2011-05-12T09:16:23-04:00 2010-06-30 GRANT THORNTON LLP 2001 MARKET STREET SUITE 3100 PHILADELPHIA PA 19103 990 2009-07-01 930433692 Holy Rosary Medical Center HOLY 5418817295 351 SW 9th St Ontario OR 97914 Douglas Wickerham 2011-05-09 true Grant Thornton LLP 2156563051 2009 2016-02-24 21:20:13Z Dominican Sisters of Ontario Inc Mark Dalley CEO 351 SW 9TH ST Ontario OR 97914 48731482 false 0928 X www.holyrosary-ontario.org X 1911 OR HOLY ROSARY MEDICAL CENTER (HRMC) PROVIDES HEALTH CARE TO ALL PEOPLE IN A COMPASSIONATE, CARING AND UNDERSTANDING MANNER. HRMC SERVES ONTARIO AND THE SURROUNDING COMMUNITIES IN EASTERN OREGON AND IDAHO. X 13 11 552 68 310958 238770 149928 58726578 47254131 -217691 236086 1020339 1072797 59767996 48712942 109040 18361192 0 0 24495524 20340609 0 0 0 33363934 45067661 57968498 83769462 1799498 -35056520 70696737 7159040 29458393 14510 41238344 7144530 THE ORGANIZATION'S MISSION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY. FIDELITY TO THE GOSPEL URGES US TO EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE MOVE TOWARD THE CREATION OF HEALTHIER COMMUNITIES. false true 72496506 18361192 47182431 Please refer to Schedule H, The Needs Assessment Narrative, Part VI, Item 2. 72496506 true true false true false false false false false true false true false false false false false false false false true true false true false false false false false false false false false false false true true true true false false true 0 0 true 552 true true false false false false true true false false false false false 13 11 false false true false true true true true true false false true true true true true true true true false OR X CHERYL MITCHELL 5418817294 351 SW 9TH ST Ontario OR 97914 ANDREW BENTZ 1.0 X 0 0 0 PATRICK CALDWELL 1.0 X 0 0 0 WES COLVIN 1.0 X X 0 0 0 MARK DALLEY 40.0 X X 0 307241 40849 SR KAY MARIE DUNCAN 1.0 X 0 0 0 PAUL GERING 1.0 X 0 0 0 DAVID GOODE 40.0 X X 0 1033054 43467 KENNETH HART 1.0 X 0 0 0 JOHN KIRBY 1.0 X 0 0 0 TIM LOPEZ 1.0 X 0 0 0 MAUREEN MCDONOUGH 1.0 X 0 0 0 JED MYERS 1.0 X 0 0 0 SHAWNA PETERSON 1.0 X 0 0 0 JOE PLAZA 1.0 X 0 0 0 DON ROUMAGOUX 1.0 X 0 0 0 CHERIE SKOGERBOE 1.0 X 0 0 0 FRANK SPOKAS 1.0 X 0 0 0 TONY TESNOHLIDEK 1.0 X 0 0 0 MATTHEW COX 40.0 X 0 299540 36190 KAREN KOSOWAN 40.0 X 135295 0 17950 PAUL VACHEK 40.0 X 133971 0 26510 LEE JACKSON 40.0 X 170458 0 26011 DAVID NAGATA 40.0 X 139498 0 21594 STEVEN REICH 40.0 X 157925 0 25120 JOHN STOUNE 40.0 X 171361 0 27007 ANDREW PETERSON 40.0 X 182394 0 25873 MOHSIN SYED 40.0 X 154273 0 8446 1245175 1639835 299017 16 false true false Interpath Laboratory PO Box 1208 PENDLETON OR 97081 Lab Services 1917611 ELks healthcare staffing PO BOX 1100 BOISE ID 83701 REHAB SERVICES 339215 Relay Health PO Box 403421 ATLANTA GA 30384 Billing Services 425039 MEDICAL STAFFING NETWORK PO BOX 840416 DALLAS TX 75284 NURSING SERVICES 260446 Morris Smith MD 256 Evergreen Rd ONTARIO OR 97914 Physician 208563 37 149928 149928 PATIENT SERVICE REVENUE 900099 47254131 46968982 285149 47254131 254626 254626 0 0 530109 530109 530109 25022 505087 18540 -18540 -18540 -18540 0 0 0 CAFETERIA REVENUE 722100 223145 780 222365 SERVICES SOLD 900099 71743 71743 RETAIL PHARMACY 900099 49189 49189 198611 7 198604 542688 48712942 46968982 310958 1283074 18361192 18361192 0 0 0 1173127 1173127 0 14303699 5100154 9203545 748006 650398 97608 4115777 4115777 0 0 -9540 -9540 71712 71712 0 0 0 7425503 6739316 686187 0 6307653 6111740 195913 0 0 368442 359631 8811 33459 25538 7921 0 0 809464 809464 0 3134766 3090162 44604 576212 576212 BAD DEBTS 23592190 23592190 LICENSE AND FEES 1083678 596182 487496 REPAIRS AND MAINTENACE 313376 313376 UNRELATED BUSINESS INC. TAX 1404 1404 0 MISCELLANEOUS 1359342 882047 477295 83769462 72496506 11272956 0 6500 0 7169926 0 8525723 704 842464 0 1188836 0 121125 0 4520286 1929433 39790281 2590853 7533827 4567483 5518055 0 70696737 7159040 5431299 344 24027094 14166 29458393 14510 X 41169618 7048645 68726 95885 41238344 7144530 70696737 7159040 X false true true X false X false false false RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED false false false false false true 1082 false false false 1082 false false Lobbying Activities Explanation Schedule C, Part II-B, Line 1F THE ENTITY'S CONTROLLING ORGANIZATION, CATHOLIC HEALTH INITIATIVES, PAYS ANNUAL DUES TO THE AMERICAN HOSPITAL ASSOCIATION (AHA) AND CATHOLIC HOSPITAL ASSOCIATION (CHA), A PORTION OF WHICH IS ALLOCATED TO LOBBYING. THE AMOUNT SHOWN IN LINE 1F ABOVE REPRESENTS THIS ENTITY'S SHARE OF ALLOCATED LOBBYING EXPENSES. THE AMOUNTS ALLOCATED FROM EACH ASSOCIATION ARE AS FOLLOWS: AHA - $630; CHA - $452. 544634 544634 0 3859852 1876636 1983215 0 0 0 44918 23120 21799 70882 29677 41205 2590853 INV. IN UNCONSOLIDATED ORGS 4567483 F 4567483 0 ACCRUED EXPENSES 14025 INTERCOMPANY PAYABLE 141 14166 48712942 83769462 -35056520 962708 962708 -34093812 Fin 48 Footnote (Now known as ASC 740) SCHEDULE D, PART X Holy Rosary Medical Center's FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI'S FIN 48 FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2010 READS AS FOLLOWS: "CHI IS A TAX-EXEMPT COLORADO CORPORATION AND HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CHI OWNS CERTAIN TAXABLE SUBSIDIARIES AND ENGAGES IN CERTAIN ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE AND THEREFORE SUBJECT TO INCOME TAX. MANAGEMENT ANNUALLY REVIEWS ITS TAX POSITIONS AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE CONSOLIDATED FINANCIAL STATEMENTS." true true false false true true true true true true 913 1054922 1054922 0.01750 8324 5610807 5210246 490561 0.00820 9237 6665729 5210246 1545483 0.02570 36161 220869 11620 209249 0.00350 65 42071 42071 0.00070 47 2773 2773 4323 95128 3160 91968 0.00150 40596 360841 14780 346061 0.00570 49833 7026570 5225026 1891544 0.03140 1 90 3387 3387 1 57 57 1 750 4157 4157 0.00010 1 300 70660 70660 0.00120 4 1140 78261 78261 0.00130 true 23592190 16004347 18582960 -2578613 X true true Holy Rosary Medical Center

351 SW 9th St Ontario OR 97914

X X When Catholic Health Initiatives (the ultimate parent organization to Holy Rosary Medical Center) established its charity care policy it was determined that establishing a household income scale based on the HUD very low income guidelines more accurately reflects the socioeconomic dispersions among the 69 urban and rural communities in 19 states served by CHI hospitals and health care facilities. In comparing HUD guidelines to the Federal Poverty Guidelines ("FPG"), we find that on average HUD guidelines compute to approximately 200% to 250% (and sometimes 300%) of FPG. Holy Rosary Medical Center bases its charity care eligibility on HUD's 130% of Very Low Income Guidelines based on geography, and affords the uninsured and underinsured the ability to obtain charity care write-offs, based on a sliding scale, ranging from 25%-100% of charges. An individual's income under the HUD guidelines is a significant factor in determining eligibility for charity care. However, in determining whether to extend discounted or free care to a patient, the patient's assets may also be taken into consideration. For example, a patient suffering a catastrophic illness may have a reasonable level of income, but a low level of liquid assets such that the payment of medical bills would be seriously detrimental to the patient's basic financial (and ultimately physical) well-being and survival. Such a patient may be extended discounted or free care based upon the facts and circumstances. Holy Rosary Medical Center prepares its own annual written community benefit report. Its community benefit report is not contained in that of a related organization. (A) A cost accounting system was not used to compute amounts in the table; rather costs in the table were computed using the organization's cost-to-charge ratio. The cost-to-charge ratio covers all patient segments. (B) The cost-to-charge ratio for the year ended 6/30/10 was computed using the a formula that ratio costs based on actual expense/revenue incurred in inpatient and outpatient units and applied overhead expenses based on the prior year cost report calculations. Using the above methodology, the cost-to-charge ratio for the 6/30/10 reporting period is 41.19%. Worksheet 2 was not used to derive the cost-to-charge ratio. There are no physician clinics included in subsidized health services. Total bad debt expense reported on Form 990 Part IX, line 25, Column A was $23,592,190. (A) Costing methodology for amounts reported on line 2 is determined using the organization's cost/charge ratio of 41.19%. When discounts are extended to self-pay patients, these patient account discounts are recorded as a reduction in revenue, not as bad debt expense. (B) Holy Rosary Medical Center does not believe that any portion of bad debt expense could reasonably be attributed to patients who qualify for financial assistance since amounts due from those individuals' accounts will be reclassified from bad debt expense to charity care within 30 days following the date that the patient is determined to qualify for charity care. Holy Rosary Medical Center does not issue separate company audited financial statements, rather it is included in the consolidated CHI financial statements. The provision for bad debts is based upon management's assessment of historical and expected net collections considering historical business and economic conditions, trends in health care coverage, and other collection indicators. Management periodically assesses the adequacy of the allowances for uncollectible accounts based upon historical write-off experience by payor category. The results of these reviews are used to modify, as necessary, the provision for bad debts and to establish appropriate allowances for uncollectible net patient accounts receivable. After satisfaction of amounts due from insurance, CHI follows established guidelines for placing certain patient balances with collection agencies, subject to the terms of certain restrictions on collection efforts as determined by each facility. Holy Rosary Medical Center ultimate reimbursement will be reduced by any applicable copayment/ deductible. Where Medicare is the secondary insurer, amounts due from the insured's primary payer were not subtracted from Medicare allowable costs because the amounts are typically immaterial. Holy Rosary Medical Center's ("HRMC") debt collection policy provides that HRMC will perform a reasonable review of each inpatient account prior to turning an account for to a third-party collection agent and prior to instituting any legal action for non-payment, to assure that the patient and patient guarantor are not eligible for any assistance program (e.g. Medicaid) and do not qualify for coverage through HRMC's community assistance policy. After having been turned over to a third-party collection agent, any patient account that is subsequently determined to meet the HRMC community assistance policy is required to be returned immediately by the third-party collection agent to HRMC for appropriate follow-up. HRMC requires its third-party collection agents to include a message on all statements indicating that if a patient or patient guarantor meets certain stipulated income requirements, the patient or patient guarantor may be eligible for financial assistance. All of Catholic Health Initiatives' hospitals' contracts with third party collection agencies include the following standards: - Neither CHI hospitals nor their collection agencies will request bench or arrest warrants as a result of non-payment; - Neither CHI hospitals nor their collection agencies will seek liens that would require the sale or foreclosure of a primary residence; and - No Catholic Health Initiatives' collection agency may seek court action without hospital approval. Finally, collection agencies are trained on the Catholic Health Initiatives Mission, Core Values and Standard of Conduct to make sure all patients are treated with dignity and respect. Not applicable INTRODUCTION: Organization's Mission, Vision, and Tax-Exempt Purpose Mission The mission of Holy Rosary Medical Center and Catholic Health Initiatives is to nurture the healing ministry of the Church by bringing it new life, energy and viability in the 21st century. Fidelity to the Gospel urges us to emphasize human dignity and social justice as we move toward the creation of healthier communities. Vision: Our Vision is to live up to our name as one CHI: Catholic: Living our Mission and Core Values. Health: Improving the health of the people and communities we serve. Initiatives: Pioneering models and systems of care to enhance care delivery. Core Values: Our core values define our organization and serve as our guiding principles. They are the roots or anchors from which all activities, decisions and behaviors follow. Reverence - Profound respect and awe for all of creation, the foundation that shapes spirituality, our relationships with others and our journey to God. Integrity - Moral wholeness, soundness, fidelity, trust, truthfulness in all we do. Compassion - Solidarity with one another, capacity to enter into another's joy and sorrow. Excellence - Preeminent performance, becoming the benchmark, putting forth our personal and professional best. Holy Rosary Medical Center is a 49-bed, acute care hospital, serving Ontario and the surrounding communities in eastern Oregon and southwestern Idaho. Holy Rosary is part of Catholic Health Initiatives, one of the largest not-for-profit health care systems in the country, spanning 24 states and more than 70 rural and urban communities and encompassing 73 hospitals and 40 long-term care facilities. Holy Rosary and CHI are guided by their mission to care for all persons who need medical care, regardless of their economic status or ability to pay. Holy Rosary Medical Center services all persons from the community on a non-discriminatory basis. Holy Rosary Medical Center Participates in Medicaid, Medicare, CHAMPUS, TRICARE and other government-sponsored health care programs. Holy Rosary Medical Center is included in the Official Catholic Directory as a tax-exempt hospital. Holy Rosary Medical Center has an open medical staff with privileges available to all qualified physicians in the area. Holy Rosary Medical Center has a governing body in which independent persons are representative of the community. Holy Rosary Medical Center is also committed in the training and education of health care professionals. Community Benefit Approach Ontario is the largest city in Malheur County, Oregon, United States. It lies along the Snake River at the Idaho border. The population was 10,985 at the 2000 census, with an estimated population of 11,245 in 2006. The per capita income for the city was $14,683. About 16.4% of families and 20.8% of the population were below the poverty line, including 29.0% of those under age 18 and 14.3% of those aged 65 or over. From sponsorship of health symposiums to community outreach programs, Holy Rosary Medical Center's services extend well beyond the medical center campus. Throughout the year, Holy Rosary sponsors health fairs, seminars and classes to educate the Ontario community on health-related issues including childbirth, CPR, menopause, proper nutrition, and smoking cessation. HRMC also works with area educational institutions, like Treasure Valley Community College, to provide clinical practicum for their students, and to subsidize their training. The health fairs, classes, food, school supply or clothing drives, and other forms of community outreach and benefit are designed to meet needs voiced by our community or derived from our experience and understanding of gaps in services. Although the bulk of HRMC's community benefit dollars are found in Charity Care, we still look for ways to extend our mission to mitigate or prevent other health issues within our community. Upon admission or visit to Holy Rosary Medical Center, our admissions and billing staff make every effort to identify additional resources for our self paying/under insured patients. They take the time to assist the patient in filling out applications for county/state assistance and if needed, they help the patient in filling out the compassionate care (charity care) application. Uncompensated Care HRMC provides a significant level of free care each year. In fiscal year 2010, the cost of charity care provided by the organization was $1.05 million. HRMC also incurred $491 thousand in unreimbursed costs for services provided to Medicaid patients. Frequently, the cost of providing services to Medicaid patients is greater than the payments HRMC receives from the Medicaid program. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT As of the 2000 Census, the median income for a household in the city was $29,173, and the median income for a family was $35,625. About 16.4% of families and 20.8% of the population were below the poverty line, including 29.0% of those under age 18 and 14.3% of those age 65 or over. (from Census Bureau online data.) In FY10, Holy Rosary provided Charity care to 913 persons in the amount of $1,054,922. Community Outreach for the Broader Community HRMC provides financial support to numerous activities and special programs within the community. The hospital is active in donating expired product and goods to local charity groups supplying third world countries with needed supplies and equipment. HRMC also is able to support local non-profit organizations by offering its facilities and meeting rooms. Another important program that the hospital financially supports is called Project Dove. This service is designed to help victims of sexual abuse and their families. In FY10, HRMC has donated $241,749 in financial support to a total of 18,801 individuals in the community. Collaborative Efforts to Improve Community Health HRMC is involved in numerous activities to educate its patients and the surrounding community. Along with basic programs, HRMC is involved in providing support to the following courses: Asthma Workshop, AWAKE Program (sleep disorders), Boot Camp (physical therapy), Weight Management and other services. In FY10, HRMC provided a total of $26,676 in health education and related programs to 13,226 people. Health Professions Education HRMC is continuing to provide financial support to the local nursing program to improve the clinical staff shortages. The hospital is also involved in providing clinical support with the Shadow Student program that provides hands on experience to the upcoming graduates. HRMC is in close contact with other graduate programs in the valley and the state of Oregon. Total annual support provided in FY10 totaled $42,071. This support will continue in the future to help promote nursing and other clinical programs. One of the most important activities that HRMC is involved in is the Bioterrorism Preparedness plan. The hospital is the county's designated provider of healthcare services during disaster, which includes bioterrorism and natural disasters. During the year, the hospital staff was involved in multiple drills and training on a local and national level. Other activities include supporting the local Chambers of Commerce in numerous projects to support local economy and its development. Total annual support provided in FY10 totaled $78,261. Holy Rosary Medical Center ("HRMC") includes information concerning its financial assistance policy on its website. In addition, HRMC prominently displays its charity care policy in both English and Spanish in obvious locations throughout the hospitals, including the emergency rooms and other patient intake areas, as well as in HRMC outpatient facilities. In addition, HRMC registration clerks are trained to provide consultation to those who have no insurance or potentially inadequate insurance concerning their financial options including application for Medicaid and for financial assistance under HRMC's charity care policy. Upon registration (and once all EMTALA requirements are met), patients who are identified as uninsured (and not covered by Medicare or Medicaid) are provided with a packet of information that addresses the financial assistance policy and procedures including an application for assistance. HRMC registration clerks read the organization's medical assistance policy to those who appear to be incapable of reading, and provide translators for non English-speaking individuals. HRMC's staff will also assist the patient / guarantor with applying for other available coverage (such as Medicaid), if necessary. Counselors assist Medicare eligible patients in enrollment by providing referrals to the appropriate government agencies. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above. Please refer to the Needs Assessment Narrative, Part VI, Item 2. above. Holy Rosary Medical Center, along with its affiliated outpatient facilities are part of Catholic Health Initiatives. Catholic Health Initiatives (CHI) is a national faith-based nonprofit health care organization with headquarters in Englewood, Colorado. CHI's exempt purpose is to serve as an integral part of its national system of hospitals and other charitable entities, which are described as market-based organizations, or MBOs. An MBO is a direct provider of care or services within a defined market area that may be an integrated health system and/or a stand-alone hospital or other facility or service provider. CHI serves as the parent corporation of its MBOs which are comprised of 73 hospitals; 40 long-term care, assisted- and residential-living facilities; and two community health-services organizations. Together, these facilities provided $590 million in charity care and community benefit in the 2010 fiscal year, including services for the poor, free clinics, education and research. CHI provides strategic planning and management services as well as centralized "shared services" for the MBOs. The provision of centralized management and shared services - including areas such as accounting, human resources, payroll and supply chain -- provides economies of scale and purchasing power to the MBOs. Cost savings associated with centralized services for the fiscal year ended June 30, 2010 include more than $105 million in supply chain expense, approximately $30 million for insurance costs and more than $3.9 million as the result of a system-wide effort to coordinate and negotiate technology and equipment purchases. The cost savings achieved through CHI's centralization enable MBOs to dedicate additional resources to high-quality health care and community outreach services to the most vulnerable members of our society. OR true Treasure Valley Community College 650 College Blvd Ontario OR 97914 930507187 501(c)3 107477 TO PROVIDE COMMUNITY BENEFIT CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 501(c)(3) 18253715 TRANSFER TO FINALIZE TRINITY TRANSACTION. 2 0 Procedures used to Monitor use of Grants Schedule I, Part I, Q. 2 Holy Rosary Medical Center establishes a restricted fund account for the initial amount of the grant. All purchases/expenses related to this grant must be reviewed and approved by 2 identified individuals. Upon approval, the expense is allocated to the grant amount. Each month the expenses are reconciled against the initial grant amount until the grant fund is depleted. Then a final accounting of the grant funds is completed. false true false false false false false false false JUDY CORDENIZ 106961 0 22593 0 3100 0 0 0 28807 0 161461 0 0 0 MATTHEW COX 0 231133 0 0 0 68407 0 0 0 36190 0 335730 0 0 MARK DALLEY 0 219589 0 63813 0 23839 0 0 0 40849 0 348090 0 0 DAVID GOODE 0 453182 0 120573 0 459299 0 126 0 43341 0 1076521 0 410385 SEAN HACKETT 121454 0 4000 0 304 0 0 0 26030 0 151788 0 0 0 LEE JACKSON 140465 0 28741 0 1252 0 0 0 26011 0 196469 0 0 0 DAVID JOLLEY 138482 0 0 0 247 0 0 0 15476 0 154205 0 0 0 KAREN KOSOWAN 111794 0 22593 0 908 0 0 0 17950 0 153245 0 0 0 DALE KUDRNA 126533 0 4375 0 4256 0 0 0 16664 0 151828 0 0 0 DAVID NAGATA 139245 0 0 0 253 0 0 0 21594 0 161092 0 0 0 STEVEN REICH 157439 0 0 0 486 0 0 0 25120 0 183045 0 0 0 JOHN STOUNE 158245 0 10977 0 2139 0 0 0 27007 0 198368 0 0 0 PAUL VACHEK 106228 0 23000 0 4743 0 0 0 26510 0 160481 0 0 0 ANDREW PETERSON 177654 0 0 0 4740 0 0 0 25873 0 208267 0 0 0 MOHSIN SYED 138298 0 6595 0 9380 0 0 0 8446 0 162719 0 0 0 NON-FIXED PAYMENTS SCHEDULE J, PART I, Q. 7 VP'S AND ABOVE PARTICIPATE IN A VARIABLE PAY PROGRAM THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION (EQUAL TO A PERCENT OF INDIVIDUAL BASE COMPENSATION) ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING HEALTH OUTCOMES, QUALITY IMPROVEMENT, LEVEL OF COMMUNITY BENEFIT PROVIDED AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE CHI BOARD OF STEWARDSHIP TRUSTEES. NO AWARD IS PAYABLE UNDER THE PROGRAM UNLESS OPERATING MARGIN AND CHARITY CARE LEVELS AT A DESIGNATED PERCENT OF BUDGET ARE MET. Physicians receive bonuses IN ACCORDANCE WITH THEIR contractS. THIS INCENTIVE COMPENSATION IS BASED UPon physician OVERALL PRODUCTIVITY. If the physician ATTAINs a TARGET productivity level, the physician is ELIGIBLE TO receive a PERCENTAGE bonus BASED on the increased productivity. BonusES for Senior leaders AND MANAGERS ARE LIMITED BY PERCENTAGE OF PAY AND DOLLAR AMOUNT, and physician bonus limits are defined in their contracts. METHODS USED TO ESTABLISH CEO COMPENSATION Schedule J, Part I, Q. 3 Compensation for the top management official of Holy Rosary Medical Center was established and paid by a related organization, catholic health initiatives (CHI). CHI used the following methods to establish the top management official's compensation: 1) compensation committee; 2) independent compensation consultant; 3) compensation survey or study; and 4) approval by the board or compensation committee; 5) written employment contract. Post-Termination Payments SCHEDULE J, PART I, Q. 4A Post-termination payments are addressed in the executive employment agreements for Catholic Health Initiative's ("CHI") MBO CEOs. These employment agreements require that in order for the executive to receive post-termination payments, these individuals must execute a general release and settlement agreement. Post-termination payment arrangements are periodically reviewed for overall reasonableness in light of the executive's overall compensation package. NO REPORTABLE INDVIDUAL RECEIVED A SEVERANCE PAYMENT THIS YEAR. SUPPLEMENTAL NON-QUALIFIED RETIREMENT PLAN SCH. J, PART I, Q. 4B DURING THE 2009 CALENDAR YEAR, CHI MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR VICE PRESIDENTS AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE: David Goode. THE FOLLOWING INDIVIDUALS RECEIVED PAYMENTS FROM THE SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN DURING THE 2009 CALENDAR YEAR, AND THE FOLLOWING AMOUNTS WERE INCLUDED IN THE INDIVIDUALS' REPORTABLE COMPENSATION FOR SCHEDULE J: David Goode $423,784. A contribution in the amount of $126 was made to the supplemental non-qualified deferred compensation plan during the 2009 calendar year. Building 2009-03-31 29937250 ACTUAL COST 271789847 Trinity Holy Rosary Medical Center 351 SW 9th Street Ontario OR 97914 501(c)(3) EQUIPMENT 2009-03-31 3937489 ACTUAL COST 271789847 Trinity Holy Rosary Medical Center 351 SW 9th Street Ontario OR 97914 501(C)(3) FURNITURE 2009-03-31 141543 ACTUAL COST 271789847 Trinity Holy Rosary Medical Center 351 SW 9th Street ONTARIO OR 97914 501(C)(3) LAND 2009-03-31 516483 ACTUAL COST 271789847 Trinity Holy Rosary Medical Center 351 SW 9th Street ONTARIO OR 97914 501(C)(3) true true false false Schedule N Part II Q 2e HOLY ROSARY MEDICAL CENTER SOLD SUBSTANIALLY ALL OF ITS ASSETS TO THE Trinity Holy Rosary Medical Center ON MARCH 31, 2009. With the exception of Mark Dalley, ALL OF THE OFFICERS, DIRECTORS, TRUSTEES, AND KEY EMPLOYEES THAT ARE LISTED ON PART VII ON THIS FORM 990 WILL HOLD THE SAME POSITIONS AFTER THE TRANSITION TO Trinity Holy Rosary Medical Center. Governing documents - COI Policy - Financial Statements available Form 990, Part VI, Q. 19 THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.COM. The organization's conflict of interest policy and governing documents are not publicly available. GOVERNING POWERS 990, Part VI, Q7b HRMC's corporate member is Catholic Health Initiatives ("CHI"). Pursuant to the organization's bylaws, the Corporate Member shall have the specific rights set forth in the governance matrix. Pursuant to the governance matrix the following rights are reserved to the CHI Board directly or through powers delegated to the CHI Chief Executive Officer: - Substantial change in the mission or philosophy of HRMC - Amendment of the corporate documents of HRMC - Approve members of HRMC's board - Removal of a member of the governing body of HRMC - Approval of issuance of debt by HRMC - Approval of participation of HRMC in a joint venture - Approval of formation of a new corporation by HRMC - Approval of a merger involving HRMC - Approval of the sale of all or substantially all of the assets of HRMC - To require the transfer of assets by HRMC to CHI to accomplish CHI's goals and objectives, and to satisfy CHI debts - Adoption of long range and strategic plans for HRMC Pursuant to the organization's bylaws, CHI may, in exercise of its approval powers, grant or withhold approval in whole or in part, or may, in its complete discretion, after consultation with the Board and the President and Chief Executive Officer of the organization, recommend such other or different actions as it deems appropriate. Conflict of Interest Policy FORM 990, PART VI, Q. 12C Policy: In concert with Catholic Health Initiative's Standards of Conduct, Holy Rosary Medical Center recognizes that conflicts of interest may occur. If conflicts do occur, it will be the employee's responsibility to follow this policy for resolution: Purpose: Holy Rosary Medical Center's direction to employees is to seek further clarification on issues related to potential conflict of interest. Additionally, this policy will provide standards to all personnel on gifts and benefits from outside sources to ensure that their conduct complies with the established standards of conduct in accordance with the Corporate Responsibility Program, Standards of Conduct, and Ethics at Work. Scope: This policy and procedure applies to all personnel. Definitions of Conflict of Interest: A conflict of interest may be considered to exist in instances where the action or activities of an employee involve: (a) the obtaining of an improper personal gain or advantage; (b) an adverse effect on Holy Rosary Medical Center's interests; or (c) the obtaining of an improper gain or advantage for or by a third party (relative of third entity). A relative is considered to be any person who is related by blood or marriage, or whose relationship with the employee is similar to that of persons who are related by blood or marriage. Conflicts of interest can also arise in other instances. While it is impossible to list every circumstance giving rise to a possible conflict of interest, the following will serve as a guide to the types of activities which might cause conflicts and which should be fully reported to the employee's manager or the Corporate Responsibility Officer. Descriptions of Types of Conflict of Interest: 1. Interest A. Holding by an employee, directly or indirectly, of a position or of a material financial interest in any outside concern (a) from which the Medical Facility secures goods or services, or (b) which provides publications or services competitive with the Medical Facility: and in the case of an employee, directly or indirectly holding such a position or material financial interest. B. Competition with the Medical Facility by an employee, directly or indirectly, in the purchase or sale of property or property rights or interest. 2. Outside Activities Employees should not have any significant ownership (i.e. greater than 5%) in any organization that does business with Holy Rosary Medical Center. Employees may only work for a competitor, supplier or potential supplier of Holy Rosary Medical Center with the approval of their supervisor/department manager. To obtain approval, the supervisor must consult with Human Resources regarding the appropriateness of the situation. 3. Gifts, Gratuities and Entertainment Holy Rosary Medical Center employees should not accept any type of gift that would influence the employee's decision-making or create the impression that such action was intended to influence the individual in the performance of his or her duties. Employees may accept gifts of nominal value, (defined as up to $50), from a patient or vendor but should exercise good judgement and discretion when accepting such gifts. A gift of money in any form or amount should never be accepted. To the extent possible, these gifts should be shared with co-workers. No employee of Holy Rosary Medical Center should accept gifts, gratuities or entertainment from a vendor where the acceptance of such would affect the ability of that employee to make objective decisions with that vendor. If in question, the employee should consult with their manager or the Corporate Responsibility Officer. 4. Inside Information No employee should disclose or use information related to the business of Holy Rosary Medical Center for personal profit or advantage. 5. Organization Assets All personnel have a responsibility to take care of the organization's assets for the good of the organization, not for personal gain. Personal gain may result not only in cases where an employee or relative has a significant ownership in a firm with which Holy Rosary Medical Center does business, but also when an employee or relative receives special consideration as a result of any transaction or business deal involving the organization. The equipment, materials, products, designs, plans, ideas and data of Holy Rosary Medical Center are the property of Holy Rosary Medical Center. Any improper transfer of material or disclosure of information, even when it is not apparent that an employee has personally gained by such action constitutes unacceptable conduct. Another example is personnel who have access to e-mail and/or the Internet. All employees are expected to limit that use to work related issues. All personnel should not use or disclose Holy Rosary Medical Center business information for personal gain or for the advantage of the person's immediate family. All personnel are responsible to accurately report all financial information and make sure that there is adequate oversight of reporting mechanisms so that conflicts of interest will not exist. Disclosure Process: All employees are required to disclose any potential conflict of interest situation as soon as they become aware that a conflict of interest may exist. Employee's who are unsure about the right thing to do or are confused about a particular action may use one of the following three sources to support in following these standards: (a) Employee's supervisor/manager; (b) Corporate Responsibility Officer; or (c) The Catholic Health Initiatives AlertLine. Compliance with these guidelines is a condition of continued employment or association with Holy Rosary Medical Center. An employee who fails to comply with these guidelines will be subject to disciplinary action up to and including termination from employment. Process the organization uses to review Form 990 Form 990, Part VI, Q. 11a Once the return is prepared, the return is reviewed by the Chief Financial Officer. The Chief Financial Officer provides the return to Holy Rosary Medical Center's board. Subsequently, the tax department files the return with the appropriate federal and state agencies, making any non-substantive changes necessary to effect e-filing. Any such changes are not re-submitted to the board. ESTIMATE OF HOURS DEVOTED TO RELATED ORGANIZATIONS FORM 990, PART VII COMPENSATION REPORTED ON FORM 990, PART VII WAS PAID TO THESE INDIVIDUALS BY RELATED ORGANIZATIONS IN EXCHANGE FOR THE FULFILLMENT OF THEIR DUTIES AS FULL-TIME, 60 HOUR-PER-WEEK EMPLOYEES. ELECTING BOARD MEMBERS FORM 990, PART VI, Q. 7A THE SOLE MEMBER HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS. MEMBERS OR STOCKHOLDERS FORM 990, PART VI, Q. 6 THE SOLE MEMBER OF THE ORGANIZATION IS CATHOLIC HEALTH INITIATIVES (CHI), A COLORADO NONPROFIT CORPORATION PROCESS FOR DETERMINING COMPENSATION - CEO/EXECUTIVE DIRECTOR FORM 990, PART VI, Q. 15A The organization's CEO's compensation is paid by CHI. CHI uses the Hay Group as the independent third party to assess executive compensation programs and to ensure the reasonableness of actual salaries and total compensation packages. Compensation of CHI's senior most executives (including each MBO CEO) are reviewed on an individual basis annually. The Hay Group reviews both cash and total compensation for overall reasonableness, for adherence to CHI's compensation philosophy, and for comparability to the not-for-profit healthcare market. This independent review is delivered by Hay Group to the HR Committee of the CHI Board of Stewardship Trustees annually at their September meeting and minutes are shared with the full board at the December meeting. The last review was September, 2010. In addition, in December 2009, Hay Group completed a comprehensive review of all CHI positions at the level of Vice President and above to determine and validate appropriate compensation levels. PROCESS FOR DETERMINING OTHER OFFICER COMPENSATION FORM 990, PART VI, Q. 15B WHEN DETERMINING COMPENSATION FOR OTHER DIRECTORS AND UPPER MANAGEMENT, A PERIODIC COMPENSATION STUDY IS PERFORMED. A REVIEW COMMITTEE, CONSISTING OF SENIOR LEADERSHIP, REVIEWS AND APPROVES ALL COMPENSATION PACKAGES AND ADJUSTMENTS PRIOR TO THE OFFERING OF EMPLOYMENT OR AN ANNUAL COMPENSATION INCREASES. SUCH OFFERS AND ADJUSTMENTS ARE REVIEWED FOR REASONABLENESS AND FOR COMPLIANCE WITH HRMC'S COMPENSATION PHILOSOPHY. Significant changes to program services Form 990, Part III, Line 3 HOLY ROSARY MEDICAL CENTER has ceased conducting business, effective March 31, 2010. Accordingly, the information contained in this Form 990 represents HOLY ROSARY MEDICAL CENTER'S wind-up period. SIGNIFICANT CHANGES TO ORGANIZATIONAL DOCUMENTS FORM 990, PART VI, Q. 4 HOLY ROSARY MEDICAL CENTER AMENDED ITS ARTICLES OF INCORPORATION, EFFECTIVE APRIL 1, 2010, TO INCLUDE THE PROVISION THAT IN FURTHERANCE OF ITS EXEMPT PURPOSE, IT WILL OWN, MANAGE, AND DISPOSE OF ITS REMAINING ASSETS AFTER THE SALE OF SUBSTANTIALLY ALL OF ITS ASSETS ON MARCH 31, 2010. St Dominic of Ontario LLC 198 Inverness Drive West Suite 800 Englewood CO 80112 273078768 MRI OR 4567483 HRMC St Joseph Community Health Services 300 Central SW Suite 300 Albuquerque NM 87102 710897107 Community NM 501(c)(3) 11a CHI St Joseph Community Health Foundation 300 Central SW Suite 300 Albuquerque NM 87102 850253087 Foundation NM 501(c)(3) 7 SJCHS St Francis of Baker City 3325 Pocahontas Road Baker City OR 97814 930412495 Hospital OR 501(c)(3) 3 CHI St Elizabeth Health Care Foundation 3325 Pocahontas Road Baker City OR 97814 943164869 Foundation OR 501(c)(3) 7 SEHS Flaget Memorial Hospital Foundation Inc 4305 New Shepherdsville Road Bardstown KY 40004 562351341 Fundraising KY 501(c)(3) 11a FH Flaget Healthcare DBA Flaget Memorial 4305 New Shepherdsville Road Bardstown KY 40004 611345363 Hospital KY 501(c)(3) 3 CHI Lakewood Health Center 600 Main Avenue South Baudette MN 56623 410758434 LTerm Care MN 501(c)(3) 3 CHI Appletree Court 601 Oak Street Breckenridge MN 56520 411850500 Senior Homes MN 501(c)(3) 9 SFH Healthcare and Wellness Foundation 2400 St Francis Drive Breckenridge MN 56520 760761782 Foundation MN 501(c)(3) 11a SFMC St Francis Home 2400 St Francis Drive Breckenridge MN 56520 410729978 LTerm Care MN 501(c)(3) 9 CHI St Francis Medical Center 2400 St Francis Drive Breckenridge MN 56520 410695598 Healthcare MN 501(c)(3) 3 CHI Carrington Health Center 800 North 4th Street Carrington ND 58421 450227311 Healthcare ND 501(c)(3) 3 CHI Saint Clare's Community Care 66 Ford Road Denville NJ 07834 222876836 Healthcare NJ 501(c)(3) 11b SCHS Saint Clare's Foundation Inc 66 Ford Road Denville NJ 07834 222502997 Fundraising NJ 501(c)(3) 7 SCHS Good Samaritan College of Nursing & Heal 375 Dixmyth Ave Cincinnati OH 45220 311778403 Education KY 501(c)(3) 2 GHS Total Healthcare PO Box 7021 Colorado Springs CO 80933 840927232 Healthcare CO 501(c)(3) 3 CHI Colorado Memorial Health Care System Inc 2525 De Sales Avenue Chattanooga TN 37404 620532345 Hospital TN 501(c)(3) 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