2014-05-08T17:00:11-05:00 2013-06-30 470617373 CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2012-07-01 930386868 MERCY MEDICAL CENTER INC MERC 5416772457 2700 Stewart Parkway Roseburg OR 97471 JOHN KASBERGER 2013-09-25 true Pamela Krohn P01210500 3032989100 2012 2015-11-30 17:44:51Z KELLY MORGAN 2700 Stewart Parkway Roseburg OR 97471 177567261 false 0928 X WWW.MERCYROSE.ORG X 1909 OR THE MISSION OF MERCY MEDICAL CENTER IS TO PROVIDE EXCELLENT, COMPASSIONATE CARE FOR THE PEOPLE OF OUR COMMUNITY, REGARDLESS OF ABILITY TO PAY. 12 8 1197 345 1890563 714855 404535 271248 172595005 170699233 1971297 4757200 2646322 1811695 177617159 177539376 393792 410146 0 0 68426051 67098541 0 0 0 85008742 82384129 153828585 149892816 23788574 27646560 183929580 207987069 55719334 52582511 128210246 155404558 X THE MISSION OF MERCY MEDICAL CENTER IS TO NURTURE THE HEALING MINISTRY OF THE ROMAN CATHOLIC 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. 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CHI'S FIN 48 (ASC 740) FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2013 READS AS FOLLOWS: "CHI IS A TAX-EXEMPT COLORADO CORPORATION AND HAS BEEN GRANTED AN EXEMPTION FROM FEDERAL INCOME TAX UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. CHI OWNS CERTAIN TAXABLE SUBSIDIARIES AND ENGAGES IN CERTAIN ACTIVITIES THAT ARE UNRELATED TO ITS EXEMPT PURPOSE AND THEREFORE SUBJECT TO INCOME TAX. MANAGEMENT REVIEWS ITS TAX POSITIONS ANNUALLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS." true true X false false true true false true true 16249 3944557 3944557 0.02800 39907 19868320 18826109 1042211 0.00740 0 0.00000 0 56156 23812877 18826109 4986768 0.03540 21 1239 39719 39719 0.00030 0 0.00000 0 0.00000 0 0.00000 14 8 110490 110490 0.00080 35 1247 150209 0 150209 0.00110 35 57403 23963086 18826109 5136977 0.03650 0 0.00000 1 720 720 0.00000 0 0.00000 0 0.00000 0 0.00000 3 1764 1764 0.00000 2 680476 680476 0.00450 0 0.00000 0 0.00000 6 0 682960 0 682960 0.00460 true 9150262 0 46306249 48184659 -1878410 X true true 1 1 MERCY MEDICAL CENTER INC

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OUTPATIENT IMAGING SERVICES MERCY MEDICAL CENTER OUTPATIENT IMAGING & LAB AT EVERGREEN FAMILY MEDICINE

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OUTPATIENT IMAGING SERVICES AND OUTPATIENT LABORATORY DRAWING SITE Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO MERCY MEDICAL CENTER, INC) ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY IT WAS DETERMINED THAT ESTABLISHING A HOUSEHOLD INCOME SCALE BASED ON THE HUD VERY LOW INCOME GUIDELINES MORE ACCURATELY REFLECTS THE SOCIOECONOMIC DISPERSIONS AMONG URBAN AND RURAL COMMUNITIES IN 17 STATES SERVED BY CHI HOSPITALS AND HEALTH CARE FACILITIES. IN COMPARING HUD GUIDELINES TO THE FEDERAL POVERTY GUIDELINES ("FPG"), WE FIND THAT ON AVERAGE HUD GUIDELINES COMPUTE TO APPROXIMATELY 200% TO 250% (AND SOMETIMES 300%) OF FPG. MERCY MEDICAL CENTER, INC BASES ITS FINANCIAL ASSISTANCE ELIGIBILITY ON HUD'S 130% OF VERY LOW INCOME GUIDELINES BASED ON GEOGRAPHY, AND AFFORDS THE UNINSURED AND UNDERINSURED THE ABILITY TO OBTAIN FINANCIAL ASSISTANCE 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 FINANCIAL ASSISTANCE. 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. PREPARES ITS OWN ANNUAL WRITTEN COMMUNITY BENEFIT REPORT SCHEDULE H, PART I, LINE 6A MERCY MEDICAL CENTER, INC PREPARES ITS OWN ANNUAL WRITTEN COMMUNITY BENEFIT REPORT. ITS COMMUNITY BENEFIT REPORT IS NOT CONTAINED IN THAT OF A RELATED ORGANIZATION. Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING THE ORGANIZATION'S COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. THE COST-TO-CHARGE RATIO FOR THE YEAR ENDED 6/30/13 WAS COMPUTED USING THE FOLLOWING FORMULA: OPERATING EXPENSE (BEFORE RESTRUCTURING, IMPAIRMENT AND OTHER LOSSES) DIVIDED BY GROSS PATIENT REVENUE. BASED ON THAT FORMULA, $134,653,893 / $456,235,794 RESULTS IN A 29.51% COST-TO-CHARGE RATIO. WORKSHEET 2 WAS NOT USED TO DERIVE THE COST-TO-CHARGE RATIO. Bad Debt Expense excluded from financial assistance calculation Schedule H, Part I, Line 7, column(f) 9,150,262 Bad debt expense - methodology used to estimate amount Schedule H, Part III, Line 2 COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 29.51%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. Bad debt expense - methodology used to estimate amount as community benefit Schedule H, Part III, Line 3 MERCY MEDICAL CENTER INC 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. Bad debt expense - financial statement footnote Schedule H, Part III, Line 4 MERCY MEDICAL CENTER INC DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS THE PROVISION FOR BAD DEBTS IS BASED UPON MANAGEMENT'S ASSESSMENT OF HISTORICAL AND EXPECTED NET COLLECTIONS, TAKING INTO CONSIDERATION HISTORICAL BUSINESS AND ECONOMIC CONDITIONS, TRENDS IN HEALTH CARE COVERAGE AND OTHER COLLECTION INDICATORS. MANAGEMENT ROUTINELY ASSESSES THE ADEQUACY OF THE ALLOWANCES FOR UNCOLLECTIBLE ACCOUNTS BASED UPON HISTORICAL WRITE OFF EXPERIENCE BY PAYOR CATEGORY. THE RESULTS OF THESE REVIEWS ARE USED TO MODIFY, AS NECESSARY, THE PROVISION FOR BAD DEBTS AND TO ESTABLISH APPROPRIATE ALLOWANCES FOR UNCOLLECTIBLE NET PATIENT ACCOUNTS RECEIVABLE. AFTER SATISFACTION OF AMOUNTS DUE FROM INSURANCE, CHI FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES, SUBJECT TO THE TERMS OF CERTAIN RESTRICTIONS ON COLLECTION EFFORTS AS DETERMINED BY EACH FACILITY. IN ACCORDANCE WITH ACCOUNTING STANDARDS UPDATE (ASU) NO. 2011 07 PRESENTATION AND DISCLOSURE OF PATIENT SERVICES REVENUE, PROVISION FOR BAD DEBTS, AND ALLOWANCES FOR DOUBTFUL ACCOUNTS FOR CERTAIN HEALTH ENTITIES, THE PROVISION FOR BAD DEBTS IS PRESENTED ON THE CONSOLIDATED STATEMENT OF OPERATIONS AS A DEDUCTION FROM PATIENT SERVICES REVENUES (NET OF CONTRACTUAL ALLOWANCES AND DISCOUNTS) SINCE CHI ACCEPTS AND TREATS ALL PATIENTS WITHOUT REGARD TO THE ABILITY TO PAY. Community benefit & methodology for determining medicare costs Schedule H, Part III, Line 8 USING ESSENTIALLY THE SAME MEDICARE COST REPORT PRINCIPLES AS TO THE ALLOCATION OF GENERAL SERVICES COSTS AND "APPORTIONMENT" METHODS, THE "CHI WORKBOOK" CALCULATES A PAYERS' GROSS ALLOWABLE COSTS BY SERVICE (SO AS TO FACILITATE A CORRESPONDING COMPARISON BETWEEN GROSS ALLOWABLE COSTS AND ULTIMATE PAYMENTS RECEIVED). THE TERM "GROSS ALLOWABLE COSTS" MEANS COSTS BEFORE ANY DEDUCTIBLES OR CO-INSURANCE ARE SUBTRACTED. MERCY MEDICAL CENTER, INC'S ULTIMATE REIMBURSEMENT WILL BE REDUCED BY ANY APPLICABLE COPAYMENT/ DEDUCTIBLE. WHERE MEDICARE IS THE SECONDARY INSURER, AMOUNTS DUE FROM THE INSURED'S PRIMARY PAYER WERE NOT SUBTRACTED FROM MEDICARE ALLOWABLE COSTS BECAUSE THE AMOUNTS ARE TYPICALLY IMMATERIAL. ALTHOUGH NOT PRESENTED ON THE MEDICARE COST REPORT, IN ORDER TO FACILITATE A MORE ACCURATE UNDERSTANDING OF THE "TRUE" COST OF SERVICES (FOR "SHORTFALL" PURPOSES) THE CHI WORKBOOK ALLOWS A HEALTH CARE FACILITY NOT TO OFFSET COSTS THAT MEDICARE CONSIDERS TO BE NON-ALLOWABLE, BUT FOR WHICH THE FACILITY CAN LEGITIMATELY ARGUE ARE RELATED TO THE CARE OF THE FACILITY'S PATIENTS. IN ADDITION, ALTHOUGH NOT REPORTABLE ON THE MEDICARE COST REPORT, THE CHI WORKBOOK INCLUDES THE COST OF SERVICES THAT ARE PAID VIA A SET FEE-SCHEDULE RATHER THAN BEING REIMBURSED BASED ON COSTS (E.G. OUTPATIENT CLINICAL LABORATORY). FINALLY, THE CHI WORKBOOK ALLOWS A FACILITY TO INCLUDE OTHER HEALTH CARE SERVICES PERFORMED BY A SEPARATE FACILITY (SUCH AS A PHYSICIAN PRACTICE) THAT ARE MAINTAINED ON SEPARATE BOOKS AND RECORDS (AS OPPOSED TO THE MAIN FACILITY'S BOOKS AND RECORDS WHICH HAS ITS COSTS OF SERVICE INCLUDED WITHIN A COST REPORT). TRUE COSTS OF MEDICARE COMPUTED USING THIS METHODOLOGY: TOTAL MEDICARE REVENUE: $54,497,281 TOTAL MEDICARE COSTS: $50,591,449 SURPLUS OR SHORTFALL $ 3,905,832 MERCY MEDICAL CENTER, INC BELIEVES THAT EXCLUDING MEDICARE LOSSES FROM COMMUNITY BENEFIT MAKES THE OVERALL COMMUNITY BENEFIT REPORT MORE CREDIBLE FOR THESE REASONS: UNLIKE SUBSIDIZED AREAS SUCH AS BURN UNITS OR BEHAVIORAL-HEALTH SERVICES, MEDICARE IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS. IN FACT, FOR-PROFIT HOSPITALS FOCUS ON ATTRACTING PATIENTS WITH MEDICARE COVERAGE, ESPECIALLY IN THE CASE OF WELL-PAID SERVICES THAT INCLUDE CARDIAC AND ORTHOPEDICS. SIGNIFICANT EFFORT AND RESOURCES ARE DEVOTED TO ENSURING THAT HOSPITALS ARE REIMBURSED APPROPRIATELY BY THE MEDICARE PROGRAM. THE MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC), AN INDEPENDENT CONGRESSIONAL AGENCY, CAREFULLY STUDIES MEDICARE PAYMENT AND THE ACCESS TO CARE THAT MEDICARE BENEFICIARIES RECEIVE. THE COMMISSION RECOMMENDS PAYMENT ADJUSTMENTS TO CONGRESS ACCORDINGLY. THOUGH MEDICARE LOSSES ARE NOT INCLUDED BY CATHOLIC HOSPITALS AS COMMUNITY BENEFIT, THE CATHOLIC HEALTH ASSOCIATION GUIDELINES ALLOW HOSPITALS TO COUNT AS COMMUNITY BENEFIT SOME PROGRAMS THAT SPECIFICALLY SERVE THE MEDICARE POPULATION. FOR INSTANCE, IF HOSPITALS OPERATE PROGRAMS FOR PATIENTS WITH MEDICARE BENEFITS THAT RESPOND TO IDENTIFIED COMMUNITY NEEDS, GENERATE LOSSES FOR THE HOSPITAL, AND MEET OTHER CRITERIA, THESE PROGRAMS CAN BE INCLUDED IN THE CHA FRAMEWORK IN CATEGORY C AS "SUBSIDIZED HEALTH SERVICES." MEDICARE LOSSES ARE DIFFERENT FROM MEDICAID LOSSES, WHICH ARE COUNTED IN THE CHA COMMUNITY BENEFIT FRAMEWORK, BECAUSE MEDICAID REIMBURSEMENTS GENERALLY DO NOT RECEIVE THE LEVEL OF ATTENTION PAID TO MEDICARE REIMBURSEMENT. MEDICAID PAYMENT IS LARGELY DRIVEN BY WHAT STATES CAN AFFORD TO PAY, AND IS TYPICALLY SUBSTANTIALLY LESS THAN WHAT MEDICARE PAYS Collection practices for patients eligible for financial assistance Schedule H, Part III, Line 9b MERCY MEDICAL CENTER, INC'S DEBT COLLECTION POLICY PROVIDES THAT MERCY MEDICAL CENTER, INC WILL PERFORM A REASONABLE REVIEW OF EACH INPATIENT ACCOUNT PRIOR TO TURNING AN ACCOUNT OVER TO A THIRD-PARTY COLLECTION AGENT AND PRIOR TO INSTITUTING ANY LEGAL ACTION FOR NON-PAYMENT, TO ASSURE THAT THE PATIENT AND PATIENT GUARANTOR ARE NOT ELIGIBLE FOR ANY ASSISTANCE PROGRAM (E.G. MEDICAID) AND DO NOT QUALIFY FOR COVERAGE THROUGH MERCY MEDICAL CENTER, INC COMMUNITY ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO MEET THE MERCY MEDICAL CENTER, INC COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO MERCY MEDICAL CENTER, INC FOR APPROPRIATE FOLLOW-UP. MERCY MEDICAL CENTER, INC 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. Community Served by Needs Assessment Schedule H, Part V Section B, Line 3 (1) MERCY MEDICAL CENTER, INC. - THE ASSESSMENT PROCESS HAS TAKEN PLACE OVER THE LAST TWO YEARS, AND WAS LED BY MERCY MEDICAL CENTER STAFF IN PARTNERSHIP WITH COMMUNITY STAKEHOLDERS. TO ENSURE BROAD INPUT FROM COMMUNITY RESIDENTS AND PARTNERS, OUT-REACH WAS CONDUCTED VIA A COMMUNITY PERCEPTION PHONE SURVEY, A COMMUNITY ENGAGEMENT FORUM; ONE-ON-ONE INTERVIEWS WITH KEY COMMUNITY LEADERS AND RESIDENTS; AND A SURVEY MONKEY WAS PROVIDED ELECTRONICALLY TO APPROXIMATELY 200 NOT-FOR-PROFIT AND HUMAN SERVICES ORGANIZATIONS. IN ADDITION, RESULTS FROM MERCY'S 2012 PATIENT SURVEY REGARDING ACCESS TO AND USAGE OF HEALTHCARE SERVICES WERE USED IN DETERMINING THE PRIORITY TOPICS. ONE-ON-ONE INTERVIEWS INCLUDED REPRESENTATIVES FROM ADAPT SUBSTANCE ABUSE TREATMENT PROGRAM, DOUGLAS COUNTY HEALTH AND HUMAN SERVICE DEPARTMENT, AND OREGON HELATH SCIENCES UNIVERSITY OFFICE OF RURAL HEALTH.; Needs not addressed in Needs Assessment Schedule H, Part V Section B, Line 7 (1) MERCY MEDICAL CENTER, INC. - FROM THE SURVEY PROCESS THE LARGEST COMMUNITY NEED NOT BEING ADDRESSED BY MERCY IS MOTOR VEHICLE SAFETY, INCLUDING SPEEDING, DUI OCCURRENCES, MOTOR VEHICLE CRASH MORTALITY. WHILE MERCY RECOGNIZES THE SERIOUSNESS OF THIS ISSUE, WE BELIEVE THAT OUR RESOURCES CAN BE MORE EFFECTIVELY USED TO IMPACT HEALTH NEEDS CURRENTLY IN PLACE. WE ARE COMMITTED TO SUPPORTING LOCAL GOVERNMENT EFFORTS TO IMPROVE MOTOR VEHICLE SAFETY, AND WILL PARTNER IN INITIATIVES WHEN POSSIBLE, MERCY IS NOT IN A POSITION TO LEAD THIS EFFORT AT THIS TIME.; Used federal poverty guidelines (FPG) to determine eligibility Schedule H, Part V Section B, Line 10 (1) MERCY MEDICAL CENTER, INC. - HUD LOW INCOME GUIDELINES USED; Used FPG to determine eligibility for providing discounted care criteria Schedule H, Part V Section B, Line 11 (1) MERCY MEDICAL CENTER, INC. - HUD LOW INCOME GUIDELINES USED; LINES 2, 4, & 5: COMMUNITY BENEFIT NARRATIVE AND NEEDS ASSESSMENT SCHEDULE H, PART VI FOR OVER THE LAST TWO YEARS, MERCY MEDICAL CENTER, INC. HAS LED A COMMUNITY WIDE NEEDS ASSESSMENT, GATHERING INPUT ON HEALTHCARE NEEDS AND PRIORITIES FROM COMMUNITY RESIDENTS AND PARTNERS. OUTREACH WAS CONDUCTED VIA A COMMUNITY PERCEPTION PHONE SURVEY, A COMMUNITY ENGAGEMENT FORUM AND ONE-ON-ONE INTERVIEWS WITH KEY COMMUNITY LEADERS AND RESIDENTS , AS WELL AS A SURVEY MONKEY WAS PROVIDED ELECTRONICALLY TO APPROXIMATELY 200 NOT-FOR-PROFIT AND HUMAN SERVICES ORGANIZATIONS. IN ADDITION, MERCY MEDICAL CENTER, INC. CONDUCTED A PATIENT SURVEY REGARDING ACCESS AND USAGE OF HEALTHCARE SERVICES. THE COMMUNITY ENGAGEMENT FORUM WAS FACILITATED TO REVIEW THE RESULTS OF THE SURVEYS ABOVE, AND PRIORITIZE THE NEEDS. A FULL REPORT FROM THE PROCESS WAS AVAILABLE BY JUNE 21, 2013. MERCY MEDICAL CENTER, INC. IS A SOLE COMMUNITY PROVIDER IN DOUGLAS COUNTY, OREGON. DOUGLAS COUNTY COVERS AN EXPANSIVE 5,071 SQUARE MILES FROM THE PACIFIC OCEAN TO WELL INTO THE CASCADE MOUNTAINS AND INCLUDES 12 INCORPORATED CITIES. DOUGLAS COUNTY INCLUDES THE ENTIRE UMPQUA RIVER WATERSHED AND A LARGE PORTION OF THE UMPQUA NATIONAL FOREST. IT IS PRIMARILY RURAL AND FORESTED AREA, AND THE FEDERAL GOVERNMENT OWNS APPROXIMATELY HALF OF THE LAND IN THE COUNTY. THE LATEST CENSUS PLACES THE POPULATION OF DOUGLAS COUNTY AT 107,490, WITH NEARLY 70% OF THE RESIDENTS LIVE NEAR THE I-5 CORRIDOR THAT RUNS THROUGH THE COUNTY. THE LARGEST CITY IS THE COUNTY SEAT OF ROSEBURG WHERE MOST OF THE HEALTH SERVICES ARE PROVIDED. DOUGLAS COUNTY FACES CHALLENGES FROM AN AGING POPULATION AND HIGH RATES OF UNEMPLOYMENT AND POVERTY. FEW EDUCATIONAL OPPORTUNITIES, HIGH RATES OF TOBACCO AND OTHER DRUG USE, AND FEW LOCAL RESOURCES TO ADDRESS THESE ISSUES ADD TO THE CHALLENGES. AS A LARGE COUNTY WITH MANY RURAL COMMUNITIES, THE SOCIO-ECONOMIC PROFILE IS LIKE THAT OF APPALACHIAN AMERICA. PER THE 2011 AMERICAN COMMUNITY SURVEY, 16.1% OF COUNTY RESIDENTS HAVE A BACHELOR'S DEGREE OR HIGHER COMPARED TO THE OREGON STATE AVERAGE OF 28.8%. THE MEDIAN HOUSEHOLD INCOME IS $38,502 COMPARED WITH THE OREGON STATE AVERAGE OF $46,876. 17% OF ALL RESIDENTS AND 25.3% OF CHILDREN UNDER 18 LIVE IN POVERTY, AND 17.9% OF RESIDENTS DO NOT HAVE HEALTH INSURANCE. 68% OF CHILDREN IN SCHOOLS LOCATED OUTSIDE OF ROSEBURG ARE ON THE FREE AND REDUCED LUNCH PROGRAM. DOUGLAS COUNTY HAS BEEN DESIGNATED AS A FEDERALLY DESIGNATED MEDICALLY UNDERSERVED AREA. ORGANIZATION'S MISSION, VISION, AND TAX-EXEMPT PURPOSE: SINCE IT WAS FOUNDED MORE THAN 100 YEARS AGO, MERCY MEDICAL CENTER HAS ALWAYS BEEN COMMITTED TO PROVIDING THE HIGHEST QUALITY HEALTH AND WELLNESS TO OUR COMMUNITY. OUR COMMITMENT URGES US TOWARDS COMPASSIONATE SUPPORT, GREATLY ENHANCING THE HEALTH CARE EXPERIENCE OF OUR PATIENTS AND THEIR FAMILIES. FROM COMMUNITY HEALTH AND HEALTH CARE EDUCATION TO PROVIDING ESSENTIAL HEALTH SERVICES, GIVING BACK TO OUR COMMUNITY IS AN ESSENTIAL PART OF WHAT WE DO. MERCY MEDICAL CENTER, FOUNDED IN 1909, IS A NOT-FOR-PROFIT HOSPITAL LOCATED IN ROSEBURG, OR. MERCY MEDICAL CENTER ("MMC") IS A 174-BED FACILITY WITH A LEVEL III TRAUMA DESIGNATION, INCLUDING TWO SPECIALTY UNITS AND AN ADULT AND ADOLESCENT INTENSIVE CARE. AS A NOT-FOR-PROFIT ORGANIZATION, MMC SERVES ALL PERSONS IN THE COMMUNITY ON A NONDISCRIMINATORY BASIS REGARDLESS OF ABILITY TO PAY SERVING ALL OF DOUGLAS COUNTY. FROM INCEPTION, MERCY MEDICAL CENTER EMBRACED THE MISSION OF THE FOUNDING CATHOLIC CONGREGATION, AND HAS JOINED WITH OTHER CONGREGATIONS TO FORM CATHOLIC HEALTH INITIATIVES. THE MISSION OF MERCY MEDICAL CENTER IS TO PROVIDE EXCELLENT, COMPASSIONATE CARE FOR THE PEOPLE OF OUR COMMUNITY. IT ALSO HAS A BOARD OF DIRECTORS THAT IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES. IN ADDITION TO PROVIDING MEDICAL SERVICES, MERCY MEDICAL CENTER PROVIDES MANY COMMUNITY-BASED SERVICES, DESIGNED TO PROMOTE HEALTHIER COMMUNITIES. TO ENHANCE THE HEALTH STATUS OF THE POPULATION, WE FOCUS ON HOLISTIC CARE INCLUDING SPIRITUAL, EMOTIONAL AND PHYSICAL WELL-BEING. MERCY MEDICAL CENTER OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THAT EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. MERCY MEDICAL CENTER PARTICIPATES IN MEDICARE AND MEDICAID, AND HAS AN ACTIVE CHARITY CARE PROGRAM. MERCY MEDICAL CENTER HAS AN OPEN MEDICAL STAFF WITH PRIVILEGES AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA. IT ALSO ENGAGES IN TRAINING AND EDUCATION OF HEALTH CARE PROFESSIONALS. MERCY MEDICAL CENTER IS INCLUDED IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. II. COMMUNITY BENEFIT APPROACH: SINCE 1909, MERCY MEDICAL CENTER HAS BEEN SERVING THE MEDICAL NEEDS OF DOUGLAS COUNTY. IN FACT, 2013 MARKS 104 YEARS OF SERVICE TO OUR COMMUNITY. OVER THE YEARS, OUR FOCUS HAS REMAINED ON MEETING THE DIVERSE HEALTH CARE NEEDS OF OUR COUNTY'S RESIDENTS. WITH A POPULATION OF GREATER THAN 100,000; DOUGLAS COUNTY HAS HIGHER THAN AVERAGE UNEMPLOYMENT AND POVERTY. THROUGH COLLABORATION WITH COMMUNITY AGENCIES, MERCY AND MERCY FOUNDATION HAVE BEEN INSTRUMENTAL IN INCREASING HEALTHCARE SERVICES FOR FAMILIES WITH ILL CHILDREN. IN 2007, THE FOUNDATION LAUNCHED THE HEALTHY KIDS OUTREACH PROGRAM, WHICH BRINGS WELLNESS NURSES AND RESOURCES TO THE MOST UNDERSERVED SCHOOLS IN THE COMMUNITY. IN AN EFFORT TO BRING NEW AND NEEDED SERVICES TO TOWN, MERCY ADDED A CORONARY INTERVENTION PROGRAM IN 2007 TO OUR SHAW HEART AND VASCULAR CENTER. BY HAVING THIS SERVICE LOCALLY FOR THE FIRST TIME, PATIENTS HAD ACCESS TO STATE-OF-THE-ART ANGIOPLASTY SERVICES WITHOUT HAVING TO TRAVEL. REALIZING THE STRONG CONNECTION THAT PHYSICIAN ACCESS HAS TO BUILDING OVERALL COMMUNITY HEALTH, MERCY HAS BEEN ACTIVE IN HELPING TO RECRUIT AN IMPRESSIVE NUMBER OF NEW PHYSICIANS. THESE NEW PHYSICIANS INCLUDE INTERNISTS AND SPECIALISTS, WHO CONTINUE TO ENHANCE DOUGLAS COUNTY RESIDENTS' ACCESS TO CARE. II. UNCOMPENSATED CARE: MERCY MEDICAL CENTER PROVIDES A SIGNIFICANT LEVEL OF FREE CARE EACH YEAR. IN FY 2013, THE COST OF CHARITY CARE PROVIDED BY THE ORGANIZATION WAS $3,944,557. MERCY MEDICAL CENTER ALSO INCURRED $3,752,165 IN UN-REIMBURSED COSTS FOR SERVICES PROVIDED TO MEDICARE AND MEDICAID PATIENTS, WHICH REPRESENT OVER 65% OF THE PATIENTS SERVED BY MERCY MEDICAL CENTER. FREQUENTLY, THE COST OF PROVIDING SERVICES TO MEDICARE AND MEDICAID PATIENTS IS GREATER THAN THE PAYMENTS MERCY MEDICAL CENTER RECEIVES FROM THE GOVERNMENT/STATE. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT: I. COMMUNITY OUTREACH FOR THE POOR: FOOD DONATIONS TO MISSION: MERCY MEDICAL CENTER HELPS TO ALLEVIATE HUNGER IN THE COMMUNITY BY DONATING EXCESS FOOD PREPARED BY THE HOSPITAL KITCHEN TO THE ROSEBURG RESCUE MISSION AND UMPQUA COMMUNITY ACTION NETWORK (UCAN) (FOODBANK). ADDITIONALLY MERCY MEDICAL CENTER, INC. PARTICIPATES IN UCAN'S "MARCH AGAINST HUNGER" ANNUAL EVENT, ENCOURAGING STAFF TO ASSIST IN THE PLANNING AND IMPLEMENTATION. COMMUNITY EDUCATION: MERCY'S COMMUNITY EDUCATION PROGRAM IS DESIGNED SPECIFICALLY TO PROVIDE THE COMMUNITY WITH PREVENTIVE AND HEALTH EDUCATION SERVICES. MERCY'S COMMUNITY EDUCATION PROGRAMS ARE FREE TO THE PUBLIC AND DESIGNED TO PROVIDE INSTRUCTION TO HELP ACHIEVE THE HEALTHIEST POSSIBLE LIFESTYLES. DURING FISCAL YEAR 2013 MERCY MEDICAL CENTER, INC. CONTRIBUTED $464,731 TO COMMUNITY HEALTH IMPROVEMENT AND EDUCATION PROGRAMS. DIABETES EDUCATION: THE AMERICAN DIABETES ASSOCIATION CERTIFIES MERCY'S DIABETES EDUCATION. MERCY'S OUTPATIENT DIABETES LEARNING CENTER PROVIDE INFORMATION, RESOURCES AND CONFIDENCE TO HELP PEOPLE WITH DIABETES CONTROL THEIR CONDITION AND ENJOY A FULL, HEALTHY LIFE. ONE-ON-ONE EDUCATION IS PROVIDED BY DIABETES CERTIFIED REGISTERED NURSE AND DIETITIAN. IN ADDITION, WE OFFER INDIVIDUAL AND GROUP CLASSES FOR DIABETES EDUCATION. CHILDBIRTH EDUCATION: MERCY MEDICAL CENTER'S FAMILY BIRTHPLACE PROVIDES CLASSES THAT MEET EVERY WEEK THROUGHOUT THE YEAR, AND INCLUDE PRENATAL EDUCATION, BREASTFEEDING, GIFT OF MOTHERHOOD AND CHILDBIRTH CLASSES. THESE CLASSES COVER ALL KINDS OF ISSUES SURROUNDING CHILDBIRTH AND PARENTING. UNITED WAY DAY OF CARING: EACH YEAR, THE UNITED WAY HOSTS A "DAY OF CARING" EVENT. UNITED WAY AGENCIES SUBMIT REQUESTS FOR VOLUNTEERS TO PAINT, PLANT, OR CLEAN AT THEIR FACILITY. EACH AGENCY IS ASSIGNED VOLUNTEERS WHO HELP MEET THE NEEDS OF THE DIFFERENT AGENCIES. EXAMPLES OF PAST DAY OF CARING PROJECTS INCLUDE SPRUCING UP A UNITED WAY FUNDED DAY CARE CENTER, HELPING WITH THE KIDS ON THE BLOCK FESTIVAL, PAINTING INTERIOR AND EXTERIOR FACILITIES, CLEANING, AND GARDENING. MERCY MEDICAL CENTER'S EMPLOYEES HAVE PARTICIPATED IN SEVERAL DAY OF CARING PROJECTS. (SEE CONTINUATION #1) LINES 2, 4, & 5: COMMUNITY BENEFIT NARRATIVE AND NEEDS ASSESSMENT SCHEDULE H, PART VI (CONTINUATION #1) DISEASE PREVENTION AND AWARENESS: MERCY MEDICAL CENTER COLLABORATES WITH LOCAL PARTNERS TO RAISE AWARENESS AND HELP FUND PREVENTION OF DISEASES SUCH AS CANCER, DIABETES, CYSTIC FIBROSIS, MUSCULAR DYSTROPHY AND AIDS. MERCY MEDICAL CENTER DONATED TO LOCAL ORGANIZATIONS SPONSORING PROMOTIONS IN PRESENTATION FORMATS, COVERING TOPICS SUCH AS HEART DISEASE, DIABETES, STROKE, AND BREAST CANCER AWARENESS. STRATEGIC PLANNING AND RECRUITING COSTS: DOUGLAS COUNTY HAS BEEN DESIGNATED AS A PHYSICIAN UNDERSERVED AREA. THERE IS A NEED FOR SIGNIFICANT PHYSICIAN RECRUITMENT TO THE AREA, TO MEET THE CURRENT NEEDS FOR CARE FOR THE COUNTY RESIDENTS AS WELL AS AN INCREASED NEED FOR FUTURE DEMAND FOR PATIENT MEDICAL CARE. MERCY HAS SUPPORTED RESEARCH INTO COUNTY NEEDS BY TYPE OF PHYSICIAN, AND ALSO HAS SUPPORTED RECRUITMENT OF NEW PHYSICIANS IN THE AREA IN CONJUNCTION WITH OTHER COMMUNITY MEDICAL PROVIDERS. HEALTH FAIRS AND SCREENINGS: MERCY MEDICAL CENTER PROVIDES CHOLESTEROL SCREENINGS, GLUCOSE SCREENING, BLOOD PRESSURE CHECKS, AND FLU SHOTS TO THE COMMUNITY. THESE FREE SCREENINGS REACHED A LARGE PORTION OF THE COUNTY. SUPPORT GROUPS: MERCY MEDICAL CENTER PROVIDES A LOCATION FOR OVER 15 SUPPORT GROUPS TO MEET, AND ADVERTISES MEETING LOCATIONS AND TIMES IN SEVERAL DIFFERENT PUBLICATIONS: BOARD ACTIVITIES: MERCY MEDICAL CENTER EMPLOYEES ARE ENCOURAGED TO BE INVOLVED IN COMMUNITY LEADERSHIP. EMPLOYEES SERVE IN A VARIETY OF LEADERSHIP CAPACITIES IN THE COMMUNITY INCLUDING SERVING ON BOARDS SUCH AS BATTERED PERSONS ADVOCACY, CHAMBER OF COMMERCE, COBB STREET BOARD, COUNCIL ON AGING, ECONOMIC DEVELOPMENT COMMITTEE, FUTURE 1ST CITIZEN, PROJECT LEADERSHIP AND THE UNITED WAY. AGENCIES SUPPORTED: MERCY MEDICAL CENTER PROVIDED CASH DONATIONS TO NUMEROUS AGENCIES SUCH AS THE BOYS AND GIRLS CLUB, CAMP MILLENNIUM, ROSEBURG CHAMBER OF COMMERCE, ROTARY FOUNDATION, UNITED WAY, WISH, COBB ST, DCCAPS, UMPQUA COMMUNITY HEALTH CLINIC AND VARIOUS HIGH SCHOOLS IN DOUGLAS COUNTY. IN ALL, MERCY MEDICAL CENTER HAD EXPENSES THAT EXCEEDED $683,000 IN COMMUNITY BUILDING ACTIVITIES. CONTRIBUTIONS: MERCY MEDICAL CENTER RECEIVES SOME COMMUNITY SUPPORT FROM DONATIONS THAT HELPS FUND RESEARCH AND EDUCATION, CAPITAL EXPANSION AND RENOVATION, INDIGENT CARE, NEW EQUIPMENT AND OPERATING COSTS. THE VALUE OF THIS COMMUNITY SUPPORT IS RETURNED TO THE COMMUNITY THROUGH LOWER COSTS IN PATIENT PROGRAMS AND COMMUNITY SERVICES DESCRIBED THROUGHOUT THIS DOCUMENT. Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 MERCY MEDICAL CENTER, INC., ALONG WITH ITS AFFILIATED OUTPATIENT FACILITIES, ARE PART OF CATHOLIC HEALTH INITIATIVES (CHI). CHI HAS A WRITTEN POLICY (STEWARDSHIP POLICY NO. 15) GOVERNING THE PROCEDURES FOR DETERMINING AND INFORMING PATIENTS ABOUT THE ENTITY'S FINANCIAL ASSISTANCE POLICY. ALL HOSPITAL FACILITIES INCLUDED IN THE FILING ORGANIZATION HAVE ADOPTED THE POLICY. THE POLICY STATES THE ORGANIZATION WILL INCLUDE INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, MERCY MEDICAL CENTER, INC. PROMINENTLY DISPLAYS ITS FINANCIAL ASSISTANCE POLICY IN BOTH ENGLISH AND SPANISH IN OBVIOUS LOCATIONS THROUGHOUT THE HOSPITALS, INCLUDING THE EMERGENCY ROOMS AND OTHER PATIENT INTAKE AREAS, AS WELL AS IN MERCY MEDICAL CENTER, INC. OUTPATIENT FACILITIES. IN ADDITION, MERCY MEDICAL CENTER, INC. 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 MERCY MEDICAL CENTER INC.'S FINANCIAL ASSISTANCE POLICY. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY AND PROCEDURES INCLUDING AN APPLICATION FOR ASSISTANCE. MERCY MEDICAL CENTER, INC. 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. MERCY MEDICAL CENTER, INC.'S STAFF WILL ALSO ASSIST THE PATIENT GARANTOR 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. Affiliated health care system Schedule H, Part VI, Line 6 MERCY MEDICAL CENTER, INC, 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; TWO COMMUNITY HEALTH-SERVICES ORGANIZATIONS; TWO ACCREDITED NURSING COLLEGES; AND HOME HEALTH AGENCIES. TOGETHER, THESE FACILITIES PROVIDED $762 MILLION IN CHARITY CARE AND COMMUNITY BENEFIT IN THE 2013 FISCAL YEAR, INCLUDING SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. CHI PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED "SHARED SERVICES" FOR THE MBOS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES - INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN -- PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE MBOS. THE COST SAVINGS ACHIEVED THROUGH CHI'S CENTRALIZATION ENABLE MBOS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. MERCY MEDICAL CENTER, INC OPERATES WITH ITS WHOLLY OWNED AFFILIATES AND COMMUNITY PARTNERS, ALONG WITH ITS FUNDRAISING ARM, THE MERCY FOUNDATION, INC, TO SERVE THE HEALTH CARE NEEDS OF THE DOUGLAS COUNTY, OREGON COMMUNITIES. State filing of community benefit report Schedule H, Part VI, Line 7 OR true ROSEBURG CHAMBER FUTURE FIRST CITIZEN SCHOLARSHIP PO BOX 1820 ROSEBURG OR 97470 911852358 501(C)(3) 6000 SCHOLARSHIP CCD BUSINESS DEVELOPMENT CORPORATION 744 SE ROSE ROSEBURG OR 97470 930594077 501(C)(3) 10000 GENERAL SUPPORT THE LEAPFROG GROUP 1660 L STREET NW SUITE 308 WASHINGTON DC 20036 522359517 501(C)(3) 5000 GENERAL SUPPORT MERCY FOUNDATION INC 2700 STEWART PARKWAY ROSEBURG OR 97471 936088946 501(C)(3) 358128 BOOK SUPPLIES GENERAL SUPPORT 4 0 Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 ALL DONATIONS ARE GIVEN TO NON-PROFIT ORGANIZATIONS TO BE USED IN ACCORDANCE WITH THEIR CHARITABLE PURPOSE; AND AS SUCH, USE OF THE FUNDS GIVEN TO THE GRANTEE IS NOT MONITORED BEYOND THEIR DISTRIBUTION. THE ORGANIZATION MAKES A RECORD OF ALL DONATIONS IN THE GENERAL LEDGER. false true false false false false false false false ALAN RADER 131549 0 0 0 374 0 11667 0 14099 0 157689 0 0 0 ANN FULLER 117192 0 9723 0 854 0 11636 0 22239 0 161644 0 0 0 CHRISTOPHER KINYON 0 137062 0 3176 0 685 0 14028 0 6702 0 161653 0 0 DEBRA BOSWELL 250139 0 40558 0 2261 0 30596 0 8458 0 332012 0 0 0 DEBRA RINAKER 122601 0 9723 0 1774 0 11666 0 8105 0 153869 0 0 0 JASON GRAY 270968 0 31941 0 1381 0 20596 0 18264 0 343150 0 0 0 JEAN LARSON 127293 0 10244 0 1260 0 12828 0 20192 0 171817 0 0 0 JOHN KASBERGER 251003 0 40612 0 2265 0 23096 0 15892 0 332868 0 0 0 JOSEPH WILCZEK 0 788016 0 262159 0 306040 0 25596 0 10481 0 1392292 0 175847 KELLY MORGAN 0 471717 0 210593 0 60519 0 65657 0 15265 0 823751 0 37907 MARK JOHNSON 123561 0 0 0 6017 0 15585 0 14225 0 159388 0 0 0 MARVIN GWALTNEY JR 0 106988 0 24212 0 4530 0 13526 0 13178 0 162434 0 0 RAHUL AGARWAL 177849 0 30155 0 1352 0 22016 0 22580 0 253952 0 0 0 Arrangement used to establish the top management official's compensation Schedule J, Part I, Line 3 COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. CHI USED THE FOLLOWING TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) WRITTEN EMPLOYMENT CONTRACTS; (4) COMPENSATION SURVEY OR STUDY; (5) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SEVERANCE PAYMENTS SCHEDULE J, PART I, LINE 4A POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR CATHOLIC HEALTH INITIATIVES ("CHI") AND RELATED ORGANIZATIONS' EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE, INCLUDING THE MBO CEOS. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. Supplemental nonqualified retirement plan Schedule J, Part I, Line 4b DURING THE 2012 CALENDAR YEAR CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR MBO CEOS AND OTHER CHI EMPLOYEES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. THE FOLLOWING REPORTABLE INDIVIDUALS WERE ELIGIBLE TO PARTICIPATE IN THAT PLAN: JOSEPH WILCZEK KELLY MORGAN DURING 2012 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: KELLY MORGAN - $42,561 DURING 2012 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: KELLY MORGAN- $37,907 JOSEPH WILCZEK - $175,847 DUE TO THE "SUPER" VESTING RULES UNDER THE CHI DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS TERMINATION, AGE, OR YEARS OF SERVICE ARE ELIGIBLE TO RECEIVE THEIR 2012 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2012, THE FOLLOWING CONTRIBUTIONS THAT WOULD HAVE BEEN MADE BY CHI TO THE DEFERRED COMPENSATION PLAN WERE PAID IN CASH: JOSEPH WILCZEK - $98,125 UMPQUA BANK KELLY MORGAN IS A BOARD MEMBER OF UMPQUA BANK AND AN OFFICER OF MMC 4744222 LOAN PAYMENTS AND BANK FEES false KANAN AGARWAL SPOUSE OF RAHUL AGARWAL, AN OFFICER OF MMC 112647 COMPENSATION FOR HER EMPLOYMENT AT MMC false DCIPA LLC FORMER OFFICER OF MMC IS PRESIDENT OF DCIPA 12345643 CAPITALIZATION PAYMENTS AND SERVICES false ARCHITRAVE HEALTH LLC SHARED BOARD MEMBERS 25875783 MEDICAL SERVICES AND MANAGMENT SERVICES false X MEDICAL EQUIPMENT 2 76222 COST 0 false true false Number of contributions or items contributed. Schedule M, part I, column (b), Line other=MEDICAL EQUIPMENT ORGANIZATION'S MISSION FORM 990, PART III, LINE 1 (CONTINUED FROM PART III) CATHOLIC HEALTH INITIATIVES, SPONSORED BY A LAY-RELIGIOUS PARTNERSHIP, CALLS TO OTHER CATHOLIC SPONSORS AND SYSTEMS TO UNITE TO ENSURE THE FUTURE OF CATHOLIC HEALTH CARE. TO FULFILL THIS MISSION, THE CORPORATION AND CATHOLIC HEALTH INITIATIVES, AS VALUE-BASED ORGANIZATIONS AND IN PARTNERSHIP WITH LAITY AND OTHERS, WILL ASSURE THE INTEGRITY OF THE MINISTRY IN BOTH CURRENT AND DEVELOPING ORGANIZATIONS AND ACTIVITIES; RESEARCH AND DEVELOP NEW MINISTRIES THAT INTEGRATE HEALTH, EDUCATION, PASTORAL, AND SOCIAL SERVICES; PROMOTE LEADERSHIP DEVELOPMENT THROUGHOUT THE ENTIRE ORGANIZATION; ADVOCATE FOR SYSTEMIC CHANGES WITH SPECIFIC CONCERN FOR PERSONS WHO ARE POOR, ALIENATED, AND UNDERSERVED; AND STEWARD RESOURCES BY GENERAL OVERSIGHT OF THE ENTIRE ORGANIZATION. Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a PURSUANT TO SECTION 8.6 OF THE BYLAWS OF MERCY MEDICAL CENTER, THE EXECUTIVE COMMITTEE IS COMPOSED OF THE BOARD CHAIR, THE BOARD VICE CHAIR, THE PRESIDENT AND CEO, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE, AND TWO VOTING MEMBERS APPOINTED BY THE BOARD OF DIRECTORS. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION. PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. Delegation of management duties Form 990, Part VI, Section A, Line 3 MERCY MEDICAL CENTER, INC. HAS DELEGATED LIMITED CONTROL OVER MANAGEMENT DUTIES FOR CERTAIN HOSPITAL DEPARTMENTS TO THE FOLLOWING MANAGEMENT COMPANIES: PROFESSIONAL MANAGEMENT OF OREGON, LLC, CALIFORNIA EMERGENCY PHYSICIANS, DOUGLAS MEDICAL GROUP, UMPQUA MEDICAL GROUP AND EVERGREEN FAMILY MEDICINE. THE SURGICAL AND EMERGENCY AREAS ARE MANAGED BY THESE MANAGEMENT ORGANIZATIONS. THE MANAGEMENT COMPANIES HAVE THEIR OWN EMPLOYEES THAT THEY HIRE, FIRE AND SUPERVISE. NONE OF MERCY MEDICAL CENTER'S CURRENT OR FORMER OFFICERS, DIRECTORS, ETC. HAVE RECEIVED COMPENSATION FROM THE MANAGEMENT COMPANIES DURING THE 2012 CALENDAR YEAR. Classes of members or stockholders Form 990, Part VI, Section A, Line 6 ACCORDING TO THE BYLAWS OF MERCY MEDICAL CENTER, INC., THE ENTITY'S SOLE MEMBER IS CATHOLIC HEALTH INITIATIVES, A COLORADO NONPROFIT CORPORATION. Members or stockholders electing members of governing body Form 990, Part VI, Section A, Line 7a ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b THE ORGANIZATION'S CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES ("CHI"). PURSUANT TO SECTION 5.4 OF THE ORGANIZATION'S BYLAWS, BOTH MERCY MEDICAL CENTER, INC.AND CATHOLIC HEALTH INITIATIVES ("CHI") HAVE RESERVED POWERS AS OUTLINED IN THE CHI GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE CHI BOARD: *APPROVE MEMBERS OF THE MERCY MEDICAL CENTER, INC. BOARD *AMENDMENT OF THE CORPORATE DOCUMENTS OF THE MERCY MEDICAL CENTER, INC. *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE MERCY MEDICAL CENTER, INC. *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE MERCY MEDICAL CENTER, INC. 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 THE MERCY MEDICAL CENTER, INC. *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE MERCY MEDICAL CENTER, INC. *APPROVAL OF ISSUANCE OF DEBT BY MERCY MEDICAL CENTER, INC. *APPROVAL OF PARTICIPATION OF MERCY MEDICAL CENTER, INC. IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY MERCY MEDICAL CENTER *APPROVAL OF A MERGER INVOLVING THE MERCY MEDICAL CENTER, INC. *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE MERCY MEDICAL CENTER INC. *TO REQUIRE THE TRANSFER OF ASSETS BY THE MERCY MEDICAL CENTER, INC. TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, CHI MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b ONCE THE RETURN IS PREPARED, THE RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER AND CONTROLLER. A COPY OF THE DRAFT RETURN IS MADE AVAILABLE TO BOARD MEMBERS THAT WOULD LIKE TO REVIEW IT. SUBSEQUENT TO THE REVIEW BY THE CFO, 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. Conflict of interest policy Form 990, Part VI, Section B, Line 12c THE CONFLICT OF INTEREST POLICY OF MERCY MEDICAL CENTER, INC. (MMC) COVERS ALL DIRECTORS AND OFFICERS WHO HOLD THE TITLE OF VICE PRESIDENT AND ABOVE. THE POLICY APPLIES TO ALL AFFILIATES OF THE CORPORATION AND IS INTENDED TO SUPPLEMENT, BUT NOT REPLACE, ANY APPLICABLE LAWS GOVERNING CONFLICTS OF INTEREST APPLICABLE TO NONPROFIT CORPORATIONS. IF A DIRECTOR OR OFFICER HAS A POTENTIAL OR ACTUAL CONFLICT WITH THE CORPORATION AND/OR ANY OF ITS AFFILIATES, SUCH DIRECTOR OR OFFICER IS DEEMED TO ALSO HAVE A POTENTIAL OR ACTUAL CONFLICT WITH RESPECT TO THE CORPORATION AND ALL OF ITS AFFILIATES. EACH DIRECTOR MUST PROMPTLY AND FULLY REPORT TO THE BOARD CHAIR SITUATIONS THAT MAY CREATE A CONFLICT OF INTEREST WHEN HE OR SHE BECOMES AWARE OF SUCH SITUATIONS. DISCLOSURE MUST BE MADE TO THE CORPORATIONS PRESIDENT AND CEO WHO WILL REPORT SUCH DISCLOSURE TO THE BOARD CHAIR. A WRITTEN RECORD OF THE DISCLOSURE WILL BE MADE. THE CEO SHALL ANNUALLY SEND TO ALL DIRECTORS AND OFFICERS A COPY OF THE CONFLICT OF INTERESTS POLICY AND DISCLOSURE STATEMENT. THE BOARD OF DIRECTORS SHALL CAREFULLY SCRUTINIZE, AND MUST IN GOOD FAITH APPROVE OR DISAPPROVE, ANY TRANSACTION IN WHICH THE CORPORATION AND/OR ANY OF ITS AFFILIATES IS A PARTY, AND IN WHICH ONE OR MORE OF THE CORPORATION'S DIRECTORS OR OFFICERS HAS EITHER A MATERIAL FINANCIAL INTEREST OR IS A DIRECTOR OR OFFICER OF THE OTHER PARTY. BY A MAJORITY VOTE OF THE DISINTERESTED DIRECTORS, THE BOARD SHALL TAKE WHATEVER ACTION IS DEEMED APPROPRIATE UNDER THE CIRCUMSTANCES WITH RESPECT TO THE DIRECTOR OR OFFICER IN ORDER TO BEST PROTECT THE INTERESTS OF THE CORPORATION, INCLUDING POSSIBLE DISCIPLINARY OR CORRECTIVE ACTION. PROCESS USED TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL FORM 990, PART VI, LINE 15A THE ORGANIZATION'S CEO'S COMPENSATION IS PAID BY CHI. CHI HAS A DEFINED COMPENSATION PHILOSOPHY. BOTH THE EXECUTIVE AND NON-EXECUTIVE COMPENSATION STRUCTURES AND RANGES ARE REVIEWED ANNUALLY IN COMPARISON TO MARKET DATA. CHI USES THE HAY GROUP AS THE INDEPENDENT THIRD PARTY TO ASSESS EXECUTIVE COMPENSATION PROGRAMS AND TO ENSURE THE REASONABLENESS OF ACTUAL SALARIES AND TOTAL COMPENSATION PACKAGES. COMPENSATION OF THE SENIOR MOST EXECUTIVES IS REVIEWED ANNUALLY. THE HAY GROUP REVIEWS BOTH CASH AND TOTAL COMPENSATION FOR OVERALL REASONABLENESS, FOR ADHERENCE TO CHI'S COMPENSATION PHILOSOPHY, AND FOR COMPARABILITY TO THE NOT-FOR-PROFIT HEALTHCARE MARKET. THIS INDEPENDENT REVIEW IS 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 17, 2013. IN ADDITION, IN DECEMBER 2009, HAY GROUP COMPLETED A COMPREHENSIVE REVIEW OF ALL POSITIONS AT THE LEVEL OF VICE PRESIDENT AND ABOVE TO DETERMINE AND VALIDATE APPROPRIATE COMPENSATION LEVELS. THESE LEVELS HAVE BEEN REVIEWED ANNUALLY SINCE AND REVISED BASED ON MARKET DATA, WHERE APPLICABLE. Process used to establish compensation of other officers/key employees Form 990, Part VI, Section B, Line 15b MERCY MEDICAL CENTER, INC ANNUALLY SEEKS COMPARABLE MARKET DATA FOR THEIR VPS FROM AN INDEPENDENT SOURCE. THE DATA IS PRESENTED TO A SUBCOMMITTE OF THE BOARD WHO APPROVES ANY INCREASES FROM A MARKET PERSPECTIVE. INCREASES ARE RECOMMENDED DEPENDING ON THE DATA AND FINANCES. FOR KEY PERSONNEL THAT HAVE EMPLOYMENT CONTRACTS IN PLACE, THE CONTRACT IS FOLLOWED FOR ANY INCREASES (MOST CONTRACTS ARE FOR 3 YRS). CONTRACT RENEWALS ARE APPROVED BY A PHYSICIAN TRANSACTION COMMITTEE. EMPLOYEES THAT HAVE EMPLOYMENT CONTRACTS AREN'T PART OF THE MERIT OR MARKET REVIEW PROCESS. PERSONS ELIGIBLE FOR MERIT INCREASES HAVE AN ANNUAL EVALUATION THAT IS APPROVED BY THE HIGHEST LEVEL OF SENIOR MANAGEMENT. DURING THE TAX YEAR ENDED 6/30/13, CERTAIN OFFICERS, DIRECTORS AND/OR TRUSTEES RECEIVED COMPENSATION FROM RELATED ORGANIZATIONS. ANY EXECUTIVE COMPENSATION PAID TO OFFICERS, DIRECTORS OR TRUSTEES BY RELATED ORGANIZATIONS WAS SET BY THE RELATED ORGANIZATION'S COMPENSATION COMMITTEE UTILIZING BOTH AN INDEPENDENT CONSULTANT AND COMPARABILITY STUDIES TO DETERMINE COMPENSATION. JOINT VENTURE POLICY FORM 990, PART VI, LINE 16B MERCY MEDICAL CENTER, INC. HAS NOT FORMALLY ADOPTED A WRITTEN POLICY OR WRITTEN PROCEDURE REGARDING JOINT VENTURES. HOWEVER CHI'S SYSTEM-WIDE JOINT VENTURE MODEL OPERATING AGREEMENT INCORPORATES CONTROLS OVER THE VENTURE SUFFICIENT TO ENSURE THAT (1) THE EXEMPT ORGANIZATION AT ALL TIMES RETAINS CONTROL OVER THE VENTURE SUFFICIENT TO ENSURE THAT THE PARTNERSHIP FURTHERS THE EXEMPT PURPOSE OF THE ORGANIZATION; (2) IN ANY PARTNERSHIP IN WHICH THE EXEMPT ORGANIZATION IS A PARTNER, ACHIEVEMENT OF EXEMPT PURPOSES IS PRIORITIZED OVER MAXIMIZATION OF PROFITS FOR THE PARTNERS; (3) THE PARTNERSHIP DOES NOT ENGAGE IN ANY ACTIVITIES THAT WOULD JEOPARDIZE THE EXEMPT ORGANIZATION'S EXEMPTION; (4) RETURNS OF CAPITAL, ALLOCATIONS, AND DISTRIBUTIONS MUST BE MADE IN PROPORTION TO THE PARTNERS' RESPECTIVE OWNERSHIP INTERESTS; AND (5) ALL CONTRACTS ENTERED INTO BY THE PARTNERSHIP WITH THE EXEMPT ORGANIZATION MUST BE AT ARM'S-LENGTH, WITH PRICES SET AT FAIR MARKET VALUE. ANY JOINT VENTURE AGREEMENTS THAT DO NOT CONFORM TO THE MODEL AGREEMENT ARE GENERALLY REVIEWED BY COUNSEL. Governing documents, conflict of interest policy and financial statements available to the public Form 990, Part VI, Section C, Line 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN CATHOLIC HEALTH INITIATIVES' CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.CATHOLICHEALTHINIT.ORG OR AT WWW.DACBOND.ORG. Other Expenses Form 990, Part IX, Line 11g CONTRACT LABOR CLINICAL - TOTAL EXPENSE: 3490960, PROGRAM SERVICE EXPENSE: 3490960, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONTRACT LABOR NON-CLINICAL - TOTAL EXPENSE: 1404086, PROGRAM SERVICE EXPENSE: 1404086, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; MEDICAL DIRECTOR FEES - TOTAL EXPENSE: 592125, PROGRAM SERVICE EXPENSE: 592125, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; OTHER PHYSICIAN/ PROF FEES - TOTAL EXPENSE: 2192766, PROGRAM SERVICE EXPENSE: 2192766, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CHI CLINICAL ENGINEERING FEES - TOTAL EXPENSE: 2440498, PROGRAM SERVICE EXPENSE: 2440498, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONTRACT SERVICES INTRACOMPANY - TOTAL EXPENSE: 916584, PROGRAM SERVICE EXPENSE: 916584, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONTRACT SERVICES COLLECTION FEES - TOTAL EXPENSE: 1162049, PROGRAM SERVICE EXPENSE: 1162049, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; PURCHASED SERVICE INTRACOMPANY - TOTAL EXPENSE: 45117, PROGRAM SERVICE EXPENSE: 45117, MANAGEMENT AND GENERAL EXPENSES: , FUNDRAISING EXPENSES: ; CONSULTING - TOTAL EXPENSE: 135116, PROGRAM SERVICE EXPENSE: 108457, MANAGEMENT AND GENERAL EXPENSES: 26659, FUNDRAISING EXPENSES: ; OTHER SERVICES - TOTAL EXPENSE: 3093689, PROGRAM SERVICE EXPENSE: 3078694, MANAGEMENT AND GENERAL EXPENSES: 14995, FUNDRAISING EXPENSES: ; Other changes in net assets or fund balances Form 990 , Part XI, Line 9 CAPITAL RESOURCE POOL CONTRIBUTION - -2197320; CHI CONNECT DEPRECIATION - 146501; ALEGENT CREIGHTON CLINIC 12809 WEST DODGE ROAD OMAHA NE 68154 HEALTHCARE NE 501(C)(3) 3 ACH true ALEGENT CREIGHTON HEALTH 12809 WEST DODGE ROAD OMAHA NE 68154 HEALTHCARE NE 501(C)(3) 3 NA true ALEGENT HEALTH - BERGAN MERCY HEALTH SYS 7500 MERCY ROAD OMAHA NE 68124 HEALTHCARE NE 501(C)(3) 3 ACH true ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA 631 N 8TH STREET MISSOURI VALLEY IA 51555 HEALTHCARE IA 501(C)(3) 3 AHIMC true ALEGENT HEALTH FOUNDATION 12809 WEST DODGE ROAD OMAHA NE 68154 FUNDRAISING NE 501(C)(3) 7 ACH true ALEGENT HEALTH IMMANUEL MEDICAL CENTER 6901 NORTH 72ND STREET OMAHA NE 68122 HEALTHCARE NE 501(C)(3) 3 ACH true ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER NE 104 W 17TH STREET SCHUYLER NE 68661 HEALTHCARE NE 501(C)(3) 3 AHIMC true ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 HEALTHCARE IA 501(C)(3) 3 AHBMHS true ALVERNA APARTMENTS 300 SE 8TH AVENUE LITTLE FALLS MN 56345 LTERM CARE MN 501(C)(3) 9 CHI true APPLETREE COURT 601 OAK STREET BRECKENRIDGE MN 56520 SENIOR HOMES MN 501(C)(3) 9 SFH true BISHOP DRUMM RETIREMENT CENTER 1111 6TH AVENUE DES MOINES IA 50314 LTERM CARE IA 501(C)(3) 9 CHI-IA CORP true BORNEMANN HEALTH CORPORATION 2500 BERNVILLE RD PO BOX 316 READING PA 19603 HEALTHCARE PA 501(C)(3) 11 - Type I CHI true CARRINGTON HEALTH CENTER 800 NORTH 4TH STREET CARRINGTON ND 58421 HEALTHCARE ND 501(C)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 9 NA true CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 6385 CORPORATE DRIVE COLORADO SPRINGS CO 80919 FUNDRAISING CO 501(C)(3) 7 CHIC true CATHOLIC HEALTH INITIATIVES INSTITUTE FOR RESEARCH AND INNOVATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 11 - Type I CHI true CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 6385 CORPORATE DRIVE COLORADO SPRINGS CO 80919 FUNDRAISING CO 501(C)(3) 9 CHI true CATHOLIC HEALTH INITIATIVES-COLORADO 188 INVERNESS DRIVE WEST SUITE 500 ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 3 CHI true CATHOLIC HEALTH INITIATIVES-IOWA CORP DBA MERCY MEDICAL CENTER-DES MOINES 1111 6TH AVENUE DES MOINES IA 50314 HEALTHCARE IA 501(C)(3) 3 CHI true CENTENNIAL MEDICAL GROUP INC 2700 STEWART PARKWAY ROSEBURG OR 97470 PHYSICIANS OR 501(C)(3) 9 MMC true CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 SURGERY CNTR KS 501(C)(3) 3 CHI true CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PARKWAY SOUTH FARGO ND 58104 HEALTHCARE ND 501(C)(3) 9 CHI true CHI KENTUCKY INC 3900 OLYMPIC BLVD SUITE 400 ERLANGER KY 41018 HEALTHCARE KY 501(C)(3) 11 - Type I CHI true CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 9 CHI NHC true CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE CO 501(C)(3) 11 - Type I CHI true CHI NEBRASKA 6940 O STREET LINCOLN NE 68510 HEALTHCARE NE 501(C)(3) 11 - Type I CHI true COMMUNITY LIMITED CARE DIALYSIS CENTER 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 DIALYSIS OH 501(C)(2) N/A GSH true COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION MISSOURI VALLEY IA 631 N 8TH STREET MISSOURI VALLEY IA 51555 FUNDRAISING IA 501(C)(3) 11 - Type I AHCMH true CONTINUING CARE HOSPITAL 150 NORTH EAGLE CREEK DRIVE LEXINGTON KY 40509 LTACH KY 501(C)(3) 3 SJHS true COVENANT HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HOME HEALTH PA 501(C)(3) 11 - Type II NA true ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1450 BATTERSBY AVENUE ENUMCLAW WA 98022 HEALTHCARE WA 501(C)(3) 3 FHS true FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE ROAD BARDSTOWN KY 40004 HEALTHCARE KY 501(C)(3) 3 KOH true FLAGET MEMORIAL HOSPITAL FOUNDATION 4305 NEW SHEPHERDSVILLE ROAD BARDSTOWN KY 40004 FUNDRAISING KY 501(C)(3) 11 - Type I FH true FRANCISCAN FOUNDATION 1717 SOUTH J STREET TACOMA WA 98405 FUNDRAISING WA 501(C)(3) 9 FHS true FRANCISCAN HEALTH SYSTEM 1717 SOUTH J STREET TACOMA WA 98405 HEALTHCARE WA 501(C)(3) 3 CHI true FRANCISCAN MEDICAL GROUP 1708 SOUTH YAKIMA AVENUE TACOMA WA 98405 HEALTHCARE WA 501(C)(3) 9 FHS true FRANCISCAN VILLA OF SOUTH MILWAUKEE 3601 SOUTH CHICAGO AVENUE SOUTH MILWAUKEE WI 53172 HEALTHCARE WI 501(C)(3) 9 CHI true GETTYSBURG MEDICAL CENTER 606 EAST GARFIELD AVENUE GETTYSBURG SD 57442 HEALTHCARE SD 501(C)(3) 3 SMHC true GLOBAL HEALTH INITIATIVES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 MINISTRIES CO 501(C)(3) 11 - Type I CHI true GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 EDUCATION OH 501(C)(3) 2 GSH true GOOD SAMARITAN FOUNDATION OF CINCINNATI INC 619 OAK STREET - ACCOUNTING 3 WEST CINCINNATI OH 45206 FUNDRAISING OH 501(C)(3) 11 - Type I GSH true GOOD SAMARITAN HOSPITAL PO BOX 1990 KEARNEY NE 68848 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true GOOD SAMARITAN HOSPITAL FOUNDATION 111 W 31ST STREET KEARNEY NE 68847 FUNDRAISING NE 501(C)(3) 7 GSH true ST LUKE'S MEDICAL GROUP FKA GREATER HOUSTON HEALTH NETWORK 6624 FANNIN HOUSTON TX 77030 PHY PRACTICES TX 501(C)(3) 3 SLHS true HEALTH SET 4200 WEST CONEJOS PLACE 436 DENVER CO 80204 LOW INC.CARE CO 501(C)(3) 7 CHIC true HEALTHCARE AND WELLNESS FOUNDATION 2400 ST FRANCIS DRIVE BRECKENRIDGE MN 56520 FUNDRAISING MN 501(C)(3) 11 - Type I SFMC true HIGHLINE MEDICAL CENTER 16251 SYLVESTER RD SW BURIEN WA 98166 HEALTHCARE WA 501(C)(3) 3 FHS true HOSPITAL ASSOCIATION FOR ST JOSEPH HOSPITAL 7601 OSLER DRIVE TOWSON MD 21204 HEALTHCARE MD 501(C)(3) 9 SJMC true HOUSE OF MERCY 1111 6TH AVENUE DES MOINES IA 50314 SHELTER IA 501(C)(3) 7 CHI-IA CORP true JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC 539 S 4TH STREET LOUISVILLE KY 40202 HEALTHCARE KY 501(C)(3) 3 KOH true JEWISH PHYSICIAN GROUP INC 539 S 4TH STREET LOUISVILLE KY 40202 HEALTHCARE KY 501(C)(3) 9 JHSMH true KENTUCKYONE HEALTH INC FKA JH PROPERTIES INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 HEALTHCARE KY 501(C)(3) 9 CHI true LAKEWOOD HEALTH CENTER 600 MAIN AVENUE SOUTH BAUDETTE MN 56623 HEALTHCARE MN 501(C)(3) 3 CHI true LINUS OAKES INC 2700 STEWART PARKWAY ROSEBURG OR 97470 SENIOR LIVING OR 501(C)(3) 9 MMC true LISBON AREA HEALTH SERVICES 905 MAIN STREET LISBON ND 58054 HEALTHCARE ND 501(C)(3) 3 CHI true MEMORIAL HEALTH CARE SYSTEM FOUNDATION 2525 DE SALES AVENUE CHATTANOOGA TN 37404 FUNDRAISING TN 501(C)(3) 7 MHCS true MEMORIAL HEALTH CARE SYSTEM INC 2525 DE SALES AVENUE CHATTANOOGA TN 37404 HEALTHCARE TN 501(C)(3) 3 CHI true MEMORIAL HEALTH PARTNERS FOUNDATION INC 5600 BRAINERD ROAD SUITE 500 CHATTANOOGA TN 37411 HEALTHCARE TN 501(C)(3) 9 MHCS true MERCY AUXILIARY OF CENTRAL IOWA 1111 6TH AVENUE DES MOINES IA 50314 AUXILIARY IA 501(C)(3) 11 - Type I CHI-IA CORP true MERCY CLINICS INC 1111 6TH AVENUE DES MOINES IA 50314 PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP true MERCY COLLEGE OF HEALTH SCIENCES 1111 6TH AVENUE DES MOINES IA 50314 EDUCATION IA 501(C)(3) 2 CHI-IA CORP true MERCY FOUNDATION OF DES MOINES IA 1111 6TH AVENUE DES MOINES IA 50314 FUNDRAISING IA 501(C)(3) 7 CHI-IA CORP true MERCY FOUNDATION INC 2700 STEWART PARKWAY ROSEBURG OR 97470 FUNDRAISING OR 501(C)(3) 7 MMC true MERCY HEALTH CARE FOUNDATION PO BOX 368 CORNING IA 50841 FUNDRAISING NE 501(C)(3) 11 - Type I AHMH true MERCY HEALTHCARE FOUNDATION 570 CHAUTAUQUA BOULEVARD VALLEY CITY ND 58072 FUNDRAISING ND 501(C)(3) 11 - Type III - FI MHVC true MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS 800 MERCY DRIVE COUNCIL BLUFFS IA 51503 FUNDRAISING IA 501(C)(3) 11 - Type I AHBMHS true MERCY HOSPITAL OF DEVILS LAKE 1031 SEVENTH STREET NE DEVILS LAKE ND 58301 HEALTHCARE ND 501(C)(3) 3 CHI true MERCY HOSPITAL OF DEVILS LAKE FOUNDATION 1031 SEVENTH STREET NE DEVILS LAKE ND 58301 FUNDRAISING ND 501(C)(3) 7 CHI true MERCY HOSPITAL OF VALLEY CITY 570 CHAUTAUQUA BOULEVARD VALLEY CITY ND 58072 HEALTHCARE ND 501(C)(3) 3 CHI true MERCY MEDICAL CENTER 1301 15TH AVENUE WEST WILLISTON ND 58801 HEALTHCARE ND 501(C)(3) 3 CHI true MERCY MEDICAL CENTER - CENTERVILLE ONE ST JOSEPHS DRIVE CENTERVILLE IA 52544 HEALTHCARE IA 501(C)(3) 3 CHI-IA CORP true MERCY MEDICAL CENTER INC 2700 STEWART PARKWAY ROSEBURG OR 97470 HEALTHCARE OR 501(C)(3) 3 CHI true MERCY MEDICAL FOUNDATION 1301 15TH AVENUE WEST WILLISTON ND 58801 FUNDRAISING ND 501(C)(3) 11 - Type I MMC true MERCY PROFESSIONAL PRACTICE ASSOCIATES INC 1111 6TH AVENUE DES MOINES IA 50314 PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP true MLIFECARES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 PROPERTY MGMT MO 501(C)(3) 11 - Type I SJRMC true MNMCH INC 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 HEALTHCARE KS 501(C)(3) 3 SJRMC true MT ST JOSEPH INC 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 NURSING CARE OR 501(C)(3) 11 - Type I CHI true NEBRASKA HEART HOSPITAL 7500 SOUTH 91ST STREET LINCOLN NE 68526 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true OAKES COMMUNITY HOSPITAL 314 SOUTH 8TH STREET OAKES ND 58474 HEALTHCARE ND 501(C)(3) 3 CHI true OAKES COMMUNITY HOSPITAL FOUNDATION 1200 N 7TH STREET OAKES ND 58474 FUNDRAISING ND 501(C)(3) 11 - Type I OCH true PUEBLO STEPUP 1925 EAST ORMAN AVE SUITE G52 PUEBLO CO 81004 COMMUNITY CO 501(C)(3) 7 CHIC true SET OF COLORADO SPRINGS INC 2864 S CIRCLE DRIVE SUITE 450 COLORADO SPRINGS CO 80906 LTERM CARE CO 501(C)(3) 7 CHIC true SAINT CLARE'S COMMUNITY CARE 25 POCONO ROAD DENVILLE NJ 07834 HEALTHCARE NJ 501(C)(3) 11 - Type II SCHS true SAINT CLARE'S FOUNDATION 25 POCONO ROAD DENVILLE NJ 07834 FUNDRAISING NJ 501(C)(3) 7 SCHS true SAINT CLARE'S HEALTH SERVICES INC 25 POCONO ROAD DENVILLE NJ 07834 MANAGEMENT NJ 501(C)(3) 7 CHI true SAINT CLARE'S HOSPITAL 25 POCONO ROAD DENVILLE NJ 07834 HEALTHCARE NJ 501(C)(3) 3 SCHS true SAINT ELIZABETH FOUNDATION 555 SOUTH 70TH STREET LINCOLN NE 68510 FUNDRAISING NE 501(C)(3) 7 SERMC true SAINT ELIZABETH HEALTH SERVICES 555 SOUTH 70TH STREET LINCOLN NE 68510 HEALTHCARE NE 501(C)(3) 3 SERMC true SAINT ELIZABETH REGIONAL MEDICAL CENTER 555 SOUTH 70TH STREET LINCOLN NE 68510 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER 2620 WEST FAIDLEY GRAND ISLAND NE 68803 HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA true SAINT FRANCIS MEDICAL CENTER FOUNDATION PO BOX 9804 GRAND ISLAND NE 68802 FUNDRAISING NE 501(C)(3) 7 SFMC true SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC 305 ESTILL STREET BEREA KY 40403 FUNDRAISING KY 501(C)(3) 7 SJHS true SAINT JOSEPH HEALTH SYSTEM INC 424 LEWIS HARGETT CIRCLE 160 LEXINGTON KY 40503 HEALTHCARE KY 501(C)(3) 3 CHI true SAINT JOSEPH LONDON FOUNDATION INC 1001 SAINT JOSEPH LANE LONDON KY 40741 FUNDRAISING KY 501(C)(3) 7 SJHS true SAINT JOSEPH MEDICAL FOUNDATION INC 200 ABRAHAM FLEXNER WAY LOUISVILLE KY 40202 PHY PRACTICES KY 501(C)(3) 3 SJHS true SAINT JOSEPH MOUNT STERLING FOUNDATION INC 225 FALCON DRIVE MOUNT STERLING KY 40353 FUNDRAISING KY 501(C)(3) 7 SJHS true SAINT JOSEPH'S HOSPITAL FOUNDATION 30 WEST 7TH STREET DICKINSON ND 58601 FUNDRAISING ND 501(C)(3) 11 - 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