Form990
Department of the Treasury
Internal Revenue Service
Return of Organization Exempt From Income Tax
Under section 501(c), 527, or 4947(a)(1) of the Internal Revenue Code (except black lung benefit trust or private foundation)

MediumBullet The organization may have to use a copy of this return to satisfy state reporting requirements.
OMB No. 1545-0047
2012
Open to Public Inspection
A For the 2012 calendar year, or tax year beginning 07-01-2012 , 2012, and ending 06-30-2013
BCheck if applicable:
CName of organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Doing Business As
 
 
Number and street (or P.O. box if mail is not delivered to street address)
2525 DeSales Avenue
 
Room/suite
City or town, state or country, and ZIP + 4
Chattanooga, TN37404
D Employer identification number

62-0532345
E Telephone number

G Gross receipts $ 544,425,389
F Name and address of principal officer:
JAMES HOBSON
2525 De Sales Avenue
Chattanooga,TN37404
I
Tax-exempt status: (   ) LeftBullet (insert no.) or
J
Website:MediumBullet
WWW.MEMORIAL.ORG
H(a)
Is this a group return for
affiliates?
H(b)
Are all affiliates included?
If "No," attach a list. (see instructions)
H(c)
Group exemption number MediumBullet0928
K Form of organization:
 
L Year of formation: 1952
M State of legal domicile: TN
Part I
Summary
Activities  & Governance 1 Briefly describe the organization’s mission or most significant activities: EMPHASIZE HUMAN DIGNITY AND SOCIAL JUSTICE AS WE CREATE HEALTHIER COMMUNITIES BY PROVIDING HEALTH CARE SERVICES REGARDLESS OF ABILITY TO PAY, FOR THOSE IN CHATTANOOGA, TN AND THE SURROUNDING AREA.
2 Check this box MediumBullet
3 Number of voting members of the governing body (Part VI, line 1a) ........ 3 20
4 Number of independent voting members of the governing body (Part VI, line 1b) ..... 4 15
5 Total number of individuals employed in calendar year 2011 (Part V, line 2a) ...... 5 4,128
6 Total number of volunteers (estimate if necessary) ............. 6 600
7a Total unrelated business revenue from Part VIII, column (C), line 12 ........ 7a 8,908,873
b Net unrelated business taxable income from Form 990-T, line 34 ......... 7b -3,149,197
Revenues Prior Year Current Year
8 Contributions and grants (Part VIII, line 1h) ......... 2,231,686 1,081,349
9 Program service revenue (Part VIII, line 2g) ......... 533,928,757 524,017,731
10 Investment income (Part VIII, column (A), lines 3, 4, and 7d ) .... 4,849,508 12,856,582
11 Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e) 6,726,867 6,444,378
12 Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)................... 547,736,818 544,400,040
Expenses; 13 Grants and similar amounts paid (Part IX, column (A), lines 1–3 )... 638,596 812,921
14 Benefits paid to or for members (Part IX, column (A), line 4)..... 0 0
15 Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10) 210,538,549 192,280,443
16a Professional fundraising fees (Part IX, column (A), line 11e)..... 0 0
b Total fundraising expenses (Part IX, column (D), line 25) MediumBullet0    
17 Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e).... 308,997,088 322,829,702
18 Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25) 520,174,233 515,923,066
19 Revenue less expenses. Subtract line 18 from line 12....... 27,562,585 28,476,974
Net Assets or Fund Balances; Beginning of Current Year End of Year
20 Total assets (Part X, line 16)............. 546,395,438 627,424,626
21 Total liabilities (Part X, line 26)............. 147,912,569 203,624,169
22 Net assets or fund balances. Subtract line 21 from line 20..... 398,482,869 423,800,457
Part II
Signature Block
Under penalties of perjury, I declare that I have examined this return, including accompanying schedules and statements, and to the best of my knowledge and belief, it is true, correct, and complete. Declaration of preparer (other than officer) is based on all information of which preparer has any knowledge.
Sign Here
JumboBullet
Signature of officer Date
JumboBullet
Type or print name and title
Paid Preparer Use Only
Print/Type preparer's name
 
Preparer's signature
Date
PTIN
Firm's name MediumBullet

Firm's EIN MediumBullet
Firm's address MediumBullet



Phone no.
May the IRS discuss this return with the preparer shown above? (see instructions) ............
For Paperwork Reduction Act Notice, see the separate instructions.
Cat. No. 11282Y
Form 990 (2012)
Form 990 (2012)
Page 2
Part III
Statement of Program Service Accomplishments
Check if Schedule O contains a response to any question in this Part III ...............
1
Briefly describe the organization’s mission: THE MISSION OF MEMORIAL HEALTH CARE SYSTEM 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.
2
Did the organization undertake any significant program services during the year which were not listed on
the prior Form 990 or 990-EZ? ......................
If “Yes,” describe these new services on Schedule O.
3
Did the organization cease conducting, or make significant changes in how it conducts, any program services? ............................
If “Yes,” describe these changes on Schedule O.
4
Describe the organization’s program service accomplishments for each of its three largest program services, as measured by expenses. Section 501(c)(3) and 501(c)(4) organizations are required to report the amount of grants and allocations to others, the total expenses, and revenue, if any, for each program service reported.
4a (Code:   ) (Expenses $ 457,473,957 including grants of $ 812,921 ) (Revenue $ 517,135,119 )
SEE SCHEDULE H
4b (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4c (Code:   ) (Expenses $   including grants of $   ) (Revenue $   )
4d Other program services (Describe in Schedule O.)
(Expenses $   including grants of $   ) (Revenue $   )
4e Total program service expensesMediumBullet457,473,957
Form 990 (2012)
Form 990 (2012)
Page 3
Part IV
Checklist of Required Schedules
Yes
No
1
Is the organization described in section 501(c)(3) or 4947(a)(1) (other than a private foundation)? If “Yes,” complete Schedule AClick to see attachment........................
1
Yes
 
2
Is the organization required to complete Schedule B, Schedule of Contributors (see instructions)? Click to see attachment...
2
Yes
 
3
Did the organization engage in direct or indirect political campaign activities on behalf of or in opposition to candidates for public office? If “Yes,” complete Schedule C, Part I..........
3
 
No
4
Section 501(c)(3) organizations. Did the organization engage in lobbying activities, or have a section 501(h) election in effect during the tax year? If “Yes,” complete Schedule C, Part IIClick to see attachment........
4
Yes
 
5
Is the organization a section 501(c)(4), 501(c)(5), or 501(c)(6) organization that receives membership dues, assessments, or similar amounts as defined in Revenue Procedure 98-19? If “Yes,” complete Schedule C,
Part III
............................
5
 
 
6
Did the organization maintain any donor advised funds or any similar funds or accounts for which donors have the right to provide advice on the distribution or investment of amounts in such funds or accounts? If “Yes,” complete Schedule D, Part I........................
6
 
No
7
Did the organization receive or hold a conservation easement, including easements to preserve open space,
the environment, historic land areas, or historic structures? If “Yes,” complete Schedule D, Part II
...
7
 
No
8
Did the organization maintain collections of works of art, historical treasures, or other similar assets? If “Yes,” complete Schedule D, Part III ....................
8
 
No
9
Did the organization report an amount in Part X, line 21 for escrow or custodial account liability; serve as a custodian for amounts not listed in Part X; or provide credit counseling, debt management, credit repair, or debt negotiation services? If “Yes,” complete Schedule D, Part IV..............
9
 
No
10
Did the organization, directly or through a related organization, hold assets in temporarily restricted endowments, permanent endowments, or quasi-endowments? If “Yes,” complete Schedule D, Part V......
10
 
No
11
If the organization’s answer to any of the following questions is "Yes," then complete Schedule D, Parts VI, VII, VIII, IX, or X as applicable.
a
Did the organization report an amount for land, buildings, and equipment in Part X, line 10?
If “Yes,” complete Schedule D, Part VI.Click to see attachment
...................
11a
Yes
 
b
Did the organization report an amount for investments—other securities in Part X, line 12 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIIClick to see attachment.......
11b
Yes
 
c
Did the organization report an amount for investments—program related in Part X, line 13 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part VIII.......
11c
 
No
d
Did the organization report an amount for other assets in Part X, line 15 that is 5% or more of its total assets reported in Part X, line 16? If “Yes,” complete Schedule D, Part IX............
11d
 
No
e
Did the organization report an amount for other liabilities in Part X, line 25? If “Yes,” complete Schedule D, Part XClick to see attachment
11e
Yes
 
f
Did the organization’s separate or consolidated financial statements for the tax year include a footnote that addresses the organization’s liability for uncertain tax positions under FIN 48 (ASC 740)? If “Yes,” complete Schedule D, Part XClick to see attachment.........................
11f
Yes
 
12a
Did the organization obtain separate, independent audited financial statements for the tax year?
If “Yes,” complete Schedule D, Parts XI and XII .................
12a
 
No
b
Was the organization included in consolidated, independent audited financial statements for the tax year? If “Yes,” and if the organization answered "No" to line 12a, then completing Schedule D, Parts XI and XII is optional Click to see attachment
12b
Yes
 
13
Is the organization a school described in section 170(b)(1)(A)(ii)? If “Yes,” complete Schedule E....
13
 
No
14a
Did the organization maintain an office, employees, or agents outside of the United States?.....
14a
 
No
b
Did the organization have aggregate revenues or expenses of more than $10,000 from grantmaking, fundraising, business, investment, and program service activities outside the United States, or aggregate foreign investments valued at $100,000 or more? If “Yes,” complete Schedule F, Parts I and IV.........
14b
 
No
15
Did the organization report on Part IX, column (A), line 3, more than $5,000 of grants or assistance to any organization or entity located outside the United States? If “Yes,” complete Schedule F, Parts II and IV
15
 
No
16
Did the organization report on Part IX, column (A), line 3, more than $5,000 of aggregate grants or assistance to individuals located outside the United States? If “Yes,” complete Schedule F, Parts III and IV...
16
 
No
17
Did the organization report a total of more than $15,000 of expenses for professional fundraising services on Part IX, column (A), lines 6 and 11e? If “Yes,” complete Schedule G, Part I (see instructions)....
17
 
No
18
Did the organization report more than $15,000 total of fundraising event gross income and contributions on Part VIII, lines 1c and 8a? If “Yes,” complete Schedule G, Part II............
18
 
No
19
Did the organization report more than $15,000 of gross income from gaming activities on Part VIII, line 9a? If “Yes,” complete Schedule G, Part III...................
19
 
No
20a
Did the organization operate one or more hospital facilities? If “Yes,” complete Schedule H.... Click to see attachment
20a
Yes
 
b
If “Yes” to line 20a, did the organization attach a copy of its audited financial statements to this return? Click to see attachment
20b
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 4
Part IV
Checklist of Required Schedules (continued)
21
Did the organization report more than $5,000 of grants and other assistance to any government or organization in the United States on Part IX, column (A), line 1? If “Yes,” complete Schedule I, Parts I and II... Click to see attachment
21
Yes
 
22
Did the organization report more than $5,000 of grants and other assistance to individuals in the United States on Part IX, column (A), line 2? If “Yes,” complete Schedule I, Parts I and III........ Click to see attachment
22
Yes
 
23
Did the organization answer “Yes” to Part VII, Section A, line 3, 4, or 5 about compensation of the organization’s current and former officers, directors, trustees, key employees, and highest compensated employees? If “Yes,” complete Schedule J....................... Click to see attachment
23
Yes
 
24a
Did the organization have a tax-exempt bond issue with an outstanding principal amount of more than $100,000 as of the last day of the year, that was issued after December 31, 2002? If “Yes,” answer lines 24b through 24d and complete Schedule K. If “No,” go to line 25................
24a
 
No
b
Did the organization invest any proceeds of tax-exempt bonds beyond a temporary period exception?...
24b
 
 
c
Did the organization maintain an escrow account other than a refunding escrow at any time during the year
to defease any tax-exempt bonds?
......................
24c
 
 
d
Did the organization act as an “on behalf of” issuer for bonds outstanding at any time during the year?...
24d
 
 
25a
Section 501(c)(3) and 501(c)(4) organizations. Did the organization engage in an excess benefit transaction with a disqualified person during the year? If “Yes,” complete Schedule L, Part I........
25a
 
No
b
Is the organization aware that it engaged in an excess benefit transaction with a disqualified person in a prior year, and that the transaction has not been reported on any of the organization’s prior Forms 990 or 990-EZ? If “Yes,” complete Schedule L, Part I...................
25b
 
No
26
Was a loan to or by a current or former officer, director, trustee, key employee, highest compensated employee, or disqualified person outstanding as of the end of the organization’s tax year? If “Yes,” complete Schedule L,
Part II
..........................
26
 
No
27
Did the organization provide a grant or other assistance to an officer, director, trustee, key employee, substantial contributor or employee thereof, a grant selection committee member, or to a 35% controlled entity or family member of any of these persons? If “Yes,” complete Schedule L, Part III.........
27
 
No
28
Was the organization a party to a business transaction with one of the following parties (see Schedule L, Part IV instructions for applicable filing thresholds, conditions, and exceptions):
a
A current or former officer, director, trustee, or key employee? If “Yes,” complete Schedule L, Part IV ..........................
28a
 
No
b
A family member of a current or former officer, director, trustee, or key employee? If “Yes,”
complete Schedule L, Part IV
.....................
28b
 
No
c
An entity of which a current or former officer, director, trustee, or key employee (or a family member thereof) was an officer, director, trustee, or direct or indirect owner? If “Yes,” complete Schedule L, Part IV...
28c
 
No
29
Did the organization receive more than $25,000 in non-cash contributions? If “Yes,” complete Schedule M..
29
 
No
30
Did the organization receive contributions of art, historical treasures, or other similar assets, or qualified conservation contributions? If “Yes,” complete Schedule M.............
30
 
No
31
Did the organization liquidate, terminate, or dissolve and cease operations? If “Yes,” complete Schedule N,
Part I
...........................
31
 
No
32
Did the organization sell, exchange, dispose of, or transfer more than 25% of its net assets? If “Yes,” complete Schedule N, Part II......................
32
 
No
33
Did the organization own 100% of an entity disregarded as separate from the organization under Regulations sections 301.7701-2 and 301.7701-3? If “Yes,” complete Schedule R, Part I........ Click to see attachment
33
Yes
 
34
Was the organization related to any tax-exempt or taxable entity? If “Yes,” complete Schedule R, Part II, III, or IV, and Part V, line 1........................ Click to see attachment
34
Yes
 
35a
Did the organization have a controlled entity within the meaning of section 512(b)(13)?
35a
Yes
 
b
If ‘Yes’ to line 35a, did the organization receive any payment from or engage in any transaction with a controlled entity within the meaning of section 512(b)(13)? If “Yes,” complete Schedule R, Part V, line 2... Click to see attachment
35b
Yes
 
36
Section 501(c)(3) organizations. Did the organization make any transfers to an exempt non-charitable related organization? If “Yes,” complete Schedule R, Part V, line 2.............
36
 
No
37
Did the organization conduct more than 5% of its activities through an entity that is not a related organization and that is treated as a partnership for federal income tax purposes? If “Yes,” complete Schedule R, Part VI
37
 
No
38
Did the organization complete Schedule O and provide explanations in Schedule O for Part VI, lines 11b and 19? Note. All Form 990 filers are required to complete Schedule O. ............
38
Yes
 
Form 990 (2012)
Form 990 (2012)
Page 5
Part V
Statements Regarding Other IRS Filings and Tax Compliance
Check if Schedule O contains a response to any question in this Part V ...............
Yes
No
1a
Enter the number reported in Box 3 of Form 1096 Enter -0- if not applicable ..
1a
5
b
Enter the number of Forms W-2G included in line 1a. Enter -0- if not applicable .
1b
0
c
Did the organization comply with backup withholding rules for reportable payments to vendors and reportable gaming (gambling) winnings to prize winners? ..................
1c
Yes
 
2a
Enter the number of employees reported on Form W-3, Transmittal of Wage and
Tax Statements, filed for the calendar year ending with or within the year covered by this return ..................
2a
4,128
b
If at least one is reported on line 2a, did the organization file all required federal employment tax returns?
Note. If the sum of lines 1a and 2a is greater than 250, you may be required to e-file (see instructions)
2b
Yes
 
3a
Did the organization have unrelated business gross income of $1,000 or more during the year?...
3a
Yes
 
b
If “Yes,” has it filed a Form 990-T for this year? If “No,” provide an explanation in Schedule O.....
3b
Yes
 
4a
At any time during the calendar year, did the organization have an interest in, or a signature or other authority over, a financial account in a foreign country (such as a bank account, securities account, or other financial account)?..........................
4a
 
No
b
If "Yes," enter the name of the foreign country: MediumBullet
See instructions for filing requirements for Form TD F 90-22.1, Report of Foreign Bank and Financial Accounts.
5a
Was the organization a party to a prohibited tax shelter transaction at any time during the tax year?..
5a
 
No
b
Did any taxable party notify the organization that it was or is a party to a prohibited tax shelter transaction?
5b
 
No
c
If “Yes,” to line 5a or 5b, did the organization file Form 8886-T? ............
5c
 
 
6a
Does the organization have annual gross receipts that are normally greater than $100,000, and did the organization solicit any contributions that were not tax deductible as charitable contributions?...
6a
 
No
b
If “Yes,” did the organization include with every solicitation an express statement that such contributions or gifts were not tax deductible?........................
6b
 
 
7
Organizations that may receive deductible contributions under section 170(c).
a
Did the organization receive a payment in excess of $75 made partly as a contribution and partly for goods and services provided to the payor?....................
7a
 
No
b
If “Yes,” did the organization notify the donor of the value of the goods or services provided?.....
7b
 
 
c
Did the organization sell, exchange, or otherwise dispose of tangible personal property for which it was required to file Form 8282?...........................
7c
 
No
d
If “Yes,” indicate the number of Forms 8282 filed during the year ....
7d
 
e
Did the organization receive any funds, directly or indirectly, to pay premiums on a personal benefit contract?............................
7e
 
No
f
Did the organization, during the year, pay premiums, directly or indirectly, on a personal benefit contract?..
7f
 
No
g
If the organization received a contribution of qualified intellectual property, did the organization file Form 8899 as required?............................
7g
 
 
h
If the organization received a contribution of cars, boats, airplanes, or other vehicles, did the organization file a Form 1098-C?..........................
7h
 
 
8
Sponsoring organizations maintaining donor advised funds and section 509(a)(3) supporting organizations. Did the supporting organization, or a donor advised fund maintained by a sponsoring organization, have excess business holdings at any time during the year?............
8
 
 
9
Sponsoring organizations maintaining donor advised funds.
a
Did the organization make any taxable distributions under section 4966?..........
9a
 
 
b
Did the organization make a distribution to a donor, donor advisor, or related person?.......
9b
 
 
10
Section 501(c)(7) organizations. Enter:
a
Initiation fees and capital contributions included on Part VIII, line 12 ...
10a
 
b
Gross receipts, included on Form 990, Part VIII, line 12, for public use of club facilities
10b
 
11
Section 501(c)(12) organizations. Enter:
a
Gross income from members or shareholders .........
11a
 
b
Gross income from other sources (Do not net amounts due or paid to other sources against amounts due or received from them.) ..........
11b
 
12a
Section 4947(a)(1) non-exempt charitable trusts. Is the organization filing Form 990 in lieu of Form 1041?
12a
 
 
b
If “Yes,” enter the amount of tax-exempt interest received or accrued during the year. ....................
12b
 
13
Section 501(c)(29) qualified nonprofit health insurance issuers.
a
Is the organization licensed to issue qualified health plans in more than one state?
Note.
See the instructions for additional information the organization must report on Schedule O.
13a
 
 
b
Enter the amount of reserves the organization is required to maintain by the states in which the organization is licensed to issue qualified health plans ....
13b
 
c
Enter the amount of reserves on hand ............
13c
 
14a
Did the organization receive any payments for indoor tanning services during the tax year?.....
14a
 
No
b
If "Yes," has it filed a Form 720 to report these payments? If “No,” provide an explanation in Schedule O..
14b
 
 
Form 990 (2012)
Form 990 (2012)
Page 6
Part VI
Governance, Management, and Disclosure For each “Yes” response to lines 2 through 7b below, and for a “No” response to lines 8a, 8b, or 10b below, describe the circumstances, processes, or changes in Schedule O. See instructions.
Check if Schedule O contains a response to any question in this Part VI ...............
Section A. Governing Body and Management
Yes
No
1a
Enter the number of voting members of the governing body at the end of the tax year .....................
1a
20
If there are material differences in voting rights among members of the governing body, or if the governing body delegated broad authority to an executive committee or similar committee, explain in Schedule O.
b
Enter the number of voting members included in line 1a, above, who are independent ...................
1b
15
2
Did any officer, director, trustee, or key employee have a family relationship or a business relationship with any other officer, director, trustee, or key employee? .................
2
 
No
3
Did the organization delegate control over management duties customarily performed by or under the direct supervision of officers, directors or trustees, or key employees to a management company or other person? .
3
 
No
4
Did the organization make any significant changes to its governing documents since the prior Form 990 was filed? ...........................
4
 
No
5
Did the organization become aware during the year of a significant diversion of the organization’s assets? .
5
 
No
6
Did the organization have members or stockholders? ................
6
Yes
 
7a
Did the organization have members, stockholders, or other persons who had the power to elect or appoint one or more members of the governing body? ....................
7a
Yes
 
b
Are any governance decisions of the organization reserved to (or subject to approval by) members, stockholders, or persons other than the governing body? ...................
7b
Yes
 
8
Did the organization contemporaneously document the meetings held or written actions undertaken during the year by the following:
a
The governing body? .........................
8a
Yes
 
b
Each committee with authority to act on behalf of the governing body? ............
8b
Yes
 
9
Is there any officer, director, trustee, or key employee listed in Part VII, Section A, who cannot be reached at the organization’s mailing address? If “Yes,” provide the names and addresses in Schedule O.......
9
 
No
Section B. Policies (This Section B requests information about policies not required by the Internal Revenue Code.)
Yes
No
10a
Did the organization have local chapters, branches, or affiliates? ............
10a
 
No
b
If “Yes,” did the organization have written policies and procedures governing the activities of such chapters, affiliates, and branches to ensure their operations are consistent with the organization's exempt purposes?
10b
 
 
11a
Has the organization provided a complete copy of this Form 990 to all members of its governing body before filing the form? ............................
11a
Yes
 
b
Describe in Schedule O the process, if any, used by the organization to review this Form 990. .....
12a
Did the organization have a written conflict of interest policy? If “No,” go to line 13.......
12a
Yes
 
b
Were officers, directors, or trustees, and key employees required to disclose annually interests that could give rise to conflicts? ..........................
12b
Yes
 
c
Did the organization regularly and consistently monitor and enforce compliance with the policy? If “Yes,” describe in Schedule O how this was done.......................
12c
Yes
 
13
Did the organization have a written whistleblower policy? ...............
13
Yes
 
14
Did the organization have a written document retention and destruction policy? .........
14
 
No
15
Did the process for determining compensation of the following persons include a review and approval by independent persons, comparability data, and contemporaneous substantiation of the deliberation and decision?
a
The organization’s CEO, Executive Director, or top management official ...........
15a
 
No
b
Other officers or key employees of the organization ................
15b
Yes
 
If "Yes" to line 15a or 15b, describe the process in Schedule O (see instructions).
16a
Did the organization invest in, contribute assets to, or participate in a joint venture or similar arrangement with a taxable entity during the year? ......................
16a
Yes
 
b
If “Yes,” did the organization follow a written policy or procedure requiring the organization to evaluate its participation in joint venture arrangements under applicable federal tax law, and take steps to safeguard the organization’s exempt status with respect to such arrangements? ............
16b
 
No
Section C. Disclosure
17
List the States with which a copy of this Form 990 is required to be filedMediumBullet
TN
18
Section 6104 requires an organization to make its Form 1023 (or 1024 if applicable), 990, and 990-T (501(c)(3)s only) available for public inspection. Indicate how you made these available. Check all that apply.
19
Describe in Schedule O whether (and if so, how), the organization made its governing documents, conflict of interest policy, and financial statements available to the public during the tax year.
20
State the name, physical address, and telephone number of the person who possesses the books and records of the organization:
MediumBulletCheryl Sadro2525 De Sales AvenueChattanoogaTN37404 (423) 495-7878
Form 990 (2012)
Form 990 (2012)
Page 7
Part VII
Compensation of Officers, Directors,Trustees, Key Employees, Highest Compensated Employees, and Independent Contractors
Check if Schedule O contains a response to any question in this Part VII ...............
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees
1a Complete this table for all persons required to be listed. Report compensation for the calendar year ending with or within the organization’s tax year.
RoundBullet List all of the organization’s current officers, directors, trustees (whether individuals or organizations), regardless of amount
of compensation. Enter -0- in columns (D), (E), and (F) if no compensation was paid.

RoundBullet List all of the organization’s current key employees, if any. See instructions for definition of "key employee."
RoundBullet List the organization’s five current highest compensated employees (other than an officer, director, trustee or key employee)
who received reportable compensation (Box 5 of Form W-2 and/or Box 7 of Form 1099-MISC) of more than $100,000 from the
organization and any related organizations.

RoundBullet List all of the organization’s former officers, key employees, or highest compensated employees who received more than $100,000
of reportable compensation from the organization and any related organizations.

RoundBullet List all of the organization’s former directors or trustees that received, in the capacity as a former director or trustee of the
organization, more than $10,000 of reportable compensation from the organization and any related organizations.

List persons in the following order: individual trustees or directors; institutional trustees; officers; key employees; highest
compensated employees; and former such persons.
Check this box if neither the organization nor any related organization compensated any current officer, director, or trustee.
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(1) CHARLES ARANT........................................................................
Vice Chair
2.00
.......................0
X   X       0 0 0
(2) JAMES HOBSON........................................................................
PRESIDENT/CEO
50.00
.......................10.00
X   X       0 644,738 81,614
(3) JUDITH RALEY SCN........................................................................
SECRETARY
2.00
.......................3.00
X   X       0 0 0
(4) KATHERINE LINDGREN........................................................................
CHAIR
2.00
.......................0
X   X       0 0 0
(5) AARON WEB........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(6) CAROLYN SMELTZER........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(7) CHRISTOPHER MCKEE........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(8) CYNTHIA NESSON........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(9) DAVID DODSON MD........................................................................
Board Member / Physician
2.00
.......................48.00
X           16,606 295,272 48,311
(10) EARLINE HOBBS........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(11) ELIZABETH BETTY VANNUCCI........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(12) JAMES LE HILL........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(13) JAMES PESNELL........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(14) JOHN F BOXELL MD........................................................................
Board Member / Physician
50.00
.......................0
X           102,075 0 0
(15) JOHN NASH........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(16) LEO BROWN........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(17) MARY ELIZABETH O'BRIEN........................................................................
SVP OPERATIONS CHI
1.00
.......................59.00
X           0 924,954 116,308
Form 990 (2012)
Form 990 (2012)
Page 8
Part VII
Section A. Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees (continued)
(A)
Name and Title
(B)
Average hours per week (list any hours for related organizations below dotted line)
(C)
Position (do not check more than one box, unless person is both an officer and a director/trustee)
(D)
Reportable compensation from the organization (W- 2/1099-MISC)
(E)
Reportable compensation from related organizations (W- 2/1099-MISC)
(F)
Estimated amount of other compensation from the organization and related organizations
Individual Trustee or Director; Institutional Trustee; Officer; Key Employee; Highest compensated employee; Former;
(18) ROBERT GREVING........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(19) WAYNE SCOTT........................................................................
BOARD MEMBER
2.00
.......................0
X           0 0 0
(20) WILLIAM WARREN MD........................................................................
Board Member/Cardiologist
50.00
.......................0
X           703,003 0 42,668
(21) CHERYL A SADRO........................................................................
SVP/CFO
50.00
.......................3.00
    X       384,510 0 42,854
(22) DEBRA MOORE........................................................................
SVP/ADMINISTRATOR OF Memorial Hospital Hixson
50.00
.......................0.00
      X     254,502 0 41,108
(23) JACQUELINE JACKSON........................................................................
VP SERVICE LINE ADMIN
50.00
.......................0
      X     303,197 0 41,108
(24) CALVIN LEDFORD........................................................................
Cardiologist
50.00
.......................0
        X   696,616 0 37,142
(25) ERIC CONN MD........................................................................
CARDIOLOGIST
50.00
.......................0
        X   717,784 0 42,668
(26) GORDON GRAHAM........................................................................
Cardiologist
50.00
.......................0
        X   700,820 0 28,536
(27) GREGG SHANDER........................................................................
Electrophysiologist
50.00
.......................0
        X   692,470 0 42,854
(28) ROBERT BERGLUND........................................................................
Cardiologist
50.00
.......................0
        X   703,176 0 34,254
(29) CAROL NEWTON........................................................................
Director-Integration Services/Former CFO
0.00
.......................0.00
          X 126,181 0 18,995
(30) DAVID WINCHESTER........................................................................
Former Interim CFO
0.00
.......................0
          X 205,923 0 32,370
1b Sub-Total................MediumBullet
c Total from continuation sheets to Part VII, Section A....MediumBullet
d Total (add lines 1b and 1c)............MediumBullet 5,606,863 1,864,964 650,790
2
Total number of individuals (including but not limited to those listed above) who received more than $100,000 of reportable compensation from the organizationMediumBullet126
Yes
No
3
Did the organization list any former officer, director or trustee, key employee, or highest compensated employee on line 1a? If “Yes,” complete Schedule J for such individual ..............
3
Yes
 
4
For any individual listed on line 1a, is the sum of reportable compensation and other compensation from the organization and related organizations greater than $150,000? If “Yes,” complete Schedule J for such individual...........................
4
Yes
 
5
Did any person listed on line 1a receive or accrue compensation from any unrelated organization or individual for services rendered to the organization? If “Yes,” complete Schedule J for such person ........
5
 
No
Section B. Independent Contractors
1
Complete this table for your five highest compensated independent contractors that received more than $100,000 of compensation from the organization. Report compensation for the calendar year ending with or within the organization’s tax year.
(A)
Name and business address
(B)
Description of services
(C)
Compensation
BRASFIELD & GORRIE LLC2748 MARY TAYLOR ROADBIRMINGHAMAL35210 CONSTRUCTION 58,690,654
EARL SWENSON ASSOCIATES INC2100 WEST END AVENASHVILLETN37203 ARCHITECT SERVICES 5,530,179
XANITOS INCPO BOX 95000-3290PHILADELPHIAPA19195 CLEANING SERVICES 4,468,188
SODEXO INC & AFFILIATESPO BOX 536922ATLANTAGA30353 DIETARY SERVICES 3,895,985
ANESTHESIOLOGISTS ASSOCIATED2341 MCCALLIE AVENUE SUITE 402CHATTANOOGATN374213239 PHYSICIAN SERVICES 3,755,428
2
Total number of independent contractors (including but not limited to those listed above) who received more than $100,000 of compensation from the organization MediumBullet38
Form 990 (2012)
Form 990 (2012)
Page 9
Part VIII
Statement of Revenue
Check if Schedule O contains a response to any question in this Part VIII ..............
(A)
Total revenue
(B)
Related or
exempt
function
revenue
(C)
Unrelated
business
revenue
(D)
Revenue
excluded from
tax under sections
512, 513, or 514
Contributions, Gifts, Grants and Other Similar Amounts 1a Federated campaigns..1a  
b Membership dues....1b  
c Fundraising events....1c  
d Related organizations...1d 954,735
e Government grants (contributions)1e 25,946
f All other contributions, gifts, grants, and
similar amounts not included above
1f
100,668
g Noncash contributions included in lines
1a-1f:$
 
h Total. Add lines 1a-1f.......MediumBullet 1,081,349
 Program Service Revenue Business Code
2a PATIENT SERVICES 900099 519,270,191 512,387,579 6,882,612  
b RENTAL INCOME 900099 4,228,032 4,228,032    
c EQUITY CHANGES OF UNCONSOLIDATED ORGS 900099 519,508 519,508    
d     0      
e     0      
f All other program service revenue . 0 0 0 0
g Total. Add lines 2a–2f........MediumBullet 524,017,731
 Other Revenue 3 Investment income (including dividends, interest, and other similar amounts).......MediumBullet 3,748,186   -1,259 3,749,445
4 Income from investment of tax-exempt bond proceeds..MediumBullet 0      
5 Royalties...........MediumBullet 0      
(i) Real (ii) Personal
6a Gross rents 17,948  
b Less: rental expenses 13,789  
c Rental income or (loss) 4,159 0
d Net rental income or (loss).......MediumBullet 4,159     4,159
(i) Securities (ii) Other
7a Gross amount from sales of assets other than inventory 9,107,609 12,347
b Less: cost or other basis and sales expenses   11,560
c Gain or (loss) 9,107,609 787
d Net gain or (loss)..........MediumBullet 9,108,396     9,108,396
8a Gross income from fundraising events (not including
$  
of contributions reported on line 1c). See Part IV, line 18 ..
a  
b Less: direct expenses ...b  
c Net income or (loss) from fundraising events..MediumBullet 0    
9a Gross income from gaming activities.
See Part IV, line 19 ...
a  
b Less: direct expenses ...b  
c Net income or (loss) from gaming activities...MediumBullet 0      
10a Gross sales of inventory, less
returns and allowances .
a  
b Less: cost of goods sold ..b  
c Net income or (loss) from sales of inventory..MediumBullet 0      
Miscellaneous Revenue Business Code
11a SERVICES SOLD 900099 2,080,370   467,044 1,613,326
b PHARMACY SERVICES 446110 1,560,476   1,560,476  
c LABORATORY SERVICES 621500 1,356,256     1,356,256
d All other revenue .... 1,443,117 0 0 1,443,117
e Total. Add lines 11a–11d ...... MediumBullet 6,440,219
12 Total revenue. See Instructions......MediumBullet 544,400,040 517,135,119 8,908,873 17,274,699
Form 990 (2012)
Form 990 (2012)
Page 10
Part IX
Statement of Functional Expenses
Section 501(c)(3) and 501(c)(4) organizations must complete all columns. All other organizations must complete column (A).Check if Schedule O contains a response to any question in this Part IX ...............
Do not include amounts reported on lines 6b,
7b, 8b, 9b, and 10b of Part VIII.
(A)
Total expenses
(B)
Program service expenses
(C)
Management and general expenses
(D)
Fundraising expenses
1 Grants and other assistance to governments and organizations in the United States. See Part IV, line 21 665,529 665,529
2 Grants and other assistance to individuals in the United States. See Part IV, line 22 147,392 147,392
3 Grants and other assistance to governments, organizations, and individuals outside the United States. See Part IV, lines 15 and 16 0  
4 Benefits paid to or for members 0  
5 Compensation of current officers, directors, trustees, and key employees .... 1,629,636 683,863 945,773  
6 Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .... 0      
7 Other salaries and wages 147,885,977 121,477,738 26,408,239  
8 Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) .... 7,585,335 6,197,591 1,387,744  
9 Other employee benefits ....... 24,720,621 20,197,962 4,522,659  
10 Payroll taxes ........... 10,458,874 8,545,414 1,913,460  
11 Fees for services (non-employees):        
a Management ...... 5,394,082   5,394,082  
b Legal ......... 1,071,764   1,071,764  
c Accounting ........... 1,540,568   1,540,568  
d Lobbying ........... 0      
e Professional fundraising services. See Part IV, line 17 0  
f Investment management fees ...... 0      
g Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O) ........ 47,594,371 47,594,371 0 0
12 Advertising and promotion .... 1,790,061   1,790,061  
13 Office expenses ....... 12,144,945 9,923,017 2,221,928  
14 Information technology ...... 24,808,785 24,808,785    
15 Royalties .. 0      
16 Occupancy ........... 11,773,999 11,773,999    
17 Travel ............ 549,394   549,394  
18 Payments of travel or entertainment expenses for any federal, state, or local public officials ...... 0      
19 Conferences, conventions, and meetings .... 41,859   41,859  
20 Interest ........... 2,204,646 2,204,646    
21 Payments to affiliates ....... 10,227,887   10,227,887  
22 Depreciation, depletion, and amortization ..... 27,022,070 26,588,379 433,691  
23 Insurance .............. 2,704,073 2,704,073    
24 Other expenses. Itemize expenses not covered above (List miscellaneous expenses in line 24e. If line 24e amount exceeds 10% of line 25, column (A) amount, list line 24e expenses on Schedule O.)
a BAD DEBTS 31,341,697 31,341,697    
b MEDICAL SUPPLIES 116,720,615 116,720,615    
c STATE PROVIDER TAX 18,250,328 18,250,328    
d REPAIRS AND MAINTENANCE 2,633,171 2,633,171    
e All other expenses 5,015,387 5,015,387 0 0
25 Total functional expenses. Add lines 1 through 24e 515,923,066 457,473,957 58,449,109 0
26 Joint costs. Complete this line only if the organization reported in column (B) joint costs from a combined educational campaign and fundraising solicitation. Check here MediumBullet if following SOP 98-2 (ASC 958-720). 0      
Form 990 (2012)
Form 990 (2012)
Page 11
Part X Balance Sheet Check if Schedule O contains a response to any question in this Part X ...............
(A)
Beginning of year
(B)
End of year
Assets 1 Cash—non-interest-bearing ............. 15,726 1 15,705
2 Savings and temporary cash investments .........   2 15,914,175
3 Pledges and grants receivable, net ...........   3  
4 Accounts receivable, net ............. 100,547,365 4 74,612,935
5 Loans and other receivables from current and former officers, directors, trustees, key employees, and highest compensated employees. Complete Part II of
Schedule L ..................
  5 0
6 Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), persons described in section 4958(c)(3)(B), and contributing employers and sponsoring organizations of section 501(c)(9) voluntary employees' beneficiary organizations (see instructions) Complete Part II of Schedule L
  6 0
7 Notes and loans receivable, net ............. 259,207 7 236,254
8 Inventories for sale or use .............. 13,903,614 8 16,137,303
9 Prepaid expenses and deferred charges .......... 1,454,020 9 1,227,190
10a Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D 10a 652,947,558
b Less: accumulated depreciation ..... 10b 303,632,745 253,495,527 10c 349,314,813
11 Investments—publicly traded securities ..........   11  
12 Investments—other securities. See Part IV, line 11 ..... 168,299,814 12 154,017,869
13 Investments—program-related. See Part IV, line 11 ..... 0 13 0
14 Intangible assets ............... 7,042,487 14 7,042,487
15 Other assets. See Part IV, line 11 ........... 1,377,678 15 8,905,895
16 Total assets. Add lines 1 through 15 (must equal line 34)...... 546,395,438 16 627,424,626
Liabilities 17 Accounts payable and accrued expenses ......... 81,487,234 17 67,613,242
18 Grants payable .................   18  
19 Deferred revenue ................ 93,681 19 88,785
20 Tax-exempt bond liabilities .............   20  
21 Escrow or custodial account liability. Complete Part IV of Schedule D..   21  
22 Loans and other payables to current and former officers, directors, trustees, key employees, highest compensated employees, and disqualified
persons. Complete Part II of Schedule L..........   22 0
23 Secured mortgages and notes payable to unrelated third parties ..   23  
24 Unsecured notes and loans payable to unrelated third parties ....   24  
25 Other liabilities (including federal income tax, payables to related third parties, and other liabilities not included on lines 17-24). Complete Part X of Schedule D.................... 66,331,654 25 135,922,142
26 Total liabilities. Add lines 17 through 25......... 147,912,569 26 203,624,169
Net Assets or Fund Balance Organizations that follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 27 through 29, and lines 33 and 34.
27 Unrestricted net assets .............. 398,492,869 27 423,800,457
28 Temporarily restricted net assets ........... -10,000 28 0
29 Permanently restricted net assets ...........   29  
Organizations that do not follow SFAS 117 (ASC 958), check here MediumBullet and complete lines 30 through 34.
30 Capital stock or trust principal, or current funds ........   30  
31 Paid-in or capital surplus, or land, building or equipment fund .....   31  
32 Retained earnings, endowment, accumulated income, or other funds   32  
33 Total net assets or fund balances ........... 398,482,869 33 423,800,457
34 Total liabilities and net assets/fund balances ........ 546,395,438 34 627,424,626
Form 990 (2012)
Form 990 (2012)
Page 12
Part XI
Reconcilliation of Net Assets
Check if Schedule O contains a response to any question in this Part XI ...............
1
Total revenue (must equal Part VIII, column (A), line 12) ............
1
544,400,040
2
Total expenses (must equal Part IX, column (A), line 25) ............
2
515,923,066
3
Revenue less expenses. Subtract line 2 from line 1 ..............
3
28,476,974
4
Net assets or fund balances at beginning of year (must equal Part X, line 33, column (A)) ..
4
398,482,869
5
Net unrealized gains (losses) on investments ...............
5
4,642,087
6
Donated services and use of facilities .................
6
 
7
Investment expenses .....................
7
 
8
Prior period adjustments .....................
8
-10,000
9
Other changes in net assets or fund balances (explain in Schedule O) ........
9
-7,791,473
10
Net assets or fund balances at end of year. Combine lines 3 through 9 (must equal Part X, line 33, column (B))
10
423,800,457
Part XII
Financial Statements and Reporting
Check if Schedule O contains a response to any question in this Part XII ..............
Yes
No
1
Accounting method used to prepare the Form 990:  
If the organization changed its method of accounting from a prior year or checked "Other," explain in
Schedule O.
2a
Were the organization’s financial statements compiled or reviewed by an independent accountant?
2a
 
No
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were compiled or reviewed on a separate basis, consolidated basis, or both:
b
Were the organization’s financial statements audited by an independent accountant?
2b
Yes
 
If ‘Yes,’ check a box below to indicate whether the financial statements for the year were audited on a separate basis, consolidated basis, or both:
c
If “Yes,” to line 2a or 2b, does the organization have a committee that assumes responsibility for oversight of the audit, review, or compilation of its financial statements and selection of an independent accountant?
2c
Yes
 
If the organization changed either its oversight process or selection process during the tax year, explain in Schedule O.
3a
As a result of a federal award, was the organization required to undergo an audit or audits as set forth in the Single Audit Act and OMB Circular A-133?
3a
Yes
 
b
If “Yes,” did the organization undergo the required audit or audits? If the organization did not undergo the required audit or audits, explain why in Schedule O and describe any steps taken to undergo such audits
3b
Yes
 
Form 990 (2012)
Form 990, Special Condition Description:
Special Condition Description
Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE A
(Form 990 or 990EZ)

Department of the Treasury
Internal Revenue Service
Public Charity Status and Public Support

Complete if the organization is a section 501(c)(3) organization or a section
4947(a)(1) nonexempt charitable trust.
right arrow Attach to Form 990 or Form 990-EZ. right arrow See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part I
Reason for Public Charity Status (All organizations must complete this part.) See instructions.
The organization is not a private foundation because it is: (For lines 1 through 11, check only one box.)
1
2
3
4
5
section 170(b)(1)(A)(iv). (Complete Part II.)
6
7
8
9
receipts from activities related to its exempt functions—subject to certain exceptions, and (2) no more than 331/3% of
its support from gross investment income and unrelated business taxable income (less section 511 tax) from businesses
acquired by the organization after June 30, 1975. See section 509(a)(2). (Complete Part III.)
10
11
e
f
g
(i) A person who directly or indirectly controls, either alone or together with persons described in (ii)
Yes
No
and (iii) below, the governing body of the supported organization? ................
11g(i)
 
 
(ii) A family member of a person described in (i) above? ......................
11g(ii)
 
 
(iii) A 35% controlled entity of a person described in (i) or (ii) above? ................
11g(iii)
 
 
h
Provide the following information about the supported organization(s).
(i) Name of supported organization (ii) EIN (iii) Type of organization (described on lines 1- 9 above or IRC section (see instructions)) (iv) Is the organization in col. (i) listed in your governing document? (v) Did you notify the organization in col. (i) of your support? (vi) Is the organization in col. (i) organized in the U.S.? (vii) Amount of monetary support
Yes No Yes No Yes No
Total                  

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990EZ.
Cat. No. 11285F
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 2
Part II
Support Schedule for Organizations Described in Sections 170(b)(1)(A)(iv) and 170(b)(1)(A)(vi)
(Complete only if you checked the box on line 5, 7, or 8 of Part I or if the organization failed to qualify under Part III. If the organization fails to qualify under the tests listed below, please complete Part III.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") ....            
2 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf.......            
3 The value of services or facilities furnished by a governmental unit to the organization without charge..            
4 Total. Add lines 1 through 3            
5 The portion of total contributions by each person (other than a governmental unit or publicly supported organization) included on line 1 that exceeds 2% of the amount shown on line 11, column (f)..            
6 Public support. Subtract line 5 from line 4.            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
7 Amounts from line 4..            
8 Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources...            
9 Net income from unrelated business activities, whether or not the business is regularly carried on..            
10 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.)..            
11 Total support (Add lines 7 through 10).            
12
12
 
13
First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a 501(c)(3) organization, check this box and stop here........................................right arrow
Section C. Computation of Public Support Percentage
14
14
 
15
15
 
16a
b
17a
b
18
Private foundation. If the organization did not check a box on line 13, 16a, 16b, 17a, or 17b, check this box and see
instructions ..................................................... right arrow
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 3
Part III
Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 9 of Part I or if the organization failed to qualify under Part II. If the organization fails to qualify under the tests listed below, please complete Part II.)
Section A. Public Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
1 Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grants.") .            
2 Gross receipts from admissions, merchandise sold or services performed, or facilities furnished in any activity that is related to the organization's tax-exempt purpose......            
3 Gross receipts from activities that are not an unrelated trade or business under section 513..            
4 Tax revenues levied for the organization's benefit and either paid to or expended on its behalf...            
5 The value of services or facilities furnished by a governmental unit to the organization without charge..            
6 Total. Add lines 1 through 5.            
7a Amounts included on lines 1, 2, and 3 received from disqualified persons...            
b Amounts included on lines 2 and 3 received from other than disqualified persons that exceed the greater of $5,000 or 1% of the amount on line 13 for the year.            
c Add lines 7a and 7b..            
8 Public support (Subtract line 7c from line 6.)            
Section B. Total Support
Calendar year (or fiscal year beginning in) right arrow (a) 2008 (b) 2009 (c) 2010 (d) 2011 (e) 2012 (f) Total
9 Amounts from line 6...            
10a Gross income from interest, dividends, payments received on securities loans, rents, royalties and income from similar sources..            
b Unrelated business taxable income (less section 511 taxes) from businesses acquired after June 30, 1975.            
c Add lines 10a and 10b.            
11 Net income from unrelated business activities not included in line 10b, whether or not the business is regularly carried on.            
12 Other income. Do not include gain or loss from the sale of capital assets (Explain in Part IV.) ..            
13 Total support. (Add lines 9, 10c, 11, and 12.)..            
14
Section C. Computation of Public Support Percentage
15
15
 
16
16
 
Section D. Computation of Investment Income Percentage
17
17
 
18
18
 
19a
b
20
Schedule A (Form 990 or 990-EZ) 2012
Schedule A (Form 990 or 990-EZ) 2012
Page 4
Part IV
Supplemental Information. Complete this part to provide the explanations required by Part II, line 10; Part II, line 17a or 17b; and Part III, line 12. Also complete this part for any additional information. (See instructions).
Facts And Circumstances Test
 
Explanation
 
 
 
 
Schedule A (Form 990 or 990-EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule B
(Form 990, 990-EZ,
or 990-PF)
Department of the Treasury
Internal Revenue Service
Schedule of Contributors
Arrow Bullet Attach to Form 990, 990-EZ, or 990-PF.
OMB No. 1545-0047
2012
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Organization type (check one):
Filers of:
Section:
Form 990 or 990-EZ





Form 990-PF




Check if your organization is covered by the General Rule or a Special Rule.  
Note. Only a section 501(c)(7), (8), or (10) organization can check boxes for both the General Rule and a Special Rule. See instructions.
General Rule
Special Rules
......................... Arrow Bullet   $    
Caution. An organization that is not covered by the General Rule and/or the Special Rules does not file Schedule B (Form 990,
990-EZ, or 990-PF), but it must answer “No” on Part IV, line 2 of its Form 990; or check the box on line H of its
Form 990-EZ or on Part I, line 2 of its Form 990-PF, to certify that it does not meet the filing requirements of Schedule B (Form 990,
990-EZ, or 990-PF).
For Paperwork Reduction Act Notice, see the Instructions
for Form 990, 990-EZ, or 990-PF.
Cat. No. 30613XSchedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 2
Name of organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part I
Contributors (see instructions). Use duplicate copies of Part I if additional space is needed.
     
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
RESTRICTED
RESTRICTED
 

     
RESTRICTED
RESTRICTED  
RESTRICTED, RESTRICTED   RESTRICTED

$RESTRICTED


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
(a)
No.
(b)
Name, address, and ZIP + 4
(c)
Total contributions
(d)
Type of contribution
 
 
 

     
 
   

$  


(Complete Part II if there is a noncash contribution.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 3
Name of organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part II
Noncash Property (see instructions). Use duplicate copies of Part II if additional space is needed.
     
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
(a) No.
from
Part I
(b)
Description of noncash property given
(c)
FMV (or estimate)
(see instructions)
(d)
Date received
 
$    
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Schedule B (Form 990, 990-EZ, or 990-PF) (2012)
Page 4
Name of organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part III
Exclusively religious, charitable, etc., individual contributions to section 501(c)(7), (8), or (10) organizations
that total more than $1,000 for the year. Complete columns (a) through (e) and the following line entry.
For organizations completing Part III, enter the total of exclusively religious, charitable, etc.,
contributions of $1,000 or less for the year. (Enter this information once. See instructions.) Arrow Bullet$  

Use duplicate copies of Part III if additional space is needed.
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
(a) No.
from
Part I
(b) Purpose of gift (c) Use of gift (d) Description of how gift is held
 
(e) Transfer of gift
Transferee's name, address, and ZIP 4 Relationship of transferor to transferee
 
 
       
 
Schedule B (Form 990, 990-EZ, or 990-PF) (2012)

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE C
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Political Campaign and Lobbying Activities

For Organizations Exempt From Income Tax Under section 501(c) and section 527
SchCMd Bullet Complete if the organization is described below.SchCMd Bullet Attach to Form 990 or Form 990-EZ.
SchCMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public
Inspection
If the organization answered “Yes” to Form 990, Part IV, Line 3, or Form 990-EZ, Part V, line 46 (Political Campaign Activities), then
Round Bullet Section 501(c)(3) organizations: Complete Parts I-A and B. Do not complete Part I-C.
Round Bullet Section 501(c) (other than section 501(c)(3)) organizations: Complete Parts I-A and C below. Do not complete Part I-B.
Round Bullet Section 527 organizations: Complete Part I-A only.
If the organization answered “Yes” to Form 990, Part IV, Line 4, or Form 990-EZ, Part VI, line 47 (Lobbying Activities), then
Round Bullet Section 501(c)(3) organizations that have filed Form 5768 (election under section 501(h)): Complete Part II-A. Do not complete Part II-B.
Round Bullet Section 501(c)(3) organizations that have NOT filed Form 5768 (election under section 501(h)): Complete Part II-B. Do not complete Part II-A.
If the organization answered “Yes” to Form 990, Part IV, Line 5 (Proxy Tax) or Form 990-EZ, Part V, line 35c (Proxy Tax), then
Round Bullet Section 501(c)(4), (5), or (6) organizations: Complete Part III.
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part I-A
Complete if the organization is exempt under section 501(c) or is a section 527 organization.

1
Provide a description of the organization’s direct and indirect political campaign activities in Part IV.
2
Political expenditures ....................................SchCMd Bullet
$  
3
Volunteer hours ........................................
 

Part I-B
Complete if the organization is exempt under section 501(c)(3).
1
Enter the amount of any excise tax incurred by the organization under section 4955 .........SchCMd Bullet
$  
2
Enter the amount of any excise tax incurred by organization managers under section 4955 ......SchCMd Bullet
$  
3
If the organization incurred a section 4955 tax, did it file Form 4720 for this year? ..............
4a
Was a correction made? .........................................
b
If "Yes," describe in Part IV.
Part I-C
Complete if the organization is exempt under section 501(c), except section 501(c)(3).
1
Enter the amount directly expended by the filing organization for section 527 exempt function activities SchCMd Bullet
$  
2
Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ...................................SchCMd Bullet

$  
3
Total exempt function expenditures. Add lines 1 and 2. Enter here and on Form 1120-POL, line 17b..SchCMd Bullet

$  
4
Did the filing organization file Form 1120-POL for this year? ..........................
5
Enter the names, addresses and employer identification number (EIN) of all section 527 political organizations to which the filing
organization made payments. For each organization listed, enter the amount paid from the filing organization’s funds. Also enter the amount of political contributions received that were promptly and directly delivered to a separate political organization, such as a separate segregated fund or a political action committee (PAC). If additional space is needed, provide information in Part IV.
(a) Name (b) Address (c) EIN (d) Amount paid from filing organization's funds. If none, enter -0-. (e) Amount of political contributions received and promptly and directly delivered to a separate political organization. If none, enter -0-.










For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.
Cat. No. 50084S
Schedule C (Form 990 or 990-EZ) 2012

Schedule C (Form 990 or 990-EZ) 2012
Page 2
Part II-A
Complete if the organization is exempt under section 501(c)(3) and filed Form 5768 (election under section 501(h)).
A Check SchCMd Bulletexpenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet
Limits on Lobbying Expenditures
(The term "expenditures" means amounts paid or incurred.)
(a) Filing
organization's
totals
(b) Affiliated group
totals
1a Total lobbying expenditures to influence public opinion (grass roots lobbying) ......    
b Total lobbying expenditures to influence a legislative body (direct lobbying) .......    
c Total lobbying expenditures (add lines 1a and 1b) ...................    
d Other exempt purpose expenditures ........................    
e Total exempt purpose expenditures (add lines 1c and 1d) ...............    
f Lobbying nontaxable amount. Enter the amount from the following table in both
columns.
   
  If the amount on line 1e, column (a) or (b) is:The lobbying nontaxable amount is:    
  Not over $500,00020% of the amount on line 1e.    
  Over $500,000 but not over $1,000,000$100,000 plus 15% of the excess over $500,000.    
  Over $1,000,000 but not over $1,500,000$175,000 plus 10% of the excess over $1,000,000.    
  Over $1,500,000 but not over $17,000,000$225,000 plus 5% of the excess over $1,500,000.    
  Over $17,000,000$1,000,000.    
       
g Grassroots nontaxable amount (enter 25% of line 1f) .................    
h Subtract line 1g from line 1a. If zero or less, enter -0-. ................    
i Subtract line 1f from line 1c. If zero or less, enter -0-. ................    
j If there is an amount other than zero on either line 1h or line 1i, did the organization file Form 4720 reporting
section 4911 tax for this year? ......................................

4-Year Averaging Period Under Section 501(h)
(Some organizations that made a section 501(h) election do not have to complete all of the five
columns below. See the instructions for lines 2a through 2f on page 4.)
Lobbying Expenditures During 4-Year Averaging Period
  Calendar year (or fiscal year
beginning in)
(a) 2009 (b) 2010 (c) 2011 (d) 2012 (e) Total
             
2a Lobbying nontaxable amount          
             
b Lobbying ceiling amount
(150% of line 2a, column(e))
         
             
c Total lobbying expenditures          
             
d Grassroots nontaxable amount          
             
e Grassroots ceiling amount
(150% of line 2d, column (e))
         
             
f Grassroots lobbying expenditures          
Schedule C (Form 990 or 990-EZ) 2012


Schedule C (Form 990 or 990-EZ) 2012
Page 3
Part II-B
Complete if the organization is exempt under section 501(c)(3) and has NOT filed Form 5768 (election under section 501(h)).
For each “Yes” response to lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.
(a)
No
Yes
(b)
Amount
1
During the year, did the filing organization attempt to influence foreign, national, state or local legislation, including any attempt to influence public opinion on a legislative matter or referendum, through the use of:
a
Volunteers? .........................................
 
No
b
Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ....
Yes
 
c
Media advertisements? ....................................
 
No
 
d
Mailings to members, legislators, or the public? .........................
 
No
 
e
Publications, or published or broadcast statements? .......................
 
No
 
f
Grants to other organizations for lobbying purposes? .......................
Yes
 
27,437
g
Direct contact with legislators, their staffs, government officials, or a legislative body? ........
Yes
 
7,701
h
Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ......
Yes
 
3,037
i
Other activities? ..........................
Yes
 
81,577
j
Total. Add lines 1c through 1i ...............................
119,752
2a
Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....
 
No
b
If "Yes," enter the amount of any tax incurred under section 4912 .................
 
c
If "Yes," enter the amount of any tax incurred by organization managers under section 4912 .....
 
d
If the filing organization incurred a section 4912 tax, did it file Form 4720 for this year? .......
 
 
Part III-A
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6).
Yes
No
1
Were substantially all (90% or more) dues received nondeductible by members? ................
1
 
 
2
Did the organization make only in-house lobbying expenditures of $2,000 or less? ................
2
 
 
3
Did the organization agree to carry over lobbying and political expenditures from the prior year? ..........
3
 
 
Part III-B
Complete if the organization is exempt under section 501(c)(4), section 501(c)(5), or section 501(c)(6) and if either (a) BOTH Part III-A, lines 1 and 2, are answered “No” OR (b) Part III-A, line 3, is answered “Yes."
1
Dues, assessments and similar amounts from members .....................
1
 
2
Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political
expenses for which the section 527(f) tax was paid).
a
Current year .........................................
2a
 
b
Carryover from last year ....................................
2b
 
c
Total ............................................
2c
 
3
Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .
3
 
4
If notices were sent and the amount on line 2c exceeds the amount on line 3, what portion of the excess does the organization agree to carryover to the reasonable estimate of nondeductible lobbying and political expenditure next year? ................................
4
 
5
Taxable amount of lobbying and political expenditures (see instructions) ..............
5
 
Part IV
Supplemental Information
Complete this part to provide the descriptions required for Part l-A, line 1; Part l-B, line 4; Part l-C, line 5; Part II-A (affiliated group list); Part II-A, line 2; and Part ll-B, line 1. Also, complete this part for any additional information.
Identifier Return Reference Explanation
Description of the activities reported on Lines 1a through 1i Schedule C, Part II-B, Line 1 B. PAID STAFF ATTENDED COMMUNITY FORUMS, VARIOUS COMMUNITY ACTIVITIES, STRATEGIC PLANNING SESSIONS AND ATTENDED OTHER LEGISLATIVE MEETINGS AND CONVENTIONS. F. THE PORTION OF THE ORGANIZATIONS' DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION ("AHA") - $7,442, CATHOLIC HEALTH ASSOCIATION ("CHA") - $2,887 AND TENNESSEE HOSPITAL ASSOCIATION ("THA") - $17,108. G. ATTENDED THE GOVERNMENT AFFAIRS CONFERENCE, THE CATHOLIC LEGISLATIVE ADVOCACY CONFERENCE, AND THE CATHOLIC DAY ON THE HILL. H. THE HEALTHY COMMUNITY COORDINATOR ATTENDS SEVERAL MEETINGS PER YEAR AT NON-PROFIT ORGANIZATIONS IN THE COMMUNITY. OTHERS ALSO ATTENDED TENNESSEE HOSPITAL ASSOCIATION ADVOCACY/MEETINGS. I. THE INGRAM GROUP, HEALTH CARE ADVOCACY, PUBLIC RELATIONS, HEALTHY COMMUNITY AND STRATEGIC PLANNING.
Schedule C (Form 990 or 990EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0

SCHEDULE D
(Form 990)
Department of the Treasury
Internal Revenue Service
Supplemental Financial Statements
SchDMd Bullet Complete if the organization answered "Yes," to Form 990,
Part IV, line 6, 7, 8, 9, 10, 11a, 11b, 11c, 11d, 11e, 11f, 12a, or 12b
SchDMd Bullet Attach to Form 990. SchDMd Bullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part I
Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" to Form 990, Part IV, line 6.
(a) Donor advised funds (b) Funds and other accounts
1 Total number at end of year .........    
2 Aggregate contributions to (during year) ...    
3 Aggregate grants from (during year) .....    
4 Aggregate value at end of year ........    
5
Did the organization inform all donors and donor advisors in writing that the assets held in donor advised
funds are the organization's property, subject to the organization's exclusive legal control? ............
6
Did the organization inform all grantees, donors, and donor advisors in writing that grant funds can be
used only for charitable purposes and not for the benefit of the donor or donor advisor, or for any other purpose conferring impermissible private benefit? ...................................
Part II
Conservation Easements. Complete if the organization answered "Yes" to Form 990, Part IV, line 7.
1
Purpose(s) of conservation easements held by the organization (check all that apply).
2
Complete lines 2a through 2d if the organization held a qualified conservation contribution in the form of a conservation easement on the last day of the tax year.
Held at the End of the Year
a Total number of conservation easements ....................... 2a  
b Total acreage restricted by conservation easements .................. 2b  
c Number of conservation easements on a certified historic structure included in (a) ..... 2c  
d Number of conservation easements included in (c) acquired after 8/17/06, and not on a historic structure listed in the National Register .................... 2d  
3
Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during
the tax year SchDMd Bullet  
4
Number of states where property subject to conservation easement is located SchDMd Bullet  
5
Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and
enforcement of the conservation easements it holds? .............................
6
Staff and volunteer hours devoted to monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet  
7
Amount of expenses incurred in monitoring, inspecting, and enforcing conservation easements during the year
SchDMd Bullet $  
8
Does each conservation easement reported on line 2(d) above satisfy the requirements of section 170(h)(4)(B)(i) and section 170(h)(4)(B)(ii)? .......................................
9
In Part XIII, describe how the organization reports conservation easements in its revenue and expense statement, and
balance sheet, and include, if applicable, the text of the footnote to the organization’s financial statements that describes
the organization’s accounting for conservation easements.
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets.
Complete if the organization answered "Yes" to Form 990, Part IV, line 8.
1a
If the organization elected, as permitted under SFAS 116 (ASC 958), not to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide, in Part XIII, the text of the footnote to its financial statements that describes these items.
b
If the organization elected, as permitted under SFAS 116 (ASC 958), to report in its revenue statement and balance sheet works of art, historical treasures, or other similar assets held for public exhibition, education, or research in furtherance of public service, provide the following amounts relating to these items:
(i)
Revenues included in Form 990, Part VIII, line 1 ........................SchDMd Bullet $  
(ii)
Assets included in Form 990, Part X ..............................SchDMd Bullet $  
2
If the organization received or held works of art, historical treasures, or other similar assets for financial gain, provide the
following amounts required to be reported under SFAS 116 (ASC 958) relating to these items:
a
Revenues included in Form 990, Part VIII, line 1 ..........................SchDMd Bullet $  
b
Assets included in Form 990, Part X ...............................SchDMd Bullet $  
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 52283D
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 2
Part III
Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)
3
Using the organization’s acquisition, accession, and other records, check any of the following that are a significant use of its collection items (check all that apply):
a
d
b
e
 
c
4
Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.
5
During the year, did the organization solicit or receive donations of art, historical treasures or other similar
assets to be sold to raise funds rather than to be maintained as part of the organization’s collection?........
Part IV
Escrow and Custodial Arrangements. Complete if the organization answered "Yes" to Form 990,
Part IV, line 9, or reported an amount on Form 990, Part X, line 21.
1a
Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................
b
If "Yes," explain the arrangement in Part XIII and complete the following table:
Amount
c Beginning balance ................................. 1c  
d Additions during the year .............................. 1d  
e Distributions during the year ............................. 1e  
f Ending balance ................................... 1f  
2a
Did the organization include an amount on Form 990, Part X, line 21? .....................
b
If “Yes,” explain the arrangement in Part XIII. Check here if the explanation has been provided in Part XIII ........
Part V
Endowment Funds. Complete if the organization answered "Yes" to Form 990, Part IV, line 10.
(a)Current year (b)Prior year b (c)Two years back (d)Three years back (e)Four years back
1a Beginning of year balance ....          
b Contributions ........          
c Net investment earnings, gains, and losses          
d Grants or scholarships .....          
e Other expenditures for facilities
and programs ........
         
f Administrative expenses ....          
g End of year balance ......          
2
Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:
a
Board designated or quasi-endowment SchDMd Bullet  
b
Permanent endowment SchDMd Bullet  
c
Temporarily restricted endowment SchDMd Bullet  
The percentages in lines 2a, 2b, and 2c should equal 100%.
3a
Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes
No
(i) unrelated organizations ........................
3a(i)
 
 
(ii) related organizations ........................
3a(ii)
 
 
b
If "Yes" to 3a(ii), are the related organizations listed as required on Schedule R? .........
3b
 
 
4
Describe in Part XIII the intended uses of the organization's endowment funds.
Part VI
Land, Buildings, and Equipment. See Form 990, Part X, line 10.
Description of property (a) Cost or other basis (investment) (b)Cost or other basis (other) (c) Accumulated depreciation (d) Book value
1a Land .................   14,451,167 14,451,167
b Buildings ................   292,313,869 103,777,079 188,536,790
c Leasehold improvements ............   1,117,976 848,444 269,532
d Equipment ................   258,261,589 191,697,937 66,563,652
e Other .................   86,802,957 7,309,285 79,493,672
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).).......SchDMdBullet 349,314,813
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 3
Part VII
Investments—Other Securities. See Form 990, Part X, line 12.
(a) Description of security or category
(including name of security)
(b)Book value (c) Method of valuation:
Cost or end-of-year market value
(1)Financial derivatives 0  
(2)Closely-held equity interests 0  
(3)Other
(A) CHI OIP - FIXED INCOME
75,756,943 F

(B) CHI OIP - EQUITY SECURITIES
78,260,926 F







Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)Small Bullet 154,017,869
Part VIII
Investments—Program Related. See Form 990, Part X, line 13.
(a) Description of investment type (b) Book value (c) Method of valuation:
Cost or end-of-year market value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)Small Bullet  
Part IX
Other Assets. See Form 990, Part X, line 15.
(a) Description (b) Book value








Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........Small Bullet  
Part X
Other Liabilities. See Form 990, Part X, line 25.
1.(a) Description of liability (b) Book value
Federal income taxes 0
INTERCOMPANY PAYABLES 5,850,873
ENVIRONMENTAL REMEDIATION LIABILITY 332,128
UNCLAIMED PROPERTY 50,147
INTERCOMPANY NOTES PAYABLE 129,688,994





Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)Small Bullet 135,922,142
2. Fin 48 (ASC 740) Footnote. In Part XIII, provide the text of the footnote to the organization's financial statements that reports the organization's liability for uncertain tax positions under FIN 48 (ASC 740). Check here if the text of the footnote has been provided in Part XIII .....................................................
Schedule D (Form 990) 2012

Schedule D (Form 990) 2012
Page 4
Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return
1 Total revenue, gains, and other support per audited financial statements ....... 1  
2 Amounts included on line 1 but not on Form 990, Part VIII, line 12:
a Net unrealized gains on investments .......... 2a  
b Donated services and use of facilities ......... 2b  
c Recoveries of prior year grants ........... 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d ..................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part VIII, line 12, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b . 4a  
b Other (Describe in Part XIII.) ........... 4b  
c Add lines 4a and 4b....................... 4c  
5 Total revenue. Add lines 3 and 4c. (This must equal Form 990, Part I, line 12.) ...... 5  
Part XII Reconciliation of Expenses per Audited Financial Statements With Expenses per Return
1 Total expenses and losses per audited financial statements ........... 1  
2 Amounts included on line 1 but not on Form 990, Part IX, line 25:
a Donated services and use of facilities .......... 2a  
b Prior year adjustments .............. 2b  
c Other losses ................ 2c  
d Other (Describe in Part XIII.) ............ 2d  
e Add lines 2a through 2d...................... 2e  
3 Subtract line 2e from line 1..................... 3  
4 Amounts included on Form 990, Part IX, line 25, but not on line 1:
a Investment expenses not included on Form 990, Part VIII, line 7b .. 4a  
b Other (Describe in Part XIII.) ............ 4b  
c Add lines 4a and 4b....................... 4c  
5 Total expenses. Add lines 3 and 4c. (This must equal Form 990, Part I, line 18.) ...... 5  
Part XIII
Supplemental Information
Complete this part to provide the descriptions required for Part II, lines 3, 5, and 9; Part III, lines 1a and 4; Part lV, lines 1b and 2b;
Part V, line 4; Part X, line 2; Part XI, lines 2d and 4b; and Part XII, lines 2d and 4b. Also complete this part to provide any additional information.
Identifier Return Reference Explanation
FIN 48 (ASC 740) footnote Schedule D, Part X, Line 2 MEMORIAL HEALTH CARE SYSTEM'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF CATHOLIC HEALTH INITIATIVES (CHI), A RELATED ORGANIZATION. 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."
Schedule D (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0




SCHEDULE H (Form 990)
Department of the Treasury
Internal Revenue Service
Hospitals
MediumBullet Complete if the organization answered "Yes" to Form 990, Part IV, question 20.
MediumBullet Attach to Form 990. MediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part I
Financial Assistance and Certain Other Community Benefits at Cost
Yes
No
1a
Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a ...
1a
Yes
 
b
If "Yes," was it a written policy? .......................
1b
Yes
 
2
If the organization had multiple hospital facilities, indicate which of the following best describes application of the financial assistance policy to its various hospital facilities during the tax year.
3
Answer the following based on the financial assistance eligibility criteria that applied to the largest number of the organization's patients during the tax year.
a
Did the organization use Federal Poverty Guidelines (FPG) as a factor in determining eligibility for providing free care?
If "Yes," indicate which of the following was the FPG family income limit for eligibility for free care:
3a
 
No
%
b
Did the organization use FPG as a factor in determining eligibility for providing discounted care? If "Yes," indicate
which of the following was the family income limit for eligibility for discounted care: .........
3b
 
No
%
c
If the organization used factors other than FPG in determining eligibility, describe in Part VI the income based criteria for determining eligibility for free or discounted care. Include in the description whether the organization used an asset test or other threshold, regardless of income, as a factor in determining eligibility for free or discounted care.
4
Did the organization's financial assistance policy that applied to the largest number of its patients during the tax year provide for free or discounted care to the "medically indigent"? ..............

4

Yes

 
5a
Did the organization budget amounts for free or discounted care provided under its financial assistance policy during the tax year? ............................

5a

Yes

 
b
If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? ......
5b
 
No
c
If "Yes" to line 5b, as a result of budget considerations, was the organization unable to provide free or discountedcare to a patient who was eligibile for free or discounted care? ..............
5c
 
 
6a
Did the organization prepare a community benefit report during the tax year? ..........
6a
Yes
 
b
If "Yes," did the organization make it available to the public? ..............
6b
Yes
 
Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.
7
Financial Assistance and Certain Other Community Benefits at Cost
Financial Assistance and
Means-Tested
Government Programs
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community benefit expense (d) Direct offsetting revenue (e) Net community benefit expense (f) Percent of total expense
a Financial Assistance at cost
(from Worksheet 1) ..
  8,552 6,899,849   6,899,849 1.420 %
b Medicaid (from Worksheet 3,
column a) ....
  14,741 39,623,152 29,522,879 10,100,273 2.080 %
c Costs of other means-tested
government programs (from
Worksheet 3, column b) .
        0 0 %
d Total Financial Assistance
and Means-Tested
Government Programs .
0 23,293 46,523,001 29,522,879 17,000,122 3.500 %
Other Benefits
18 7,770 1,458,584 9,356 1,449,228 0.300 %
e Community health
improvement services and
community benefit operations
(from Worksheet 4) ..
f Health professions education
(from Worksheet 5) ..
6 65 1,282,095   1,282,095 0.270 %
g Subsidized health services
(from Worksheet 6) ..
6 11,867 18,373,137 13,210,666 5,162,471 1.060 %
h Research (from Worksheet 7) 2   335,839   335,839 0.070 %
i Cash and in-kind
contributions for community
benefit (from Worksheet 8)
5 1,040 1,427,351   1,427,351 0.300 %
j Total. Other Benefits .. 37 20,742 22,877,006 13,220,022 9,656,984 2.000 %
k Total. Add lines 7d and 7j . 37 44,035 69,400,007 42,742,901 26,657,106 5.500 %
For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part II
Community Building Activities Complete this table if the organization conducted any community building activities during the tax year, and describe in Part VI how its community building activities promoted the health of the communities it serves.
(a) Number of activities or programs (optional) (b) Persons served (optional) (c) Total community building expense (d) Direct offsetting
revenue
(e) Net community building expense (f) Percent of total expense
1 Physical improvements and housing         0 0 %
2 Economic development 1   7,164   7,164 0 %
3 Community support 6 742 715,739   715,739 0.140 %
4 Environmental improvements         0 0 %
5 Leadership development and training for community members         0 0 %
6 Coalition building 4 200 137,240 520 136,720 0.020 %
7 Community health improvement advocacy 1   22,395   22,395 0 %
8 Workforce development 1   2,300   2,300 0 %
9 Other         0 0 %
10 Total 13 942 884,838 520 884,318 0.170 %
Part III
Bad Debt, Medicare, & Collection Practices
Section A. Bad Debt Expense
Yes
No
1
Did the organization report bad debt expense in accordance with Heathcare Financial Management Association Statement No. 15? ..........................
1
Yes
 
2
Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......
2
31,341,697
3
Enter the estimated amount of the organization's bad debt expense attributable to patients eligible under the organization's financial assistance policy. Explain in Part VI the methodology used by the organization to estimate this amount and the rationale, if any, for including this portion of bad debt as community benefit. ......
3
0
4
Provide in Part VI the text of the footnote to the organization’s financial statements that describes bad debt expense or the page number on which this footnote is contained in the attached financial statements.
Section B. Medicare
5
Enter total revenue received from Medicare (including DSH and IME).....
5
167,071,355
6
Enter Medicare allowable costs of care relating to payments on line 5.....
6
171,764,325
7
Subtract line 6 from line 5. This is the surplus (or shortfall)........
7
-4,692,970
8
Describe in Part VI the extent to which any shortfall reported in line 7 should be treated as community benefit.Also describe in Part VI the costing methodology or source used to determine the amount reported on line 6.Check the box that describes the method used:
Section C. Collection Practices
9a
Did the organization have a written debt collection policy during the tax year? ..........
9a
Yes
 
b
If "Yes," did the organization’s collection policy that applied to the largest number of its patients during the tax year contain provisions on the collection practices to be followed for patients who are known to qualify for financial assistance? Describe in Part VI.......................

9b

Yes

 
Part IV
Management Companies and Joint Ventures(owned 10% or more by officers, directors, trustees, key employees, and physicians—see instructions)
(a) Name of entity (b) Description of primary
activity of entity
(c) Organization's
profit % or stock
ownership %
(d) Officers, directors,
trustees, or key
employees' profit %
or stock ownership %
(e) Physicians'
profit % or stock
ownership %
1MEMORIAL MISSION SUR
 
AMBULATORY SURGERY CENTER 29.3 % 0 % 70.7 %
2BERYWOOD OFFICE PROP
 
PHYSICIAN OFFICE BUILDING 63 % 0 % 37 %
3
4
5
6
7
8
9
10
11
12
13
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information
Section A. Hospital Facilities
(list in order of size from largest to smallest—see instructions)
How many hospital facilities did the organization operate during the tax year?2
Name, address, and primary website address
Licensed Hospital General-Medical-Surgical Children's Hospital Teaching Hospital Critical Hospital Research Facility ER-24Hours ER-Other Other (Describe) Facility reporting group
1 MEMORIAL HOSPITAL
2525 DESALES AVENUE
CHATTANOOGA,TN37404
WWW.MEMORIAL.ORG
X X         X     A
2 MEMORIAL HOSPITAL HIXSON
2051 HAMILL ROAD
HIXSON,TN37343
X X         X     A
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section B. Facility Policies and Practices

(Complete a separate Section B for each of the hospital facilities or facility reporting groups listed in Part V, Section A)
A
Name of hospital facility or facility reporting group  
For single facility filers only: line Number of Hospital Facility (from Schedule H, Part V, Section A) 1
Yes No
Community Health Needs Assessment (Lines 1 through 8c are optional for tax years begining on or before March 23, 2012)
1 During the tax year or either of the two immediately preceding tax years, did the hospital facility conduct a community health needs assessment (CHNA)? If "No," skip to line 9.................... 1 Yes  
If “Yes,” indicate what the CHNA report describes (check all that apply):
a
b
c
d
e
f
g
h
i
j
2 Indicate the tax year the hospital facility last conducted a CHNA: 20 12
3 In conducting its most recent CHNA, did the hospital facility take into account input from representatives of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If “Yes,” describe in Part VI how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................... 3 Yes  
4 Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If “Yes,” list the other hospital facilities in Part VI................................ 4   No
5 Did the hospital facility make its CHNA report widely available to the public? ............. 5 Yes  
If “Yes,” indicate how the CHNA report was made widely available (check all that apply):
a
b
c
6 If the hospital facility addressed needs identified in its most recently conducted CHNA, indicate how (check all that apply to date):
a
b
c
d
e
f
g
h
i
7 Did the hospital facility address all of the needs identified in its most recently conducted CHNA? If “No,” explain in Part VI which needs it has not addressed and the reasons why it has not addressed such needs ........ 7   No
8a Did the organization incur an excise tax under section 4959 for the hospital facility's failure to conduct a CHNA as required by section 501(r)(3)? ........................... 8a   No
b If "Yes" to line 8a, did the organization file Form 4720 to report the section 4959 excise tax? ...... 8b    
c If "Yes" to line 8b, what is the total amount of section 4959 excise tax the organization reported on Form 4720 for all of its hospital facilities? $  

Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Financial Assistance Policy Yes No
9 Did the hospital facility have in place during the tax year a written financial assistance policy that:
Explained eligibility criteria for financial assistance, and whether such assistance includes free or discounted care? 9 Yes  
10 Used federal poverty guidelines (FPG) to determine eligibility for providing free care?........... 10   No
If "Yes," indicate the FPG family income limit for eligibility for free care:   %
If "No," explain in Part VI the criteria the hospital facility used.
11 Used FPG to determine eligibility for providing discounted care?................. 11   No
If “Yes,” indicate the FPG family income limit for eligibility for discounted care:   %
If "No," explain in Part VI the criteria the hospital facility used.
12 Explained the basis for calculating amounts charged to patients?................. 12 Yes  
If “Yes,” indicate the factors used in determining such amounts (check all that apply):
a
b
c
d
e
f
g
h
13 Explained the method for applying for financial assistance?................... 13 Yes  
14 Included measures to publicize the policy within the community served by the hospital facility?....... 14 Yes  
If “Yes,” indicate how the hospital facility publicized the policy (check all that apply):
a
b
c
d
e
f
g
Billing and Collections
15 Did the hospital facility have in place during the tax year a separate billing and collections policy, or a written financial assistance policy (FAP) that explained actions the hospital facility may take upon non-payment?....... 15 Yes  
16 Check all of the following actions against an individual that were permitted under the hospital facility's policies during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP:
a
b
c
d
e
17 Did the hospital facility or an authorized third party perform any of the following actions during the tax year before making reasonable efforts to determine the patient’s eligibility under the facility’s FAP?.......... 17   No
If “Yes,” check all actions in which the hospital facility or a third party engaged:
a
b
c
d
e
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

18 Indicate which efforts the hospital facility made before initiating any of the actions listed in line 17 (check all that apply):
a
b
c
d
e
Policy Relating to Emergency Medical Care
Yes No
19 Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that requires the hospital facility to provide, without discrimination, care for emergency medical conditions to individuals regardless of their eligibility under the hospital facility’s financial assistance policy?.......... 19 Yes  
If “No,” indicate why:
a
b
c
d
Charges to Individuals Eligible for Assistance under the FAP (FAP-Eligible Individuals)
20 Indicate how the hospital facility determined, during the tax year, the maximum amounts that can be charged to FAP-eligible individuals for emergency or other medically necessary care.
a
b
c
d
21 During the tax year, did the hospital facility charge any FAP-eligible individuals to whom the hospital facility provided emergency or other medically necessary services, more than the amounts generally billed to individuals who had insurance covering such care? ............................ 21   No
If “Yes,” explain in Part VI.
22 During the tax year, did the hospital facility charge any FAP-eligible individuals an amount equal to the gross charge for any service provided to that individual? ......................... 22   No
If “Yes,” explain in Part VI.
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VFacility Information (continued)

Section C. Other Health Care Facilities That Are Not Licensed, Registered, or Similarly Recognized as a Hospital Facility
(list in order of size, from largest to smallest)
How many non-hospital health care facilities did the organization operate during the tax year?5
Name and address Type of Facility (describe)
1 MEMORIAL OOLTEWAH IMAGING CENTER
6401 MOUNTAIN VIEW ROAD
OOLTEWAH,TN37363
OUTPATIENT IMAGING CENTER
2 MEMORIAL HEART INSTITUTE
2501 CITICO AVENUE
CHATTANOOGA,TN37404
CARDIAC PHYSICIAN PRACTICE
3 MEMORIAL HEART INSTITUTE
2051 HAMILL ROAD
HIXSON,TN37343
CARDIAC PHYSICIAN PRACTICE
4 MEMORIAL HEART INSTITUTE
400 BERYWOOD TRAIL SUITE A
CLEVELAND,TN37312
CARDIAC PHYSICIAN PRACTICE
5 BERYWOOD OFFICE PROPERTIES LLC
2501 CITICO AVENUE
CHATTANOOGA,TN37404
PHYSICIAN OFFICE BUILDING
6
7
8
9
10
Schedule H (Form 990) 2012
Schedule H (Form 990) 2012
Page
Part VI
Supplemental Information
Complete this part to provide the following information.
1 Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II; Part III, lines 4, 8, and 9b; Part V, Section A; and Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
2 Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any needs assessments reported in Part V, Section B.
3 Patient education of eligibility for assistance. Describe how the organization informs and educates patients and persons who may be billed for patient care about their eligibility for assistance under federal, state, or local government programs or under the organization’s financial assistance policy.
4 Community information. Describe the community the organization serves, taking into account the geographic area and demographic constituents it serves.
5 Promotion of community health. Provide any other information important to describing how the organization’s hospital facilities or other health care facilities further its exempt purpose by promoting the health of the community (e.g., open medical staff, community board, use of surplus funds, etc.).
6 Affiliated health care system. If the organization is part of an affiliated health care system, describe the respective roles of the organization and its affiliates in promoting the health of the communities served.
7 State filing of community benefit report. If applicable, identify all states with which the organization, or a related organization, files a community benefit report.
8 Facility reporting group(s). If applicable, for each hospital facility in a facility reporting group provide the descriptions required for Part V, Section B, lines 1j, 3, 4, 5c, 6i, 7, 10, 11, 12h, 14g, 16e, 17e, 18e, 19c, 19d, 20d, 21, and 22.
Identifier ReturnReference Explanation
Eligibility criteria for free or discounted care Schedule H, Part I, Line 3c WHEN CATHOLIC HEALTH INITIATIVES (THE ULTIMATE PARENT ORGANIZATION TO MEMORIAL HEALTH CARE SYSTEM) ESTABLISHED ITS FINANCIAL ASSISTANCE POLICY IT WAS DETERMINED THAT USING 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 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. MEMORIAL HEALTH CARE SYSTEM 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 BASED ON A SLIDING SCALE, RANGING FROM 25%-100% OF CHARGES. COINCIDING WITH HUD'S ANNUAL UPDATE TO THE PUBLISHED INCOME LIMITS, MEMORIAL HEALTH CARE SYSTEM APPROPRIATELY UPDATES THE SLIDING SCALE. 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 ARE ALSO TAKEN INTO CONSIDERATION. FOR EXAMPLE, A PATIENT SUFFERING A CATASTROPHIC ILLNESS MAY HAVE AN INCOME ABOVE THE INCOME LIMITS, BUT HIGH EXPENSES AND 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.
Costing Methodology used to calculate financial assistance Schedule H, Part I, Line 7 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. THIS RESULTED IN A COST TO CHARGE RATIO OF 27.63%. 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) 31,341,697
Subsidized Health Services Schedule H, Part I, Line 7g THERE ARE NO PHYSICIAN CLINICS INCLUDED IN SUBSIDIZED HEALTH SERVICES.
Bad debt expense - methodology used to estimate amount Schedule H, Part III, Line 2 MEMORIAL HEALTH CARE SYSTEM (MHCS) IS INCLUDED IN THE AUDITED FINANCIAL STATEMENTS OF ITS PARENT ORGANIZATION, CATHOLIC HEALTH INITIATIVES AND DOES NOT ISSUE SEPARATE AUDITED FINANCIAL STATEMENTS, THUS THERE IS NO FOOTNOTE. BAD DEBT EXPENSE REPORTED ON THE MHCS UNAUDITED FINANCIAL STATEMENTS REPRESENTS AN ESTIMATE OF BAD DEBTS BASED ON HISTORICAL COLLECTION RESULTS. IT DOES NOT REPRESENT ACTUAL WRITE-OFFS INCURRED DURING THE PERIOD. 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, MHCS FOLLOWS ESTABLISHED GUIDELINES FOR PLACING CERTAIN PATIENT BALANCES WITH COLLECTION AGENCIES. COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 27.63% WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. MEMORIAL HEALTH CARE SYSTEM USES A NUMBER OF PROCESSES AS DESCRIBED IN PART VI, ITEM 3 BELOW TO IDENTIFY WHO CAN AND CANNOT AFFORD TO PAY. PATIENTS WHO ARE UNABLE TO PAY ARE IDENTIFIED IN ADVANCE OF BILLING OR DURING THE BILLING AND COLLECTION PROCESS, PARTICULARLY THOSE WHO ARE MEDICALLY INDIGENT OR UNDERINSURED. AT ANY TIME IN THE PROCESS THAT A PATIENT IS DETERMINED TO BE ELIGIBLE FOR CHARITY CARE, THE PATIENT IS RE-CLASSIFIED FROM BAD DEBT AND ALL BILLING AND COLLECTION EFFORTS ARE DISCONTINUED. IN SPITE OF THE BEST EFFORTS OF MEMORIAL HEALTH CARE SYSTEM, SOME PATIENTS DO NOT SELF-IDENTIFY AS NEEDING ASSISTANCE OR PROVIDE ENOUGH INFORMATION TO ALLOW THE HOSPITAL TO DETERMINE THEIR ELIGIBILITY AND REMAIN CLASSIFIED AS BAD DEBT.
Bad debt expense - methodology used to estimate amount as community benefit Schedule H, Part III, Line 3 MEMORIAL HEALTH CARE SYSTEM 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 THE AMOUNT REPORTED ON THE SCHEDULE H, PART III, LINES 2 AND 3 ARE THE SAME AMOUNTS REPORTED FOR BAD DEBT IN THE AUDITED FINANCIAL STATEMENTS. PLEASE REFER TO THE FINANCIAL STATEMENT FOOTNOTE BELOW FOR INFORMATION REGARDING THE METHODOLOGY USED TO DETERMINE AND REPORT BAD DEBT EXPENSE. MEMORIAL HEALTH CARE SYSTEM 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 CONSIDERING 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."
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. MEMORIAL HEALTH CARE SYSTEM'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: THESE COSTS AND REIMBURSEMENTS ARE NOT LIMITED TO TRADITIONAL MEDICARE PLANS EITHER BUT ENCOMPASS MEDICARE MANAGED CARE PLANS. TOTAL MEDICARE REVENUE: 237,359,815 TOTAL MEDICARE COSTS: 261,631,773 SURPLUS OR SHORTFALL (24,271,958) MEMORIAL HEALTH CARE SYSTEM 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. 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 MEMORIAL HEALTH CARE SYSTEM'S DEBT COLLECTION POLICY PROVIDES THAT MEMORIAL HEALTH CARE SYSTEM 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 MEMORIAL HEALTH CARE SYSTEM COMMUNITY ASSISTANCE POLICY. AFTER HAVING BEEN TURNED OVER TO A THIRD-PARTY COLLECTION AGENT, ANY PATIENT ACCOUNT THAT IS SUBSEQUENTLY DETERMINED TO MEET THE MEMORIAL HEALTH CARE SYSTEM COMMUNITY ASSISTANCE POLICY IS REQUIRED TO BE RETURNED IMMEDIATELY BY THE THIRD-PARTY COLLECTION AGENT TO MEMORIAL HEALTH CARE SYSTEM FOR APPROPRIATE FOLLOW-UP. MEMORIAL HEALTH CARE SYSTEM 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) MEMORIAL HOSPITAL - IN 2010, MEMORIAL HEALTH CARE SYSTEM ENGAGED THE OCHS CENTER TO ASSIST IN CONDUCTING A FORMAL COMMUNITY NEEDS ASSESSMENT AND HAVE BEEN ENGAGED IN 2013 TO HELP REASSESS THE HEALTH NEEDS OF THE COMMUNITY TO HELP IDENTIFY THE DISPROPORTIONATE UNMET HEALTH NEEDS IN THE COMMUNITY WE SERVE. THE OCHS CENTER COMPLETED THE SECOND COMMUNITY HEALTH NEEDS ASSESSMENT ON MARCH 1, 2013. THE FOLLOWING SOURCES WERE UTILIZED TO GATHER THE DATA: -MEMORIAL HEALTH CARE SYSTEM DATA TO DETERMINE SERVICE AREA -TENNESSEE DEPARTMENT OF HEALTH -GEORGIA DEPARTMENT OF PUBLIC HEALTH -WWW.COUNTYHEALTHRANKINGS.ORG -WWW.CHNA.ORG FROM COMMUNITY COMMONS -CDC AND THE NATIONAL VITAL STATISTICS DATABASE -THE COMMONWEALTH FUND'S SCORECARD ON LOCAL HEALTH SYSTEM PERFORMANCE -DIGNITY HEALTH'S COMMUNITY NEEDS INDEX MHCS SOUGHT INPUT FROM COMMUNITY REPRESENTATIVES INCLUDING THOSE SPECIAL KNOWLEDGE OR EXPERTISE IN PUBLIC HEALTH ON THE COMMUNITY BENEFIT PLAN THAT WAS DEVELOPED IN RESPONSE TO COMMUNITY HEALTH NEEDS ASSESSMENT. IN MAY 2013 MANY COMMUNITY STAKEHOLDERS WERE INVITED TO A MEETING TO DISCUSS THE GOALS OF MHCS'S COMMUNITY BENEFIT PLAN AND TO PROVIDE COMMUNITY INPUT ;
Needs not addressed in Needs Assessment Schedule H, Part V Section B, Line 7 (1) MEMORIAL HOSPITAL - THE FOCUS OF OUR 2013 - 2016 COMMUNITY BENEFIT PLAN ADDRESSES THE FOLLOWING IDENTIFIED COMMUNITY HEALTH NEEDS: CARDIOVASCULAR HEALTH, CANCER, DIABETES, MINORITY HEALTH AND VIOLENCE. THE AREAS WE DID NOT ADDRESS ARE: -RESPIRATORY DISEASE - -LOW BIRTH WEIGHT INFANTS - WE DO NOT HAVE OBSTETRICAL SERVICES SO IT IS NOT AN AREA OF EXPERTISE FOR US. -HISPANIC/LATINO HEALTH - WHILE WE SERVE HISPANIC/LATINO PATIENTS WITHIN OUR SYSTEM AND THE POPULATION IS GROWING SOMEWHAT IT IS A RELATIVELY SMALL PERCENTAGE OF OUR TOTAL POPULATION. WE DO HAVE SOME TRAINED MEDICAL INTERPRETERS TO ASSIST WITH THE COMMUNICATION AND CARE OF THESE PATIENTS. ;
Used federal poverty guidelines (FPG) to determine eligibility Schedule H, Part V Section B, Line 10 (1) MEMORIAL HOSPITAL - HUD LOW INCOME GUIDELINES USED;
Used FPG to determine eligibility for providing discounted care criteria Schedule H, Part V Section B, Line 11 (1) MEMORIAL HOSPITAL - HUD LOW INCOME GUIDELINES USED;
Means used to determine amounts billed Schedule H, Part V Section B, Line 20d (1) MEMORIAL HOSPITAL - ALL PATIENTS THAT DO NOT HAVE INSURANCE RECEIVE A DISCOUNT THAT IS CALCULATED EACH YEAR AS 150% OF THE COST TO CHARGE RATIO IN ACCORDANCE WITH TENNESSEE STATE CODE. THIS DISCOUNT IS APPLIED TO THE PATIENTS ACCOUNT PRIOR TO BILLING AND IS TREATED AS AN ADJUSTMENT TO NET PATIENT REVENUE IN THE SAME MANNER AS A MANAGED CARE DISCOUNT. THE PROVISION OF THIS DISCOUNT TO ALL PATIENTS WITHOUT INSURANCE LOWERS THE AMOUNT THAT IS BILLED TO THE PATIENT AND REDUCES THE AMOUNT OF ANY SUBSEQUENT BAD DEBT EXPENSE. IN FISCAL YEAR 2013, SELF PAY DISCOUNTS WERE 27.5 MILLION REPRESENTING $7.6 MILLION AT COST.;
LINES 2, 4, & 5: COMMUNITY BENEFIT NARRATIVE AND NEEDS ASSESSMENT SCHEDULE H, PART VI INTRODUCTION MEMORIAL HEALTH CARE SYSTEM INC ("MHCS") IS PART OF CATHOLIC HEALTH INITIATIVES ("CHI"), A NATIONAL HEALTH CARE SYSTEM ESTABLISHED TO FOSTER A MORE EFFECTIVE MINISTRY OF FAITH-BASED HEALTHCARE IN THE UNITED STATES. THE MISSION OF MHCS AND CHI IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH BY BRINGING IT NEW LIFE, ENERGY AND VIABILITY IN THE 21ST CENTURY. BOTH MHCS AND CHI ARE COMMITTED TO FIDELITY TO THE GOSPEL, WITH EMPHASIS ON HUMAN DIGNITY AND SOCIAL JUSTICE IN THE CREATION OF HEALTHIER COMMUNITIES. MHCS IS PRIMARILY MADE UP OF TWO HOSPITALS, MEMORIAL HOSPITAL AND MEMORIAL HIXSON HOSPITAL. MEMORIAL HOSPITAL OPENED ITS DOORS ON JANUARY 2, 1952 IN RESPONSE TO CONCERNS ABOUT THE SEVERE SHORTAGE OF HOSPITAL BEDS IN THE COMMUNITY. FROM THE BEGINNING, WHEN MEMORIAL HOSPITAL WAS ESTABLISHED AND THE SISTERS OF CHARITY OF NAZARETH PUT FORTH THEIR COMMITMENT TO PROVIDE LEADERSHIP TO THE OPERATIONS OF THE HOSPITAL, THE CARE OF THE POOR AND QUALITY HEALTH CARE FOR THE ENTIRE COMMUNITY WAS CENTRAL TO OUR MISSION. MEMORIAL HIXSON HOSPITAL JOINED MHCS WHEN IT WAS PURCHASED FEBRUARY 1, 1998 AND HAS ADOPTED THE SAME COMMITMENT TO EXCELLENT HEALTH CARE TO EVERYONE IN THE COMMUNITY. MHCS IS ONE OF THE SOUTHEAST'S LEADING MEDICAL SYSTEMS AND THE REGION'S PREEMINENT PROVIDER OF CARDIAC AND CANCER CARE WITH CENTERS OF EXCELLENCE IN SURGERY AND ORTHOPEDICS. MHCS HOSPITALS HAVE BEEN NAMED ONE OF THE NATION'S 100 TOP HOSPITALS® SIX TIMES BY THOMSON REUTERS, THE HEALTH CARE INDUSTRY'S LEADING SOURCE OF INFORMATION ON HOSPITAL QUALITY. ACCORDING TO THOMSON'S RESEARCH, FACILITIES NAMED TO THE ANNUAL 100 TOP HOSPITALS ROSTER OUTPERFORM THEIR PEERS IN QUALITY, SAFETY AND EFFICIENCY. COMMUNITY NEEDS ASSESSMENT MEMORIAL HEALTH CARE SYSTEM ASSESSED THE NEEDS OF THE COMMUNITY SERVED BY MEMORIAL HOSPITAL AND MEMORIAL HIXSON HOSPITAL DURING THE YEAR BY CONSULTING WITH BOARD MEMBERS, OTHER HEALTH RELATED ORGANIZATIONS, AND COMMUNITY OUTREACH ORGANIZATIONS. INITIALLY EIGHT COUNTIES WERE INCLUDED IN THE ORIGINAL NEEDS ASSESSMENT. THE COMMUNITY NEEDS ASSESSMENT HAD SEVERAL KEY FINDINGS: THE COMMUNITY NEEDS ASSESSMENT OF 2010 SHOWED THE FOLLOWING AS SIGNIFICANT HEALTH ISSUES WITHIN OUR COMMUNITY: HEALTH CARE ACCESS, HEART DISEASE, CANCER, STROKE, CHRONIC LOWER RESPIRATORY DISEASES, DIABETES, ALZHEIMER'S DISEASE, SMOKING, OBESITY, HYPERTENSION, HIGH CHOLESTEROL, AND VIOLENCE (VIOLENT CRIMES AND DOMESTIC VIOLENCE). THE UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT OF MARCH 2013 REVEALED THAT SOME OF THE SAME HEALTH ISSUES CONTINUE TO BE A CONCERN FOR OUR COMMUNITY WHILE SURFACING A FEW DIFFERENCES FROM THE ASSESSMENT OF THREE YEARS AGO. THE RECENT ASSESSMENT LISTED THE FOLLOWING AS MAJOR HEALTH ISSUES OF THE COMMUNITY WE SERVE: *CARDIOVASCULAR HEALTH - HEART DISEASE IS THE LEADING CAUSES OF DEATH IN ALL OF THE COUNTIES. MORTALITY RATES FOR HEART DISEASE ARE ALSO SIGNIFICANTLY HIGHER IN THE AREA. RATES ARE CONSISTENT WITH HIGH RISK FACTOR PERCENTAGES RELATED TO OBESITY, DIET, SMOKING, AND EXERCISE. *CANCER - CANCER IS THE SECOND LEADING CAUSE OF DEATH IN THE COUNTIES, AND MOST OF THE COUNTIES HAVE HIGHER RATES THAN THOSE OF THE NATION. RATES FOR BREAST AND LUNG CANCER ARE ESPECIALLY HIGH. *RESPIRATORY DISEASE - THIS IS THE THIRD LEADING CAUSE OF DEATH IN THE COUNTIES. ALL ARE HIGHER THAN THE NATIONAL RATE. THIS IS CONSISTENT WITH THE SMOKING RATE. *DIABETES - MORTALITY RATES AND PREVALENCE RATES ARE HIGH FOR DIABETES, WHICH CONTRIBUTES TO HEART DISEASE. *LOW BIRTH WEIGHT INFANTS - THE RATES FOR THE AREA REMAIN HIGH, ESPECIALLY FOR HAMILTON COUNTY. *RISK FACTORS - RISK FACTORS ARE HIGH FOR OBESITY, SMOKING, DIET, AND EXERCISE. THESE ARE FACTORS THAT CONTRIBUTE TO HEART DISEASE, DIABETES, CANCER, AND INFANT HEALTH. POOR DENTAL HEALTH IS ALSO A RISK FACTOR FOR OTHER DISEASES. *MINORITY HEALTH - AFRICAN AMERICAN MORTALITY RATES FOR HEART DISEASE, CANCER (ESPECIALLY PROSTATE AND BREAST CANCER) ARE HIGH. DIABETES MORTALITY RATES FOR AFRICAN AMERICANS ARE MORE THAN THREE TIMES THAT OF WHITES IN HAMILTON COUNTY, AND RATES FOR LOW BIRTH WEIGHT INFANTS ARE TWICE THAT OF WHITES. *HISPANIC/LATINO HEALTH - THE GROWING HISPANIC/LATINO POPULATION WILL BRING ABOUT NEW HEALTH NEEDS. CURRENTLY WHITFIELD COUNTY HAS A HIGHER PERCENTAGE OF DIABETES, WHICH IS CONSISTENT WITH THE HIGHER PERCENTAGE OF HISPANICS/LATINOS IN THE COMMUNITY. THIS GROUP ALSO HAS A HIGH RATE OF BEING UNINSURED, WHICH INDICATES ACCESS ISSUES. TAX EXEMPT PURPOSE MHCS IS A FAITH BASED, TAX-EXEMPT 501(C)(3) ORGANIZATION THAT PROVIDES MEDICAL CARE TO ALL REGARDLESS OF THEIR ABILITY TO PAY. OUR TAX EXEMPT STATUS IS SUBSTANTIATED BY ITS INCLUSION IN THE OFFICIAL CATHOLIC DIRECTORY AS A TAX-EXEMPT HOSPITAL. COMMUNITY SERVICES HAVE ALWAYS BEEN A SIGNIFICANT PART OF MHCS. EACH YEAR, SERVICES AND PROGRAMS OFFERED TO THE COMMUNITY ARE EVALUATED AND EXPANDED TO PROMOTE INCREASED ACCESS TO HEALTHCARE AND HEALTHIER COMMUNITIES THAT TARGETS CHRONIC DISEASE PREVENTION AND MANAGEMENT FOR VULNERABLE AND UNDERSERVED POPULATIONS. TO ENHANCE THE HEALTH STATUS OF CHATTANOOGANS, MHCS FOCUSES ON THE WHOLE PERSON INCLUDING THE PERSON'S SPIRITUAL, EMOTIONAL, AND PHYSICAL WELL-BEING. IN ACCORDANCE WITH ITS MISSION AND PHILOSOPHY, MHCS COMMITS SUBSTANTIAL RESOURCES TO SPONSOR A BROAD RANGE OF SERVICES TO BOTH THE POOR AS WELL AS THE BROADER COMMUNITY. BENEFITS FOR THE POOR INCLUDE THE COST OF PROVIDING SERVICES TO INDIVIDUALS WHO ARE UNABLE TO AFFORD HEALTH CARE DUE TO INADEQUATE RESOURCES AND/OR THOSE THAT ARE UNINSURED OR UNDERINSURED. BENEFITS FOR THE POOR INCLUDE TRADITIONAL CHARITY CARE, UNPAID COSTS OF MEDICAID, SUBSIDIZED OR FREE HEALTH SERVICES, AND CASH AND IN-KIND DONATIONS TO ORGANIZATIONS THAT SERVE THE POOR. THE AMOUNTS REPORTED REFLECT THE COSTS OF THESE SERVICES, NET OF CONTRIBUTIONS, GOVERNMENT PAYMENTS AND OTHER REVENUES RECEIVED AS DIRECT ASSISTANCE. COMMUNITY BENEFITS PROVIDED TO THE BROADER COMMUNITY INCLUDE THE COSTS OF PROVIDING SERVICES TO OTHER POPULATIONS WHO MAY NOT QUALIFY AS POOR BUT MAY NEED SPECIAL SERVICES AND SUPPORT. BENEFITS TO THE BROADER COMMUNITY INCLUDE: HEALTH PROMOTION AND EDUCATION; HEALTH FAIRS AND SCREENINGS; UNPAID COSTS OF TRAINING HEALTH PROFESSIONALS SUCH AS MEDICAL RESIDENTS, NURSING STUDENTS AND STUDENTS IN ALLIED HEALTH PROFESSIONS; CASH AND IN-KIND DONATIONS TO ORGANIZATIONS THAT SERVE THE BROADER COMMUNITY; AND THE UNPAID COSTS OF TESTING MEDICAL EQUIPMENT AND CONTROLLED STUDIES OF THERAPEUTIC PROTOCOLS. IN FISCAL YEAR 2013, MHCS PROVIDED COMMUNITY BENEFITS AND COMMUNITY BUILDING ACTIVITIES TO APPROXIMATELY 44,977 PEOPLE AT A TOTAL COST OF $70,284,845. DONATIONS, GRANTS, AND OTHER RECEIPTS TOTALING $42,743,421 WERE AVAILABLE AS DIRECT OFFSETS TO THESE COSTS.
LINES 2, 4, & 5: COMMUNITY BENEFIT NARRATIVE AND NEEDS ASSESSMENT (CONTINUATION 1) SCHEDULE H, PART VI EMERGENCY ROOM MHCS OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR AT BOTH MEMORIAL AND MEMORIAL HIXSON HOSPITAL. BOTH EMERGENCY ROOMS ARE OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. DU RING FY 2013, OVER 74,729 PATIENTS VISITED ONE OF THESE EMERGENCY ROOMS. MEMORIAL HOSPITAL'S EMERGENCY ROOM IS A LEVEL 3 CERTIFIED CHEST PAIN CENTER. THIS IS IMPORTANT FOR A HOSPITAL THAT FOCUSES ON CARDIAC CARE WHERE EVERY MINUTE COUNTS WHEN PATIENTS ARE EXPERIENCING CHEST PAIN. UNCOMPENSATED CARE CHARITY CARE IS THE COST OF CARE OF UNINSURED OR UNDERINSURED, LOW-INCOME PATIENTS WHO ARE NOT EXPECTED TO PAY ALL OF A BILL, OR WHO ARE ABLE TO PAY ONLY A PORTION USING AN INCOME-RELATED SCALE. THOSE RECEIVING CHARITY CARE ARE NOT ELIGIBLE FOR PUBLIC PROGRAMS SUCH AS TENNCARE. MHCS HAS A CHARITY CARE POLICY, WHICH ASSURES THAT ALL PERSONS RECEIVE MEDICALLY NECESSARY HOSPITAL SERVICES REGARDLESS OF THEIR ABILITY TO PAY. MHCS PROVIDES A SIGNIFICANT LEVEL OF CHARITY CARE EACH YEAR. IN FY 2013, THE COST OF CHARITY CARE WAS $6,899,849. ADDITIONALLY, MHCS PROVIDED UNREIMBURSED COSTS IN THE AMOUNT OF $10,100,273 FOR PATIENTS WHO QUALIFIED FOR THE TENNCARE PROGRAM. IN FY 2013, MHCS CLASSIFIED CHARITY AND UNREIMBURSED TENNCARE COSTS FOR REPORTING PURPOSES IN A MANNER CONSISTENT WITH A STANDARDIZED APPROACH DEVELOPED BY CHI FOR REPORTING AND BUDGETING BENEFITS PROVIDED TO THE COMMUNITY. COMMUNITY OUTREACH FOR THE POOR PRESCRIPTION DRUG PROGRAM MHCS PROVIDES PRESCRIPTION DRUGS TO THOSE CHATTANOOGANS WHO CANNOT AFFORD TO PURCHASE THEM. IN FY 2013 MHCS PROVIDED $86,678 IN FREE PRESCRIPTION DRUGS. WE ALSO PROVIDE FUNDING TO THE EPILEPSY FOUNDATION FOR THEM TO HELP EPILEPTIC PATIENTS WITH MEDICATIONS THEY CANNOT AFFORD. PHARMACEUTICAL ASSISTANCE PROGRAMS MHCS HAS PARTNERED WITH DISPENSARY OF HOPE, A NATIONAL ORGANIZATION THAT HELPS QUALIFYING UNINSURED PATIENTS OBTAIN NECESSARY MEDICATIONS AND OTHER PHARMACEUTICAL ASSISTANCE PROGRAMS. MHCS IS ONE OF 80 DISPENSARY OF HOPE SITES THAT REDISTRIBUTE PHARMACEUTICALS THAT HAVE BEEN RECEIVED AS A DONATION FROM PHYSICIANS, DISTRIBUTORS, AND MANUFACTURERS. PATIENTS ARE MADE AWARE OF THIS PROGRAM THROUGH PHYSICIANS, CASE MANAGERS, NURSES AND OTHER CAREGIVERS. MHCS WAS ABLE TO ASSIST 1,485 INDIVIDUALS TO RECEIVE THEIR PRESCRIPTION DRUGS THROUGH DISPENSARY OF HOPE AND OTHER PROGRAMS. MHCS INCURRED $123,160 IN EXPENSES RELATED TO THIS PROGRAM. HOMELESS HEALTH CARE CLINIC THE HOMELESS HEALTH CARE CLINIC PROVIDES COMPREHENSIVE HEALTH CARE TO HOMELESS MEN, WOMEN, AND CHILDREN. THE CLINIC STAFF GOES TO ABANDONED BUILDINGS, CAMPSITES AND SHELTERS LOOKING FOR HOMELESS PEOPLE WHO MAY NEED MEDICAL ATTENTION. MANY HOMELESS PEOPLE ARE AFRAID TO TALK TO PEOPLE OR LEAVE THEIR FAMILIAR SURROUNDINGS. THE CLINIC PROVIDES THEM WITH BLANKETS AND WARM CLOTHES IN THE WINTER AND WATER IN THE SUMMER. MEMORIAL HOSPITAL ASSISTS THE HOMELESS BY PROVIDING FREE LAB TESTS COSTING $54,982 AND FUNDS A NURSING POSITION IN THE AMOUNT OF $40,000 FREE LABORATORY TESTS MHCS PROVIDES FREE LAB TESTS TO THE SAMARITAN CENTER, HOMELESS HEALTH CARE CLINIC, VOLUNTEERS IN MEDICINE, PROJECT ACCESS, NORTHSHORE CLINIC, AND WESTSIDE CLINIC FOR THOSE PATIENTS WITHOUT INSURANCE OR ADEQUATE MEANS TO PAY. LAB TESTS PROVIDED IN FY 2012 TOTALED $253,751 AND SERVED 8,037 PEOPLE. CATHOLIC CHARITIES MHCS PROVIDED $41,000 IN FY 2013 TO CATHOLIC CHARITIES TO HELP FUND THEIR INTERFAITH SENIOR SERVICES, FAMILY SUPPORT SERVICES, AND THEIR COUNSELING PROGRAM. THESE FUNDS ARE USED TO HELP PROVIDE TRANSPORTATION SERVICES TO FRAIL AND LOW INCOME ELDERLY INDIVIDUALS. PROJECT ACCESS PROJECT ACCESS IS A REFERRAL NETWORK THAT OFFERS ACCESS TO MEDICAL CARE FOR LOW-INCOME RESIDENTS OF HAMILTON COUNTY WHO DO NOT HAVE INSURANCE. PATIENTS ENROLLED IN THIS PROGRAM MUST BE BELOW 150% OF THE POVERTY LEVEL AND CANNOT BE ELIGIBLE FOR HEALTH INSURANCE OR OTHER MEDICAL BENEFITS SUCH AS MEDICARE OR TENNCARE. PROJECT ACCESS HELPS PATIENTS GET SPECIALTY HEALTH CARE THAT PRIMARY CLINICS MAY NOT BE ABLE TO PROVIDE. INDIVIDUALS THAT QUALIFY ARE ELIGIBLE FOR SPECIALTY CARE FOR THREE MONTHS AND PRIMARY CARE FOR SIX MONTHS. PATIENTS ARE ALSO PROVIDED A PRESCRIPTION CARD THAT WILL ALLOW THEM TO GET THEIR MEDICATION WITH A $5.00 CO-PAY. MEMORIAL HOSPITAL PARTICIPATES AS A PROVIDER IN THIS NETWORK. COSTS ASSOCIATED WITH THIS PROGRAM ARE REPORTED IN THE PRESCRIPTION DRUG PROGRAM, FREE LABORATORY TESTS AND THE COST OF CHARITY CARE. EMERGENCY SITTING SERVICES MHCS PROVIDES EMERGENCY SITTING SERVICES AT NO COST TO FAMILIES OF PATIENTS WHO ARE UNABLE TO AFFORD TO HAVE SOMEONE STAY WITH THE PATIENT. THIS SERVICE IS AVAILABLE WHEN IT HAS BEEN DETERMINED THAT THE PATIENT SHOULD NOT BE LEFT ALONE FOR SAFETY REASONS. IN FY2013 COSTS ASSOCIATED WITH PROVIDING THIS SERVICE WERE $163,006. COMMUNITY OUTREACH FOR THE BROADER COMMUNITY FAITH COMMUNITY NURSE PROGRAM MHCS PIONEERED A FAITH COMMUNITY NURSE PROGRAM THAT OFFERS TRAINING TO NURSES ON HOW TO SERVE AS A VITAL LINK BETWEEN AREA CHURCHES AND HEALTHCARE PROVIDERS. THE FAITH COMMUNITY NURSE PROGRAM HAS PLACED SPECIAL FOCUS ON TRACKING ENCOUNTERS FOR PATIENTS WITH OBESITY, DIABETES, HYPERTENSION, AND HEART DISEASE SINCE THESE HAVE BEEN IDENTIFIED AS THE MAJOR HEALTH ISSUES IN OUR COMMUNITY. INTERNS ENROLLED IN THIS PROGRAM ARE PROVIDED MONTHLY WORKSHOPS ON TOPICS SUCH AS CRISIS INTERVENTION, FAMILY SYSTEMS, LOSS AND GRIEF, MIND/BODY/SPIRIT CONNECTION AND MORE. THIS TRAINING GIVES THESE NURSES THE TOOLS TO GUIDE PARISHIONERS THROUGH THE HEALTHCARE SYSTEM, PROMOTE HEALTH EDUCATION, CONDUCT HEALTH FAIRS AND SCREENINGS, AND PROVIDE A RESOURCE TO CHURCH MEMBERS WHO ARE COPING WITH A CHRONIC ILLNESS, LONELINESS, OR FAMILY CRISIS. FAITH COMMUNITY NURSES HELP TO ADD A SPIRITUAL DIMENSION TO THE HEALING PROCESS. THE COST OF THIS PROGRAM IN FY2013 WAS $33,874. HOSPICE UNIT MEMORIAL HEALTH CARE SYSTEM PROVIDES INPATIENT SERVICES TO THE DIFFERENT HOSPICE ORGANIZATIONS FOR HOSPICE PATIENTS REQUIRING INPATIENT CARE.. THE TOTAL COST OF THIS PROGRAM FOR FY 2013 WAS $1,319,928. FUNDING FOR HOSPICE PATIENTS OF $732,789 WAS RECEIVED IN FY2013 TO HELP OFFSET THESE EXPENSES TO TREAT 469 PATIENTS. DIABETES NUTRITION CENTER THE DIABETES NUTRITION CENTER AT MEMORIAL HOSPITAL PROVIDES MANY SERVICES TO PEOPLE WITH DIABETES THAT ARE NOT COVERED BY INSURANCE. THIS CENTER FOCUSES ON SELF-MANAGEMENT AND PROVIDING EDUCATION TO PATIENTS ON DIET AND NUTRITION AND OTHER SKILLS TO HELP THE PATIENT BETTER MANAGE THEIR DISEASE. IN FY 2013, THIS PROGRAM INCURRED 268,607 IN UNREIMBURSED COSTS FOR 2,114 PATIENTS.
LINES 2, 4, & 5: COMMUNITY BENEFIT NARRATIVE AND NEEDS ASSESSMENT (CONTINUATION 2) SCHEDULE H, PART VI CANCER RESOURCE CENTER MHCS HAS DEVELOPED A PROGRAM TO HELP CANCER PATIENTS AND THEIR FAMILIES COPE, OFFERING THEM THE LATEST INFORMATION ABOUT CANCER CARE. WHETHER AN INDIVIDUAL HAS JUST BEEN DIAGNOSED OR HAS A FAMILY MEMBER WITH CANCER, THE ONCOLOGY PROFESSIONALS AT THE CANCER RESOURCE CENTER CAN ANSWER QUESTIONS OR HELP INDIVIDUALS UNDERSTAND THEIR OPTIONS REGARDLESS OF WHERE THEY GO FOR TREATMENT. YOU CAN LEARN ABOUT FINANCIAL RESOURCES, SCREENING OPPORTUNITIES, THE MOST CURRENT CLINICAL TRIALS, AND SUPPORT GROUPS AND SEMINARS OFFERED TO PATIENTS, FAMILY, AND FRIENDS. THE CANCER RESOURCE CENTER ALSO OFFERS A HEALING ARTS PROGRAM TO ENHANCE THE HEALING AND PROVIDE ALTERNATIVE APPROACHES TO COPING. NONE OF THE SERVICES ARE BILLED TO THE PATIENT AND FEW QUALIFY FOR INSURANCE REIMBURSEMENT. IN FY 2013 THE COST OF THIS PROGRAM WAS $516,523. MOBILE MAMMOGRAPHY COACH MHCS OPERATES A MOBILE MAMMOGRAPHY COACH THAT SERVICES 31 COUNTIES IN SOUTHEAST TENNESSEE, NORTHWEST GEORGIA AND NORTHEAST ALABAMA. IN THESE COUNTIES MINORITIES, UNINSURED, UNDERINSURED, HOMELESS AND SHELTERED WOMEN ARE GIVEN THE OPPORTUNITY TO RECEIVE BREAST SERVICES THAT WOULD NORMALLY NOT BE AVAILABLE. NO CHARGE CANCER RISK COUNSELING AS WELL AS LIFE STYLE MODIFICATIONS TO REDUCE THE RISK OF CANCER ARE ALSO MADE AVAILABLE THROUGH THE COACH. IN FY2013 5,090 PATIENTS WERE SEEN ON THE MOBILE COACH. UNREIMBURSED COSTS FOR THE MOBILE COACH AND OTHER BREAST SERVICES TOTALED $387,049 FOR FY 2013. HATS FROM THE HEART PROGRAM MHCS ADMINISTERS THE HATS FROM THE HEART PROGRAM WHICH PROVIDES HATS TO CANCER PATIENTS WHO HAVE LOST THEIR HAIR DURING THEIR CANCER TREATMENT. PRIVATE DONATIONS FUND THIS PROGRAM WHICH IS AVAILABLE IN SEVERAL COMMUNITY CANCER TREATMENT FACILITIES. UNITED WAY MHCS HAS AN ANNUAL CAMPAIGN FOR UNITED WAY WHICH CONSISTS OF SEVERAL EVENTS FOR ASSOCIATES DURING THE FISCAL YEAR. THE STAFF COST TO PUT ON THESE EVENTS IS APPROXIMATELY $15,000. THE DONATIONS MADE BY ASSOCIATES TO THE UNITED WAY HELP FUND LOCAL COMMUNITY ORGANIZATIONS. IN ADDITION TO THE EMPLOYEE CAMPAIGN, MEMORIAL HOSPITAL ALSO PROVIDES SUPPORT THROUGH A CORPORATE DONATION TOTALING $28,550. GOODWILL IN FY 2013, WE DONATED $10,000 TO GOODWILL TO FUND THEIR MEDICAL EQUIPMENT PROGRAM. THIS PROGRAM REFURBISHES MEDICAL EQUIPMENT AND PROVIDES IT TO PEOPLE WHO CANNOT AFFORD TO RENT OR PURCHASE THE EQUIPMENT. SUPPORT GROUPS MHCS OFFERS A WIDE VARIETY OF SUPPORT GROUPS FOR PATIENTS AND THE BROADER COMMUNITY. SUPPORT GROUPS MEETING AT MHCS INCLUDE GROUPS DEALING WITH VARIOUS CANCER DIAGNOSIS, CAREGIVERS FOR ALZHEIMERS FAMILY MEMBERS, WEIGHT MANAGEMENT AND BARIATRICS, DIABETES, OSTOMY PATIENTS, NICOTINE ANONYMOUS, AND GRIEF SUPPORT. SOME OF THESE GROUPS HAVE A STAFF MEMBER WHO LEADS THE GROUPS AND OTHERS ARE SELF LED. THE SALARY COSTS ASSOCIATED WITH GROUPS LED BY A STAFF MEMBER ARE $4,939 NOTRE DAME HIGH SCHOOL MHCS PROVIDES FINANCIAL AID TO STUDENTS FROM THE IMMEDIATE COMMUNITY TO ATTEND NOTRE DAME HIGH SCHOOL. NOTRE DAME HIGH SCHOOL IS A PRIVATE SCHOOL THAT IS ABOUT 2 MILES FROM MEMORIAL HOSPITAL. APPLICANTS ARE REQUIRED TO COMPLETE AN APPLICATION AS WELL AS WRITE AN ESSAY TO DETERMINE IF THEY ARE ELIGIBLE FOR A SCHOLARSHIP. THE APPLICATIONS AND ESSAYS ARE REVIEWED BY AN INTERNAL COMMITTEE; SCHOLARSHIPS ARE THEN AWARDED TO STUDENTS BASED UPON THE RECOMMENDATION OF THE COMMITTEE. IN FY 2013 MHCS PROVIDED 3 STUDENTS WITH PARTIAL SCHOLARSHIPS WHICH TOTALED $10,000. RESEARCH PROGRAMS MHCS IS ACTIVE IN RESEARCHING NEW TREATMENT PROTOCOLS AND DETERMINING ALL THE ALTERNATIVES AVAILABLE TO BOTH OUR CARDIAC AND CANCER PATIENTS. IN FY 2013, MEMORIAL SPENT $335,839 ON RESEARCH PROGRAMS THAT WERE NOT FUNDED BY AN OUTSIDE ORGANIZATION. HEALTH CARE STUDENT EDUCATION MHCS SERVES AS A CLINICAL EDUCATION SITE FOR HEALTH CARE STUDENTS BY PROVIDING HANDS ON TRAINING IN NURSING, PHYSICAL THERAPY, PHARMACY, LAB AND SURGERY. WITH NURSING SHORTAGES PROJECTED TO INCREASE WITH AGING BABY BOOM POPULATION, MHCS FEELS VERY STRONGLY ABOUT EDUCATING OUR FUTURE HEALTHCARE PROFESSIONALS. MEMORIAL ALSO PROVIDES A PROGRAM FOR EMPLOYEES TO FURTHER THEIR EDUCATION AND RECEIVE TUITION REIMBURSEMENT. EXPENSES RELATED TO STUDENT EDUCATION AND TUITION REIMBURSEMENT WERE $1,282,095 DURING FY 2013. CONTRIBUTIONS MHCS RECEIVES SOME COMMUNITY SUPPORT FROM DONATIONS THAT HELPS FUND RESEARCH AND EDUCATION, CAPITAL EXPANSION AND RENOVATION, INDIGENT CARE, NEW EQUIPMENT AND OPERATING COST. THE VALUE OF THIS COMMUNITY SUPPORT IS RETURNED TO THE COMMUNITY THROUGH LOWER COSTS IN PATIENT CARE PROGRAMS AND COMMUNITY SERVICES DESCRIBED THROUGHOUT THIS DOCUMENT.
Patient education of eligibility for assistance. Schedule H, Part VI, Line 3 MEMORIAL HEALTHCARE SYSTEM 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. MEMORIAL HEALTH CARE SYSTEM INCLUDES INFORMATION CONCERNING ITS FINANCIAL ASSISTANCE POLICY ON ITS WEBSITE. IN ADDITION, MEMORIAL HEALTH CARE SYSTEM PROMINENTLY DISPLAYS INFORMATION CONCERNING ITS CHARITY CARE POLICY IN BOTH ENGLISH AND SPANISH IN ALL WAITING AREAS THROUGHOUT THE HOSPITALS, INCLUDING THE EMERGENCY ROOMS AND OTHER PATIENT INTAKE AREAS, AS WELL AS IN MEMORIAL HEALTH CARE SYSTEM OUTPATIENT FACILITIES. IN ADDITION, MEMORIAL HEALTH CARE SYSTEM REGISTRARS AND FINANCIAL COUNSELORS 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 MEMORIAL HEALTH CARE SYSTEM'S CHARITY CARE POLICY. ONCE ALL EMTALA REQUIREMENTS ARE MET, PATIENTS WHO ARE IDENTIFIED AS UNINSURED DURING THE REGISTRATION PROCESS (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. MEMORIAL HEALTH CARE SYSTEM REGISTRARS AND FINANCIAL COUNSELORS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON ENGLISH-SPEAKING INDIVIDUALS. MEMORIAL HEALTH CARE SYSTEM'S STAFF WILL ALSO ASSIST THE PATIENT / GUARANTOR WITH COMPLETING THE FINANCIAL ASSISTANCE APPLICATION AND APPLYING FOR OTHER AVAILABLE COVERAGE (SUCH AS MEDICAID), IF NECESSARY. AFTER ALL EMTALA REQUIREMENTS ARE MET, DURING THE REGISTRATION PROCESS UNINSURED PATIENTS ARE SCREENED IN THE EMERGENCY DEPARTMENT FOR POSSIBLE ELIGIBILITY FOR THE MEDICAID PROGRAM. A TENNCARE APPLICATION IS FAXED TO THE DEPARTMENT OF HUMAN SERVICES IN THE SCREENING DETERMINED THAT THE PATIENT MIGHT HAVE A CATEGORY THAT WOULD QUALIFY THEM FOR MEDICAID. THE PATIENT IS GIVEN INSTRUCTIONS ON HOW TO FOLLOW-UP WITH THE DEPARTMENT OF HUMAN SERVICES TO COMPLETE THE APPLICATION PROCESS. COUNSELORS ASSIST MEDICARE ELIGIBLE PATIENTS IN ENROLLMENT BY PROVIDING REFERRALS TO THE APPROPRIATE GOVERNMENT AGENCIES. DURING THE BILLING AND COLLECTION PROCESS, ALL STATEMENTS TO THE PATIENT, INCLUDING THOSE MAILED FROM THE THIRD PARTY COLLECTION AGENCY, ALERT THE PATIENT THAT FINANCIAL ASSISTANCE IS AVAILABLE IF THEY NEED IT AND INSTRUCTS THEM ON HOW TO OBTAIN AN APPLICATION.
Affiliated health care system Schedule H, Part VI, Line 6 MEMORIAL HEALTH CARE SYSTEM, 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 $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. MEMORIAL HEALTH CARE SYSTEM OPERATES WITH ITS WHOLLY OWNED AFFILIATES AND COMMUNITY PARTNERS, ALONG WITH ITS FUNDRAISING ARM, THE MEMORIAL HEALTH CARE SYSTEM FOUNDATION, TO SERVE THE HEALTH CARE NEEDS OF THE CHATTANOOGA, TENNESSEE COMMUNITIES.
State filing of community benefit report Schedule H, Part VI, Line 7 TN
Schedule H (Form 990) 2012
Additional Data


Software ID: 12000266
Software Version: v2012.1.0
Schedule I
(Form 990)
Department of the Treasury
Internal Revenue Service
Grants and Other Assistance to Organizations,
Governments and Individuals in the United States
Complete if the organization answered "Yes," to Form 990, Part IV, line 21 or 22.
lBullet Attach to Form 990
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number
62-0532345
Part I
General Information on Grants and Assistance
1
Does the organization maintain records to substantiate the amount of the grants or assistance, the grantees' eligibility for the grants or assistance, and
the selection criteria used to award the grants or assistance? ....................................
2
Describe in Part IV the organization's procedures for monitoring the use of grant funds in the United States.
Part II
Grants and Other Assistance to Governments and Organizations in the United States. Complete if the organization answered "Yes" to
Form 990, Part IV, line 21, for any recipient that received more than $5,000. Part II can be duplicated if additional space is needed.
(a) Name and address of organization
or government
(b) EIN (c) IRC Code section
if applicable
(d) Amount of cash grant (e) Amount of non-cash
assistance
(f) Method of valuation
(book, FMV, appraisal,
other)
(g) Description of
non-cash assistance
(h) Purpose of grant
or assistance
(1) UNIVERSITY OF TENNESSEE
960 EAST THIRD STREET
SUITE 100
CHATTANOOGA,TN37403
62-6001636 501(C)(3) 99,322       COMMUNITY SUPPORT
(2) CYCLONELEARFIELDMOCS
PO BOX 1467
JEFFERSON CITY,MO65102
90-0776492   44,572       COMMUNITY SUPPORT
(3) UNITED WAY
630 MARKET STREET
CHATTANOOGA,TN37405
62-0565962 501(C)(3) 43,023       COMMUNITY SUPPORT
(4) CATHOLIC CHARITIES OF EAST TENNESSEE
859 MCCALLIE AVENUE
CHATTANOOGA,TN37403
62-1377551 501(C)(3) 41,000       COMMUNITY SUPPORT
(5) HAMILTON COUNTY GOVERNMENT
921 EAST THIRD STREET
CHATTANOOGA,TN37403
62-6000636 FINANCE DIVISION 40,500       HEALTH DEPARTMENT
(6) AMERICAN HEART ASSOCIATION
7272 GREENVILLE AVENUE
DALLAS,TX75231
13-5613797 501(C)(3) 36,250       COMMUNITY SUPPORT
(7) CHATTANOOGA AREA CHAMBER OF COMMERCE
811 BROAD STREET
SUITE 100
CHATTANOOGA,TN37402
62-0154480 501(C)(6) 25,400       COMMUNITY SUPPORT
(8) CHATTANOOGA STATE TECH COLLEGE FOUNDATION
4501 AMNICOLA HIGHWAY
CHATTANOOGA,TN37406
58-1311669 501(C)(3) 20,000       COMMUNITY SUPPORT
(9) GOODWILL INDUSTRIES CHATTANOOGA
3500 DODDS AVENUE
CHATTANOOGA,TN37407
62-0544853 501(C)(3) 20,000       COMMUNITY SUPPORT
(10) EAST CHATTANOOGA IMPROVEMENT
1502 MCCALLIE AVENUE
SUITE A
CHATTANOOGA,TN65102
43-0998586 501(C)(3) 14,912       COMMUNITY SUPPORT
(11) NORTH RIVER YMCA
301 W 6TH STREET
CHATTANOOGA,TN37402
62-0475699 501(C)(3) 14,769       COMMUNITY SUPPORT
(12) AMERICAN LUNG ASSOCIATION
ONE VANTAGE WAY
SUITE B-130
NASHVILLE,TN37228
31-4379531 501(C)(3) 12,500       COMMUNITY SUPPORT
(13) ASSESS ONE EAPPARTNERSHIP
1800 MCCALLIE AVENUE
CHATTANOOGA,TN37404
62-0911679 501(C)(3) 10,000       COMMUNITY SUPPORT
(14) CREATIVE DISCOVERY MUSEUM
321 CHESTNUT STREET
CHATTANOOGA,TN37405
62-1509462 501(C)(3) 10,000       COMMUNITY SUPPORT
(15) NOTRE DAME HIGH SCHOOL
2701 VERMONT AVENUE
CHATTANOOGA,TN37404
43-1694323 501(C)(3) 10,000       COMMUNITY SUPPORT
(16) SUSAN G KOMEN FOR THE CURE
PO BOX 11208
CHATTANOOGA,TN37401
75-2875175 501(C)(3) 10,000       COMMUNITY SUPPORT
(17) TENNESSEE AQUARIUM
ONE BROAD STREET
CHATTANOOGA,TN37402
58-1837154 501(C)(3) 10,000       COMMUNITY SUPPORT
(18) AMERICAN CANCER SOCIETY
1100 IRELAND WAY SUITE 300
BIRMINGHAM,AL35205
64-0329009 501(C)(3) 8,500       COMMUNITY SUPPORT
(19) SISKIN HOSPITAL FOR PHYSICAL REHAB
3RD STREET
CHATTANOOGA,TN37403
62-1220402 501(C)(3) 7,100       COMMUNITY SUPPORT
(20) AMERICAN DIABETES ASSOCIATION
1701 N BEAUREGARD ST
ALEXANDRIA,VA22311
13-1623888 501(C)(3) 6,000       COMMUNITY SUPPORT
(21) MEMORIAL HEALTH CARE SYSTEM FOUNDATION
2525 DE SALES AVENUE
CHATTANOOGA,TN37404
62-1839548 501(C)(3) 10,000       COMMUNITY SUPPORT
(22) CONSOLIDATED HEALTH SERVICES INC
1700 EDISON DRIVE
MILDFORD,OH45150
31-1378212     72,861 BOOK EQUIPMENT COMMUNITY SUPPORT
2
Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................ Bullet Image
18
3
Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image
4
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50055P
Schedule I (Form 990) 2012

Schedule I (Form 990) 2012
Page 2
Part III
Grants and Other Assistance to Individuals in the United States. Complete if the organization answered "Yes" to Form 990, Part IV, line 22.
Part III can be duplicated if additional space is needed.
(a)Type of grant or assistance (b)Number of
recipients
(c)Amount of
cash grant
(d)Amount of
non-cash assistance
(e)Method of valuation (book,
FMV, appraisal, other)
(f)Description of non-cash assistance
(1) RADIOLOGIST INTERPRETAIONS PAID THROUGH GRANT 2500 79,576      
(2) WE CARE WEEKEND FOR CANCER SURVIVORS AND THEIR FAMILIES 100 25,457      
(3) EDUCATION ASSISTANCE 20 24,300      
(4) MOBILE COACH HEALTH SERVICES 61 11,425      
(5) TRANSPORTATION ASSISTANCE 44 6,635      




Part IV
Supplemental Information.
Complete this part to provide the information required in Part I, line 2, Part III, column (b), and any other additional information.
Identifier Return Reference Explanation
Procedures for monitoring use of grant funds Schedule I, Part I, Line 2 GRANT REQUESTS ARE COORDINATED THROUGH THE MEMORIAL HEALTH CARE SYSTEM FOUNDATION. THE BENEFICIARY OF THE GRANT IS RESPONSIBLE FOR USING THE FUNDS IN ACCORDANCE WITH THE GRANT REQUIREMENTS. ALL GRANT SPENDING IS REVIEWED BY FISCAL SERVICES AND THE FOUNDATION BEFORE GRANT SPENDING IS REIMBURSED THROUGH THE FOUNDATION. PERIODIC REPORTING IS COORDINATED BETWEEN THE BENEFICIARY, FISCAL SERVICES, AND THE FOUNDATION.
Schedule I (Form 990) 2012


Additional Data


Software ID: 12000266
Software Version: v2012.1.0


Schedule J
(Form 990)
Department of the Treasury
Internal Revenue Service
Compensation Information
For certain Officers, Directors, Trustees, Key Employees, and Highest
Compensated Employees
SchJMediumBullet Complete if the organization answered "Yes" to Form 990,
Part IV, question 23.
SchJMediumBullet Attach to Form 990. SchJMediumBullet See separate instructions.
OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part I
Questions Regarding Compensation
Yes
No
1a
Check the appropiate box(es) if the organization provided any of the following to or for a person listed in Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.
b
If any of the boxes in line 1a are checked, did the organization follow a written policy regarding payment or reimbursement or provision of all of the expenses described above? If "No," complete Part III to explain....
1b
 
 
2
Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all officers,
directors, trustees, and the CEO/Executive Director, regarding the items checked in line 1a? .......
2
 
 
3
Indicate which, if any, of the following the filing organization used to establish the compensation of the
organization's CEO/Executive Director. Check all that apply. Do not check any boxes for methods
used by a related organization to establish compensation of the CEO/Executive Director, but explain in Part III.
4
During the year, did any person listed in Form 990, Part VII, Section A, line 1a with respect to the filing organization or a related organization:
a
Receive a severance payment or change-of-control payment? ................
4a
Yes
 
b
Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........
4b
Yes
 
c
Participate in, or receive payment from, an equity-based compensation arrangement? .........
4c
 
No
If "Yes" to any of lines 4a-c, list the persons and provide the applicable amounts for each item in Part III.
Only 501(c)(3) and 501(c)(4) organizations only must complete lines 5-9.
5
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:
a
The organization? ...........................
5a
 
No
b
Any related organization? .........................
5b
 
No
If "Yes," to line 5a or 5b, describe in Part III.
6
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:
a
The organization? ...........................
6a
 
No
b
Any related organization? .........................
6b
 
No
If "Yes," to line 6a or 6b, describe in Part III.
7
For persons listed in Form 990, Part VII, Section A, line 1a, did the organization provide any non-fixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............
7
Yes
 
8
Were any amounts reported in Form 990, Part VII, paid or accured pursuant to a contract that was
subject to the initial contract exception described in Regulations section 53.4958-4(a)(3)? If "Yes," describe
in Part III .............................
8
 
No
9
If "Yes" to line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................
9
 
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50053T
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 2
Part II
Officers, Directors, Trustees, Key Employees, and Highest Compensated Employees. Use duplicate copies if additional space is needed.
For each individual whose compensation must be reported in Schedule J, report compensation from the organization on row (i) and from related organizations, described in the
instructions, on row (ii). Do not list any individuals that are not listed on Form 990, Part VII.
Note. The sum of columns (B)(i)-(iii) for each listed individual must equal the total amount of Form 990, Part VII, Section A, line 1a, applicable column (D) and (E) amounts for that individual.
(A) Name and Title (B) Breakdown of W-2 and/or 1099-MISC compensation (C) Retirement and other deferred compensation (D) Nontaxable
benefits
(E) Total of columns
(B)(i)-(D)
(F) Compensation
reported as deferred
in prior Form 990
(i) Base compensation (ii) Bonus & incentive compensation (iii) Other reportable compensation
(1)CALVIN LEDFORDCARDIOLOGIST (i)
(ii)
595,840
0
99,179
0
1,597
0
20,596
0
16,546
0
733,758
0
0
0
(2)CAROL NEWTONDIRECTOR-INTEGRATION SERVICES/FORMER CFO (i)
(ii)
125,960
0
0
0
221
0
12,237
0
6,758
0
145,176
0
0
0
(3)CHERYL A SADROSVP/CFO (i)
(ii)
322,374
0
0
0
62,136
0
20,596
0
22,258
0
427,364
0
0
0
(4)DAVID DODSON MDBOARD MEMBER / PHYSICIAN (i)
(ii)
16,606
295,272
0
0
0
0
0
26,052
1,185
21,074
17,791
342,398
0
0
(5)DAVID WINCHESTERFORMER INTERIM CFO (i)
(ii)
69,399
0
30,000
0
106,524
0
20,827
0
11,543
0
238,293
0
0
0
(6)DEBRA MOORESVP/ADMINISTRATOR OF MEMORIAL HOSPITAL HIXSON (i)
(ii)
253,913
0
0
0
589
0
33,096
0
8,012
0
295,610
0
0
0
(7)ERIC CONN MDCARDIOLOGIST (i)
(ii)
614,082
0
99,179
0
4,523
0
20,596
0
22,072
0
760,452
0
0
0
(8)GORDON GRAHAMCARDIOLOGIST (i)
(ii)
597,220
0
99,179
0
4,421
0
20,596
0
7,940
0
729,356
0
0
0
(9)GREGG SHANDERELECTROPHYSIOLOGIST (i)
(ii)
591,694
0
99,179
0
1,597
0
20,596
0
22,258
0
735,324
0
0
0
(10)JACQUELINE JACKSONVP SERVICE LINE ADMIN (i)
(ii)
301,787
0
0
0
1,410
0
33,096
0
8,012
0
344,305
0
0
0
(11)JAMES HOBSONPRESIDENT/CEO (i)
(ii)
0
490,524
0
92,562
0
61,652
0
64,593
0
17,021
0
726,352
0
38,320
(12)MARY ELIZABETH O'BRIENSVP OPERATIONS CHI (i)
(ii)
0
714,927
0
139,200
0
70,827
0
106,965
0
9,343
0
1,041,262
0
43,883
(13)ROBERT BERGLUNDCARDIOLOGIST (i)
(ii)
595,568
0
99,179
0
8,429
0
20,596
0
13,658
0
737,430
0
0
0
(14)WILLIAM WARREN MDBOARD MEMBER/CARDIOLOGIST (i)
(ii)
603,082
0
99,179
0
742
0
20,596
0
22,072
0
745,671
0
0
0
Schedule J (Form 990) 2012

Schedule J (Form 990) 2012
Page 3
Part III
Supplemental Information
Complete this part to provide the information, explanation, or descriptions required for Part I, lines 1a, 1b, 3, 4a, 4b, 4c, 5a, 5b, 6a, 6b, 7, and 8, and for Part II.
Also complete this part for any additional information.
Identifier Return Reference Explanation
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 or change-of-control payment 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 POSTTERMINATION 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. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION DURING THE 2012 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUAL'S W-2 INCOME AND REPORTABLE COMPENSATION ON SCHEDULE J: DAVID WINCHESTER $81,072
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: JAMES HOBSON, MARY ELIZABETH O'BRIEN DURING 2012 THE FOLLOWING CONTRIBUTIONS WERE MADE BY CHI TO THE DEFERRED COMPENSATION PLAN: JAMES HOBSON $43,997 MARY ELIZABETH O'BRIEN $83,869 DURING 2012 THE FOLLOWING DISTRIBUTIONS WERE MADE BY CHI FROM THE DEFERRED COMPENSATION PLAN: JAMES HOBSON $38,320 MARY ELIZABETH O'BRIEN $43,883
Non-fixed payments Schedule J, Part I, Line 7 MEMORIAL HEALTH CARE SYSTEM (MHCS) ISSUED BONUSES BASED ON INDIVIDUAL PERFORMANCE AND SPECIFIED EVENTS. BONUSES ARE SUBJECT TO MANAGEMENT AND BOARD APPROVAL.
Schedule J (Form 990) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE O
(Form 990 or 990-EZ)

Department of the Treasury
Internal Revenue Service
Supplemental Information to Form 990 or 990-EZ

Complete to provide information for responses to specific questions on
Form 990 or to provide any additional information.
MediumBullet Attach to Form 990 or 990-EZ.
OMB No. 1545-0047
2012
Open to Public
Inspection
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Identifier Return Reference Explanation
Significant changes in program services Form 990, Part III, Line 3 IN 2011, CATHOLIC HEALTH INITIATIVES ("CHI"), A RELATED ORGANIZATION, CREATED CHI NATIONAL HOME CARE ("CNHC"), A COLORADO NONPROFIT CORPORATION THAT WILL BE OPERATED TO HOUSE CHI'S TAX-EXEMPT HOME HEALTH ACTIVITIES. CHI NATIONAL SERVICES ("CNS"), A COLORADO NONPROFIT AND THE SOLE CORPORATE MEMBER OF CNHC, WAS FORMED TO SERVE AS A SUPPORT STRUCTURE FOR CHI'S NATIONAL SERVICE LINES ACROSS THE COUNTRY. CHI NATIONAL SERVICES WILL SERVE AS A HOLDING COMPANY, PERMITTING MAXIMUM OPERATIONAL AND GOVERNANCE FLEXIBILITY WITH RESPECT TO THE FUTURE FOR-PROFIT AND CURRENT TAX-EXEMPT NATIONAL BUSINESS LINES SERVED BY CHI. THE CONSOLIDATION OF THE HOME CARE OPERATIONS WILL REDUCE VARIATION IN CLINICAL OUTCOMES, LOWER THE COST OF ADMINISTRATIVE AND BACK OFFICE SERVICES, ENHANCE GROWTH THROUGH THE STANDARDIZED MARKETING PROGRAM, AND ENHANCE OVERALL CORPORATE COMPLIANCE THROUGH STANDARDIZATION AND REVIEW. DURING THE FISCAL YEAR ENDING JUNE, 30 2013, MEMORIAL HEALTH CARE SYSTEM, INC. TRANSFERRED THEIR HOME CARE SERVICES DIVISION TO CNHC.
Delegate broad authority to a committee Form 990, Part VI, Section A, Line 1a PURSUANT TO SECTION 8.6 OF THE BYLAWS OF MEMORIAL HEALTH CARE SYSTEM, THE EXECUTIVE COMMITTEE SHALL CONSIST OF ONLY DIRECTORS OF THE CORPORATION AND SHALL BE COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, THE IMMEDIATE PAST CHAIRPERSON OF THE BOARD, THE PRESIDENT AND CHIEF EXECUTIVE OFFICER, AND THE SECRETARY, WITH ONE (1) OR TWO (2) OTHER DIRECTORS; PROVIDED THAT THE EXECUTIVE COMMITTEE SHALL INCLUDE: (1) TO THE EXTENT POSSIBLE, AT LEAST ONE MEMBER OF A PARTICIPATING CONGREGATION OR OTHER RELIGIOUS INSTITUTE OF THE ROMAN CATHOLIC CHURCH, AND (2) AT LEAST ONE DIRECTOR WHO IS A PHYSICIAN MEMBER OF THE MEDICAL STAFF. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE (1) YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. ANY VACANCY OF AN APPOINTED EXECUTIVE COMMITTEE MEMBERSHIP MAY BE FILLED FOR THE UNEXPIRED PORTION OF THE TERM IN THE MANNER THAT THE ORIGINAL COMMITTEE MEMBER WAS APPOINTED. PURSUANT TO SECTION 8.1 OF THE CORPORATIONS BYLAWS, THE BOARD OF DIRECTORS MAY, BY RESOLUTION ADOPTED BY A MAJORITY OF THE DIRECTORS THEN IN OFFICE, ESTABLISH ONE OF MORE COMMITTEES, AS NEEDED OR REQUIRED TO CONDUCT AND TRANSACT THE BUSINESS OF THE CORPORATION. EXCEPT AS OTHERWISE PROVIDED IN THESE BYLAWS, THE BOARD OF DIRECTORS MAY SET THE QUALIFICATIONS FOR MEMBERSHIP ON ANY COMMITTEE IT MAY ESTABLISH; PROVIDED THAT EACH COMMITTEE SHALL CONSIST OF AT LEAST TWO (2) BOARD MEMBERS. COMMITTEES MAY INCLUDE PERSONS OTHER THAN DIRECTORS, EXCEPT THAT A COMMITTEE THAT HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MUST INCLUDE ONLY DIRECTORS OF THE CORPORATION. COMMITTEE MEMBERS SHALL SERVE FOR A TERM OF ONE (1) YEAR OR UNTIL THEIR SUCCESSORS ARE DULY APPOINTED AND QUALIFIED. 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.
Classes of members or stockholders Form 990, Part VI, Section A, Line 6 ACCORDING TO THE BYLAWS OF MEMORIAL HEALTH CARE SYSTEM, THE ENTITY'S SOLE MEMBER IS CATHOLIC HEALTH INITIATIVES ("CHI"), 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 OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30TH 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 AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS.
Decisions requiring approval by members or stockholders Form 990, Part VI, Section A, Line 7b MEMORIAL HEALTH CARE SYSTEM'S ("MHCS"), CORPORATE MEMBER IS CATHOLIC HEALTH INITIATIVES ("CHI"). PURSUANT TO SECTION 5.4 OF MHCS'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 MHCS * AMENDMENT OF THE CORPORATE DOCUMENTS OF MHCS * APPROVE MEMBERS OF THE MHCS BOARD * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF MHCS * APPROVAL OF ISSUANCE OF DEBT BY MHCS * APPROVAL OF PARTICIPATION OF MHCS IN A JOINT VENTURE * APPROVAL OF FORMATION OF A NEW CORPORATION BY MHCS * APPROVAL OF A MERGER INVOLVING MHCS * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF MHCS * TO REQUIRE THE TRANSFER OF ASSETS BY MHCS TO CHI TO ACCOMPLISH CHI'S GOALS AND OBJECTIVES, AND TO SATISFY CHI DEBTS. * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR MHCS. IN ADDITION, PURSUANT TO SECTION 5.5.2 OF 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.
Review of form 990 by governing body Form 990, Part VI, Section B, Line 11b MHCS'S FORM 990 IS PREPARED AND REVIEWED BY THE INTERNAL TAX DEPARTMENT OF ITS PARENT ORGANIZATION, CHI. THE RETURN IS THEN REVIEWED BY MHCS'S FISCAL SERVICES DEPARTMENT AND ITS CHIEF FINANCIAL OFFICER. PRIOR TO FILING, A COPY OF THE RETURN IS PROVIDED TO EACH MEMBER OF THE BOARD ELECTRONICALLY. SUBSEQUENT TO PRESENTATION TO THE BOARD 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 MHCS 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 CORPORATION'S 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 INTEREST POLICY AND DISCLOSURE STATEMENT. AT THE BEGINNING OF THE BOARD MEETING AND ALL COMMITTEE MEETINGS, MEMBERS ARE ASKED TO DECLARE ANY CONFLICTS OF INTEREST THAT NEED TO BE DISCLOSED. 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.
DOCUMENT RETENTION POLICY FORM 990, PART VI, LINE 14 WHILE THE ORGANIZATION DOES HAVE A WRITTEN DOCUMENT RETENTION AND DESTRUCTION POLICY IT HAS NOT BEEN FORMALLY ADOPTED BY THE BOARD.
PROCESS FOR DETERMINING CEO'S COMPENSATION 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 ON AN ANNUAL BASIS MHCS ENGAGES AN EXTERNAL CONSULTANT TO REVIEW THE COMPENSATION OF ITS EXECUTIVES. THE REVIEW IS PERFORMED TO ENSURE THAT EXECUTIVE SALARIES ARE WITHIN COMPARABLE MARKET RANGES FOR THAT POSITION. THE RESULTS OF THE REVIEW ARE PRESENTED TO THE EXECUTIVE COMPENSATION HUMAN RESOURCES COMMITTEE FOR REVIEW AND RECOMMENDATION TO THE BOARD OF DIRECTORS FOR APPROVAL.
JOINT VENTURE POLICY FORM 990, PART VI, LINE 16B MHCS 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 ORGANIZING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE NOT AVAILABLE TO THE PUBLIC. 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. THE FINANCIAL STATEMENTS ARE ALSO AVAILABLE THROUGH ANNUAL REPORTS FILED WITH THE STATE OF TENNESSEE.
Other changes in net assets or fund balances Form 990 , Part XI, Line 9 CAPITAL RESOURCE POOL CONTRIBUTIONS - -537540; CONTRIBUTIONS OF SERVICES - -7661967; NONCONTROLLING INTEREST - -25657; CHI CONNECT DEPRECIATION - 433691;
For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.
Cat. No. 51056K
Schedule O (Form 990 or 990-EZ) 2012

Additional Data


Software ID: 12000266
Software Version: v2012.1.0
SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service
Related Organizations and Unrelated Partnerships
MediumBulletComplete if the organization answered "Yes" to Form 990, Part IV, line 33, 34, 35, 36, or 37.
MediumBulletAttach to Form 990. MediumBullet See separate instructions.

OMB No. 1545-0047
2012
Open to Public Inspection
Name of the organization
MEMORIAL HEALTH CARE SYSTEM INC
 
Employer identification number

62-0532345
Part I
Identification of Disregarded Entities (Complete if the organization answered "Yes" to Form 990, Part IV, line 33.)
(a)
Name, address, and EIN (if applicable) of disregarded entity


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Total income


(e)
End-of-year assets


(f)
Direct controlling
entity

(1) MEMORIAL HEALTH PARTNERS
2525 DE SALES AVENUE
CHATTANOOGA,TN37404
62-1784262
CONTRACT SVCS TN 0 0 MHCS
 
(2) MEMORIAL HEART INSTITUTE LLC DBA THE CHATTANOOGA HEART INSTITUTE
2525 DE SALES AVENUE
CHATTANOOGA,TN37404
27-3799362
PHYSICIAN SVC TN -7,308,909 5,634,665 MHCS
 
(3) ORTHOPEDIC SERVICE LINE MANAGEMENT LLC
2525 DE SALES AVENUE
CHATTANOOGA,TN37404
ORTHOPEDIC MGMT TN 0 0 MHCS
 






Part II
Identification of Related Tax-Exempt Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related tax-exempt organizations during the tax year.)
(a)
Name, address, and EIN of related organization


(b)
Primary activity


(c)
Legal domicile (state
or foreign country)

(d)
Exempt Code section


(e)
Public charity status
(if section 501(c)(3))

(f)
Direct controlling
entity

(g)
Section 512(b)(13) controlled entity?
Yes No
(1) ALEGENT CREIGHTON CLINIC

12809 WEST DODGE ROAD

OMAHA,NE68154
HEALTHCARE NE 501(C)(3) 3 ACH
 
Yes
 
(2) ALEGENT CREIGHTON HEALTH

12809 WEST DODGE ROAD

OMAHA,NE68154
HEALTHCARE NE 501(C)(3) 3 NA
 
Yes
 
(3) ALEGENT HEALTH - BERGAN MERCY HEALTH SYS

7500 MERCY ROAD

OMAHA,NE68124
HEALTHCARE NE 501(C)(3) 3 ACH
 
Yes
 
(4) ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IA

631 N 8TH STREET

MISSOURI VALLEY,IA51555
HEALTHCARE IA 501(C)(3) 3 AHIMC
 
Yes
 
(5) ALEGENT HEALTH FOUNDATION

12809 WEST DODGE ROAD

OMAHA,NE68154
FUNDRAISING NE 501(C)(3) 7 ACH
 
Yes
 
(6) ALEGENT HEALTH IMMANUEL MEDICAL CENTER

6901 NORTH 72ND STREET

OMAHA,NE68122
HEALTHCARE NE 501(C)(3) 3 ACH
 
Yes
 
(7) ALEGENT HEALTH MEMORIAL HOSPITAL SCHUYLER NE

104 W 17TH STREET

SCHUYLER,NE68661
HEALTHCARE NE 501(C)(3) 3 AHIMC
 
Yes
 
(8) ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA

PO BOX 368

CORNING,IA50841
HEALTHCARE IA 501(C)(3) 3 AHBMHS
 
Yes
 
(9) ALVERNA APARTMENTS

300 SE 8TH AVENUE

LITTLE FALLS,MN56345
LTERM CARE MN 501(C)(3) 9 CHI
 
Yes
 
(10) APPLETREE COURT

601 OAK STREET

BRECKENRIDGE,MN56520
SENIOR HOMES MN 501(C)(3) 9 SFH
 
Yes
 
(11) BISHOP DRUMM RETIREMENT CENTER

1111 6TH AVENUE

DES MOINES,IA50314
LTERM CARE IA 501(C)(3) 9 CHI-IA CORP
 
Yes
 
(12) BORNEMANN HEALTH CORPORATION

2500 BERNVILLE RD PO BOX 316

READING,PA19603
HEALTHCARE PA 501(C)(3) 11 - Type I CHI
 
Yes
 
(13) CARRINGTON HEALTH CENTER

800 NORTH 4TH STREET

CARRINGTON,ND58421
HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(14) CATHOLIC HEALTH INITIATIVES

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
HEALTHCARE CO 501(C)(3) 9 NA
 
Yes
 
(15) CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION

6385 CORPORATE DRIVE

COLORADO SPRINGS,CO80919
FUNDRAISING CO 501(C)(3) 7 CHIC
 
Yes
 
(16) CATHOLIC HEALTH INITIATIVES INSTITUTE FOR RESEARCH AND INNOVATION

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
HEALTHCARE CO 501(C)(3) 11 - Type I CHI
 
Yes
 
(17) CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION

6385 CORPORATE DRIVE

COLORADO SPRINGS,CO80919
FUNDRAISING CO 501(C)(3) 9 CHI
 
Yes
 
(18) CATHOLIC HEALTH INITIATIVES-COLORADO

188 INVERNESS DRIVE WEST SUITE 500

ENGLEWOOD,CO80112
HEALTHCARE CO 501(C)(3) 3 CHI
 
Yes
 
(19) CATHOLIC HEALTH INITIATIVES-IOWA CORP DBA MERCY MEDICAL CENTER-DES MOINES

1111 6TH AVENUE

DES MOINES,IA50314
HEALTHCARE IA 501(C)(3) 3 CHI
 
Yes
 
(20) CENTENNIAL MEDICAL GROUP INC

2700 STEWART PARKWAY

ROSEBURG,OR97470
PHYSICIANS OR 501(C)(3) 9 MMC
 
Yes
 
(21) CENTRAL KANSAS MEDICAL CENTER

3515 BROADWAY

GREAT BEND,KS67530
SURGERY CNTR KS 501(C)(3) 3 CHI
 
Yes
 
(22) CHI HEALTH CONNECT AT HOME - FARGO

4816 AMBER VALLEY PARKWAY SOUTH

FARGO,ND58104
HEALTHCARE ND 501(C)(3) 9 CHI
 
Yes
 
(23) CHI KENTUCKY INC

3900 OLYMPIC BLVD SUITE 400

ERLANGER,KY41018
HEALTHCARE KY 501(C)(3) 11 - Type I CHI
 
Yes
 
(24) CHI NATIONAL HOME CARE

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
HEALTHCARE CO 501(C)(3) 9 CHI NHC
 
Yes
 
(25) CHI NATIONAL SERVICES

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
HEALTHCARE CO 501(C)(3) 11 - Type I CHI
 
Yes
 
(26) CHI NEBRASKA

6940 O STREET

LINCOLN,NE68510
HEALTHCARE NE 501(C)(3) 11 - Type I CHI
 
Yes
 
(27) COMMUNITY LIMITED CARE DIALYSIS CENTER

619 OAK STREET - ACCOUNTING 3 WEST

CINCINNATI,OH45206
DIALYSIS OH 501(C)(2) N/A GSH
 
Yes
 
(28) COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICE FOUNDATION MISSOURI VALLEY IA

631 N 8TH STREET

MISSOURI VALLEY,IA51555
FUNDRAISING IA 501(C)(3) 11 - Type I AHCMH
 
Yes
 
(29) CONTINUING CARE HOSPITAL

150 NORTH EAGLE CREEK DRIVE

LEXINGTON,KY40509
LTACH KY 501(C)(3) 3 SJHS
 
Yes
 
(30) COVENANT HOME CARE

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
HOME HEALTH PA 501(C)(3) 11 - Type II NA
 
Yes
 
(31) ENUMCLAW REGIONAL HOSPITAL ASSOCIATION

1450 BATTERSBY AVENUE

ENUMCLAW,WA98022
HEALTHCARE WA 501(C)(3) 3 FHS
 
Yes
 
(32) FLAGET HEALTHCARE INC

4305 NEW SHEPHERDSVILLE ROAD

BARDSTOWN,KY40004
HEALTHCARE KY 501(C)(3) 3 KOH
 
Yes
 
(33) FLAGET MEMORIAL HOSPITAL FOUNDATION

4305 NEW SHEPHERDSVILLE ROAD

BARDSTOWN,KY40004
FUNDRAISING KY 501(C)(3) 11 - Type I FH
 
Yes
 
(34) FRANCISCAN FOUNDATION

1717 SOUTH J STREET

TACOMA,WA98405
FUNDRAISING WA 501(C)(3) 9 FHS
 
Yes
 
(35) FRANCISCAN HEALTH SYSTEM

1717 SOUTH J STREET

TACOMA,WA98405
HEALTHCARE WA 501(C)(3) 3 CHI
 
Yes
 
(36) FRANCISCAN MEDICAL GROUP

1708 SOUTH YAKIMA AVENUE

TACOMA,WA98405
HEALTHCARE WA 501(C)(3) 9 FHS
 
Yes
 
(37) FRANCISCAN VILLA OF SOUTH MILWAUKEE

3601 SOUTH CHICAGO AVENUE

SOUTH MILWAUKEE,WI53172
HEALTHCARE WI 501(C)(3) 9 CHI
 
Yes
 
(38) GETTYSBURG MEDICAL CENTER

606 EAST GARFIELD AVENUE

GETTYSBURG,SD57442
HEALTHCARE SD 501(C)(3) 3 SMHC
 
Yes
 
(39) GLOBAL HEALTH INITIATIVES

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
MINISTRIES CO 501(C)(3) 11 - Type I CHI
 
Yes
 
(40) GOOD SAMARITAN COLLEGE OF NURSING & HEALTH SCIENCE

619 OAK STREET - ACCOUNTING 3 WEST

CINCINNATI,OH45206
EDUCATION OH 501(C)(3) 2 GSH
 
Yes
 
(41) GOOD SAMARITAN FOUNDATION OF CINCINNATI INC

619 OAK STREET - ACCOUNTING 3 WEST

CINCINNATI,OH45206
FUNDRAISING OH 501(C)(3) 11 - Type I GSH
 
Yes
 
(42) GOOD SAMARITAN HOSPITAL

PO BOX 1990

KEARNEY,NE68848
HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(43) GOOD SAMARITAN HOSPITAL FOUNDATION

111 W 31ST STREET

KEARNEY,NE68847
FUNDRAISING NE 501(C)(3) 7 GSH
 
Yes
 
(44) ST LUKE'S MEDICAL GROUP FKA GREATER HOUSTON HEALTH NETWORK

6624 FANNIN

HOUSTON,TX77030
PHY PRACTICES TX 501(C)(3) 3 SLHS
 
Yes
 
(45) HEALTH SET

4200 WEST CONEJOS PLACE 436

DENVER,CO80204
LOW INC.CARE CO 501(C)(3) 7 CHIC
 
Yes
 
(46) HEALTHCARE AND WELLNESS FOUNDATION

2400 ST FRANCIS DRIVE

BRECKENRIDGE,MN56520
FUNDRAISING MN 501(C)(3) 11 - Type I SFMC
 
Yes
 
(47) HIGHLINE MEDICAL CENTER

16251 SYLVESTER RD SW

BURIEN,WA98166
HEALTHCARE WA 501(C)(3) 3 FHS
 
Yes
 
(48) HOSPITAL ASSOCIATION FOR ST JOSEPH HOSPITAL

7601 OSLER DRIVE

TOWSON,MD21204
HEALTHCARE MD 501(C)(3) 9 SJMC
 
Yes
 
(49) HOUSE OF MERCY

1111 6TH AVENUE

DES MOINES,IA50314
SHELTER IA 501(C)(3) 7 CHI-IA CORP
 
Yes
 
(50) JEWISH HOSPITAL AND ST MARY'S HEALTHCARE INC

539 S 4TH STREET

LOUISVILLE,KY40202
HEALTHCARE KY 501(C)(3) 3 KOH
 
Yes
 
(51) JEWISH PHYSICIAN GROUP INC

539 S 4TH STREET

LOUISVILLE,KY40202
HEALTHCARE KY 501(C)(3) 9 JHSMH
 
Yes
 
(52) KENTUCKYONE HEALTH INC FKA JH PROPERTIES INC

200 ABRAHAM FLEXNER WAY

LOUISVILLE,KY40202
HEALTHCARE KY 501(C)(3) 9 CHI
 
Yes
 
(53) LAKEWOOD HEALTH CENTER

600 MAIN AVENUE SOUTH

BAUDETTE,MN56623
HEALTHCARE MN 501(C)(3) 3 CHI
 
Yes
 
(54) LINUS OAKES INC

2700 STEWART PARKWAY

ROSEBURG,OR97470
SENIOR LIVING OR 501(C)(3) 9 MMC
 
Yes
 
(55) LISBON AREA HEALTH SERVICES

905 MAIN STREET

LISBON,ND58054
HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(56) MEMORIAL HEALTH CARE SYSTEM FOUNDATION

2525 DE SALES AVENUE

CHATTANOOGA,TN37404
FUNDRAISING TN 501(C)(3) 7 MHCS
 
Yes
 
(57) MEMORIAL HEALTH CARE SYSTEM INC

2525 DE SALES AVENUE

CHATTANOOGA,TN37404
HEALTHCARE TN 501(C)(3) 3 CHI
 
Yes
 
(58) MEMORIAL HEALTH PARTNERS FOUNDATION INC

5600 BRAINERD ROAD SUITE 500

CHATTANOOGA,TN37411
HEALTHCARE TN 501(C)(3) 9 MHCS
 
Yes
 
(59) MERCY AUXILIARY OF CENTRAL IOWA

1111 6TH AVENUE

DES MOINES,IA50314
AUXILIARY IA 501(C)(3) 11 - Type I CHI-IA CORP
 
Yes
 
(60) MERCY CLINICS INC

1111 6TH AVENUE

DES MOINES,IA50314
PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP
 
Yes
 
(61) MERCY COLLEGE OF HEALTH SCIENCES

1111 6TH AVENUE

DES MOINES,IA50314
EDUCATION IA 501(C)(3) 2 CHI-IA CORP
 
Yes
 
(62) MERCY FOUNDATION OF DES MOINES IA

1111 6TH AVENUE

DES MOINES,IA50314
FUNDRAISING IA 501(C)(3) 7 CHI-IA CORP
 
Yes
 
(63) MERCY FOUNDATION INC

2700 STEWART PARKWAY

ROSEBURG,OR97470
FUNDRAISING OR 501(C)(3) 7 MMC
 
Yes
 
(64) MERCY HEALTH CARE FOUNDATION

PO BOX 368

CORNING,IA50841
FUNDRAISING NE 501(C)(3) 11 - Type I AHMH
 
Yes
 
(65) MERCY HEALTHCARE FOUNDATION

570 CHAUTAUQUA BOULEVARD

VALLEY CITY,ND58072
FUNDRAISING ND 501(C)(3) 11 - Type III - FI MHVC
 
Yes
 
(66) MERCY HOSPITAL FOUNDATION COUNCIL BLUFFS

800 MERCY DRIVE

COUNCIL BLUFFS,IA51503
FUNDRAISING IA 501(C)(3) 11 - Type I AHBMHS
 
Yes
 
(67) MERCY HOSPITAL OF DEVILS LAKE

1031 SEVENTH STREET NE

DEVILS LAKE,ND58301
HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(68) MERCY HOSPITAL OF DEVILS LAKE FOUNDATION

1031 SEVENTH STREET NE

DEVILS LAKE,ND58301
FUNDRAISING ND 501(C)(3) 7 CHI
 
Yes
 
(69) MERCY HOSPITAL OF VALLEY CITY

570 CHAUTAUQUA BOULEVARD

VALLEY CITY,ND58072
HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(70) MERCY MEDICAL CENTER

1301 15TH AVENUE WEST

WILLISTON,ND58801
HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(71) MERCY MEDICAL CENTER - CENTERVILLE

ONE ST JOSEPHS DRIVE

CENTERVILLE,IA52544
HEALTHCARE IA 501(C)(3) 3 CHI-IA CORP
 
Yes
 
(72) MERCY MEDICAL CENTER INC

2700 STEWART PARKWAY

ROSEBURG,OR97470
HEALTHCARE OR 501(C)(3) 3 CHI
 
Yes
 
(73) MERCY MEDICAL FOUNDATION

1301 15TH AVENUE WEST

WILLISTON,ND58801
FUNDRAISING ND 501(C)(3) 11 - Type I MMC
 
Yes
 
(74) MERCY PROFESSIONAL PRACTICE ASSOCIATES INC

1111 6TH AVENUE

DES MOINES,IA50314
PHYSICIAN IA 501(C)(3) 9 CHI-IA CORP
 
Yes
 
(75) MLIFECARES

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
PROPERTY MGMT MO 501(C)(3) 11 - Type I SJRMC
 
Yes
 
(76) MNMCH INC

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
HEALTHCARE KS 501(C)(3) 3 SJRMC
 
Yes
 
(77) MT ST JOSEPH INC

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
NURSING CARE OR 501(C)(3) 11 - Type I CHI
 
Yes
 
(78) NEBRASKA HEART HOSPITAL

7500 SOUTH 91ST STREET

LINCOLN,NE68526
HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(79) OAKES COMMUNITY HOSPITAL

314 SOUTH 8TH STREET

OAKES,ND58474
HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(80) OAKES COMMUNITY HOSPITAL FOUNDATION

1200 N 7TH STREET

OAKES,ND58474
FUNDRAISING ND 501(C)(3) 11 - Type I OCH
 
Yes
 
(81) PUEBLO STEPUP

1925 EAST ORMAN AVE SUITE G52

PUEBLO,CO81004
COMMUNITY CO 501(C)(3) 7 CHIC
 
Yes
 
(82) SET OF COLORADO SPRINGS INC

2864 S CIRCLE DRIVE SUITE 450

COLORADO SPRINGS,CO80906
LTERM CARE CO 501(C)(3) 7 CHIC
 
Yes
 
(83) SAINT CLARE'S COMMUNITY CARE

25 POCONO ROAD

DENVILLE,NJ07834
HEALTHCARE NJ 501(C)(3) 11 - Type II SCHS
 
Yes
 
(84) SAINT CLARE'S FOUNDATION

25 POCONO ROAD

DENVILLE,NJ07834
FUNDRAISING NJ 501(C)(3) 7 SCHS
 
Yes
 
(85) SAINT CLARE'S HEALTH SERVICES INC

25 POCONO ROAD

DENVILLE,NJ07834
MANAGEMENT NJ 501(C)(3) 7 CHI
 
Yes
 
(86) SAINT CLARE'S HOSPITAL

25 POCONO ROAD

DENVILLE,NJ07834
HEALTHCARE NJ 501(C)(3) 3 SCHS
 
Yes
 
(87) SAINT ELIZABETH FOUNDATION

555 SOUTH 70TH STREET

LINCOLN,NE68510
FUNDRAISING NE 501(C)(3) 7 SERMC
 
Yes
 
(88) SAINT ELIZABETH HEALTH SERVICES

555 SOUTH 70TH STREET

LINCOLN,NE68510
HEALTHCARE NE 501(C)(3) 3 SERMC
 
Yes
 
(89) SAINT ELIZABETH REGIONAL MEDICAL CENTER

555 SOUTH 70TH STREET

LINCOLN,NE68510
HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(90) SAINT FRANCIS MEDICAL CENTER

2620 WEST FAIDLEY

GRAND ISLAND,NE68803
HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(91) SAINT FRANCIS MEDICAL CENTER FOUNDATION

PO BOX 9804

GRAND ISLAND,NE68802
FUNDRAISING NE 501(C)(3) 7 SFMC
 
Yes
 
(92) SAINT JOSEPH BEREA HOSPITAL FOUNDATION INC

305 ESTILL STREET

BEREA,KY40403
FUNDRAISING KY 501(C)(3) 7 SJHS
 
Yes
 
(93) SAINT JOSEPH HEALTH SYSTEM INC

424 LEWIS HARGETT CIRCLE 160

LEXINGTON,KY40503
HEALTHCARE KY 501(C)(3) 3 CHI
 
Yes
 
(94) SAINT JOSEPH LONDON FOUNDATION INC

1001 SAINT JOSEPH LANE

LONDON,KY40741
FUNDRAISING KY 501(C)(3) 7 SJHS
 
Yes
 
(95) SAINT JOSEPH MEDICAL FOUNDATION INC

200 ABRAHAM FLEXNER WAY

LOUISVILLE,KY40202
PHY PRACTICES KY 501(C)(3) 3 SJHS
 
Yes
 
(96) SAINT JOSEPH MOUNT STERLING FOUNDATION INC

225 FALCON DRIVE

MOUNT STERLING,KY40353
FUNDRAISING KY 501(C)(3) 7 SJHS
 
Yes
 
(97) SAINT JOSEPH'S HOSPITAL FOUNDATION

30 WEST 7TH STREET

DICKINSON,ND58601
FUNDRAISING ND 501(C)(3) 11 - Type I SJHHC
 
Yes
 
(98) SAMARITAN BEHAVIORAL HEALTH

2222 PHILADELPHIA DRIVE

DAYTON,OH45406
HEALTHCARE OH 501(C)(3) 3 SHP
 
Yes
 
(99) SAMARITAN HEALTH FOUNDATION

2222 PHILADELPHIA DRIVE

DAYTON,OH45406
FUNDRAISING OH 501(C)(3) 7 SHP
 
Yes
 
(100) SAMARITAN HEALTH PARTNERS

110 NORTH MAIN STREET

DAYTON,OH45402
HEALTHCARE OH 501(C)(3) 11 - Type I CHI
 
Yes
 
(101) SCHUYLER MEMORIAL HOSPITAL FOUNDATION INC

104 W 17TH STREET

SCHUYLER,NE68661
FUNDRAISING NE 501(C)(3) 11 - Type I AHMHS
 
Yes
 
(102) SJMGROUP

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
PHYS PRACTICE MO 501(C)(3) 9 SJRMC
 
Yes
 
(103) SJRMC JOPLIN MISSOURI

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
HEALTHCARE MO 501(C)(3) 3 CHI
 
Yes
 
(104) SL AUGUSTA CORP

PO BOX 20269

HOUSTON,TX77225
TITLE HOLDING TX 501(C)(2) N/A SL PROPERTIES
 
Yes
 
(105) ST JOSEPH HEALTH MINISTRIES

1929 LINCOLN HWY E STE 150

LANCASTER,PA17602
HEALTHCARE PA 501(C)(3) 11 - Type I CHI
 
Yes
 
(106) ST LUKE'S MEDICAL TOWER CORPORATION

6624 FANNIN SUITE 1100

HOUSTON,TX77030
PROPERTY MGMT TX 501(C)(3) 11 - Type I SL PROPERTIES
 
Yes
 
(107) ST ANTHONY HOSPITAL

1601 SE COURT AVENUE

PENDLETON,OR97801
HEALTHCARE OR 501(C)(3) 3 CHI
 
Yes
 
(108) ST ANTHONY HOSPITAL FOUNDATION

1601 SE COURT AVENUE

PENDLETON,OR97801
FUNDRAISING OR 501(C)(3) 11 - Type I SA HOSPITAL
 
Yes
 
(109) ST ANTHONY'S HOSPITAL ASSOCIATION

FOUR HOSPITAL DRIVE

MORRILTON,AR72110
HEALTHCARE AR 501(C)(3) 3 SVIMC
 
Yes
 
(110) ST CATHERINE HOSPITAL

401 EAST SPRUCE STREET

GARDEN CITY,KS67846
HEALTHCARE KS 501(C)(3) 3 CHI
 
Yes
 
(111) ST CATHERINE HOSPITAL DEVELOPMENT FOUNDATION

401 EAST SPRUCE STREET

GARDEN CITY,KS67846
FUNDRAISING KS 501(C)(3) 11 - Type I SCH
 
Yes
 
(112) ST DOMINIC OF ONTARIO OREGON

351 SW 9TH STREET

ONTARIO,OR97914
HEALTHCARE OR 501(C)(4) N/A CHI
 
Yes
 
(113) ST FRANCIS HOME

2400 ST FRANCIS DRIVE

BRECKENRIDGE,MN56520
LTERM CARE MN 501(C)(3) 9 CHI
 
Yes
 
(114) ST FRANCIS LIFE CARE CORPORATION

19 POCONO ROAD

DENVILLE,NJ07834
ELDERLY CARE NJ 501(C)(3) 9 SCHS
 
Yes
 
(115) ST FRANCIS MEDICAL CENTER

2400 ST FRANCIS DRIVE

BRECKENRIDGE,MN56520
HEALTHCARE MN 501(C)(3) 3 CHI
 
Yes
 
(116) ST FRANCIS OF BAKER CITY

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
HEALTHCARE OR 501(C)(3) 3 CHI
 
Yes
 
(117) ST JOHN'S MERCY REGIONAL FOUNDATION

198 INVERNESS DRIVE WEST

ENGLEWOOD,CO80112
FUNDRAISING MO 501(C)(3) 7 SJRMC
 
Yes
 
(118) ST JOSEPH COMMUNITY HEALTH

300 CENTRAL AVENUE SW

ALBUQUERQUE,NM87102
COMMUNITY NM 501(C)(3) 11 - Type I CHI
 
Yes
 
(119) ST JOSEPH HOSPITAL FOUNDATION INC

ONE SAITN JOSEPH DRIVE

LEXINGTON,KY40504
FUNDRAISING KY 501(C)(3) 11 - Type I SJHS
 
Yes
 
(120) ST JOSEPH MEDICAL CENTER FOUNDATION

2500 BERNVILLE ROAD PO BOX 316

READING,PA19603
FUNDRAISING PA 501(C)(3) 11 - Type I SJRHN
 
Yes
 
(121) ST JOSEPH MEDICAL CENTER FOUNDATION

7601 OSLER DRIVE

TOWSON,MD21204
FUNDRAISING MD 501(C)(3) 7 SJMC
 
Yes
 
(122) ST JOSEPH MEDICAL CENTER INC

7601 OSLER DRIVE

TOWSON,MD21204
HEALTHCARE MD 501(C)(3) 3 CHI
 
Yes
 
(123) ST JOSEPH MEDICAL GROUP

2500 BERNVILLE ROAD PO BOX 316

READING,PA19603
HEALTHCARE PA 501(C)(3) 9 BHC
 
Yes
 
(124) ST JOSEPH PHYSICIAN ENTERPRISE INC

7601 OSLER DRIVE

TOWSON,MD21204
PHYSICIANS MD 501(C)(3) 11 - Type I SJMC
 
Yes
 
(125) ST JOSEPH REGIONAL HEALTH NETWORK

2500 BERNVILLE ROAD PO BOX 316

READING,PA19603
HEALTHCARE PA 501(C)(3) 3 CHI
 
Yes
 
(126) ST JOSEPH'S AREA HEALTH SERVICES

600 PLEASANT AVENUE

PARK RAPIDS,MN56470
HEALTHCARE MN 501(C)(3) 3 CHI
 
Yes
 
(127) ST JOSEPH'S HOSPITAL AND HEALTH CENTER

30 WEST 7TH STREET

DICKINSON,ND58601
HEALTHCARE ND 501(C)(3) 3 CHI
 
Yes
 
(128) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE WOODLANDS

6624 FANNIN SUITE 2505

HOUSTON,TX77030
HEALTHCARE TX 501(C)(3) 3 SL CDC
 
Yes
 
(129) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - SUGAR LAND DBA ST LUKE'S SUGA
R LAND HOSPITAL
6624 FANNIN SUITE 2505

HOUSTON,TX77030
HEALTHCARE TX 501(C)(3) 3 SLHS
 
Yes
 
(130) ST LUKE'S HEALTH SYSTEM CORPORATION DBA CHI ST LUKE'S HEALTH

6624 FANNIN SUITE 1100

HOUSTON,TX77030
MANAGEMENT TX 501(C)(3) 11 - Type I CHI
 
Yes
 
(131) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION

6624 FANNIN SUITE 2505

HOUSTON,TX77030
MANAGEMENT TX 501(C)(3) 11 - Type I SLHS
 
Yes
 
(132) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION - THE VINTAGE

6624 FANNIN SUITE 2505

HOUSTON,TX77030
HEALTHCARE TX 501(C)(3) 3 SL CDC
 
Yes
 
(133) ST LUKE'S COMMUNITY DEVELOPMENT CORPORATION -PMC

6624 FANNIN SUITE 2505

HOUSTON,TX77030
HEALTHCARE TX 501(C)(3) 3 SL CDC
 
Yes
 
(134) ST LUKE'S COMMUNITY HEALTH SERVICES DBA ST LUKE'S THE WOODLANDS HOSPITAL

6624 FANNIN SUITE 1100

HOUSTON,TX77030
HEALTHCARE TX 501(C)(3) 3 SLHS
 
Yes
 
(135) ST LUKE'S HEALTH SYSTEM FOUNDATION

6624 FANNIN SUITE 1100

HOUSTON,TX77030
INVESTMENT MANAGEMENT TX 501(C)(3) 11 - Type I SLHS
 
Yes
 
(136) ST LUKE'S PROPERTIES CORPORATION

6624 FANNIN SUITE 1100

HOUSTON,TX77030
PROPERTY MGMT TX 501(C)(3) 11 - Type I SLHS
 
Yes
 
(137) ST LUKE'S FOUNDATION

1213 HERMANN DRIVE SUITE 855

HOUSTON,TX77004
FUNDRAISING TX 501(C)(3) 7 SLHS
 
Yes
 
(138) ST LUKE'S MEDICAL CENTER

6624 FANNIN

HOUSTON,TX77030
HEALTHCARE TX 501(C)(3) 3 SLHS
 
Yes
 
(139) ST MARY'S COMMUNITY HOSPITAL

1314 3RD AVENUE

NEBRASKA CITY,NE68410
HEALTHCARE NE 501(C)(3) 3 CHI NEBRASKA
 
Yes
 
(140) ST MARY'S HEALTHCARE CENTER

801 EAST SIOUX AVENUE

PIERRE,SD57501
HEALTHCARE SD 501(C)(3) 3 CHI
 
Yes
 
(141) ST MARY'S HOSPITAL FOUNDATION

1314 3RD AVENUE

NEBRASKA CITY,NE68410
FUNDRAISING NE 501(C)(3) 7 SMH
 
Yes
 
(142) ST VINCENT FOUNDATION

TWO ST VINCENT CIRCLE

LITTLE ROCK,AR72205
FUNDRAISING AR 501(C)(3) 11 - Type I SVIMC
 
Yes
 
(143) ST VINCENT INFIRMARY MEDICAL CENTER

TWO ST VINCENT CIRCLE

LITTLE ROCK,AR72205
HEALTHCARE AR 501(C)(3) 3 CHI
 
Yes
 
(144) ST VINCENT MEDICAL GROUP

TWO ST VINCENT CIRCLE

LITTLE ROCK,AR72205
HEALTHCARE AR 501(C)(3) 9 SVIMC
 
Yes
 
(145) ST LUKE'S SUGAR LAND PROPERTIES CORPORATION

6624 FANNIN SUITE 2505

HOUSTON,TX77030
PROPERTY MGMT TX 501(C)(3) 11 - Type I SL CDC - SL
 
Yes
 
(146) THE GOOD SAMARITAN HOSPITAL OF CINCINNATI OH

619 OAK STREET ACCOUNTING-3 W

CINCINNATI,OH45206
HEALTHCARE OH 501(C)(3) 3 CHI
 
Yes
 
(147) THE PHYSICIAN NETWORK

2000 Q STREET SUITE 500

LINCOLN,NE68503
PHYS PRACTICE NE 501(C)(3) 11 - Type I CHI NEBRASKA
 
Yes
 
(148) TOTAL HEALTHCARE

188 INVERNESS DRIVE WEST SUITE 500

ENGLEWOOD,CO80112
HEALTHCARE CO 501(C)(3) 3 CHIC
 
Yes
 
(149) UNITY FAMILY HEALTHCARE

815 SE 2ND STREET

LITTLE FALLS,MN56345
HEALTHCARE MN 501(C)(3) 3 CHI
 
Yes
 
(150) VILLA NAZARETH INC

801 PAGE DRIVE

FARGO,ND58103
LT CARE ND 501(C)(3) 9 CHI
 
Yes
 
(151) VISITING NURSE ASSOCIATION OF ST CLARE'S

191 WOODPORT ROAD

SPARTA,NJ07871
HOME HEALTH NJ 501(C)(3) 9 SCHS
 
Yes
 
(152) WOMEN'S AUXILIARY OF HIGHLINE COMMUNITY HOSPITAL

16251 SYLVESTER RD SW

BURIEN,WA98166
AUXILIARY WA 501(C)(3) 11 - Type II HMC
 
Yes
 
(153) WOODLANDS DOCTOR GROUP

17200 ST LUKES WAY SUITE 170

THE WOODLANDS,TX77384
PHY PRACTICES TX 501(C)(3) 9 SL CHS
 
Yes
 
For Paperwork Reduction Act Notice, see the Instructions for Form 990.
Cat. No. 50135Y
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 2
Part III
Identification of Related Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a partnership during the tax year.)
(a)
Name, address, and EIN of
related organization



(b)
Primary activity




(c)
Legal
domicile
(state or foreign
country)


(d)
Direct controlling
entity



(e)
Predominant income(related, unrelated, excluded from tax under sections 512-514)

(f)
Share of total income




(g)
Share of end-of-year
assets



(h)
Disproprtionate allocations?




(i)
Code V—UBI
amount in box 20 of
Schedule K-1
(Form 1065)
(j)
General or
managing
partner?



(k)
Percentage
ownership


Yes No Yes No
(1) AUDUBON LAND COMPANY LLC

5390 N ACADEMY BLVD SUITE 300
COLORADO SPRINGS,CO80918
84-1513085
REAL ESTATE CO CHIC
 
RELATED 34,991 8,665,388   No 0   No 50.1 %
(2) AVANTAS LLC

11128 JOHN GALT BLVD SUITE 400
OMAHA,NE68137
39-2045003
STAFFING OF NURSES NE AHBMHS
 
RELATED -210,405 4,806,071   No -439,536   No 95 %
(3) BERYWOOD OFFICE PROPERTIES LLC

400 BERYWOOD TRAIL
CLEVELAND,TN37312
62-1875199
PHYS OFFICE TN MHCS
 
RELATED 57,545 1,013,237   No 0 Yes   63 %
(4) BLUEGRASS REGIONAL IMAGING CENTER

1218 SOUTH BROADWAY SUITE 310
LEXINGTON,KY40504
61-1386736
DIAGNOSTIC KY SJHS
 
RELATED 308,428 3,317,191   No 0   No 65 %
(5) CENTRAL NEBRASKA HOME CARE SERVICES

PO BOX 1146-4510 SECOND AVENUE
KEARNEY,NE68848
47-0692112
HEALTHCARE SRVC NE NA
 
RELATED 228,435 675,251   No 0 Yes   100 %
(6) CENTRAL NEBRASKA REHAB SERVICES

3004 W FAIDLEY AVE
GRAND ISLAND,NE68802
81-0653461
PHYSICAL THERAPY NE SFMC
 
RELATED 1,710,199 2,712,656   No 0   No 51 %
(7) CHI OPERATING INVESTMENT PROGRAM LP

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
47-0727942
INVESTMENTS CO CHI
 
UNRELATED 344,962,532 4,617,413,792   No 0 Yes   79.92 %
(8) HEALTHCARE SUPPORT SERVICES

PO BOX 9804
GRAND ISLAND,NE68802
72-1546196
LAUNDRY NE NA
 
RELATED 98,583 3,190,677   No 0   No 100 %
(9) MRI AT ST JOESPH MEDICAL CENTER LLC

7253 AMBASSADOR ROAD
BALTIMORE,MD21244
52-1958002
MEDICAL IMAGING MD SJMC
 
RELATED 423,167 2,174,155   No 0 Yes   51 %
(10) NORTH RIVER SURGERY CENTER LLC

2209 WILDWOOD AVENUE
SHERWOOD,AR72120
71-0799771
AMBUL SURG CTR AR SVIMC
 
RELATED 81,071 1,077,536   No 0   No 57.45 %
(11) O'DEA MEDICAL ARTS LIMITED PARTNERSHIP

7601 OSLER DRIVE
TOWSON,MD21204
52-1682964
REAL ESTATE MD TMI
 
RELATED 9,490 0   No 0 Yes   66.58 %
(12) ORTHOCOLORADO LLC

11650 WEST 2ND PLACE
LAKEWOOD,CO80255
37-1577105
ORTHO HOSPITAL CO THC
 
RELATED 1,846,153 8,411,844   No 0   No 60 %
(13) PENINSULA RADIATION ONCOLOGY LLC

315 MARTIN LUTHER KING JR WAY 111
TACOMA,WA98405
87-0808610
HEALTHCARE SRVC WA FHS
 
RELATED 256,567 3,262,002   No 0   No 60 %
(14) PENRAD IMAGING

1390 KELLY JOHNSON BLVD
COLORADO SPRINGS,CO80920
84-1072619
MEDICAL IMAGING CO CHIC
 
RELATED 715,094 3,489,436   No 0   No 70 %
(15) RUXTON SURGICENTER LLC

8322 BELLONA AVENUE SUITE 201
BALTIMORE,MD21204
52-2095835
SURGERY CENTER MD SJMC
 
RELATED -69,345 0   No 0 Yes   51 %
(16) SAINT JOSEPH - SCA HOLDINGS LLC

1451 HARRDOSBURG ROAD
LEXINGTON,KY40504
45-3801157
OP SURGERY DE SJHS
 
RELATED 0 0   No 0 Yes   51 %
(17) SCA PREMIER SURGERY CENTER OF LOUISVILLE LLC

200 ABRAHAM FLEXNER WAY
LOUISVILLE,KY40202
72-1386840
SURGERY CENTER KY JH
 
RELATED 3,388 666,017   No 0 Yes   51 %
(18) ST FRANCIS LAND COMPANY LLC

5390 N ACADEMY BLVD SUITE 300
COLORADO SPRINGS,CO80918
26-3134100
REAL ESTATE CO CHIC
 
RELATED -130,967 13,823,763   No 0   No 51 %
(19) ST FRANCIS MEDICAL CENTER ASSOCIATES

1717 SOUTH J STREET
TACOMA,WA98405
91-1352698
MED. OFFICE WA FHS
 
RELATED 238,717 1,907,063   No 0   No 58.46 %
(20) ST JOSEPH-PAML LLC

424 LEWIS HARGETT CIRCLE STE 160
LEXINGTON,KY40503
45-2116736
MGMT SVCS KY SJHS
 
RELATED 30,446 1,149,003   No 0 Yes   62.5 %
(21) SUPERIOR MEDICAL IMAGING LLC

5000 NORTH 26TH STREET
LINCOLN,NE68521
26-2884555
OP DIAGNOSTICS NE SERMC
 
RELATED -200,323 821,112   No 0 Yes   51 %
(22) SURGERY CENTER OF LEXINGTON LLC

424 LEWIS HARGETT CIRCLE STE 160
LEXINGTON,KY40503
62-1179539
SURGERY CENTER DE SJHS
 
RELATED -200,318 4,079,584   No 0 Yes   51 %
(23) SURGERY CENTER OF LOUISVILLE LLC

200 ABRAHAM FLEXNER WAY
LOUISVILLE,KY40202
62-1179537
SURGERY CENTER KY JH
 
RELATED -15,452 396,101   No 0 Yes   51 %
(24) ALEGENT HEALTH NORTHWEST IMAGING CENTER LLC

3606 N 156TH STREET
OMAHA,NE68116
06-1786985
OP DIAGNOSTICS NE ACH
 
RELATED 116,752 776,649   No 0 Yes   51 %
(25) BERGAN MERCY SURGERY CENTER LLC

7710 MERCY ROAD STE 100
OMAHA,NE68124
20-8671994
AMBUL SURG CTR NE ACH
 
RELATED 142,085 3,294,472   No 0   No 63.94 %
(26) LAKESIDE AMBULATORY SURGICAL CENTER LLC

17031 LAKESIDE HILLS DR
OMAHA,NE68130
20-4267902
AMBUL SURG CTR NE ACH
 
RELATED 3,465,880 1,951,221   No 0   No 51.6 %
(27) LAKESIDE ENDOSCOPY CENTER LLC

17001 LAKESIDE HILLS PLZ STE 201
OMAHA,NE68130
20-5544496
ENDOSCOPY SRVC NE ACH
 
RELATED 1,455,294 1,013,126   No 0   No 52.28 %
(28) NEBRASKA SPINE HOSPITAL LLC

6901 N 72ND STREET
OMAHA,NE68122
27-0263191
SPINE HOSPITAL NE ACH
 
RELATED 10,501,730 17,301,869   No 0   No 51 %
(29) PRAIRIE HEALTH VENTURES LLC

421 S 9TH ST 102
LINCOLN,NE68508
20-4962103
TECH SERVICES NE AH-IMC
 
RELATED 1,011,804 5,564,586   No 68,565 Yes   62.7 %
(30) SAINT JOSEPH-ANC HOME CARE SERVICES

1700 EDISON DRIVE SUITE 300
MILFORD,OH45150
26-3330545
HOME HEALTH KY JH
 
RELATED 3,208,139 9,684,824   No 0   No 96.9 %
(31) LINCOLN CK LEASING LLC

8770 BRYN MAWR SUITE 1370
CHICAGO,IL60631
26-2496856
REAL ESTATE NE SERMC
 
RELATED 397,452 439,334   No 0   No 53.76 %
(32) HIGHLINE IMAGING LLC

275 SW 160TH ST
BURIEN,WA98166
20-0460005
DIAGNOSTIC WA HMC
 
RELATED 840,222 1,784,058   No 0   No 80 %
(33) HC SL VINTAGE I LLC

18000 WEST SARAH LANE SUITE 250
BROOKFIELD,WI53045
27-0453767
PROPERTY HOLD WI SL CDC - VINTAGE
 
RELATED 1,027,057 105,658,490   No 0   No 51 %
(34) ST LUKE'S HOSPITAL AT THE VINTAGE LLC

6624 FANNIN SUITE 2505
HOUSTON,TX77030
26-3734516
HOSPITAL TX SL CDC - VINTAGE
 
RELATED -19,253,743 69,158,748   No 0 Yes   51 %
(35) PMC HOSPITAL LLC

6624 FANNIN SUITE 2505
HOUSTON,TX77030
27-3280598
HOSPITAL TX SL CDC - PMC
 
RELATED 1,092,540 20,751,174   No 0 Yes   51 %
(36) ST LUKE'S DIAGNOSTIC CATH LAB LLP

6620 MAIN ST SUITE 1520
HOUSTON,TX77030
71-0959365
DIAGNOSTIC TX SLHS HOLDINGS
 
RELATED 273,448 868,814   No 0   No 57.3 %
(37) ST LUKE'S LAKESIDE HOSPITAL LLC

6624 FANNIN SUITE 2505
HOUSTON,TX77030
30-0427437
HOSPITAL TX SL CDC - WOODLANDS
 
RELATED 1,106,628 25,874,619   No 0 Yes   51 %
(38) ST LUKE'S THE WOODLANDS SLEEP CENTER LLC

6624 FANNIN SUITE 800
HOUSTON,TX77030
46-2795726
DIAGNOSTIC TX SLHS HOLDINGS
 
RELATED 0 0   No 0   No 51 %
Part IV
Identification of Related Organizations Taxable as a Corporation or Trust (Complete if the organization answered "Yes" to Form 990, Part IV, line 34 because it had one or more related organizations treated as a corporation or trust during the tax year.)
(a)
Name, address, and EIN of
related organization
(b)
Primary activity
(c)
Legal
domicile
(state or foreign
country)
(d)
Direct controlling
entity
(e)
Type of entity
(C corp, S corp,
or trust)
(f)
Share of total income
(g)
Share of end-of-year
assets
(h)
Percentage
ownership
(i)
Section 512(b)(13) controlled entity?
Yes No
(1) ALTERNATIVE INSURANCE MANAGEMENT SERVICE

3900 OLYMPIC BOULEVARD SUITE 400
ERLANGER,KY41018
84-1112049
MANAGEMENT SERVICES CO CHI
 
C CORPORATION 0 6,272,746 100 % Yes  
(2) AMERICAN NURSING CARE

1700 EDISON DRIVE
MILFORD,OH45150
31-1085414
HOME HEALTH OH CHS
 
C CORPORATION 5,118,606 51,920,207 100 % Yes  
(3) AMERIMED INC

1700 EDISON DRIVE
MILFORD,OH45150
31-1158699
HOME HEALTH OH ANC
 
C CORPORATION 2,134,392 14,669,219 100 % Yes  
(4) BC HOLDING COMPANY INC

1850 BLUEGRASS AVE
LOUISVILLE,KY40215
31-1542851
FITNESS CLUB KY JH
 
C CORPORATION 0 0 100 % Yes  
(5) CADUCEUS MEDICAL ASSOCIATES INC

5600 BRAINERD ROAD SUITE 500
CHATTANOOGA,TN37411
62-1570736
HEALTHCARE TN MHCS
 
C CORPORATION 0 1,008 100 % Yes  
(6) CAPTIVE MANAGEMENT INITIATIVES

PO BOX 10073 APO
GEORGETOWN,GRAND CAYMANKY1-1001
CJ
98-0663022
CAPTIVE MANAGEMENT CJ CHI
 
C CORPORATION 0 0 100 % Yes  
(7) CATHOLIC HEALTH INITIATIVES CENTER FOR TRANSLATIONAL RESEARCH

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
27-2269511
RESEARCH CO CIRI
 
C CORPORATION -2,286,538 1,241,259 100 % Yes  
(8) CGH REALTY COMPANY INC

2500 BERNVILLE RD
READING,PA19603
23-2326801
REAL ESTATE PA SJHM
 
C CORPORATION 0 0 100 % Yes  
(9) COMCARE SERVICES

4231 W 16TH AVENUE
DENVER,CO80204
84-0904813
INACTIVE CO CHIC
 
C CORPORATION 0 0 100 % Yes  
(10) CONSOLIDATED HEALTH SERVICES

1700 EDISON DRIVE
MILFORD,OH45150
31-1378212
HOME HEALTH OH CHI
 
C CORPORATION -879,467 52,379,487 100 % Yes  
(11) DES MOINES MEDICAL CENTER INC

1111 6TH AVENUE
DES MOINES,IA50314
42-0837382
REAL ESTATE IA CHI-IA CORP
 
C CORPORATION 61,204 1,064,032 92.98 % Yes  
(12) FIRST INITIATIVES INSURANCE LTD

PO BOX 10073 APO
GEORGETOWN,GRAND CAYMANKY1-1001
CJ
98-0203038
INSURANCE CJ CHI
 
C CORPORATION 0 0 100 % Yes  
(13) FRANCISCAN SERVICES INC

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
23-2487967
HEALTHCARE CO CHI
 
C CORPORATION -7,868 718,254 100 % Yes  
(14) GOOD SAMARITAN OUTREACH SERVICES

PO BOX 1990
KEARNEY,NE68848
47-0659440
MEDICAL CLINIC NE CHI NEBRASKA
 
C CORPORATION -257,418 180,468 100 % Yes  
(15) HEALTH SYSTEMS ENTERPRISES INC

PO BOX 1990
KEARNEY,NE68848
47-0664558
MANAGEMENT NE GSH
 
C CORPORATION 87,278 1,377,820 100 % Yes  
(16) HEALTHCARE MGMT SERVICES ORG INC

1149 MARKET ST
TACOMA,WA98402
91-1865474
HEALTH ORG. WA FHS
 
C CORPORATION 0 0 100 % Yes  
(17) MEDQUEST

1301 15TH AVENUE WEST
WILLISTON,ND58801
45-0392137
SALE OF DME ND MMC WILLISTON
 
C CORPORATION 153,510 1,152,715 100 % Yes  
(18) MERCY PARK APARTMENTS LTD

1111 6TH AVENUE
DES MOINES,IA50314
42-1202422
HOUSING IA CHI-IA CORP
 
C CORPORATION 369,231 1,937,218 100 % Yes  
(19) MERCY SERVICES CORP

2700 STEWART PARKWAY
ROSEBURG,OR97470
93-0824308
RETAIL SALES OR MMC
 
C CORPORATION -440,596 1,423,377 100 % Yes  
(20) MHSERVICES CORPORATION

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
43-1457881
DME MO SJRMC
 
C CORPORATION 0 0 100 % Yes  
(21) MOUNTAIN MANAGEMENT SERVICES INC

5600 BRAINERD ROAD SUITE 500
CHATTANOOGA,TN37411
62-1570739
MGMT SVC ORG TN MHCS
 
C CORPORATION 96,044 6,465,179 100 % Yes  
(22) NAZARETH ASSURANCE COMPANY

PO BOX 10073 APO
GEORGETOWN,GRAND CAYMANKY1-1001
CJ
03-0304831
INSURANCE CJ CHI
 
C CORPORATION 0 0 100 % Yes  
(23) PATIENT TRANSPORT SERVICES INC

1700 EDISON DRIVE
MILFORD,OH45150
31-1100798
HOME HEALTH OH ANC
 
C CORPORATION -164,340 5,488,275 100 % Yes  
(24) PHYSICIAN HEALTH SYSTEM NETWORK

1149 MARKET ST
TACOMA,WA98402
91-1746721
HEALTH ORG. WA FHS
 
C CORPORATION 0 0 100 % Yes  
(25) SAINT CLARES PRIMARY CARE INC

66 FORD ROAD
DENVILLE,NJ07834
22-2441202
BILLING SERVICES NJ SCCC
 
C CORPORATION -357,263 1,361,242 100 % Yes  
(26) SAMARITAN FAMILY CARE INC

40 W FOURTH ST 1700
DAYTON,OH45402
31-1299450
HEALTHCARE OH SHP
 
C CORPORATION 0 0 100 % Yes  
(27) SJH SERVICES CORPORATION

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
23-2307408
HEALTHCARE CO FSI
 
C CORPORATION -197,039 3,331,737 100 % Yes  
(28) SJL PHYSICIAN MANAGEMENT SERVICES INC

424 LEWIS HARGETT CR 160
LEXINGTON,KY40503
27-0164198
MANAGEMENT KY SJHS
 
C CORPORATION 0 0 100 % Yes  
(29) ST ANTHONY DEVELOPMENT COMPANY

1415 SOUTHGATE
PENDLETON,OR97801
93-1216943
ATHLETIC CLUB OR SAH
 
C CORPORATION 114,663 2,936,102 100 % Yes  
(30) ST VINCENT COMMUNITY HEALTH SERVICES INC

TWO ST VINCENT CIRCLE
LITTLE ROCK,AR72205
71-0710785
HEALTHCARE AR SVIMC
 
C CORPORATION 2,408,638 15,225,732 100 % Yes  
(31) ST JOSEPH DEVELOPMENT COMPANY INC

1717 SOUTH J STREET
TACOMA,WA98405
91-1480569
RENTAL WA FSI
 
C CORPORATION 655,478 12,357,418 100 % Yes  
(32) ST JOSEPH OFFICE PARK ASSOCIATION

1401 HARRODSBURG ROAD BLDG B70
LEXINGTON,KY40504
61-1079899
MANAGEMENT KY SJHS
 
C CORPORATION 0 882,139 85 % Yes  
(33) TOWSON MANAGEMENT INC

7601 OSLER DRIVE
TOWSON,MD21204
52-1710750
MANAGEMENT SERVICES MD FSI
 
C CORPORATION 516,457 197,196 100 % Yes  
(34) COLLABHEALTH MANAGED SOLUTIONS INC

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
46-1222808
HOLDING CO CO CHI
 
C CORPORATION 0 23,806,707 100 % Yes  
(35) COLLABHEALTH PLAN SERVICES INC

198 INVERNESS DRIVE WEST
ENGLEWOOD,CO80112
46-1224037
ADMIN SERVICES CO CHMS
 
C CORPORATION -1,082,933 38,272,608 100 % Yes  
(36) HIGHLINE MEDICAL GROUP

15811 AMBAUM BLVD SW 170
BURIEN,WA98166
91-1407026
MEDICAL SERVICES WA HMC
 
C CORPORATION -6,049,147 5,689,139 100 % Yes  
(37) SOUNDPATH HEALTH INC

32129 WEYERHAEUSER WAY S SUITE 201
FEDERAL WAY,WA98001
42-1720801
INSURANCE WA CHPS
 
C CORPORATION -154,741 10,976,973 55.6 % Yes  
(38) SLEHS HOLDINGS INC

6624 FANNIN SUITE 800
HOUSTON,TX77030
76-0637138
HOLDING CO TX SLHS
 
C CORPORATION 1,425,313 33,114,103 100 % Yes  
(39) ST LUKE'S ANESTHESIOLOGY ASSOCIATES

6624 FANNIN SUITE 1100
HOUSTON,TX77030
46-1517163
MEDICAL CLINIC TX SLMC
 
C CORPORATION 0 0 100 % Yes  
(40) SLMT PARKING INC

6624 FANNIN SUITE 800
HOUSTON,TX77030
76-0637140
PARKING TX SLHS
 
C CORPORATION 1,117,934 13,768,221 100 % Yes  
(41) ST LUKE'S 6620 MAIN CONDOMINIUM ASSOCIATION

6624 FANNIN SUITE 1100
HOUSTON,TX77030
30-0355517
CONDOMINIUM ASSOC TX SLPC
 
C CORPORATION 0 0 100 % Yes  
(42) ST LUKE'S EPISCOPAL HOSPITAL PHYSICIAN HOSPITAL ORGANIZATION INC

6720 BERTNER
HOUSTON,TX77030
76-0377932
PHO TX SLMC
 
C CORPORATION 6 0 60 % Yes  
(43) ST LUKE'S MEDICAL ARTS CENTER I CONDOMINIUM ASSOCIATION

6624 FANNIN SUITE 1100
HOUSTON,TX77030
30-0355518
CONDOMINIUM ASSOC TX SLPC
 
C CORPORATION 0 0 100 % Yes  
(44) ST LUKE'S MEDICAL TOWER CONDOMINIUM ASSOCIATION

6624 FANNIN SUITE 1100
HOUSTON,TX77030
76-0298751
CONDOMINIUM ASSOC TX SLMTC
 
C CORPORATION 0 0 100 % Yes  
(45) SUGAR LAND DOCTOR GROUP

1317 LAKE POINTE PARKWAY
SUGAR LAND,TX77478
45-4270163
MEDICAL CLINIC TX SL CHS
 
C CORPORATION -1,159,411 566,590 100 % Yes  
(46) THE TEXAS HEART INSTITUTE AT ST LUKE'S EPISCOPAL HOSPITAL DENTON A COOLEY B
UILDING CONDOMINIUM ASSOCIATION
6624 FANNIN SUITE 1100
HOUSTON,TX77030
90-0064009
CONDOMINIUM ASSOC TX SLMC
 
C CORPORATION 0 0 100 % Yes  
(47) ALEGENT HEALTHCREIGHTON ST JOSEPH MANAGED CARE SERVICES INC

12809 WEST DODGE ROAD
OMAHA,NE68154
47-0802396
MANAGED CARE NE ACH
 
C CORPORATION 5,312,313 4,520,865 100 % Yes  
(48) ALL SAINTS INSURANCE COMPANY SPC LTD

PO BOX 69 GT 720 WEST BAY ROAD
GEORGETOWN,GRAND CAYMANKY-1102
CJ
INSURANCE CJ SLHS
 
C CORPORATION 0 43,866,961 100 % Yes  
(49) VINTAGE DOCTOR GROUP

6624 FANNIN SUITE 1100
HOUSTON,TX77030
MEDICAL CLINIC TX SLMC
 
C CORPORATION 0 0 100 % Yes  
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 3
Part V
Transactions With Related Organizations (Complete if the organization answered "Yes" to Form 990, Part IV, line 34, 35b, or 36.)
Note. Complete line 1 if any entity is listed in Parts II, III, or IV of this schedule.
Yes
No
1 During the tax year, did the orgranization engage in any of the following transactions with one or more related organizations listed in Parts II-IV?
a Receipt of (i) interest (ii) annuities (iii) royalties or (iv) rent from a controlled entity . . . . . . . . . . . . . . . . . . . . . . .
1a
Yes
 
b Gift, grant, or capital contribution to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1b
Yes
 
c Gift, grant, or capital contribution from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1c
Yes
 
d Loans or loan guarantees to or for related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1d
 
No
e Loans or loan guarantees by related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1e
Yes
 
f Dividends from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1f
 
No
g Sale of assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1g
 
No
h Purchase of assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1h
 
No
i Exchange of assets with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1i
 
No
j Lease of facilities, equipment, or other assets to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1j
Yes
 
k Lease of facilities, equipment, or other assets from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . .
1k
 
No
l Performance of services or membership or fundraising solicitations for related organization(s) . . . . . . . . . . . . . . . . . . . .
1l
 
No
m Performance of services or membership or fundraising solicitations by related organization(s) . . . . . . . . . . . . . . . . . . . .
1m
Yes
 
n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) . . . . . . . . . . . . . . . . . . . . .
1n
Yes
 
o Sharing of paid employees with related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1o
Yes
 
p Reimbursement paid to related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1p
Yes
 
q Reimbursement paid by related organization(s) for expenses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1q
Yes
 
r Other transfer of cash or property to related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1r
Yes
 
s Other transfer of cash or property from related organization(s) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
1s
Yes
 
2
If the answer to any of the above is "Yes," see the instructions for information on who must complete this line, including covered relationships and transaction thresholds.
(a)
Name of other organization
(b)
Transaction
type (a-s)
(c)
Amount involved
(d)
Method of determining amount involved
(1) MEMORIAL HEALTH CARE SYSTEM FOUNDATION

P 689,742 FMV
(2) MEMORIAL HEALTH CARE SYSTEM FOUNDATION

C 646,593 FMV
(3) MEMORIAL HEALTH CARE SYSTEM FOUNDATION

N 65,474 FMV
(4) MHP FOUNDATION

A 1,359,442 FMV
(5) MHP FOUNDATION

J 1,168,826 FMV
(6) MOUNTAIN MANAGEMENT SERVICES

Q 25,200,000 FMV
(7) MEMORIAL HEALTH CARE SYSTEM FOUNDATION

M 245,956 FMV
(8) MOUNTAIN MANAGEMENT SERVICES

O 137,295 FMV
(9) MHP FOUNDATION

B 7,661,967 FMV
(10) MHP FOUNDATION

Q 29,500,000 FMV
Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 4
Part VI
Unrelated Organizations Taxable as a Partnership (Complete if the organization answered "Yes" to Form 990, Part IV, line 37.)
Provide the following information for each entity taxed as a partnership through which the organization conducted more than five percent of its activities (measured by total assets or gross revenue) that was not a related organization. See instructions regarding exclusion for certain investment partnerships.
(a)
Name, address, and EIN of entity
(b)
Primary activity
(c)
Legal domicile
(state or foreign
country)
(d)
Predominant income (related, unrelated, excluded from tax under section 512-514)

(e)
Are all partners
section
501(c)(3)
organizations?
(f)
Share of total income




(g)
Share of
end-of-year
assets
(h)
Disproprtionate allocations?
(i)
Code V—UBI
amount in box 20
of Schedule K-1
(Form 1065)
(j)
General or
managing
partner?
(k)
Percentage
ownership


Yes No Yes No Yes No






























Schedule R (Form 990) 2012
Schedule R (Form 990) 2012
Page 5
Part VII
Supplemental Information
Complete this part to provide additional information for responses to questions on Schedule R (see instructions).
Identifier Return Reference Explanation

Additional Data


Software ID: 12000266
Software Version: v2012.1.0