2012-05-15T07:15:28-05:00 2011-06-30 990 2010-07-01 820200896 SAINT ALPHONSUS MEDICAL CENTER - NAMPA INC SAIN 2084635589 1512 12TH AVENUE ROAD NAMPA ID 836866008 B LANNIE CHECKETTS 2084635589 2012-05-15 2010 2016-02-24 21:20:13Z SEE SCHEDULE O KARL KEELER 1512 12TH AVENUE ROAD NAMPA ID 836866008 88902423 0 0928 X WWW.MERCYNAMPA.ORG X 2007 ID HEALTHCARE SERVICES 13 11 654 165 447488 -73760 466156 182503 83611033 84560967 1260169 1811133 2108541 2307657 87445899 88862260 18725 89733 0 0 33011632 32485462 0 0 0 51722604 51325229 84752961 83900424 2692938 4961836 73050318 88986955 11405781 17704535 61644537 71282420 X HEALTHCARE SERVICES - SEE SCHEDULE H FOR MORE INFORMATION 0 0 72268453 89733 85228927 SINCE 1917 WHEN THE SISTERS OF MERCY BEGAN PROVIDING CARE TO THE NAMPA, IDAHO COMMUNITY, SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. HAS BEEN COMMITTED TO THE PROVISION OF QUALITY HEALTHCARE REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, AGE OR ABILITY TO PAY. SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. IS THE ONLY CATHOLIC HOSPITAL TO SERVE THE NAMPA COMMUNITY. IT IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL.SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. IS A 152-BED ACUTE CARE HOSPITAL SERVING THE NEEDS OF THE GREATER NAMPA AREA. SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THE EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF THEIR ABILITY TO PAY. SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. HAS AN OPEN MEDICAL STAFF, PARTICIPATES IN MEDICARE AND MEDICAID, AND HAS AN ACTIVE CHARITY CARE PROGRAM.SEE SCHEDULE H FOR MORE INFORMATION. THE MISSION STATEMENT FOR SAINT ALPHONSUS MEDICAL CENTER - NAMPA,INC. IS AS FOLLOWS:WE SERVE TOGETHER IN TRINITY HEALTHIN THE SPIRIT OF THE GOSPELTO HEAL BODY, MIND AND SPIRITTO IMPROVE THE HEALTH OF OUR COMMUNITIESAND TO STEWARD THE RESOURCES ENTRUSTED TO US. 72268453 1 1 0 1 0 0 0 0 1 1 1 0 1 1 0 0 1 0 0 0 0 0 0 0 0 1 1 1 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 1 1 0 0 1 17 0 1 654 1 1 1 0 0 0 0 0 0 0 0 0 X 13 11 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 0 X B LANNIE CHECKETTS 2084635589 1512 12TH AVENUE ROAD NAMPA ID 83686 X B LANNIE CHECKETTS 49.00 X X 290066 0 28199 BRENT LLOYD 2.00 X X 0 0 0 GEORGE JUETTEN 2.00 X X 0 0 0 NATALIE RAYNOR 50.00 X X 56011 0 19098 JEFF AGENBROAD 2.00 X 0 0 0 STEVE BROCATO 2.00 X 0 0 0 LYNDA CLARK 2.00 X 0 0 0 ADEBAYO CROWNSON MD 2.00 X 0 186046 32275 SR SHARON FORD RSM 2.00 X 0 0 0 RONALD GRAVES 2.00 X 0 0 0 MARTI HALES 2.00 X 0 0 0 LYNN HARRIS 2.00 X 0 0 0 KENNETH HART 2.00 X 0 0 0 STUART HARTLEY 2.00 X 0 0 0 DUSTAN HUGHES MD 2.00 X 0 0 0 RANDALL HUTCHINGS 2.00 X 0 0 0 SALLY JEFFCOAT 2.00 X X 0 680947 100231 NED KERR 2.00 X 0 0 0 J RICHARD O'CONNELL 2.00 X 0 761373 137960 KAYE O'RIORDAN 2.00 X 0 0 0 SR RITA PARKS 2.00 X 0 0 0 DOLORES PREISINGER 2.00 X 0 0 0 SR SHARLET WAGNER CSC 2.00 X 0 0 0 JON WAGNILD MD 2.00 X 0 0 0 CHARLES WHITE 2.00 X 0 0 0 PAM WHITE 2.00 X 0 0 0 VICTOR YAMAMOTO 2.00 X 0 0 0 STEPHANIE WESTERMEIER 2.00 X 0 305382 34635 BLAINE PETERSEN 2.00 X 0 39832 1938 KARL KEELER 50.00 X 0 112811 6011 JOSEPH SWEDISH 2.00 X 0 2853932 791453 KEDRICK ADKINS 2.00 X 0 1160870 198248 MICHAEL SLUBOWSKI 2.00 X 0 1153164 271732 MICHAEL MURPHY 2.00 X 0 539823 68542 AUDRA PRATT 50.00 X 43532 198010 75050 CLINTON CHILD 50.00 X 215032 0 36210 JANELLE REILLY 2.00 X 0 363449 36738 JAMES POLK 2.00 X 0 354260 54343 PETER ROAN MD 50.00 X 510462 0 34167 BARRY MALLARD 50.00 X 147007 0 22757 DARWIN WATERS 50.00 X 131269 0 29914 ANDREW MORGAN 50.00 X 127026 0 12921 TREVOR WALKER 50.00 X 126592 0 18826 1646997 8709899 2011248 16 0 1 0 SOUND PHYSICIANS 1123 PACIFIC AVENUE TACOMA WA 98402 HEALTHCARE SERVICES 775973 ANESTHESIOLOGY CONSULTANTS ID 1512 12TH AVENUE ROAD NAMPA ID 83686 ANESTHESIA SERVICES 344167 ELITE SPECIALTY STAFFING INC 5903 FLAMINGO DRIVE BOISE ID 83704 STAFFING SERVICES 327532 APOGEE MEDICAL MGMT 2525 EAST CAMELBACK RD STE 1100 PHOENIX AZ 85016 HEALTHCARE SERVICES 299632 MEDICAL STAFFING NETWORK INC PO BOX 840416 DALLAS TX 75284 STAFFING SERVICES 282040 17 13000 28914 140589 182503 NET PATIENT SVC REV 900099 84198022 84198022 LABORATORY REVENUE 621500 362945 362945 84560967 643891 643891 791250 791250 791250 53832 737418 1207405 40163 1207405 -40163 1167242 1167242 CAFETERIA REVENUE 722100 452967 30711 422256 PHARMACY REVENUE 446110 32535 32535 1030905 1030905 1516407 88862260 85228927 447488 3003342 89733 89733 1052535 1052535 24675568 23349016 1326552 1516454 1408258 108196 3206225 2986261 219964 2034680 1653241 381439 9037 9037 67703 67703 5497233 4519592 977641 86451 1293 85158 1801135 1358546 442589 2079598 109029 1970569 1154602 1152494 2108 134615 95705 38910 10229 9233 996 47271 47271 1899029 1855847 43182 827688 827688 BAD DEBT 16726429 16726429 MEDICAL SUPPLIES 12458399 12458399 INTERCO. PURCHASED SVCS 4053768 141247 3912521 TAXES & LICENSE FEES 1728165 1701575 26590 UBI TAXES 30 30 2743847 2605254 138593 83900424 72268453 11631971 0 754811 111495 1285377 1122011 8084539 8068615 236086 77154 1968030 1883542 158407 79675 37019960 2395223 29730795 34624737 18056916 17417710 9161830 20446877 3613527 5155139 73050318 88986955 9428613 15380371 26398 7829 1950770 2316335 11405781 17704535 X 60365024 70160409 1274513 1117011 5000 5000 61644537 71282420 73050318 88986955 X 4961836 4676047 X X 0 1 1 X 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 4990 0 0 0 4990 0 EXPLANATION OF OTHER LOBBYING ACTIVITIES: PART II-B, LINE 1I: SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. HAS MADE GRANTS TO OTHER ORGANIZATIONS IN THE FORM OF MEMBERSHIP DUES PAID TO REGIONAL AND NATIONAL HEALTH CARE ORGANIZATIONS. THESE ORGANIZATIONS HAVE PROVIDED SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 5000 5000 5000 5000 1.00000 0 1 1 5931211 3810233 9741444 17887255 1102036 16785219 4730568 1293187 3437381 4660693 4660693 34624737 COMMINGLED FUNDS DIRECTLY HOLDING SECURITIES 2650521 F ABSOLUTE RETURN STRATEGY FUNDS 9466147 F BOND FUND 8330209 F 20446877 INTERCOMPANY RECEIVABLES 2025550 INVESTMENT IN ENTITIES 161865 MISCELLANEOUS RECEIVABLES 1031703 OTHER LONG-TERM ASSETS 1936021 5155139 INTERCOMPANY PAYABLES 970875 INTERCOMPANY NOTES PAYABLE 1172144 ASSET RETIREMENT OBLIGATION (FIN 47) 173316 2316335 DESCRIPTION OF INTENDED USE OF ENDOWMENT FUNDS: PART V, LINE 4: ENDOWMENT FUNDS ARE FOR THE SUPPORT OF VARIOUS MEDICAL PROGRAMS CONDUCTED BY SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. 1 1 X 1 X 1 X 1 1 1 0 1 1 1 1250 2036376 0 2036376 0.03030 31 3250 13154156 10637152 2517004 0.03750 32 4500 15190532 10637152 4553380 0.06780 18 20086 198909 456 198453 0.00300 2 1500 132082 0 132082 0.00200 2 5968 0 5968 0.00010 7 141 95735 2500 93235 0.00140 29 21727 432694 2956 429738 0.00650 61 26227 15623226 10640108 4983118 0.07430 1 380 254 25 229 0.00000 1 143 143 0.00000 1 2694 2694 0.00000 2 80 1187 1187 0.00000 1 243 243 0.00000 9 1332 70250 70250 0.00100 15 1792 74771 25 74746 0.00100 0 6075636 1336640 14836856 15971379 -1134523 X 1 1 1 MERCY OUTPATIENT SURGERY CENTER LLC SURGICAL CARE 0.60000 0.40000 1 1 SAINT ALPHONSUS MEDICAL CENTER - NAMPA

1512 12TH AVENUE ROAD NAMPA ID 83686

X X X NOT REQUIRED 1 PART I, LINE 6A: SAINT ALPHONSUS MEDICAL CENTER - NAMPA (SAMC - NAMPA) 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, SAMC - NAMPA 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, $16,726,429, 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 - SAMC- NAMPA STRIVES TO MAKE THE CITIZENS OF OUR COMMUNITY MORE PRODUCTIVE, HEALTHY MEMBERS OF SOCIETY. THROUGH OUR COMMUNITY NEEDS ASSESSMENT AND OTHER COMMUNITY DATA, WE LEARNED THAT SEVERAL AREAS CAN BENEFIT FROM OUR HEALTH CARE EXPERTISE AND MONETARY SUPPORT. PARTICIPATION IN LOCAL BOARDS AND TASK FORCES: SAINT ALPHONSUS LEADERS AND ASSOCIATES PARTICIPATE IN A VARIETY OF LOCAL NONPROFIT BOARDS AND TASK FORCES AIMED AT IMPROVING THE HEALTH OF OUR COMMUNITIES AND MAKING OUR COMMUNITY A MORE LIVABLE PLACE. EXAMPLES OF BOARD PARTICIPATION INCLUDE: - BOYS & GIRLS CLUBS OF CANYON COUNTY: ENHANCEMENT OF BEFORE AND AFTER-SCHOOL PROGRAMMING FOR LOCAL AT-RISK YOUTH. THE SAINT ALPHONSUS REPRESENTATIVE SERVES ON THE STEERING COMMITTEE AND MANAGES THE DATABASE FOR THE ANNUAL FUNDRAISER AUCTION (FORMERLY COMMUNITY SALE), WHICH BRINGS IN THE BULK OF ANNUAL OPERATING FUNDS FOR THE CLUB. - COMMUNITY MENTAL HEALTH MEETINGS: A SAINT ALPHONSUS REPRESENTATIVE PARTICIPATES IN DISCUSSIONS WITH MENTAL HEALTH PROVIDERS THROUGHOUT THE COMMUNITY, TO WORK THROUGH ISSUES AND IMPROVE COORDINATION OF SERVICES. - LATINO HEALTH COALITION: THE LATINO HEALTHCARE COALITION INCLUDES MEMBERS FROM SAMC-NAMPA, CASEY FAMILY SERVICES, BOISE STATE UNIVERSITY, IDAHO HEALTH AND WELFARE, IDAHO CENTRAL DISTRICT HEALTH, THE IDAHO COMMISSION ON HISPANIC AFFAIRS, CATHOLIC CHARITIES, THE HISPANIC CULTURAL CENTER, AND OTHER INTERESTED COMMUNITY MEMBERS. THE GOALS ARE TO REMOVE BARRIERS TO HEALTH CARE SERVICES; TO INCREASE THE LATINO PATIENT'S KNOWLEDGE REGARDING ACCESS TO HEALTH CARE; AND TO EMPOWER THEM TO BE MORE ACTIVE PARTICIPANTS IN THE HEALTH CARE TREATMENT AND DECISION-MAKING. - NAMPA MINISTERIAL ASSOCIATION: LOCAL PASTORS COME TOGETHER AT SAMC-NAMPA TO LEARN ABOUT COMMUNITY ACTIVITIES AND DISCUSS HOW THEY CAN HAVE AN IMPACT ON THE LOCAL ISSUES. THEY SPONSOR ECUMENICAL SERVICES FOR THANKSGIVING, LENTEN SERVICES AND BACCALAUREATE. SAMC-NAMPA'S CHAPLAINS PARTICIPATE WITH THIS GROUP. - HEALTH EDUCATION LEADERSHIP PROGRAM (HELP): DR. ROGER CURRAN FOUNDED HELP AS A WAY TO ADDRESS THE DEPARTMENT OF LABOR'S PREDICTIONS OF FUTURE SHORTAGES OF HEALTH PROFESSIONALS. HELP PROVIDES SCHOLARSHIPS TO STUDENTS PURSUING HEALTH CARE RELATED EDUCATION. HELP RAISES FUNDS THROUGH MEMORIAL CONTRIBUTIONS AND THE ANNUAL ROGER CURRAN FUN RUN. A SAMC-NAMPA REPRESENTATIVE PARTICIPATES ON THE BOARD. - LEADERSHIP NAMPA: PROVIDES IN-DEPTH EXPOSURE TO A VARIETY OF ISSUES THAT IMPACT THE CITIZENS OF NAMPA. INTERACTION TAKES PLACE WITH COMMUNITY LEADERS VISITING A VARIETY OF ORGANIZATIONS WITHIN NAMPA GIVING PARTICIPANTS A BROADENED PERSPECTIVE OF THE CHALLENGES AND OPPORTUNITIES FACING OUR COMMUNITY. SAMC-NAMPA REPRESENTATIVES PARTICIPATE IN THE CLASS. IN ADDITION, SAMC-NAMPA HOSTS THE CLASS ONE DAY EACH YEAR. - CANYON COUNTY FESTIVAL OF TREES: SAINT ALPHONSUS REPRESENTATIVES PARTICIPATE ON THE BOARD OF DIRECTORS TO BRING THE CANYON COUNTY FESTIVAL OF TREES FUNDRAISER TO NAMPA IN SUPPORT OF THE MEALS ON WHEELS PROGRAMS FOR NAMPA, CALDWELL, GREENLEAF, MIDDLETON AND SURROUNDING AREAS. SAMC-NAMPA IS A MAJOR SPONSOR OF THE FESTIVAL. - MERCY HOUSING: PROVIDES AFFORDABLE MULTIFAMILY HOUSING ACROSS THE STATE OF IDAHO AND SAMC-NAMPA PROVIDES SUPPORT IN TERMS OF PHYSICAL IMPROVEMENTS ON MERCY HOUSING PROPERTIES (NAMPA). - DISASTER READINESS: SAMC-NAMPA REPRESENTATIVE SITS ON THE COUNTY (LEPCE) AND DISTRICT (SWDH) PLANNING TEAMS AND PARTICIPATES IN DISCUSSIONS REGARDING DISASTER READINESS. - CHARITY CARE AND FINANCIAL ASSISTANCE: SAMC-NAMPA HAS ESTABLISHED A FINANCIAL ASSISTANCE PROGRAM TO ASSIST PATIENTS WHO DO NOT HAVE INSURANCE OR OTHER RESOURCES TO COVER THE FULL COST OF NECESSARY MEDICAL CARE. - MISSION AND MINISTRY GRANT: SAMC- NAMPA, FORMERLY RECEIVED GRANT FUNDING FROM CATHOLIC HEALTH INITIATIVES. THE MONIES RECEIVED SUPPORTED TERRY REILLY HEALTH SERVICES COMMUNITY CLINIC PROVIDING FAMILY CASE MANAGEMENT; LATINO HEALTHCARE ACCESS COALITION PROVIDING HEALTHCARE RESOURCES TO LATINO FAMILIES; KINSHIP CARE OFFERING SUPPORT FOR GRANDPARENTS RAISING GRANDCHILDREN; AND IMPROVEMENTS IN CHILD SAFETY, HEALTH AND EDUCATION; AND TEEN EDUCATION FOR CHILDBIRTH AND PARENTING. PART III, LINE 4: SAMC - NAMPA IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH. THE FOLLOWING IS THE TEXT OF THE ALLOWANCE FOR DOUBTFUL ACCOUNTS FOOTNOTE FROM THOSE STATEMENTS: "SUBSTANTIALLY ALL OF THE CORPORATION'S RECEIVABLES ARE RELATED TO PROVIDING HEALTHCARE SERVICES TO PATIENTS. ACCOUNTS RECEIVABLE ARE REDUCED BY AN ALLOWANCE FOR AMOUNTS THAT COULD BECOME UNCOLLECTIBLE IN THE FUTURE. THE CORPORATION'S ESTIMATE FOR ITS ALLOWANCE FOR DOUBTFUL ACCOUNTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS BY PAYOR."COSTING METHODOLOGY FOR LINES 2 AND 3: AMOUNTS ARE CALCULATED ON LINE 2 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.REVIEW AND DISCUSSION OF COLLECTION ACCOUNTS HELPED DETERMINE THE RATIO FOR THE CALCULATION AND THE KNOWLEDGE OF THE NUMBER OF PATIENTS WHO WILL NOT COMPLY WITH SUBMITTING THE REQUIRED DOCUMENTATION THAT WOULD AFFORD THEM THE DETERMINATION OF CHARITY OR OTHER RESOURCES. PART III, LINE 8: SAMC - NAMPA 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: SAMC - NAMPA'S COLLECTION POLICY CONTAINS THE CRITERIA FOR FINANCIAL ASSISTANCE, AND CONTAINS THE FOLLOWING VERBIAGE FOR ARRANGEMENTS WITH OUTSIDE COLLECTION AGENCIES: THE AGREEMENT MUST DEFINE THE STANDARDS AND SCOPE OF PRACTICES TO BE USED BY OUTSIDE COLLECTION AGENTS ACTING ON BEHALF OF THE SAINT ALPHONSUS HEALTH SYSTEM, ALL OF WHICH MUST BE IN COMPLIANCE WITH THIS POLICY. PART VI, LINE 2: NEEDS ASSESSMENT - EFFECTIVE APRIL 1, 2010, MERCY MEDICAL CENTER - NAMPA, IDAHO, HOLY ROSARY MEDICAL CENTER - ONTARIO, OREGON, AND ST. ELIZABETH HEALTH SERVICES - BAKER CITY, OREGON WERE PURCHASED BY TRINITY HEALTH. THESE HOSPITALS WERE COMBINED WITH SAINT ALPHONSUS REGIONAL MEDICAL CENTER TO FORM THE SAINT ALPHONSUS HEALTH SYSTEM (SAHS) TO STRENGTHEN THE CARE SERVICES AND IMPROVE THE HEALTH NEEDS OF THE COMMUNITIES.SAINT ALPHONSUS MEDICAL CENTER - NAMPA (SAMC - NAMPA), FORMERLY KNOWN AS MERCY MEDICAL CENTER, ASSESSES THE HEALTH NEEDS OF THE COMMUNITY THROUGH COMMUNITY NEEDS ASSESSMENTS EVERY THREE YEARS. A COMMUNITY NEEDS ASSESSMENT IS A POINT-IN-TIME EFFORT TO MEASURE THE HEALTH AND WELL BEING OF THE COMMUNITY. IT SERVES AS THE BASIS FOR SAHS STRATEGIC AND SUBSEQUENT ACTION PLANNING TO DEVELOP HEALTH POLICY, ALLOCATE RESOURCES, IMPROVE OR EXPAND EXISTING SERVICES, IMPLEMENT NEW PROGRAMS AND COLLABORATE WITH OTHER COMMUNITY HEALTHCARE PROVIDERS. A COMMUNITY NEEDS ASSESSMENT ALSO SERVES AS A BENCHMARK FOR FUTURE ASSESSMENT OF RELATIVE PROGRESS TOWARD ESTABLISHED COMMUNITY HEALTH OBJECTIVES.THE SAMC - NAMPA COMMUNITY NEEDS ASSESSMENT PROVIDES THE OPPORTUNITY TO:- GAIN INSIGHTS INTO THE NEEDS AND ASSETS OF THE COMMUNITIES SERVED - IDENTIFY AND ADDRESS THE NEEDS OF VULNERABLE POPULATIONS WITHIN THE COMMUNITY- ENHANCE HOSPITAL/COMMUNITY RELATIONSHIPS AND THE OPPORTUNITY FOR COLLABORATIVE COMMUNITY ACTION, INCLUDING INVOLVEMENT WITH COALITIONS, PARTNERSHIPS, BOARDS, COMMITTEES, COMMISSIONS, ADVISORY GROUPS AND PANELS- PROVIDE THE INFORMATION REQUIRED FOR COMMUNITY OUTREACH PLANNINGTHE COMMUNITY NEEDS ASSESSMENT PROCESS, PERFORMED JOINTLY BY SAHS AND SAMC - NAMPA, INVOLVES THE GATHERING OF TWO TYPES OF DATA: QUANTITATIVE (DEMOGRAPHICS, HEALTH INDICATORS, ETC.) AND QUALITATIVE (PUBLIC SURVEYS, FORUMS, FOCUS GROUPS). THE DATA HELPS SUPPORT SHORT-TERM AND LONG-TERM DECISIONS ABOUT ALLOCATION OF COMMUNITY HUMAN AND CAPITAL RESOURCES. THE SAHS COMMUNITY NEEDS ASSESSMENT IS CURRENT AS OF JUNE 2008 (WITH SEVERAL KEY AREAS UPDATED IN DECEMBER 2009), AND ACTION PLANS TO ADDRESS IDENTIFIED COMMUNITY NEEDS HAVE BEEN DEVELOPED THROUGH FY 2012. THE COMMUNITY NEEDS ASSESSMENT WAS CONDUCTED BY SAINT ALPHONSUS STAFF AND HAS BEEN MADE AVAILABLE TO THE COMMUNITY ON OUR WEBSITE. WE ALSO HAVE SHARED COPIES WITH OTHER NONPROFIT AGENCIES, SUCH AS UNITED WAY OF TREASURE VALLEY AND THE IDAHO NONPROFIT CENTER.DURING FY11, SAINT ALPHONSUS PARTNERED WITH UNITED WAY OF TREASURE VALLEY, ST. LUKE'S HEALTH SYSTEM, AND ELKS REHABILITATION HOSPITAL TO CONDUCT A COMPREHENSIVE COMMUNITY NEEDS ASSESSMENT FOCUSING ON HEALTH, EDUCATION AND FINANCIAL INDEPENDENCE. ASSESSMENT WORK WAS LARGELY COMPLETED DURING FY11, AND THE PARTNERS HAVE NOW MOVED INTO THE PROCESS OF PRIORITIZING NEEDS AND CREATING AN IMPLEMENTATION PLAN. BOISE STATE UNIVERSITY SERVED AS RESEARCH PARTNER, AND UTAH FOUNDATION HAS PROVIDED TECHNICAL ASSISTANCE TO THIS PROJECT. THIS ASSESSMENT COVERED BOTH ADA AND CANYON COUNTIES. PART VI, LINE 3: PATIENT EDUCATION OF ELIGIBILITY FOR ASSISTANCE - SAMC - NAMPA 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 AMERICAN HOSPITAL ASSOCIATION RECOMMENDATIONS, SAMC - NAMPA 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 OBLIGATIONSSAMC - NAMPA 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. SAMC - NAMPA HAS SIGNS POSTED IN ALL REGISTRATION AREAS AND PLASTIC TABLE TOP CARDS IN THE REGISTRATION WAITING ROOMS, NOTIFYING PATIENTS THAT FINANCIAL ASSISTANCE IS AVAILABLE. ALL SELF-PAY PATIENTS ARE OFFERED FINANCIAL ASSISTANCE FORMS. EACH PATIENT RECEIVES A BILLING BROCHURE THAT LISTS 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.SAMC - NAMPA 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 THROUGH SIGNS POSTED IN REGISTRATION AREAS, PLASTIC TABLE TOP CARDS IN REGISTRATION WAITING ROOMS AND PATIENT BROCHURES. SELF-PAY INPATIENTS AND SURGERY PATIENTS RECEIVE A VISIT FROM A FINANCIAL ACCOUNT REPRESENTATIVE WHO ASSISTS THEM IN COMPLETING FINANCIAL ASSISTANCE FORMS FOR COUNTY INDIGENT ASSISTANCE, MEDICAID, SOCIAL SECURITY AND HOSPITAL CHARITY CARE. SAMC - NAMPA HAS ESTABLISHED A WRITTEN POLICY FOR THE BILLING, COLLECTION AND SUPPORT FOR PATIENTS WITH PAYMENT OBLIGATIONS. SAMC - NAMPA 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 SAMC - NAMPA ENCOMPASSES A FIVE-COUNTY REGION OF SOUTHWEST IDAHO, INCLUDING CANYON, ADA, OWYHEE, PAYETTE AND GEM COUNTIES. AREA HOSPITAL FACILITIES INCLUDE ST. LUKE'S, IDAHO ELKS REHABILITATION CENTER, TREASURE VALLEY HOSPITAL, AND WEST VALLEY MEDICAL CENTER.SAMC - NAMPA'S PRIMARY SERVICE AREA IS A MIX OF URBAN AND RURAL COMMUNITIES WITHIN THE TREASURE VALLEY, BORDERED BY RUGGED MOUNTAINOUS TERRAIN AND DESERT. THE REGION HAS EXPERIENCED RAPID POPULATION GROWTH SINCE 2000. ADA COUNTY POPULATION GREW 30.4% FROM 2000-2010 WHILE CANYON COUNTY POPULATION GREW 43.7% FROM 2000-2010.WITH MEDIAN HOUSEHOLD INCOMES OF $39,457 IN CANYON COUNTY AND $53,828 IN ADA COUNTY, AREA RESIDENTS ARE WITHIN RANGE OF THE STATE MEDIAN OF $44,644. THE POVERTY LEVEL STANDS AT 18.2% IN CANYON COUNTY AND 11.8% IN ADA, COMPARED TO A STATE AVERAGE OF 14.4% AND A NATIONAL AVERAGE OF 14.3%. AS OF SEPTEMBER 2011, THE 8.5% UNEMPLOYMENT RATE WAS SLIGHTLY LOWER THAN THE STATE RATE (9%), AND THE NATIONAL RATE OF 9.1% (BUREAU OF LABOR STATISTICS). OTHER RELEVANT STATISTICS CHARACTERIZING SAMC-NAMPA'S PRIMARY SERVICE AREA ARE INCLUDED BELOW (FROM CENSUS.GOV QUICK FACTS, 2011):TOTAL POPULATION (2010): ADA COUNTY - 392,365CANYON COUNTY - 188,923OWYHEE COUNTY - 11,526GEM COUNTY - 16,719PAYETTE COUNTY - 22,623PERCENT WHITE PERSONS NOT HISPANIC:ADA COUNTY - 86.5%CANYON COUNTY - 72.3%OWYHEE COUNTY - 68.3%GEM COUNTY - 89.1%PAYETTE COUNTY - 81.3%PERCENT HISPANIC/LATINO ORIGIN:ADA COUNTY - 7.1%CANYON COUNTY - 23.9%OWYHEE COUNTY - 25.8%GEM COUNTY - 8%PAYETTE COUNTY - 14.9%MEDIAN HOUSEHOLD INCOME (2009):ADA COUNTY - $53,828CANYON COUNTY - $39,457OWYHEE COUNTY - $33,753GEM COUNTY - $42,396PAYETTE COUNTY - $45,974PERSONS BELOW POVERTY LEVEL (2009):ADA COUNTY - 11.8%CANYON COUNTY - 18.2%OWYHEE COUNTY - 17.4%GEM COUNTY - 14.8%PAYETTE COUNTY - 15.5%MEDICALLY UNDERSERVED POPULATIONS AND HEALTH PROFESSIONAL SHORTAGE AREAS WITHIN OUR SERVICE AREA INCLUDE A SHORTAGE OF PRIMARY CARE AND MENTAL HEALTH SERVICES.THE REGION SEES A HIGH PREVALENCE OF MENTAL HEALTH & SUBSTANCE ABUSE ISSUES, WITH INADEQUATE PUBLIC BEHAVIORAL HEALTH SYSTEMS IN PLACE TO MEET THE EXISTING NEEDS FOR COMMUNITY-BASED AND INPATIENT SERVICES.ON REVIEW OF DEMOGRAPHIC AND SOCIO-ECONOMIC DATA AND TRENDS, SEVERAL FACTORS CLEARLY HAVE AN IMPACT ON THE HEALTH STATUS OF THE COMMUNITIES SERVED BY SAMC - NAMPA, WITH IMPLICATIONS FOR FUTURE PLANNING. DRAMATIC POPULATION GROWTH, ESPECIALLY IN ADA AND CANYON COUNTIES, IS EXPECTED TO CONTINUE, WITH A GROWING HISPANIC POPULATION. THE GROWING REFUGEE POPULATION HAS GREATER LANGUAGE INTERPRETATION AND HEALTH EDUCATION NEEDS AS WELL.GROWTH IN IDAHO'S SENIOR POPULATION IS ALSO PROJECTED TO ACCELERATE, WHICH WILL REQUIRE INCREASED HEALTH CARE SPENDING. MAMMOGRAPHY RATES, THE RISING RATE OF LOW BIRTH WEIGHT BABIES, OVERWEIGHT AND OBESITY, TOBACCO USE, MENTAL HEALTH AND DRINKING/DRUG USE ARE ALSO OF GREAT CONCERN. PART VI, LINE 6: OTHER INFORMATION - SAINT ALPHONSUS STRONGLY SUPPORTS HEALTHCARE WORKFORCE DEVELOPMENT EFFORTS FOR AN ARRAY OF DIFFERENT CLINICAL STUDENTS. WE HAVE COMPLETED AN ASSORTMENT OF TRAINING FOR SOCIAL WORK AND PHLEBOTOMY STUDENTS, AND CNA'S, EMT'S, RT'S, PA'S AND NURSES IN THE AREAS OF OBSTETRICS AND MEDICAL/ SURGICAL, ICU AND ER. IN ADDITION, SAINT ALPHONSUS SERVES AS A KEY CLINICAL TRAINING SITE FOR STUDENTS ATTENDING BOISE STATE UNIVERSITY, IDAHO STATE UNIVERSITY, NORTHWEST NAZARENE UNIVERSITY, COLLEGE OF WESTERN IDAHO, COLLEGE OF SOUTHERN IDAHO, STEVENS-HENEGER COLLEGE, MILAN INSTITUTE, IDAHO CENTER FOR EMERGENCY TRAINING AND THE NAMPA SCHOOL DISTRICT.SAINT ALPHONSUS ALSO COLLABORATES WITH UNITED WAY OF TREASURE VALLEY TO ADDRESS COMMUNITY NEEDS IN THE AREAS OF HEALTH, EDUCATION AND INCOME. SAINT ALPHONSUS HAS AN ANNUAL UNITED WAY WORKPLACE GIVING CAMPAIGN TO SUPPORT UNITED WAY INITIATIVES AND GRANTS TO LOCAL NONPROFITS PRODUCING MEASURABLE OUTCOMES IN ADDRESSING TOP COMMUNITY NEEDS.CANCER EDUCATION & AWARENESS: SAMC-NAMPA PARTNERS WITH SUSAN G. KOMEN, AND THE SNAKE RIVER STAMPEDE - STAMPEDE FOR THE CURE, TO SUPPORT THE UNINSURED AND PROVIDE SCREENING MAMMOGRAMS. SAMC-NAMPA ALSO PARTNERS WITH THE NAMPA SCHOOL DISTRICT, AND OTHER LOCAL BUSINESSES TO PROVIDE CANCER EDUCATION AND AWARENESS. MERCY FITNESS PARK: SAMC-NAMPA MAINTAINS THE MERCY FITNESS PARK PROMOTING HEALTHY HABITS AND PROVIDING FREE ACCESS TO THE COMMUNITY. HANDS OF HOPE: A FAITH-BASED ORGANIZATION THAT SUPPLIES USED OR USEABLE MEDICAL EQUIPMENT FOR OVERSEAS MISSIONS, AND COOPERATES WITH LOCAL AGENCIES TO LOAN EQUIPMENT TO INDIVIDUALS IN NEED IN OUR COMMUNITY. SAMC-NAMPA DONATED $86,511 IN MEDICAL SUPPLIES/EQUIPMENT TO THIS ORGANIZATION DURING FY 2011. PART VI, LINE 7: SAMC - NAMPA IS A MEMBER ORGANIZATION OF TRINITY HEALTH, ONE OF THE LARGEST CATHOLIC HEALTH CARE SYSTEMS IN THE COUNTRY. BASED IN NOVI, MICHIGAN, TRINITY HEALTH ANNUALLY REQUIRES THAT ALL MEMBER ORGANIZATIONS DEVELOP, AND ARE HELD ACCOUNTABLE FOR ACHIEVING, COMMUNITY BENEFIT GOALS THAT INCLUDE DEVELOPING NEEDED SERVICES OR EXPANDING ACCESS TO SERVICES FOR LOW-INCOME INDIVIDUALS. AS A NOT-FOR-PROFIT HEALTH SYSTEM, TRINITY HEALTH REINVESTS ITS PROFITS BACK INTO THE COMMUNITY THROUGH PROGRAMS TO SERVE THE POOR AND UNINSURED, MANAGE CHRONIC CONDITIONS LIKE DIABETES, HEALTH EDUCATION AND PROMOTION INITIATIVES, AND OUTREACH FOR THE ELDERLY. IN FISCAL YEAR 2011, THIS INCLUDED NEARLY $453 MILLION IN SUCH COMMUNITY BENEFITS. THEREFORE, TRINITY HEALTH TAKES A SYSTEMS APPROACH IN ITS COMMUNITY BENEFIT PLANNING AND IMPLEMENTATION, AND IS CONSEQUENTLY ABLE TO ENSURE THAT ITS MEMBER HOSPITALS AND OTHER ENTITIES/AFFILIATES ARE HELPING PROMOTE AND ADDRESS THE HEALTH NEEDS OF THEIR RESPECTIVE COMMUNITIES. FOR MORE INFORMATION ABOUT TRINITY HEALTH, VISIT WWW.TRINITY-HEALTH.ORG. 1 NAMPA HARVEST FESTIVAL ASSOCIATION 16114 IDAHO CENTER BLVD STE 4 NAMPA ID 83687 820148165 501(C)(4) 12500 SUPPORT OF THE ANNUAL SNAKE RIVER STAMPEDE HANDS OF HOPE NORTHWEST INC PO BOX 161 NAMPA ID 83653 841398889 501(C)(3) 86511 BOOK MEDICAL SUPPLIES & EQUIPMENT GENERAL SUPPORT 1 1 PROCEDURE FOR MONITORING GRANTS IN THE U.S.: PART I, LINE 2: SCHEDULE I, PART I, LINE 2: DONATIONS MADE BY SAMC - NAMPA TO CHARITABLE ORGANIZATIONS ARE MADE IN FURTHERANCE OF THE RECIPIENT ORGANIZATION'S EXEMPT PURPOSE AND ARE CONSIDERED UNRESTRICTED WITH REGARD TO THE USE OF THE FUNDS. X X X X 1 1 0 0 0 0 0 0 0 B LANNIE CHECKETTS 262382 0 27282 0 402 0 10095 0 18104 0 318265 0 0 0 ADEBAYO CROWNSON MD 0 184565 0 1392 0 89 0 7622 0 24653 0 218321 0 0 SALLY JEFFCOAT 0 455371 0 163850 0 61726 0 78781 0 21450 0 781178 0 0 J RICHARD O'CONNELL 0 533392 0 113794 0 114187 0 116680 0 21280 0 899333 0 0 STEPHANIE WESTERMEIER 0 249155 0 55745 0 482 0 18755 0 15880 0 340017 0 0 JOSEPH SWEDISH 0 1240774 0 645161 0 967997 0 763945 0 27508 0 3645385 0 690161 KEDRICK ADKINS 0 717356 0 326029 0 117485 0 184461 0 13787 0 1359118 0 0 MICHAEL SLUBOWSKI 0 701008 0 291561 0 160595 0 246925 0 24807 0 1424896 0 42832 MICHAEL MURPHY 0 343184 0 68618 0 128021 0 47238 0 21304 0 608365 0 0 AUDRA PRATT 43532 138260 0 21097 0 38653 0 68164 0 6886 43532 273060 0 0 CLINTON CHILD 192388 0 22529 0 115 0 8717 0 27493 0 251242 0 0 0 JANELLE REILLY 0 292035 0 70445 0 969 0 20382 0 16356 0 400187 0 0 JAMES POLK 0 281447 0 68676 0 4137 0 37606 0 16737 0 408603 0 0 PETER ROAN MD 484191 0 23750 0 2521 0 14420 0 19747 0 544629 0 0 0 BARRY MALLARD 146623 0 0 0 384 0 6145 0 16612 0 169764 0 0 0 DARWIN WATERS 131116 0 0 0 153 0 7697 0 22217 0 161183 0 0 0 PART I, LINES 4A-B THE FOLLOWING INDIVIDUAL RECEIVED A SEVERANCE PAYMENT IN CALENDAR 2010. THIS AMOUNT IS INCLUDED IN COLUMN B(III): AUDRA PRATT - $27,865 IN ADDITION, COLUMN (C) OF SCHEDULE J, PART II INCLUDES $58,517 OF SEVERANCE FOR AUDRA PRATT WHICH WAS UNPAID AS OF 12/31/10. THE $58,517 WAS PAID AND INCLUDED IN AUDRA PRATT'S TAXABLE INCOME FOR 2011. PART I, LINE 4B: THE FOLLOWING ARE PARTICIPANTS IN THE TRINITY HEALTH PENSION RESTORATION PLAN, A NONQUALIFIED PLAN, WHICH PROVIDES RETIREMENT BENEFITS FOR CERTAIN ASSOCIATES WITH EARNINGS ABOVE THE IRS PAY CAP FOR QUALIFIED PLANS ($245,000 FOR 2010). THE FOLLOWING ACCRUAL FOR 2010 FOR THIS PLAN IS INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $113,498 SALLY JEFFCOAT - $54,476 KARL KEELER - $1,586 MICHAEL MURPHY - $26,316 J. RICHARD O'CONNELL - $83,058 MICHAEL SLUBOWSKI - $136,445 JOSEPH SWEDISH - $223,342 THE FOLLOWING ARE PARTICIPANTS IN A SUPPLEMENTAL EXECUTIVE RETIREMENT PLAN (SERP). THE FOLLOWING SERP ACCRUALS FOR 2010 ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS - $49,977 MICHAEL SLUBOWSKI - $77,185 JOSEPH SWEDISH - $511,613 MEDNOW INC B. LANNIE CHECKETTS, SAMC-NAMPA CFO, IS AN OFFICER OF MEDNOW, INC. 115125 VARIOUS TRANSACTIONS BETWEEN SAMC - NAMPA AND MEDNOW. MEDNOW IS OWNED 100% BY SAMC - NAMPA. SEE SCHEDULE R PART V FOR MORE INFORMATION. 0 BLUE CROSS OF IDAHO (BCI) SALLY JEFFCOAT, TRUSTEE, SERVES ON THE BOARD OF BCI 13212759 PAYMENTS MADE BY BLUE CROSS OF IDAHO TO SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC. FOR HEALTH CARE SERVICES PROVIDED TO BCI COVERED MEMBERS. 0 FORM 990, PART VI, SECTION A, LINE 2 KAYE O'RIORDAN, TRUSTEE, AND BRENT LLOYD, CHAIR, HAVE A BUSINESS RELATIONSHIP. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF SAINT ALPHONSUS MEDICAL CENTER - NAMPA, 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 - NAMPA, INC. SAINT ALPHONSUS HEALTH SYSTEM, INC. HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF TRUSTEES OF SAINT ALPHONSUS MEDICAL CENTER - NAMPA, 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 - NAMPA, INC. IS REVIEWED BY SENIOR MANAGEMENT. 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 - NAMPA, INC. (SAMC - NAMPA) 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 SAMC - NAMPA, 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 SAMC - NAMPA'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO SAMC - NAMPA 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 SAMC - NAMPA IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO SAMC - NAMPA. 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 SAMC - NAMPA 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 SAMC - NAMPA 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 SAMC - NAMPA 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, SAMC - NAMPA INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON BOTH ITS OWN WEBSITE AND TRINITY HEALTH'S WEBSITE. ESTIMATE OF THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: FORM 990, PART VII, SECTION A, LINE 1, COLUMN B: THE HOURS LISTED IN COLUMN B OF PART VII, SECTION A, LINE 1 REFLECT ONLY THE INDIVIDUALS' AVERAGE WEEKLY HOURS SPENT DIRECTLY ON THE ACTIVITIES OF THE REPORTING ORGANIZATION. IN ADDITION, THESE ARE THE AVERAGE HOURS PER WEEK DEVOTED TO RELATED ORGANIZATIONS: KEDRICK ADKINS - 53 HOURS B. LANNIE CHECKETTS - 1 HOUR ADEBAYO CROWNSON - 48 HOURS SALLY JEFFCOAT - 48 HOURS MICHAEL MURPHY - 53 HOURS J. RICHARD O'CONNELL - 53 HOURS BLAINE PETERSEN - 48 HOURS JAMES POLK - 48 HOURS JANELLE REILLY - 48 HOURS MICHAEL SLUBOWSKI - 53 HOURS JOSEPH SWEDISH - 53 HOURS STEPHANIE WESTERMEIER - 48 HOURS CHANGES IN NET ASSETS OR FUND BALANCES: FORM 990, PART XI, LINE 5: NET UNREALIZED GAINS ON INVESTMENTS: 2,208,076. NET ASSETS RELEASED FROM RESTRICTIONS FOR CAPITAL ACQUISITIONS: 15,153. GAIN ON SALE, DIVESTITURES: 2,303,547. EQUITY GAIN IN UNCONSOLIDATED AFFILIATES: 149,271. TOTAL TO FORM 990, PART XI, LINE 5: 4,676,047. FORM 990, PART XII, LINE 2: SAINT ALPHONSUS MEDICAL CENTER - NAMPA, INC.'S FINANCIAL STATEMENTS WERE INCLUDED IN THE FY11 CONSOLIDATED FINANCIAL STATEMENTS OF TRINITY HEALTH, WHICH WERE AUDITED BY AN INDEPENDENT PUBLIC ACCOUNTING FIRM. FORM 990, PAGE 1, DOING BUSINESS AS: SAINT ALPHONSUS MEDICAL CENTER-NAMPA ADDITIONALLY, THE FORMER NAME OF SAINT ALPHONSUS MEDICAL CENTER-NAMPA, INC. WAS MERCY MEDICAL CENTER. THIS NAME CHANGE WAS EFFECTIVE NOVEMBER 17, 2010. ADVANTAGE HEALTHSAINT MARY'S MEDICAL GROUP 245 STATE ST SE GRAND RAPIDS MI 49503 272491974 HEALTHCARE SERVICES MI 501(C)(3) 9 TRINITY HEALTH-MICHIGAN 0 AMICARE HOSPICE SERVICES INC 27870 CABOT DRIVE NOVI MI 483772920 382949053 PROVIDE HOSPICE SERVICES MI 501(C)(3) 11, TYPE I 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) 9 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 0 BATTLE CREEK HEALTH SYSTEM 300 NORTH AVENUE BATTLE CREEK MI 49016 382776791 HEALTHCARE SERVICES MI 501(C)(3) 3 TRINITY HEALTH - MICHIGAN 0 BATTLE CREEK HEALTH SYSTEM AUXILIARY 300 NORTH AVENUE BATTLE CREEK MI 49016 383355520 SUPPORT OF TAX EXEMPT HEALTH ORGANIZATION MI 501(C)(3) 11, TYPE I BATTLE CREEK HEALTH SYSTEM 0 BAUM HARMON MERCY HOSPITAL 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 421500277 ACUTE/AMBULATORY HEALTHCARE SERVICES IA 501(C)(3) 3 MERCY HEALTH SERVICES-IOWA CORP 0 BAUM HARMON MERCY HOSPITAL & CLINICS FOUNDATION 255 NORTH WELCH AVENUE PRIMGHAR IA 51245 262973307 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I BAUM HARMON MERCY HOSPITAL 0 CAPITAL PARK FAMILY HEALTH CENTER INC 6150 EAST BROAD STREET COLUMBUS OH 43213 311387838 OPERATION OF A FEDERALLY QUALIFIED HEALTH CENTER (FORMERLY) OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 0 CATHERINE MCAULEY HEALTH SERVICES CORP PO BOX 995 ANN ARBOR MI 48106 382507173 FURTHER TRINITY HEALTH ACTIVITIES, ORGANIZE AND DEVELOP MEDICAL SERVICES MI 501(C)(3) 11, TYPE II TRINITY HEALTH-MICHIGAN 0 COMMUNITY HEALTH PARTNERS OF SOUTH BEND PO BOX 3998 SOUTH BEND IN 46619 263051440 HEALTHCARE SERVICES IN 501(C)(3) 3 SAINT JOSEPH REGIONAL MEDICAL CENTER INC 0 CRANBROOK HOSPICE CARE 281 ENTERPRISE COURT BLOOMFIELD HILLS MI 48302 383320699 PROVIDE HOSPICE HEALTH SERVICES MI 501(C)(3) 11, TYPE I TRINITY HOME HEALTH SERVICES INC 0 DILEY RIDGE MEDICAL CENTER 6150 EAST BROAD STREET COLUMBUS OH 43213 342032340 HOSPITAL CAMPUS IN FAIRFIELD COUNTY OHIO OH 501(C)(3) 3 MOUNT CARMEL HEALTH SYSTEM 0 DUBUQUE MERCY HEALTH FOUNDATION INC 250 MERCY DRIVE DUBUQUE IA 52001 262227941 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP 0 DYERSVILLE HEALTH FOUNDATION INC 1111 3RD STREET SW DYERSVILLE IA 52040 205383271 SUPPORT THE SERVICES OF RELATED HOSPITAL IA 501(C)(3) 11, TYPE I MERCY HEALTH SERVICES-IOWA CORP 0 HACKLEY HOSPITAL 1700 CLINTON ST PO BOX 3302 MUSKEGON MI 494433302 381358196 HEALTHCARE SERVICES MI 501(C)(3) 3 MERCY HEALTH PARTNERS 0 HACKLEY HOSPITAL SELF INSURANCE PROFESSIONAL LIABILITY TRUST PO BOX 3302 MUSKEGON MI 494433302 382299878 SELF INSURANCE FOR GENERAL AND MALPRACTICE LIABILITY MI 501(C)(3) 11, TYPE III-FI MERCY HEALTH PARTNERS 0 HACKLEY LIFE COUNSELING 1352 TERRACE ST MUSKEGON MI 494423545 381386362 COUNSELING, EDUCATION, AND SUPPORT MI 501(C)(3) 9 MERCY HEALTH PARTNERS 0 HACKLEY VISITING NURSE SERVICES AND HOSPICE INC 888 TERRACE ST MUSKEGON MI 49440 381359598 PROVIDE HOME HEALTH CARE SERVICES MI 501(C)(3) 7 MERCY HEALTH PARTNERS 0 HOLY CROSS CARENET INC PO BOX 9184 FARMINGTON HILLS MI 48333 521945054 LONG-TERM CARE AND REHABILITATION FOR THE ELDERLY MD 501(C)(3) 9 TRINITY CONTINUING CARE SERVICES 0 HOLY CROSS HOSPITAL FOUNDATION INC 11801 TECH ROAD SILVER SPRING MD 20904 208428450 CHARITABLE FUNDRAISING MD 501(C)(3) 11, TYPE I HOLY CROSS HOSPITAL OF SILVER SPRING INC 0 HOLY CROSS HOSPITAL OF SILVER SPRING INC 1500 FOREST GLEN RD SILVER SPRING MD 209101484 520738041 HEALTHCARE SERVICES MD 501(C)(3) 3 TRINITY HEALTH CORPORATION 0 HOLY CROSS MEDICAL CENTER 27870 CABOT DRIVE NOVI MI 483772920 951985442 HEALTHCARE SERVICES (FORMERLY) CA 501(C)(3) 3 TRINITY HEALTH CORPORATION 0 HOLY ROSARY MEDICAL CENTER FOUNDATION 351 SW 9TH STREET ONTARIO OR 97914 202683560 SUPPORT THE SERVICES OF RELATED HOSPITAL OR 501(C)(3) 11, TYPE I SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 0 HOSPICE OF NORTH IOWA 232 SECOND STREET SE MASON CITY IA 504016208 421173708 HOSPICE 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