AND WORKS TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ENHANCE THE OVERALL HEALTH OF THE COMMUNITIES THEY SERVE BY ADDRESSING EACH COMMUNITY'S SPECIFIC NEEDS. FOR MORE INFORMATION ABOUT CHE TRINITY HEALTH, VISIT WWW.NEWHEALTHMINISTRY.ORG. REPORTS FILED WITH STATES PART VI, LINE 7 OR 1 TREASURE VALLEY COMMUNITY COLLEGE FOUNDATION 650 COLLEGE BLVD ONTARIO OR 97914 237052989 501(C)3 50000 BUILDING DONATION RENT DONATION 1 0 PRESCRIPTIONS FOR INDIGENT 62 5172 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY SAINT ALPHONSUS MEDICAL CENTER- ONTARIO TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE. DONATIONS ARE INCLUDED IN COMMUNITY BENEFITS IN SCHEDULE H IF THE CONTRIBUTION HAS BEEN FORMALLY RESTRICTED TO A COMMUNITY BENEFIT ACTIVITY THAT MEETS THE CRITERIA TO BE REPORTED ON SCHEDULE H. 0 1 0 0 0 0 0 0 0 SALLY JEFFCOAT 0 488811 0 186812 0 74381 0 75635 0 24241 0 849880 0 0 J RICHARD O'CONNELL 0 607209 0 284428 0 144773 0 97104 0 33319 0 1166833 0 0 STEPHANIE WESTERMEIER 0 278391 0 0 0 937 0 19972 0 19490 0 318790 0 0 BLAINE PETERSEN 0 336245 0 84666 0 3262 0 20109 0 23084 0 467366 0 0 RICHARD PALAGI 0 246311 0 49380 0 43594 0 36635 0 20772 0 396692 0 0 PAUL VACHEK 128468 0 8032 0 5817 0 5412 0 23777 0 171506 0 0 0 JOSEPH SWEDISH 0 1402192 0 786411 0 1044897 0 572762 0 28714 0 3834976 0 520902 KEDRICK ADKINS 0 784856 0 366716 0 670047 0 112792 0 13375 0 1947786 0 265335 JAMES POLK 0 296572 0 66854 0 4335 0 34460 0 17601 0 419822 0 0 RODNEY REIDER 0 333028 0 73439 0 6258 0 37537 0 25051 0 475313 0 0 JEAN BASOM 0 139149 0 24098 0 1875 0 54156 0 15452 0 234730 0 0 GLEN ZAUSMER DO 383176 0 0 0 19487 0 21162 0 19806 0 443631 0 0 0 ANDREW ALLEN DO 331209 0 0 0 17081 0 17550 0 19295 0 385135 0 0 0 FRANK SPOKAS MD 315440 0 0 0 19396 0 26554 0 17668 0 379058 0 0 0 JOHN HANSIL MD 285938 0 0 0 31601 0 7500 0 7669 0 332708 0 0 0 PAMELA BRUCE MD 294483 0 0 0 15179 0 16327 0 21640 0 347629 0 0 0 MICHAEL MURPHY 0 139488 0 0 0 41394 0 4650 0 11980 0 197512 0 0 PART I, LINE 3 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO IS A SUBSIDIARY IN THE TRINITY HEALTH SYSTEM. SAINT ALPHONSUS MEDICAL CENTER'S CEO IS PAID DIRECTLY BY THE SYSTEM'S PARENT ENTITY, TRINITY HEALTH CORPORATION. TRINITY HEALTH CORPORATION USED THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION FOR SAINT ALPHONSUS MEDICAL CENTER'S CEO: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - FORM 990 OF OTHER ORGANIZATIONS - COMPENSATION SURVEY OR STUDY, AND - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE PART I, LINE 4B THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH CASH BALANCE RESTORATION AND RETENTION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETENTION BENEFITS PLUS RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($250,000 FOR 2012). THE FOLLOWING ACCRUALS FOR 2012 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS- $100,292 SALLY JEFFCOAT- $55,635 J. RICHARD O'CONNELL- $77,104 RICHARD PALAGI- $16,678 RODNEY REIDER- $16,858 JOSEPH SWEDISH- $543,977 PART II: THE FOLLOWING INDIVIDUALS ARE VESTED IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING VESTED SERP AMOUNTS ARE INCLUDED IN COLUMN B(III) OF SCHEDULE J, PART II: KEDRICK ADKINS - $185,540 JOSEPH SWEDISH - $530,000 COLUMN F OF SCHEDULE J INCLUDES THE PORTION OF THESE AMOUNTS THAT WERE REPORTED AS DEFERRED COMPENSATION IN PRIOR YEARS FRANK SPOKAS EMPLOYEE PHYS LOAN X 90000 49500 0 0 1 PAMELA BRUCE EMPLOYEE PHYS LOAN X 40000 226 0 0 1 49726 BLUE CROSS OF IDAHO (BCI) SALLY JEFFCOAT, TRUSTEE & SYS PRES & CEO, ALSO SERVES ON THE BOARD OF BCI 1649753 PAYMENTS MADE BY BLUE CROSS OF IDAHO TO SAINT ALPHONSUS MEDICAL CENTER - ONTARIO FOR HEALTH CARE SERVICES PROVIDED TO BCI COVERED MEMBERS 0 LEANNA BENTZ FAMILY MEMBER OF ANDREW BENTZ, TRUSTEE 53204 EMPLOYMENT ARRANGEMENT 0 FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS SAINT ALPHONSUS HEALTH SYSTEM, INC. SEE LINE 7 FOR ADDITIONAL INFORMATION. FORM 990, PART VI, SECTION A, LINE 7A SAINT ALPHONSUS HEALTH SYSTEM, INC. IS THE SOLE MEMBER OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. SAINT ALPHONSUS HEALTH SYSTEM, INC. HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. FORM 990, PART VI, SECTION A, LINE 7B AS SOLE MEMBER, SAINT ALPHONSUS HEALTH SYSTEM, INC. MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. SAINT ALPHONSUS HEALTH SYSTEM, INC. MUST ALSO APPROVE SIGNIFICANT CHANGES SUCH AS A MERGER, DISSOLUTION, SALE OF ASSETS IN EXCESS OF CERTAIN LIMITS, A MATERIAL CHANGE IN MISSION, AND MODIFICATIONS TO GOVERNING DOCUMENTS. FORM 990, PART VI, SECTION B, LINE 11 PRIOR TO FILING, THE FORM 990 FOR SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE FINANCE COMMITTEE OF SAINT ALPHONSUS HEALTH SYSTEM. (SAINT ALPHONSUS HEALTH SYSTEM IS THE SOLE MEMBER OF THE CORPORATION.) THE BOARD RECEIVES A COPY OF THE RETURN IN ITS FINAL FORM BEFORE IT IS FILED WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. HAS ADOPTED A CONFLICT OF INTEREST POLICY WHICH CONTAINS THE ELEMENTS IN THE MODEL CONFLICT OF INTEREST POLICY ISSUED BY THE IRS. IT APPLIES TO ALL "INTERESTED PERSONS" OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC., WHICH INCLUDES TRUSTEES, PRINCIPAL OFFICERS AND EXECUTIVES, AND MEMBERS OF COMMITTEES WITH BOARD DESIGNATED POWERS. INTERESTED PERSONS ARE REQUIRED TO ACT AT ALL TIMES IN A MANNER CONSISTENT WITH SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC.'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. OF ANY FINANCIAL OR BUSINESS INTERESTS THAT MIGHT RESULT IN OR HAVE THE APPEARANCE OF A CONFLICT OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO RECUSE THEMSELVES FROM DISCUSSION AND VOTING ON MATTERS INVOLVING A CONFLICT OF INTEREST. THE BOARD OF TRUSTEES OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. ON AN ANNUAL BASIS, INTERESTED PERSONS ARE REQUIRED TO COMPLETE A CONFLICT OF INTEREST DISCLOSURE STATEMENT AND TO AFFIRM THEIR RECEIPT OF THE CONFLICT OF INTEREST POLICY, COMPLIANCE WITH ITS REQUIREMENTS, AND AGREE TO NOTIFY THE ORGANIZATION OF CHANGES IMPACTING THEIR ANNUAL DISCLOSURE IN ACCORDANCE WITH THE POLICY. THE ANNUAL DISCLOSURES ARE REVIEWED WITH THE BOARD OF TRUSTEES OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. ON AN ANNUAL BASIS. FORM 990, PART VI, SECTION B, LINE 15 TRINITY HEALTH FOLLOWS A PROCESS AND POLICY THAT IS INTENDED TO MIRROR THE IRC SECTION 4958 GUIDELINES FOR OBTAINING A "REBUTTABLE PRESUMPTION OF REASONABLENESS" WITH REGARD TO COMPENSATION AND BENEFITS. AS PART OF THAT PROCESS, THE COMPENSATION AND BENEFITS OF CERTAIN OFFICERS AND KEY MANAGEMENT OFFICIALS OF SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. ARE REVIEWED AT LEAST ANNUALLY BY THE TRINITY HEALTH BOARD OR THE TRINITY HEALTH HUMAN RESOURCES AND COMPENSATION COMMITTEE (HRCC) OF THE BOARD, AUTHORIZED TO ACT ON BEHALF OF THE BOARD WITH RESPECT TO CERTAIN COMPENSATION MATTERS. AS PART OF ITS REVIEW PROCESS, THE HRCC RETAINS AN INDEPENDENT FIRM EXPERIENCED IN COMPENSATION AND BENEFIT MATTERS FOR NOT-FOR-PROFIT HEALTHCARE ORGANIZATIONS TO ADVISE IT IN THE DETERMINATIONS IT MAKES ON THE REASONABLENESS OF PROPOSED COMPENSATION AND BENEFITS ARRANGEMENTS. FORM 990, PART VI, SECTION C, LINE 19 SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. IS A SUBSIDIARY ORGANIZATION IN THE TRINITY HEALTH SYSTEM. TRINITY HEALTH MAKES CERTAIN OF ITS KEY DOCUMENTS AVAILABLE TO THE PUBLIC ON ITS WEBSITE, WWW.TRINITY-HEALTH.ORG, IN THE "ABOUT US" SECTION. IN THIS SECTION, THE ANNUAL REPORT (WHICH INCLUDES COMMUNITY BENEFIT MINISTRY INFORMATION) AND CONSOLIDATED AUDITED FINANCIAL STATEMENTS ARE PUBLICLY AVAILABLE. IN ADDITION, SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC. INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 9: OTHER TRANSACTIONS: 2,543. FORM 990, PART XII, LINE 2: SAINT ALPHONSUS MEDICAL CENTER - ONTARIO, INC'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY13 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PAGE I, DOING BUSINESS AS NAMES: HOLY ROSARY, TRINITY HOLY ROSARY, SAINT ALPHONSUS, SAINT ALPHONSUS - ONTARIO, SAMG-ONTARIO PATHWAY HOSPICE LLC 1050 SW 3RD AVE SUITE 1600 ONTARIO OR 97914 931310235 HOSPICE CARE OR -24791 0 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) LINE 9 TRINITY HEALTH-MICHIGAN 0 AMICARE HOSPICE SERVICES INC 20555 VICTOR PARKWAY LIVONIA MI 48152 382949053 PROVIDE HOSPICE SERVICES MI 501(C)(3) LINE 9 TRINITY HOME HEALTH SERVICES INC 0 AUXILIARY OF HOLY ROSARY HOSPITAL 351 SW 9TH STREET ONTARIO OR 97914 943059469 SUPPORTS SERVICES OF RELATED HOSPITAL OR 501(C)(3) LINE 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 1 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) LINE 3 MERCY HEALTH SERVICES-IOWA CORP 0 BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH 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