2011-05-09T09:58:16-05:00 2010-06-30 990 2009-07-01 870790288 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL MOUN 6145464300 7333 SMITHS MILL ROAD NEW ALBANY OH 430549291 JACQUELINE PRIMEAU 6145464300 2011-05-09 2009 2016-02-24 21:20:13Z JACQUELINE PRIMEAU 6150 EAST BROAD ST COLUMBUS OH 43213 97107613 0 X WWW.MOUNTCARMELHEALTH.COM X 2006 OH SPECIALTY HOSPITAL PROVIDING ORTHOPEDIC, NEUROLOGIC AND MUSCULOSKELETAL CARE 5 2 0 20 0 0 1134 93288821 96152318 -288583 0 607673 954161 93607911 97107613 0 0 0 0 0 76269937 79655697 76269937 79655697 17337974 17451916 100178235 95576073 9120457 7754480 91057778 87821593 SPECIALTY HOSPITAL PROVIDING INPATIENT AND OUTPATIENT ORTHOPEDIC, NEUROLOGIC AND MUSCULOSKELETAL CARE - SEE SCHEDULE H FOR MORE INFORMATION 0 0 74668231 96715371 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL IS THE NEWEST ADDITION TO THE MOUNT CARMEL HEALTH SYSTEM SINCE ITS PURCHASE ON JANUARY 1, 2007. MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL IS A PLACE WHERE YEARS OF PHYSICIAN EXPERIENCE MEET PERSONAL ATTENTION - WHERE WORLD-CLASS CARE MEETS WORLD-CLASS CARING. AS A SPECIALTY HOSPITAL FOCUSED SOLELY ON INPATIENT AND OUTPATIENT ORTHOPEDIC, NEUROLOGIC AND MUSCULOSKELETAL CARE, IT IS A FACILITY BUILT DIFFERENTLY FROM THE GROUND UP; A PLACE WHERE TECHNOLOGY AND TOUCH PLAY AN EQUAL ROLE IN THE HEALING PROCESS. MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL FEATURES TECHNOLOGICALLY ADVANCED TREATMENTS COMBINED WITH A PURPOSEFUL CARING PHILOSOPHY FOR EACH PATIENT.THE TWO-STORY FACILITY INCLUDES 96,000 SQUARE FEET, FORTY-TWO PATIENT ROOMS AND EIGHT OPERATING ROOMS. APPROXIMATELY EIGHTY PERCENT OF THE PROCEDURES PERFORMED AT MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL ARE DONE ON AN OUTPATIENT BASIS. THE REMAINING TWENTY PERCENT ARE INPATIENT AND ARE PRIMARILY TOTAL JOINT REPLACEMENT AND SPINE PROCEDURES. MISSIONTHE MISSION STATEMENT FOR THE HOSPITAL IS AS FOLLOWS: WE SERVE TOGETHER IN TRINITY HEALTH IN THE SPIRIT OF THE GOSPEL TO HEAL BODY, MIND AND SPIRIT TO IMPROVE THE HEALTH OF OUR COMMUNITIES AND TO STEWARD THE RESOURCES ENTRUSTED TO US. 74668231 1 0 0 1 0 0 0 0 0 1 0 1 0 0 0 0 0 0 0 0 1 0 0 1 0 0 0 0 0 0 0 1 0 0 0 0 0 1 0 1 0 1 0 0 1 0 0 0 0 0 0 0 0 0 0 5 2 1 1 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 0 X JACQUELINE PRIMEAU 6145464300 6150 EAST BROAD STREET COLUMBUS OH 43213 CLAUS VON ZYCHLIN 5.00 X X 0 1007069 70248 CARL BERASI DO 2.00 X X 0 0 0 SR BARBARA HAHL CSC 5.00 X X 0 0 8213 CHARLES HICKEY MD 2.00 X 0 0 0 ROBERT DURBIN MD 2.00 X 0 0 0 CHARLES KERR DO 2.00 X 0 0 0 JACQUELINE PRIMEAU 5.00 X 0 491642 32586 RICHARD D'ENBEAU 50.00 X 700928 0 0 RONALD WHITESIDE 5.00 X 0 453976 269271 JOHN HEISLER 5.00 X 0 299295 43505 HUGH JONES 5.00 X 0 286450 32785 JOSEPH SWEDISH 2.00 X 0 3023292 798303 MICHAEL SLUBOWSKI 2.00 X 0 1617841 154389 KEDRICK ADKINS 2.00 X 0 1453695 130171 J RICHARD OCONNELL 2.00 X 0 495143 11123 ANGELA M GILMORE 40.00 X 0 121410 23329 DONNA HUTCHINSON 40.00 X 0 103370 21919 CHRISTINA ROSS 40.00 X 0 101429 19677 MARY BOTOS 40.00 X 0 101264 41454 700928 9555876 1656973 1 0 1 1 NEW ALBANY HOSPITAL MANAGEMENT COMPANY I 11 SECOND STREET NEW ALBANY OH 43054 MANAGEMENT SERVICES 1823428 SODHEXHO INC AND AFFILIATES 4880 PAYSHERE CIRCLE CHICAGO IL 60674 MANAGEMENT SERVICES 1278726 LABORATORY CORPORATION OF AMERICA 6370 WILCOX RD DUBLIN OH 43016 LABORATORY SERVICES 1043961 ELFORD INC 1220 DUBLIN ROAD COLUMBUS OH 43215 CONSTRUCTION SVCS 764161 MESSER CONSTRUCTION 5158 FISHWICK DRIVE CINCINNATI OH 45216 CONSTRUCTION SVCS 672000 14 1134 1134 NET PATIENT SVC REV 621110 96152318 96152318 96152318 OTHER REVENUE 900099 563053 563053 CAFETERIA 900099 391108 391108 954161 97107613 96715371 0 391108 4138486 2288057 1850429 2316075 1687947 628128 2000 2000 35852061 35174292 677769 2273233 2146002 127231 12662 7789 4873 35226 15960 19266 1400792 1400792 6727494 6516271 211223 407824 407824 LBR COSTS PD BY PARENT 12768686 11436976 1331710 CORPORATE ALLOCATION 7810717 7810717 CONTRACT LABOR 3007876 3007876 HOSPITAL PROVIDER TAX 1202243 1202243 BAD DEBT 946192 946192 754130 619293 134837 79655697 74668231 4987466 0 400 700 11220708 8649206 511321 708525 560037 617361 52918461 8031343 44933357 44887118 42924979 40290389 27433 422774 100178235 95576073 9120457 7663385 0 91095 9120457 7754480 X 91057778 87821593 91057778 87821593 100178235 95576073 X 0 1 1 X 0 X 0 0 0 0 0 1 2326 0 0 0 2326 0 Part II-B, Line 1i: Explanation of Other Lobbying Activities: MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL (MCNASH) HAS MADE GRANTS TO OTHER ORGANIZATIONS FOR LOBBYING PURPOSES. THESE GRANTS HAVE BEEN IN THE FORM OF MEMBERSHIP DUES PAID TO STATE AND NATIONAL ORGANIZATIONS, WHERE THE ORGANIZATION HAS PROVIDED MCNASH WITH AN ESTIMATED PERCENTAGE OF DUES PAYMENTS WHICH ARE USED FOR LOBBYING ACTIVITIES. MCNASH MADE NO CONTRIBUTIONS TO ANY LEGISLATORS OR CANDIDATES. 8091311 8091311 36507682 4915409 31592273 7809374 3115934 4693440 510094 510094 44887118 OTHER CURRENT LIABILITIES 91095 91095 Part X: Description of Uncertain Tax Positions Under FIN 48: MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF ITS SOLE MEMBER, MOUNT CARMEL HEALTH SYSTEM (MCHS). MCHS' FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2010 DID NOT INCLUDE A FIN 48 FOOTNOTE. MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL is ALSO included in the consolidated financial statements of Trinity Health (THE SOLE MEMBER OF MOUNT CARMEL HEALTH SYSTEM). Trinity Health's financial statements for the year ended June 30, 2010 did not include a FIN 48 footnote. 1 1 X 1 X 1 X 1 1 0 1 1 1 184 925722 0 925722 0.01180 4 136 2158048 719278 1438770 0.01830 5 320 3083770 719278 2364492 0.03010 5 320 3083770 719278 2364492 0.03010 1 351962 70 17828999 21149087 -3320088 X 1 1 Mount Carmel New Albany Surgical Hosp

7333 Smiths Mill Road New Albany OH 43054

X X X Part I, Line 3c: Part I, Line 6a: Mount carmel new albany surgical hospital 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, mount carmel new albany surgical Hospital includes a copy of its most recently filed schedule H on trinity health's website as well as mount carmel health system's website (www.mountcarmelhealth.com). 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, Line 7f: The following number, $946,192, 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 III, Line 4: MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL 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.THE ORGANIZATION IDENTIFIES MANY CHARITY PATIENTS AT THE TIME OF SERVICE AND INCLUDES A CHARITY APPLICATION WITH EVERY STATEMENT PER OHIO LAW. THE AMOUNT ON LINE 3 WAS OBTAINED BY A THIRD PARTY VENDOR, QUALINK, WHO REVIEWS ACCOUNTS ASSIGNED TO BAD DEBT WHO MAY QUALIFY FOR HCAP, OHIO'S PROGRAM FOR THE INDIGENT POPULATION, IN ORDER TO IDENTIFY ANY REMAINING DOLLARS THAT MAY QUALIFY FOR CHARITY. Part III, Line 8: 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, Mount Carmel New Albany Surgical hospital does not believe any Medicare shortfall should be treated as community benefit.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 ORGANIZATION'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 MINISTRY ORGANIZATION, ALL OF WHICH MUST BE IN COMPLIANCE WITH THIS POLICY. Part VI, Line 2: NEEDS ASSESSMENT-Mount Carmel Health System, WHICH INCLUDES MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL, is committed to helping assess and address the healthcare needs of the communities it serves through its own programs and services and in partnership with others.Mount Carmel Health System assesses the health needs of the community through Community Health Needs Assessments every three (3) years. A Community Health Needs Assessment is a point-in-time effort to measure the health and well being of the community. It serves as the basis for Mount Carmel's 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 Health Needs Assessment also serves as a benchmark for future assessment of relative progress toward established community health objectives.Mount Carmel's Community Health 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 planningMount Carmel's Community Health Needs Assessment process involves the gathering of two types of data: quantitative (demographics, health indicators, etc.) and qualitative (public surveys, forums, focus groups). While Mount Carmel conducts some of its own original research in completing the Community Needs Assessment, it also relies upon the availability of data collected by others whenever possible to avoid unnecessary duplication. The data help support short-term and long-term decisions about allocation of community human and capital resources. Mount Carmel's most recent Community Needs Assessment was released in January 2007. Besides its Board of Trustees, Mount Carmel shares the findings of its Community Needs Assessments with other non-profit organizations and government officials/entities and seeks to form collaborative partnerships with them when possible to avoid unnecessary duplication of efforts in addressing identified community health needs.The Mount Carmel Health System is in the process of conducting a new survey which will be completed by January 30th, 2012. Part VI, Line 3: Patient Education of Eligibility for Assistance - Mount Carmel Health System, including Mount Carmel New Albany Surgical Hospital, 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 community.In accordance with AMERICAN HOSPITAL ASSOCIATION (AHA) recommendations, Mount Carmel Health System 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 obligationsMount Carmel Health System is committed to effectively communicating with patients regarding patient payment obligations. Financial counseling is provided to patients about their payment obligations and hospital bills. Information about Mount Carmel's patient financial assistance program 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. This information is communicated through Patient Financial Services associates in patient registration, customer service, and billing and collections -- all of whom receive training regarding federal, state and local public financial assistance programs and Mount Carmel's patient financial assistance program. In addition, the external collection agencies and external Medicaid eligibility verification vendor with whom Mount Carmel works also receive training regarding these programs. All Mount Carmel patient financial statements include a financial assistance application and phone number for patients to call with questions.Financial counselors make affirmative efforts to help patients apply for public and private programs for which they may qualify and which may assist them in obtaining and paying for healthcare services. Mount Carmel Health System utilizes both internal resources and an external vendor to assist patients in applying for Medicaid. Inpatients, Emergency Department patients, Clinic patients, and patients receiving high-cost outpatient services are screened to determine whether they qualify for federal, state or local public financial assistance programs or Mount Carmel's patient financial assistance program. 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.Mount Carmel Health System offers financial support to patients with limited financial means who do not qualify for public programs like Medicaid or other public assistance. Notification about financial assistance, including contact information, is communicated via signs that are prominently displayed in all patient registration areas. Brochures placed in patient registration areas educate patients in greater detail about the availability of federal, state and local assistance programs as well as Mount Carmel's patient financial assistance program.Summaries of federal, state and local public financial assistance programs and Mount Carmel's own patient financial assistance program also are made available through Mount Carmel services that directly interact with the community, including Mount Carmel Community Outreach and Mount Carmel Health Stations clinics; other organizations that serve the uninsured and underinsured such as Access Health Columbus; social services agencies like Catholic Social Services and homeless shelters; and federally qualified health centers like Heart of Ohio Family Health Centers, AND LOWER LIGHTS CHRISTIAN HEALTH CENTER. Information regarding patient financial assistance programs also is available on Mount Carmel's Website.In addition to English, patient financial assistance information is also available in Spanish and Somali for those with limited English proficiency, reflecting other predominant languages spoken in the communities served by Mount Carmel. Mount Carmel also has Interpreting Services available for limited English proficiency patients who speak other languages.Mount Carmel Health System has established a written policy for the billing, collection and support for patients with payment obligations. Mount Carmel Health System 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. Mount Carmel Health System educates staff members who work closely with patients (including those working in patient registration, 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 - Mount Carmel Health System, which includes Mount Carmel New Albany SURGICAL HOSPITAL, predominately serves Central Ohio, which includes Franklin and five contiguous counties (Delaware, Fairfield, Licking, Madison and Pickaway). This region is home to nearly 1.7 million residents. Among Central Ohio households, 20% have a household income of less than $25,000, and another 26% have a household income of between $25,000 and $50,000.Over the next five years, Central Ohio's population is expected to experience a high growth rate (18%) in adults age 55 and older and a slight decline in adults between the ages of 18 and 34. In 2009, approximately 33% of the population over age 25 held a bachelor's or higher degree, nearly five AND A HALF percentage points higher than the national average.Central Ohio features a diverse employer base, including manufacturing, trade, education, service, finance and agriculture. The OCTOBER 2010 unemployment rate was 8.4%, a DECLINE of 0.4 percentage points over November 2009.According to the 2008-2009 Ohio Family Health Survey, 138,625 adults in Franklin County between the ages of 18-64, or about 19% of that population, do not have health insurance. This number is slightly higher than the statewide percentage of 17% uninsured adults in that age group. Part VI, Line 5: Part VI, Line 6: Other Information - One hundred percent of Mount Carmel's surplus revenue is invested back into supporting the organization's healthcare ministry. Mount Carmel Health System is governed by a 15-member Board of Trustees, with a majority of the seats allocated to community representatives and leaders. Our governance structure ensures that the community and its interests are strongly represented in important decision-making.Mount Carmel Health System maintains an open medical staff - medical staff privileges are extended to all qualified physicians. Mount Carmel actively recruits, and employs doctors to serve in under-served areas of the community. Mount Carmel Health System also helps train medical professionals by operating a Graduate Medical Education program that trains physicians in family practice, internal medicine, obstetrics & gynecology, general surgery, orthopedic surgery and transitional year (for physicians who want to pursue sub-specialty training.)System wide senior leadership members serve on a number of boards for community agencies such as the Westside health advisory board, Franklinton Area Commission, Hilltop Business Association, The New Albany Chamber of Commerce, and the Lifeline of Ohio (LOOP) board. Part VI, Line 7: MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL IS A MEMBER ORGANIZATION OF Trinity Health, the fourth-largest Catholic health care system 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 2010, this included nearly $456 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. X X X X X X 0 1 0 0 0 0 0 0 0 CLAUS VON ZYCHLIN 0 466168 0 442450 0 98451 0 42829 0 27419 0 1077317 0 0 JACQUELINE PRIMEAU 0 343908 0 70753 0 76981 0 22360 0 10226 0 524228 0 60642 RICHARD D'ENBEAU 0 0 0 0 700928 0 0 0 0 0 700928 0 0 0 RONALD WHITESIDE 0 357508 0 70976 0 25492 0 248590 0 20681 0 723247 0 0 JOHN HEISLER 0 241561 0 44566 0 13168 0 21667 0 21838 0 342800 0 0 HUGH JONES 0 222663 0 46769 0 17018 0 12051 0 20734 0 319235 0 6759 JOSEPH SWEDISH 0 1214458 0 1607837 0 200997 0 769899 0 28404 0 3821595 0 0 MICHAEL SLUBOWSKI 0 696108 0 681725 0 240008 0 125922 0 28467 0 1772230 0 94766 KEDRICK ADKINS 0 712415 0 611975 0 129305 0 117250 0 12921 0 1583866 0 0 J RICHARD OCONNELL 0 440925 0 0 0 54218 0 11123 0 0 0 506266 0 0 Part I, Line 4a 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 2009).THE FOLLOWING ACCRUALS FOR 2009 FOR THIS PLAN ARE INCLUDED IN COLUMN C OF SCHEDULE J, PART II: KEDRICK ADKINS $59,584 MICHAEL SLUBOWSKI $42,832 JOSEPH SWEDISH $249,263 CLAUS VON ZYCHLIN $22,044 Part I, Line 4B: The following are participants in a supplemental executive retirement plan (SERP). The following SERP accruals for 2009 are included in column C of Schedule J, Part II: KEDRICK ADKINS $38,675 MICHAEL SLUBOWSKI $55,733 JOSEPH SWEDISH $493,225 RONALD WHITESIDE $206,250 Part II, Column B (ii): The following individuals received amounts in 2009 from a long-term incentive plan (LTIP). Participants in the LTIP (CEOs and certain Trinity executives) were eligible to receive a payment under the plan only if certain patient loyalty improvement targets were achieved by the end of a three-year period (FY07 through FY09). The following LTIP amounts are included in Schedule J, Part II, Column B(ii): KEDRICK ADKINS $337,826 MICHAEL SLUBOWSKI $403,918 JOSEPH SWEDISH $1,042,563 CLAUS VON ZYCHLIN $292,000 Supplemental Information Part III PART II: RICHARD D'ENBEAU - THE AMOUNT LISTED IN COLUMN B(III) OF SCHEDULE J, PART II REPRESENTS THE AMOUNT PAID BY MOUNT CARMEL HEALTH SYSTEM (MCHS) IN CALENDAR 2009 TO NEW ALBANY MANAGEMENT COMPANY II, LLC FOR MR. D'ENBEAU'S SERVICES, AS WELL AS FOR THE SERVICES OF THREE OTHER INDIVIDUALS. MCHS DOES NOT KNOW THE PORTION OF THE $700,928 THAT WAS FOR MR. D'ENBEAU'S SERVICES VS. THE OTHER THREE INDIVIDUALS. MCHS ALSO DOES NOT KNOW HOW MUCH MR. D'ENBEAU RECEIVED AS WAGES FROM THE MANAGEMENT COMPANY IN CALENDAR 2009. THE $700,928 IS INCLUDED IN THE TOTAL MANAGEMENT FEE REPORTED IN SCHEDULE L, PART IV. NEW ALBANY HOSPITAL MANAGEMENT COMPANY II LLC CARL BERASI, CHAIR, IS PART OWNER AND BOARD MEMBER OF NEW ALBANY MGT CO II. 1823428 MANAGEMENT FEES PAID TO NEW ALBANY MANAGEMENT COMPANY II, LLC 0 Form 990, Part VI, Section A, line 2 CHARLES KERR, D.O., RICHARD D'ENBEAU, AND CARL BERASI, D.O. HAVE A BUSINESS RELATIONSHIP. Form 990, Part VI, Section A, line 3 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL RECEIVES MANAGEMENT SERVICES FROM NEW ALBANY MANAGEMENT COMPANY II, LLC. UNDER THE MANAGEMENT SERVICES AGREEMENT, NEW ALBANY MANAGEMENT COMPANY MANAGES THE DAY-TO-DAY OPERATION, MANAGEMENT, AND SUPERVISION OF MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL. INCLUDED IN THE AGREEMENT IS THE PROVISION BY THE MANAGEMENT COMPANY OF A CHIEF OPERATING OFFICER, SENIOR VICE PRESIDENT OF CLINICAL SERVICES, SENIOR FINANCIAL ANALYST, AND CHIEF NURSING OFFICER FOR THE HOSPITAL. SEE SCHEDULE J, PART III AND SCHEDULE L FOR ADDITIONAL INFORMATION. Form 990, Part VI, Section A, line 6 THE SOLE MEMBER OF MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL IS MOUNT CARMEL HEALTH SYSTEM. SEE LINE 7 FOR ADDITIONAL INFORMATION. Form 990, Part VI, Section A, line 7a MOUNT CARMEL HEALTH SYSTEM (MCHS) IS THE SOLE MEMBER OF MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL (MCNASH). MCHS HAS THE RIGHT TO APPOINT ALL PERSONS TO THE BOARD OF DIRECTORS OF MCNASH. Form 990, Part VI, Section A, line 7b AS SOLE MEMBER, MOUNT CARMEL HEALTH SYSTEM (MCHS) MUST APPROVE CERTAIN DECISIONS OF THE GOVERNING BODY, INCLUDING THE STRATEGIC PLAN, ANNUAL CAPITAL PLAN, AND ANNUAL OPERATING BUDGET. MCHS 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 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL IS REVIEWED BY SENIOR MANAGEMENT. IN ADDITION, CERTAIN KEY SECTIONS OF THE FORM ARE REVIEWED BY THE FINANCE COMMITTEE AS WELL AS THE BOARD OF TRUSTEES. 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 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL 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 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL, 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 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL'S CHARITABLE PURPOSE AND SERVICE TO THE COMMUNITY AND TO AVOID CONFLICTS OF INTEREST. INTERESTED PERSONS ARE REQUIRED TO MAKE FULL DISCLOSURE TO MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL 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 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL IS RESPONSIBLE FOR THE REVIEW AND APPROVAL OF TRANSACTIONS WITH INTERESTED PERSONS, INCLUDING DETERMINING THAT SUCH TRANSACTIONS ARE FAIR AND REASONABLE TO MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL. 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 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL 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 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL 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 MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL 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, MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL INCLUDES A COPY OF ITS MOST RECENTLY FILED SCHEDULE H ON TRINITY HEALTH'S WEBSITE AS WELL AS MOUNT CARMEL HEALTH SYSTEM'S WEBSITE (WWW.MOUNTCARMELHEALTH.COM). SCH L, PART IV: (B) CONTINUED - CHARLES KERR, TRUSTEE, IS ALSO PART OWNER OF NEW ALBANY MGT CO II Form 990, Part VII, Section A, Line 1 , Column B: Estimate of the average hours per week devoted to related organizations: 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 SR. BARBARA HAHL, CSC - 50 HOURS JOHN HEISLER - 50 HOURS HUGH JONES - 50 HOURS J. RICHARD O'CONNELL - 53 HOURS JACQUELINE PRIMEAU - 50 HOURS MICHAEL SLUBOWSKI - 53 HOURS JOSEPH SWEDISH - 53 HOURS RONALD WHITESIDE - 50 HOURS CLAUS VON ZYCHLIN - 50 HOURS Form 990, Part VII, Section A, Line 1: Trustees: SR. BARBARA HAHL IS A MEMBER OF THE CONGREGATION OF THE SISTERS OF THE HOLY CROSS. HAVING TAKEN A VOW OF POVERTY, SR. BARBARA DID NOT RECEIVE COMPENSATION FOR THE SERVICES SHE PROVIDED TO MOUNT CARMEL HEALTH SYSTEM EXCEPT FOR INSURANCE BENEFITS ($5,093) AND THE USE OF A LEASED CAR ($3,120). INSTEAD, A TOTAL OF $257,696 WAS PAID BY MOUNT CARMEL HEALTH SYSTEM DIRECTLY TO THE SISTERS OF THE HOLY CROSS FOR SR. BARBARA'S SERVICES. FORM 990, PART XI, LINE 2: MOUNT CARMEL NEW ALBANY SURGICAL HOSPITAL'S financial statements were included in the FY10 consolidated financial statements of MOUNT CARMEL HEALTH SYSTEM, AS WELL AS THE CONSOLIDATED FINANCIAL STATEMENTS OF Trinity Health. BOTH SETS OF CONSOLIDATED FINANCIAL STATEMENTS WERE audited by an independent public accounting firm. CLR Investments LLC 120 W HARRIS ST CADILLAC MI 49601 320008631 Real estate rental & development MI 19827 175469 Trinity Health-Michigan Saint Agnes Home Health and Hospice LLC 17410 COLLEGE PARKWAY STE 150 LIVONIA MI 48152 382621935 Provide home health services CA 9367604 1116725 Trinity Home Health Services Inc Saint Mary's Pharmacy LLC 200 JEFFERSON AVE SE GRAND RAPIDS MI 49503 383404443 Pharmacy MI 0 0 Trinity Health-Michigan Mount Carmel HealthProviders Two LLC 6150 E BROAD STREET COLUMBUS OH 43213 201983271 MEDICAL SERVICES OH 0 0 MOUNT CARMEL HEALTH PROVIDERS INC PATHWAY HOSPICE LLC 1050 SW 3RD AVE SUITE 1600 ONTARIO OR 97914 931310235 HOSPICE CARE OR 1273503 1512716 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO TRINITY HEALTH-WARDE LAB LLC 34605 W TWELVE MILE ROAD FARMINGTON HILLS MI 48331 272681908 REAL ESTATE RENTAL DE 0 0 TRINITY HEALTH - MICHIGAN MOUNT CARMEL HEALTH PROVIDERS III LLC 10 West Broad St Ste 2100 COLUMBUS OH 43215 204145781 MEDICAL SERVICES OH 1741059 6043 MOUNT CARMEL HEALTH PROVIDERS INC 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 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 BATTLE CREEK HEALTH SYSTEM 300 NORTH AVENUE BATTLE CREEK MI 49016 382776791 HEALTHCARE SERVICES MI 501(C)(3) 3 TRINITY HEALTH - MICHIGAN 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 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 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 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 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 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 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 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 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 Hackley Hospital 1700 CLINTON ST PO BOX 3302 MUSKEGON MI 494433302 381358196 HEALTHCARE SERVICES MI 501(C)(3) 3 Mercy Health Partners 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 Hackley Life Counseling 1352 TERRACE ST MUSKEGON MI 494423545 381386362 Counseling, education, and support MI 501(C)(3) 9 Mercy Health Partners 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 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 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 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 Holy Cross Medical Center 27870 CABOT DRIVE NOVI MI 483772920 951985442 HEALTHCARE SERVICES (FORMERLY) CA 501(C)(3) 3 Trinity Health Corporation 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 Hospice of North Iowa 232 SECOND STREET SE MASON CITY IA 504016208 421173708 Hospice health care services IA 501(C)(3) 7 Mercy Health Services-Iowa Corp Hospice of Washtenaw II 806 AIRPORT BLVD ANN ARBOR MI 48108 383320707 Hospice health care services MI 501(C)(3) 11, TYPE I Trinity Health-Michigan HPCN 1675 LEAHY STREET MUSKEGON MI 49442 300207909 HEALTHCARE SERVICES MI 501(C)(3) 11, TYPE II Mercy Health Partners Lakeshore Community Hospital Inc 72 S STATE STREET SHELBY MI 494551228 382549295 Acute healthcare services MI 501(C)(3) 3 Mercy Health Partners Lifespan Inc 166 EAST GOODALE AVE BATTLE CREEK MI 490372728 383298476 Provide hospice health services MI 501(C)(3) 9 Battle Creek Health System Marian Home Healthcare 801 5TH STREET SIOUX CITY IA 51101 383320705 Provide home health care services IA 501(C)(3) 11, TYPE I Mercy Health Services-Iowa Corp McAuley Clinic Corporation PO BOX 992 ANN ARBOR MI 48106 382561013 HEALTHCARE SERVICES (FORMERLY) MI 501(C)(3) 3 Catherine McAuley Health Services Corp Mercy Amicare Home Healthcare Oakland 281 ENTERPRISE COURT BLOOMFIELD HILLS MI 483020312 383320698 Provide home health care services MI 501(C)(3) 11, TYPE I Trinity Home Health Services Inc Mercy Amicare Home Healthcare Port Huron 2540 16TH STREET PORT HURON MI 48060 383320701 Provide home health care services MI 501(C)(3) 11, TYPE I Trinity Home Health Services Inc Mercy Community Physicians 363 FREMONT ST BATTLE CREEK MI 49017 264252468 HEALTHCARE SERVICES MI 501(C)(3) 3 Battle Creek Health System Mercy General Health Partners Amicare Homecare 684 HARVEY STREET MUSKEGON MI 49442 383321856 Provide home health care services MI 501(C)(3) 11, TYPE I Trinity Home Health Services Inc Mercy Health Partners 1415 LEAHY STREET MUSKEGON MI 49442 382589966 Healthcare system support MI 501(C)(3) 11, TYPE I Trinity Health-Michigan Mercy Health Services - Iowa Corp 1000 4TH STREET SW MASON CITY IA 50401 311373080 HEALTHCARE SERVICES DE 501(C)(3) 3 Trinity Health-Michigan Mercy Healthcare Foundation 1410 N 4TH ST CLINTON IA 52732 421316126 Fundraising and financial assistance for hospital charitable services IA 501(C)(3) 11, TYPE I Mercy Medical Center-Clinton Mercy Hosp & Health Services of DetroitMarshall Park Health Services Inc 27870 CABOT DRIVE NOVI MI 483772920 381562325 Supports malpractice contingencies of closed hospital MI 501(C)(3) 11, TYPE I Trinity Health-Michigan Mercy Hospital Cadillac Foundation 400 HOBART CADILLAC MI 496012331 203357131 Support the services of related hospital MI 501(C)(3) 11, TYPE I Trinity Health-Michigan Mercy Hospital Gift Shop 2601 ELECTRIC AVE PORT HURON MI 48060 381630480 Volunteer Service Auxiliary MI 501(C)(3) 11, TYPE I Trinity Health-Michigan Mercy Medical Center - Clinton Inc 1410 NORTH 4TH ST CLINTON IA 527322940 421336618 To provide quality health care DE 501(C)(3) 3 Mercy Health Services-Iowa Corp Mercy Medical Center - Sioux City Foundation 801 5TH STREET SIOUX CITY IA 51102 141880022 Support the services of related hospital IA 501(C)(3) 7 Mercy Health Services-Iowa Corp Mercy Medical Center Foundation - North Iowa 1000 4TH STREET SW MASON CITY IA 504012800 421229151 Support the services of related hospital IA 501(C)(3) 11, TYPE III-FI Mercy Health Services-Iowa Corp MERCY MEDICAL CENTER FOUNDATION INC 1512 12TH AVENUE ROAD NAMPA ID 83686 261737256 SUPPORT THE SERVICES OF RELATED HOSPITAL ID 501(C)(3) 7 SAINT ALPHONSUS MEDICAL CENTER-NAMPA Mercy North Homecare and Hospice 7985 MACKINAW TRAIL CADILLAC MI 49601 383313897 Home health and hospice services MI 501(C)(3) 11, TYPE I Trinity Home Health Services Inc Mercy Pavilion of Battle Creek 300 NORTH AVENUE BATTLE CREEK MI 49016 382783350 Provides long-term care for the elderly MI 501(C)(3) 9 Battle Creek Health System MERCY PHYSICIAN GROUP INC 1512 12TH AVENUE ROAD NAMPA ID 83686 208192593 TO PROVIDE QUALITY HEALTH CARE ID 501(C)(3) 9 SAINT ALPHONSUS MEDICAL CENTER-NAMPA Mercy Services for Aging Non-profit Housing Corporation PO BOX 9184 FARMINGTON HILLS MI 483339184 382719605 Provides long-term care for the elderly MI 501(C)(3) 11, TYPE II Trinity Continuing Care Services Inc Midwest Medflight 1300 VICTORS WAY ANN ARBOR MI 48108 382684671 Aeromedical transport MI 501(C)(3) 9 Trinity Health-Michigan Mount Carmel Care Continuum Services Corp 793 WEST STATE STREET COLUMBUS OH 43222 311126211 Cooperative hospital service organization OH 501(C)(3) 3 Mount Carmel Health System Mount Carmel College of Nursing 6150 EAST BROAD STREET COLUMBUS OH 43213 311308555 College of nursing OH 501(C)(3) 2 Mount Carmel Health Mount Carmel Health 6150 EAST BROAD STREET COLUMBUS OH 43213 314379602 HEALTHCARE SERVICES OH 501(C)(3) 3 Mount Carmel Health System Mount Carmel Health Insurance Company 6150 EAST BROAD STREET COLUMBUS OH 43213 251912781 Health Insurance OH 501(C)(4) N/A Mount Carmel Health System Mount Carmel Health Plan Inc 6150 EAST BROAD STREET COLUMBUS OH 43213 311471229 Medicare HMO for seniors OH 501(C)(4) N/A Mount Carmel Health System Mount Carmel Health System 6150 EAST BROAD STREET COLUMBUS OH 43213 311439334 Healthcare system management and support OH 501(C)(3) 11, TYPE I Trinity Health Corporation MOUNT CARMEL HEALTH SYSTEM FOUNDATION 6150 EAST BROAD STREET COLUMBUS OH 43213 311113966 SUPPORT THE SERVICES OF RELATED HOSPITAL OH 501(C)(3) 11, TYPE I MOUNT CARMEL HEALTH SYSTEM Mount Carmel Home Care LLC 1144 DUBLIN ROAD SUITE B COLUMBUS OH 43215 262729300 Provide home health care services OH 501(C)(3) 9 Trinity Home Health Services Inc Mount Carmel New Albany Surgical Hospital 7333 SMITHS MILL RD NEW ALBANY OH 43054 870790288 HEALTHCARE SERVICES OH 501(C)(3) 3 Mount Carmel Health System MRI Mobile Services of West Michigan 1820 - 44TH STREET KENTWOOD MI 49508 383073745 OPERATE MAGNETIC IMAGING RESONANCE (FORMERLY) MI 501(C)(3) 9 Trinity Health-Michigan MUSKEGON COMMUNITY HEALTH PROJECT 565 W WESTERN AVENUE MUSKEGON MI 49440 911932918 FACILITATE AND COORDINATE HEALTHCARE AND RELATED SERVICES MI 501(C)(3) 7 MERCY HEALTH PARTNERS Oakland Mercy Hospital 601 EAST 2ND STREET OAKLAND NE 68045 208072234 HEALTHCARE SERVICES NE 501(C)(3) 3 Mercy Health Services-Iowa Corp Port Huron Mercy Family Care Inc 2601 ELECTRIC AVE PORT HURON MI 48060 201855647 HEALTHCARE SERVICES MI 501(C)(3) 11, TYPE I Trinity Health-Michigan Professional Med Team 965 FORK STREET MUSKEGON MI 494423257 382638284 Medical care, transportation and education MI 501(C)(3) 9 Trinity Health-Michigan Professional Office Corporation 1303 EAST HERNDON AVE FRESNO CA 93720 942839324 HEALTHCARE SERVICES CA 501(C)(3) 11, TYPE I Saint Agnes Medical Center Saint Agnes Medical Center 1303 EAST HERNDON AVE FRESNO CA 93720 941437713 HEALTHCARE SERVICES CA 501(C)(3) 3 Trinity Health Corporation Saint Alphonsus Building Company Inc 1055 NORTH CURTIS RD BOISE ID 83706 820401011 Supports services of related hospital ID 501(C)(3) 11, TYPE I Saint Alphonsus Regional Medical Center Inc Saint Alphonsus Diversified Care Inc 1055 NORTH CURTIS RD BOISE ID 83706 943028978 Supports services of related hospital ID 501(C)(3) 11, TYPE I Saint Alphonsus Regional Medical Center Inc SAINT ALPHONSUS HEALTH SYSTEM INC 1055 N CURTIS ROAD BOISE ID 83706 271929502 HEALTHCARE SYSTEM MANAGEMENT AND SUPPORT ID 501(C)(3) 11, TYPE I TRINITY HEALTH CORPORATION SAINT ALPHONSUS MEDICAL CENTER-BAKER CITY 3325 POCAHONTAS ROAD BAKER CITY OR 97814 271790052 TO PROVIDE QUALITY HEALTH CARE OR 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC SAINT ALPHONSUS MEDICAL CENTER-NAMPA 1512 12TH AVENUE ROAD NAMPA ID 83686 820200896 TO PROVIDE QUALITY HEALTH CARE ID 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC SAINT ALPHONSUS MEDICAL CENTER-ONTARIO 351 SW 9TH STREET ONTARIO OR 97914 271789847 TO PROVIDE QUALITY HEALTH CARE OR 501(C)(3) 3 SAINT ALPHONSUS HEALTH SYSTEM INC Saint Joseph Regional Medical Center - Plymouth Campus Inc 1915 LAKE AVENUE PO BOX 670 PLYMOUTH IN 46563 351142669 Healthcare services IN 501(C)(3) 3 Saint Joseph Regional Medical Center Inc Saint Joseph Regional Medical Center - South Bend Campus Inc PO BOX 1935 SOUTH BEND IN 466341935 350868157 Healthcare services IN 501(C)(3) 3 Saint Joseph Regional Medical Center Inc Saint Joseph Regional Medical Center Inc 801 EAST LASALLE AVE SOUTH BEND IN 46617 351568821 Healthcare system management and support IN 501(C)(3) 11, TYPE I Trinity Health Corporation Saint Joseph's Auxiliary of Marshall County 1915 LAKE AVENUE PLYMOUTH IN 46563 356043563 Hospital Service Auxiliary IN 501(C)(3) 11, TYPE II Saint Joseph Regional Medical Center - Plymouth Campus Inc Saint Joseph's Tower Inc PO BOX 9184 FARMINGTON HILLS MI 483339184 311040468 Provides housing for low income elderly individuals IN 501(C)(3) 9 Trinity Continuing Care Services-Indiana Saint Mary's Amicare Home Healthcare 1430 MONROE NW GRAND RAPIDS MI 48905 383320700 Provide home health care services MI 501(C)(3) 11, TYPE I Trinity Home Health Services Inc Saint Mary's Doran Foundation CO Saint Mary's Health Care 200 JEFFERSON ST SE GRAND RAPIDS MI 49503 381779602 Supports services of related hospital MI 501(C)(3) 7 Trinity Health-Michigan St Alphonsus Regional Medical Center 1055 NORTH CURTIS RD BOISE ID 83706 820200895 Healthcare services ID 501(C)(3) 3 Trinity Health Corporation St John's Health System 27870 CABOT DRIVE NOVI MI 483772920 350877584 HEALTHCARE SERVICES (FORMERLY) IN 501(C)(3) 3 Trinity Health Corporation St Joseph Mercy Oakland Foundation 44405 WOODWARD AVE PONTIAC MI 48341 352356789 Supports services of related hospital MI 501(C)(3) 11, TYPE I Trinity Health-Michigan St Ann's Hospital 500 SOUTH CLEVELAND AVE WESTERVILLE OH 43081 314412701 HEALTHCARE SERVICES OH 501(C)(3) 3 Mount Carmel Health System ST ELIZABETH HEALTH CARE FOUNDATION 3325 POCAHONTAS ROAD BAKER CITY OR 97814 943164869 SUPPORT THE SERVICES OF RELATED HOSPITAL OR 501(C)(3) 7 SAINT ALPHONSUS MEDICAL CENTER-ONTARIO St Joseph's Medical Center Auxiliary 801 E LASALLE AVE PO BOX 1935 SOUTH BEND IN 466341935 356033285 Hospital Service Auxiliary IN 501(C)(4) N/A Saint Joseph Regional Medical Center - South Bend Campus Inc The Foundation of Saint Joseph Regional Medical Center 4215 EDISON LAKES PARKWAY MISHAWAKA IN 46545 351654543 Supports services of related hospital IN 501(C)(3) 11, TYPE I Saint Joseph Regional Medical Center Inc Trinity Continuing Care Services PO BOX 9184 FARMINGTON HILLS MI 483339184 382559656 Management services for Long term care and senior living facilities MI 501(C)(3) 11, TYPE I Trinity Health Corporation Trinity Continuing Care Services - Indiana Inc PO BOX 9184 FARMINGTON HILLS MI 483339184 930907047 Provides long-term care and residential housing IN 501(C)(3) 9 Trinity Continuing Care Services Trinity Health - Michigan 27870 CABOT DRIVE NOVI MI 483772920 382113393 HEALTHCARE SERVICES MI 501(C)(3) 3 Trinity Health Corporation Trinity Health Corporation 27870 CABOT DRIVE NOVI MI 483772920 351443425 Healthcare system management and support IN 501(C)(3) 11, TYPE I N/A Trinity Health International 27870 CABOT DRIVE NOVI MI 483772920 421253527 Healthcare training and support services MI 501(C)(3) 11, TYPE I Trinity Health Corporation Trinity Health Welfare Benefit Trust 27870 CABOT DRIVE NOVI MI 483772920 208151733 Retiree medical and retiree life insurance coverage MI 501(C)(9) N/A Trinity Health Corporation Trinity Home Health Services Inc 17410 COLLEGE PARKWAY LIVONIA MI 48152 382621935 Home health care system management services MI 501(C)(3) 11, TYPE I Trinity Health Corporation ADVANCED IMAGING SERVICES OF BATTLE CREEK 5352 BECKLEY ROAD STE A BATTLE CREEK MI 49015 204594297 RADIOLOGY/IMAGING MI N/A N/A 0 0 ADVENT REHABILITATION LLC 560 FIFTH ST NW STE 404 GRAND RAPIDS MI 49504 383306673 REHABILITATION THERAPY SERVICES MI N/A N/A 0 0 BIG RUN MEDICAL OFFICE BUILDING LIMITED PARTNERSHIP 793 W STATE STREET COLUMBUS OH 43222 311608125 MEDICAL OFFICE BUILDING RENTAL OH N/A N/A 0 0 BSV MEDICAL OFFICE BUILDING II LLC 855 M STREET TENTH FLOOR FRESNO CA 93721 202673839 MEDICAL OFFICE BUILDING RENTAL CA N/A N/A 0 0 CCH LABORATORY 775 SOUTH MAIN STREET CHELSEA MI 48118 382910400 LABORATORY MI N/A N/A 0 0 CENTRAL OHIO SLEEP MEDICINE LTD 5955 EAST BROAD ST COLUMBUS OH 43213 311701029 SLEEP MEDICINE SERVICES OH N/A N/A 0 0 CLINTON IMAGING SERVICES LLC 1410 NORTH 4TH ST CLINTON IA 52732 412044739 MRI DIAGNOSTIC SERVICES IA N/A N/A 0 0 FOREST PARK IMAGING LLC 1000 4TH 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