TY 2017 Form 990

(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)	(E) Reportable compensation from related organizations (W-2/1099-MISC)	(F) Estimated amount of other compensation from the organization and related organizations
(1) DAVID CAHILL CHAIR	1.0 ................. 1.0	X	X		0	0
(2) FRANK GRECO JR VICE CHAIR	1.0 ................. 1.0	X	X		0	0
(3) STEPHEN VANNOSTRAND SECRETARY	1.0 ................. 1.0	X	X		0	0
(4) ROBERT FISHER TREASURER	1.0 ................. 1.0	X	X		0	0
(5) KATHRYN CONNERTON PRESIDENT & CEO	50.0 ................. 2.0	X	X		753,562	28,289
(6) KEVIN DRUMM PHD BOARD MEMBER	1.0 ................. 1.0	X			0	0
(7) MICHAEL FARRELL MD BOARD MEMBER	1.0 ................. 1.0	X			0	0
(8) CATHERINE MALIWACKI BOARD MEMBER	1.0 ................. 1.0	X			0	0
(9) KIM MYERS BOARD MEMBER	1.0 ................. 1.0	X			0	0
(10) JAMES ORBAND BOARD MEMBER	1.0 ................. 1.0	X			0	0
(11) BRIAN ROSE BOARD MEMBER	1.0 ................. 1.0	X			0	0
(12) JAMES STEINMETZ MD BOARD MEMBER/PHYSICIAN	50.0 ................. 1.0	X			537,280	43,103
(13) SISTER ELLEN REILLY BOARD MEMBER	1.0 ................. 0	X			0	0
(14) SEAN MILLS VP-FINANCE/CFO	50.0 ................. 2.0		X		259,762	31,281
(15) DEBORAH S MICAN VP-NURSING (END 3/2018)	50.0 ................. 0			X	241,196	33,459
(16) LISA YVETTE HARRIS SR VP MEDICAL AFFAIRS/CMO (END 8/2018)	50.0 ................. 0			X	358,858	30,784
(17) CHAD A PATTON VP-PHYSICIAN NETWORK	50.0 ................. 0			X	239,620	40,822

(A) Name and title	(B) Average hours per week (list any hours for related organizations below dotted line)	(F) Estimated amount of other compensation from the organization and related organizations
(18) RICHARD BLANSKY MD CHIEF MEDICAL OFFICER	50.0 .......................0	X			605,231	0	19,567
(19) ANNE E WOLANSKI FORMER KEY EMPLOYEE (END 12/2016)	0.0 .......................0	X			187,151	0	5,290
(20) DEBORAH BLAKENEY VP-CONTINUUM CARE	50.0 .......................0	X			207,857	0	10,464
(21) SANJIV PATEL PRESIDENT MEDICAL STAFF	50.0 .......................0	X			235,631	0	16,402
(22) MARY E HUGHS CHRO	50.0 .......................0.0	X			0	229,110	31,298
(23) RATNAKISHORE PALLAPOTHU PHYSICIAN	50.0 .......................0		X		650,531	0	43,803
(24) JOHN DIMENNA MD PHYSICIAN	50.0 .......................0		X		531,268	0	30,023
(25) JOYLEEN EARLE MD PHYSICIAN	50.0 .......................0		X		517,333	0	30,318
(26) CHARLES CAMPBELL MD PHYSICIAN	50.0 .......................0		X		513,213	0	35,122
(27) ELDAD EINVA MD PHYSICIAN	50.0 .......................0		X		504,813	0	41,680
(28) DAVID F CLEMENTS FORMER OFFICER (END 8/2016)	0.0 .......................0.0			X	211,707	0	16,994
(29) LINDA A MCCORMACK-MILLER FORMER OFFICER (END 11/2016)	0.0 .......................0			X	231,716	0	1,772

(A) Name and business address	(B) Description of services	(C) Compensation
RIVERSIDE ASSOCIATES IN ANESTHESIA PC 40 FRONT STREET BINGHAMTON,NY13905	PHYSICIAN SERVICES	3,411,810
COGENT MEDICAL CARE PC PO BOX 742936 LOS ANGELES,CA900742936	MEDICAL SERVICES	2,487,416
ARUP LABORATORIES 500 S CHIPETA WAY SALT LAKE CITY,UT841081221	LABORATORY SERVICES	1,202,185
BROOME OBSTETRICS AND GYNECOLOGY PC 161 RIVERSIDE DR STE 109 BINGHAMTON,NY13905	PHYSICIAN SERVICES	620,535
PIPPA ADAMS 564 HALL ROAD FRIENDSVILLE,PA18818	ENVIRONMENTAL SERVICES	604,470
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 40

- TIN:

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.
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Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Our Lady of Lourdes Memorial Hospital Inc

Employer identification number

15-0532221

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 12, check only one box.)

A church, convention of churches, or association of churches described in section 170(b)(1)(A)(i).

A school described in section 170(b)(1)(A)(ii). (Attach Schedule E (Form 990 or 990-EZ).)

A hospital or a cooperative hospital service organization described in section 170(b)(1)(A)(iii).

A medical research organization operated in conjunction with a hospital described in section 170(b)(1)(A)(iii). Enter the hospital's name, city, and state:

An organization operated for the benefit of a college or university owned or operated by a governmental unit described in section 170(b)(1)(A)(iv). (Complete Part II.)

A federal, state, or local government or governmental unit described in section 170(b)(1)(A)(v).

An organization that normally receives a substantial part of its support from a governmental unit or from the general public described in section 170(b)(1)(A)(vi). (Complete Part II.)

A community trust described in section 170(b)(1)(A)(vi). (Complete Part II.)

An agricultural research organization described in 170(b)(1)(A)(ix) operated in conjunction with a land-grant college or university or a non-land grant college of agriculture. See instructions. Enter the name, city, and state of the college or university:

An organization that normally receives: (1) more than 331/3% of its support from contributions, membership fees, and gross 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.)

An organization organized and operated exclusively to test for public safety. See section 509(a)(4).

An organization organized and operated exclusively for the benefit of, to perform the functions of, or to carry out the purposes of one or more publicly supported organizations described in section 509(a)(1) or section 509(a)(2). See section 509(a)(3). Check the box in lines 12a through 12d that describes the type of supporting organization and complete lines 12e, 12f, and 12g.

Type I. A supporting organization operated, supervised, or controlled by its supported organization(s), typically by giving the supported organization(s) the power to regularly appoint or elect a majority of the directors or trustees of the supporting organization. You must complete Part IV, Sections A and B.

Type II. A supporting organization supervised or controlled in connection with its supported organization(s), by having control or management of the supporting organization vested in the same persons that control or manage the supported organization(s). You must complete Part IV, Sections A and C.

Type III functionally integrated. A supporting organization operated in connection with, and functionally integrated with, its supported organization(s) (see instructions). You must complete Part IV, Sections A, D, and E.

Type III non-functionally integrated. A supporting organization operated in connection with its supported organization(s) that is not functionally integrated. The organization generally must satisfy a distribution requirement and an attentiveness requirement (see instructions). You must complete Part IV, Sections A and D, and Part V.

Check this box if the organization received a written determination from the IRS that it is a Type I, Type II, Type III functionally integrated, or Type III non-functionally integrated supporting organization.

Enter the number of supported organizations ...............................

Provide the following information about the supported organization(s).

(i) Name of supported organization	(ii) EIN	(iv) Is the organization listed in your governing document?		(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)
(i) Name of supported organization	(ii) EIN	Yes	No	(v) Amount of monetary support (see instructions)	(vi) Amount of other support (see instructions)


Total

For Paperwork Reduction Act Notice, see the Instructions for
Form 990 or 990-EZ.

Cat. No. 11285F

Schedule A (Form 990 or 990-EZ) 2019

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 failed to qualify under the tests listed below, please complete Part III.)

Section A. Public Support

Calendar year (or fiscal year beginning in)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(f) Total
1	Gifts, grants, contributions, and membership fees received. (Do not include any "unusual grant.") ..
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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 VI.)..
11	Total support. Add lines 7 through 10

Gross receipts from related activities, etc. (see instructions) ..................

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization, check this box and stop here........................................ right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 6, column (f) divided by line 11, column (f)) .........

Public support percentage for 2018 Schedule A, Part II, line 14 ...............

16a

33 1/3% support test—2019. If the organization did not check the box on line 13, and line 14 is 33 1/3% or more, check this box
and stop here. The organization qualifies as a publicly supported organization ....................... right arrow

33 1/3% support test—2018. If the organization did not check a box on line 13 or 16a, and line 15 is 33 1/3% or more, check this
box and stop here. The organization qualifies as a publicly supported organization ..................... right arrow

17a

10%-facts-and-circumstances test—2019. If the organization did not check a box on line 13, 16a, or 16b, and line 14
is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here. Explain
in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly supported
organization ..................................................... right arrow

10%-facts-and-circumstances test—2018. If the organization did not check a box on line 13, 16a, 16b, or 17a, and line
15 is 10% or more, and if the organization meets the "facts-and-circumstances" test, check this box and stop here.
Explain in Part VI how the organization meets the "facts-and-circumstances" test. The organization qualifies as a publicly
supported organization ................................................ right arrow

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) 2019

Page 3

Part III

Support Schedule for Organizations Described in Section 509(a)(2)
(Complete only if you checked the box on line 10 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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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)		(a) 2015	(b) 2016	(c) 2017	(d) 2018	(e) 2019	(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 VI.) ..
13	Total support. (Add lines 9, 10c, 11, and 12.)..

First five years. If the Form 990 is for the organization's first, second, third, fourth, or fifth tax year as a section 501(c)(3) organization,
check this box and stop here............................................. right arrow

Section C. Computation of Public Support Percentage

Public support percentage for 2019 (line 8, column (f) divided by line 13, column (f)) .........

Public support percentage from 2018 Schedule A, Part III, line 15 ...............

Section D. Computation of Investment Income Percentage

Investment income percentage for 2019 (line 10c, column (f) divided by line 13, column (f)) ......

Investment income percentage from 2018 Schedule A, Part III, line 17 .............

19a

331/3% support tests—2019. If the organization did not check the box on line 14, and line 15 is more than 33 1/3%, and line 17 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization ....... right arrow

33 1/3% support tests—2018. If the organization did not check a box on line 14 or line 19a, and line 16 is more than 33 1/3% and line 18 is not more than 33 1/3%, check this box and stop here. The organization qualifies as a publicly supported organization .... right arrow

Private foundation. If the organization did not check a box on line 14, 19a, or 19b, check this box and see instructions .... right arrow

Schedule A (Form 990 or 990-EZ) 2019

Page 4

Part IV

Supporting Organizations

(Complete only if you checked a box on line 12 of Part I. If you checked 12a of Part I, complete Sections A and B. If you checked 12b of Part I, complete Sections A and C. If you checked 12c of Part I, complete Sections A, D, and E. If you checked 12d of Part I, complete Sections A and D, and complete Part V.)

Section A. All Supporting Organizations

Yes

Are all of the organization’s supported organizations listed by name in the organization’s governing documents?
If "No," describe in Part VI how the supported organizations are designated. If designated by class or purpose,
describe the designation. If historic and continuing relationship, explain.

Did the organization have any supported organization that does not have an IRS determination of status under section 509(a)(1) or (2)? If "Yes," explain in Part VI how the organization determined that the supported organization was described in section 509(a)(1) or (2).

Did the organization have a supported organization described in section 501(c)(4), (5), or (6)? If "Yes," answer (b) and (c) below.

Did the organization confirm that each supported organization qualified under section 501(c)(4), (5), or (6) and satisfied the public support tests under section 509(a)(2)? If "Yes," describe in Part VI when and how the organization made the determination.

Did the organization ensure that all support to such organizations was used exclusively for section 170(c)(2)(B) purposes? If "Yes," explain in Part VI what controls the organization put in place to ensure such use.

Was any supported organization not organized in the United States ("foreign supported organization")? If “Yes” and if you checked 12a or 12b in Part I, answer (b) and (c) below.

Did the organization have ultimate control and discretion in deciding whether to make grants to the foreign supported organization? If “Yes,” describe in Part VI how the organization had such control and discretion despite being controlled or supervised by or in connection with its supported organizations.

Did the organization support any foreign supported organization that does not have an IRS determination under sections 501(c)(3) and 509(a)(1) or (2)? If “Yes,” explain in Part VI what controls the organization used to ensure that all support to the foreign supported organization was used exclusively for section 170(c)(2)(B) purposes.

Did the organization add, substitute, or remove any supported organizations during the tax year? If “Yes,” answer (b) and (c) below (if applicable). Also, provide detail in Part VI, including (i) the names and EIN numbers of the supported organizations added, substituted, or removed; (ii) the reasons for each such action; (iii) the authority under the organization's organizing document authorizing such action; and (iv) how the action was accomplished (such as by amendment to the organizing document).

Type I or Type II only. Was any added or substituted supported organization part of a class already designated in the organization's organizing document?

Substitutions only. Was the substitution the result of an event beyond the organization's control?

Did the organization provide support (whether in the form of grants or the provision of services or facilities) to anyone other than (i) its supported organizations, (ii) individuals that are part of the charitable class benefited by one or more of its supported organizations, or (iii) other supporting organizations that also support or benefit one or more of the filing organization’s supported organizations? If “Yes,” provide detail in Part VI.

Did the organization provide a grant, loan, compensation, or other similar payment to a substantial contributor (defined in section 4958(c)(3)(C)), a family member of a substantial contributor, or a 35% controlled entity with regard to a substantial contributor? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ) .

Did the organization make a loan to a disqualified person (as defined in section 4958) not described in line 7? If “Yes,” complete Part I of Schedule L (Form 990 or 990-EZ).

Was the organization controlled directly or indirectly at any time during the tax year by one or more disqualified persons as defined in section 4946 (other than foundation managers and organizations described in section 509(a)(1) or (2))? If “Yes,” provide detail in Part VI.

Did one or more disqualified persons (as defined in line 9a) hold a controlling interest in any entity in which the supporting organization had an interest? If “Yes,” provide detail in Part VI.

Did a disqualified person (as defined in line 9a) have an ownership interest in, or derive any personal benefit from, assets in which the supporting organization also had an interest? If “Yes,” provide detail in Part VI.

10a

Was the organization subject to the excess business holdings rules of section 4943 because of section 4943(f) (regarding certain Type II supporting organizations, and all Type III non-functionally integrated supporting organizations)? If “Yes,” answer line 10b below.

10a

Did the organization have any excess business holdings in the tax year? (Use Schedule C, Form 4720, to determine whether the organization had excess business holdings).

10b

Schedule A (Form 990 or 990-EZ) 2019

Page 5

Part IV

Supporting Organizations (continued)

Yes

Has the organization accepted a gift or contribution from any of the following persons?

A person who directly or indirectly controls, either alone or together with persons described in (b) and (c) below, the governing body of a supported organization?

11a

A family member of a person described in (a) above?

11b

A 35% controlled entity of a person described in (a) or (b) above? If “Yes” to a, b, or c, provide detail in Part VI.

11c

Section B. Type I Supporting Organizations

Yes

Did the directors, trustees, or membership of one or more supported organizations have the power to regularly appoint or elect at least a majority of the organization’s directors or trustees at all times during the tax year? If “No,” describe in Part VI how the supported organization(s) effectively operated, supervised, or controlled the organization’s activities. If the organization had more than one supported organization, describe how the powers to appoint and/or remove directors or trustees were allocated among the supported organizations and what conditions or restrictions, if any, applied to such powers during the tax year.

Did the organization operate for the benefit of any supported organization other than the supported organization(s) that operated, supervised, or controlled the supporting organization? If “Yes,” explain in Part VI how providing such benefit carried out the purposes of the supported organization(s) that operated, supervised or controlled the supporting organization.

Section C. Type II Supporting Organizations

Yes

Were a majority of the organization’s directors or trustees during the tax year also a majority of the directors or trustees of each of the organization’s supported organization(s)? If “No,” describe in Part VI how control or management of the supporting organization was vested in the same persons that controlled or managed the supported organization(s).

Section D. All Type III Supporting Organizations

Yes

Did the organization provide to each of its supported organizations, by the last day of the fifth month of the organization’s tax year, (i) a written notice describing the type and amount of support provided during the prior tax year, (ii) a copy of the Form 990 that was most recently filed as of the date of notification, and (iii) copies of the organization’s governing documents in effect on the date of notification, to the extent not previously provided?

Were any of the organization’s officers, directors, or trustees either (i) appointed or elected by the supported organization(s) or (ii) serving on the governing body of a supported organization? If "No," explain in Part VI how the organization maintained a close and continuous working relationship with the supported organization(s).

By reason of the relationship described in (2), did the organization’s supported organizations have a significant voice in the organization’s investment policies and in directing the use of the organization’s income or assets at all times during the tax year? If "Yes," describe in Part VI the role the organization’s supported organizations played in this regard.

Section E. Type III Functionally-Integrated Supporting Organizations

Check the box next to the method that the organization used to satisfy the Integral Part Test during the year (see instructions):

The organization satisfied the Activities Test. Complete line 2 below.

The organization is the parent of each of its supported organizations. Complete line 3 below.

The organization supported a governmental entity. Describe in Part VI how you supported a government entity (see instructions)

Activities Test. Answer (a) and (b) below.

Yes

Did substantially all of the organization’s activities during the tax year directly further the exempt purposes of the supported organization(s) to which the organization was responsive? If "Yes," then in Part VI identify those supported organizations and explain how these activities directly furthered their exempt purposes, how the organization was responsive to those supported organizations, and how the organization determined that these activities constituted substantially all of its activities.

Did the activities described in (a) constitute activities that, but for the organization’s involvement, one or more of the organization’s supported organization(s) would have been engaged in? If "Yes," explain in Part VI the reasons for the organization’s position that its supported organization(s) would have engaged in these activities but for the organization’s involvement.

Parent of Supported Organizations. Answer (a) and (b) below.

Did the organization have the power to regularly appoint or elect a majority of the officers, directors, or trustees of each of the supported organizations? Provide details in Part VI.

Did the organization exercise a substantial degree of direction over the policies, programs and activities of each of its supported organizations? If "Yes," describe in Part VI. the role played by the organization in this regard.

Schedule A (Form 990 or 990-EZ) 2019

Page 6

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations

Check here if the organization satisfied the Integral Part Test as a qualifying trust on Nov. 20, 1970 (explain in Part VI). See instructions. All other Type III non-functionally integrated supporting organizations must complete Sections A through E.

	Section A - Adjusted Net Income		(A) Prior Year	(B) Current Year (optional)
1	Net short-term capital gain	1
2	Recoveries of prior-year distributions	2
3	Other gross income (see instructions)	3
4	Add lines 1 through 3	4
5	Depreciation and depletion	5
6	Portion of operating expenses paid or incurred for production or collection of gross income or for management, conservation, or maintenance of property held for production of income (see instructions)	6
7	Other expenses (see instructions)	7
8	Adjusted Net Income (subtract lines 5, 6 and 7 from line 4)	8

	Section B - Minimum Asset Amount		(A) Prior Year	(B) Current Year (optional)
1	Aggregate fair market value of all non-exempt-use assets (see instructions for short tax year or assets held for part of year):	1
a	Average monthly value of securities	1a
b	Average monthly cash balances	1b
c	Fair market value of other non-exempt-use assets	1c
d	Total (add lines 1a, 1b, and 1c)	1d
e	Discount claimed for blockage or other factors (explain in detail in Part VI):
2	Acquisition indebtedness applicable to non-exempt use assets	2
3	Subtract line 2 from line 1d	3
4	Cash deemed held for exempt use. Enter 1-1/2% of line 3 (for greater amount, see instructions).	4
5	Net value of non-exempt-use assets (subtract line 4 from line 3)	5
6	Multiply line 5 by .035	6
7	Recoveries of prior-year distributions	7
8	Minimum Asset Amount (add line 7 to line 6)	8

	Section C - Distributable Amount		Current Year
1	Adjusted net income for prior year (from Section A, line 8, Column A)	1
2	Enter 85% of line 1	2
3	Minimum asset amount for prior year (from Section B, line 8, Column A)	3
4	Enter greater of line 2 or line 3	4
5	Income tax imposed in prior year	5
6	Distributable Amount. Subtract line 5 from line 4, unless subject to emergency temporary reduction (see instructions)	6

Check here if the current year is the organization's first as a non-functionally-integrated Type III supporting organization (see instructions)

Schedule A (Form 990 or 990-EZ) 2019

Page 7

Part V

Type III Non-Functionally Integrated 509(a)(3) Supporting Organizations(continued)

Section D - Distributions		Current Year
1 Amounts paid to supported organizations to accomplish exempt purposes
2 Amounts paid to perform activity that directly furthers exempt purposes of supported organizations, in excess of income from activity
3 Administrative expenses paid to accomplish exempt purposes of supported organizations
4 Amounts paid to acquire exempt-use assets
5 Qualified set-aside amounts (prior IRS approval required)
6 Other distributions (describe in Part VI). See instructions
7Total annual distributions. Add lines 1 through 6.
8 Distributions to attentive supported organizations to which the organization is responsive (provide details in Part VI). See instructions
9 Distributable amount for 2019 from Section C, line 6
10 Line 8 amount divided by Line 9 amount

Section E - Distribution Allocations (see instructions)		(i) Excess Distributions	(ii) Underdistributions Pre-2019	(iii) Distributable Amount for 2019
1 Distributable amount for 2019 from Section C, line 6
2 Underdistributions, if any, for years prior to 2019 (reasonable cause required-- explain in Part VI). See instructions.
3 Excess distributions carryover, if any, to 2019:
a From 2014.......
b From 2015.......
c From 2016.......
d From 2017.......
e From 2018.......
fTotal of lines 3a through e
g Applied to underdistributions of prior years
h Applied to 2019 distributable amount
i Carryover from 2014 not applied (see instructions)
j Remainder. Subtract lines 3g, 3h, and 3i from 3f.
4Distributions for 2019 from Section D, line 7:
$
a Applied to underdistributions of prior years
b Applied to 2019 distributable amount
c Remainder. Subtract lines 4a and 4b from 4.
5 Remaining underdistributions for years prior to 2019, if any. Subtract lines 3g and 4a from line 2. If the amount is greater than zero, explain in Part VI. See instructions.
6 Remaining underdistributions for 2019. Subtract lines 3h and 4b from line 1. If the amount is greater than zero, explain in Part VI. See instructions.
7 Excess distributions carryover to 2020. Add lines 3j and 4c.
8 Breakdown of line 7:
a Excess from 2015.....
b Excess from 2016.....
c Excess from 2017.....
d Excess from 2018.....
e Excess from 2019.....

Schedule A (Form 990 or 990-EZ) (2019)

Schedule A (Form 990 or 990-EZ) 2019

Page 8

Part VI

Supplemental Information. Provide the explanations required by Part II, line 10; Part II, line 17a or 17b; Part III, line 12; Part IV, Section A, lines 1, 2, 3b, 3c, 4b, 4c, 5a, 6, 9a, 9b, 9c, 11a, 11b, and 11c; Part IV, Section B, lines 1 and 2; Part IV, Section C, line 1; Part IV, Section D, lines 2 and 3; Part IV, Section E, lines 1c, 2a, 2b, 3a and 3b; Part V, line 1; Part V, Section B, line 1e; Part V Section D, lines 5, 6, and 8; and Part V, Section E, lines 2, 5, and 6. Also complete this part for any additional information. (See instructions).

Facts And Circumstances Test

Return Reference	Explanation

Schedule A (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

Schedule B
(Form 990, 990-EZ,
or 990-PF)

Department of the Treasury
Internal Revenue Service

Schedule of Contributors

Attach to Form 990, 990-EZ, or 990-PF.

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Name of the organization

Our Lady of Lourdes Memorial Hospital Inc

Employer identification number

15-0532221

Organization type (check one):

Filers of:

Section:

Form 990 or 990-EZ

501(c)( ) (enter number) organization

4947(a)(1) nonexempt charitable trust not treated as a private foundation

527 political organization

Form 990-PF

501(c)(3) exempt private foundation

4947(a)(1) nonexempt charitable trust treated as a private foundation

501(c)(3) taxable private foundation

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

For an organization filing Form 990, 990-EZ, or 990-PF that received, during the year, contributions totaling $5,000 or more (in money or other property) from any one contributor. Complete Parts I and II. See instructions for determining a contributor's total contributions.

Special Rules

For an organization described in section 501(c)(3) filing Form 990 or 990-EZ that met the 33¹/3% support test of the regulations
under sections 509(a)(1) and 170(b)(1)(A)(vi), that checked Schedule A (Form 990 or 990-EZ), Part II, line 13, 16a, or 16b, and that received from any one contributor, during the year, total contributions of the greater of (1) $5,000 or (2) 2% of the amount on (i) Form 990, Part VIII, line 1h, or (ii) Form 990-EZ, line 1. Complete Parts I and II.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, total contributions of more than $1,000 exclusively for religious, charitable, scientific, literary, or educational purposes, or for the prevention of cruelty to children or animals. Complete Parts I, II, and III.

For an organization described in section 501(c)(7), (8), or (10) filing Form 990 or 990-EZ that received from any one contributor,
during the year, contributions exclusively for religious, charitable, etc., purposes, but no such contributions totaled more than $1,000. If this box is checked, enter here the total contributions that were received during the year for an exclusively religious, charitable, etc., purpose. Don't complete any of the parts unless the General Rule applies to this organization because it received nonexclusively religious, charitable, etc., contributions totaling $5,000 or more during the year ......... Arrow Bullet

Caution: An organization that isn't covered by the General Rule and/or the Special Rules doesn't 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 its Form 990PF, Part I, line 2, to certify that it doesn't 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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019) Page 2

Name of organization Our Lady of Lourdes Memorial Hospital Inc

Part I Contributors	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
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
(a) No.	(b) Name, address, and ZIP + 4	(c) Total contributions	(d) Type of contribution
		$	Person Payroll Noncash (Complete Part II for noncash contributions.)
Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 3

Name of organization Our Lady of Lourdes Memorial Hospital Inc		Employer identification number 15-0532221

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) (2019)

Schedule B (Form 990, 990-EZ, or 990-PF) (2019)

Page 4


Name of organization Our Lady of Lourdes Memorial Hospital Inc			Employer identification number 15-0532221
Part III Exclusively religious, charitable, etc., contributions to organizations described in section 501(c)(7), (8), or (10) that total more than $1,000 for the year from any one contributor. 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.) $ Use duplicate copies of Part III if additional space is needed.

(a)
No. from Part I

(b) Purpose 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

(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

(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

(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) (2019)

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

If the organization answered "Yes" on 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" on 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" on Form 990, Part IV, Line 5 (Proxy Tax) (see separate instructions) or Form 990-EZ, Part V, line 35c (Proxy Tax) (see separate instructions), then
Round Bullet

Section 501(c)(4), (5), or (6) organizations: Complete Part III.

Name of the organization

Our Lady of Lourdes Memorial Hospital Inc

Employer identification number

15-0532221

Part I-A

Complete if the organization is exempt under section 501(c) or is a section 527 organization.

Provide a description of the organization’s direct and indirect political campaign activities in Part IV (see instructions for definition of “political campaign activities")

Political campaign activity expenditures (see instructions) .................................................................... SchCMd Bullet

Volunteer hours for political campaign activities (see instructions) ..................................................................

Part I-B

Complete if the organization is exempt under section 501(c)(3).

Enter the amount of any excise tax incurred by the organization under section 4955 ................................ SchCMd Bullet

Enter the amount of any excise tax incurred by organization managers under section 4955 ....................... SchCMd Bullet

If the organization incurred a section 4955 tax, did it file Form 4720 for this year? .........................................

Yes No

Was a correction made? ......................................................................................................................

Yes No

If "Yes," describe in Part IV.

Part I-C

Complete if the organization is exempt under section 501(c), except section 501(c)(3).

Enter the amount directly expended by the filing organization for section 527 exempt function activities ..... SchCMd Bullet

Enter the amount of the filing organization's funds contributed to other organizations for section 527 exempt function activities ............................................................................................................................ SchCMd Bullet

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

Did the filing organization file Form 1120-POL for this year? ...................................................................

Yes No

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-.
1
2
3
4
5
6

For Paperwork Reduction Act Notice, see the instructions for Form 990 or 990-EZ.

Cat. No. 50084S

Schedule C (Form 990 or 990-EZ) 2019

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 Bullet

if the filing organization belongs to an affiliated group (and list in Part IV each affiliated group member's name, address, EIN, expenses, and share of excess lobbying expenditures).
B Check SchCMd Bullet

if the filing organization checked box A and "limited control" provisions apply.

Limits on Lobbying Expenditures (The term "expenditures" means amounts paid or incurred.)		(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? ...................................................................................................................	Yes No

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 separate instructions for lines 2a through 2f.)
Lobbying Expenditures During 4-Year Averaging Period
	Calendar year (or fiscal year beginning in)	(a) 2016	(b) 2017	(c) 2018	(d) 2019	(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) 2019

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 on lines 1a through 1i below, provide in Part IV a detailed description of the lobbying activity.

(a)

Yes|No

(b)

Amount

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:

Volunteers? ...........................................................................................................

Paid staff or management (include compensation in expenses reported on lines 1c through 1i)? ........

Media advertisements? ...................................................................................................

Mailings to members, legislators, or the public? .............................................................................

Publications, or published or broadcast statements? ...........................................................

Grants to other organizations for lobbying purposes? ..........................................................

Direct contact with legislators, their staffs, government officials, or a legislative body? .......................

Rallies, demonstrations, seminars, conventions, speeches, lectures, or any similar means? ..................

Other activities? ...................................................................................................................

Yes

4,674

Total. Add lines 1c through 1i ....................................................................................................

4,674

Did the activities in line 1 cause the organization to be not described in section 501(c)(3)? .....

If "Yes," enter the amount of any tax incurred under section 4912 ...........................................

If "Yes," enter the amount of any tax incurred by organization managers under section 4912 ...................

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

Were substantially all (90% or more) dues received nondeductible by members? ...............................................

Did the organization make only in-house lobbying expenditures of $2,000 or less? ............................................

Did the organization agree to carry over lobbying and political expenditures from the prior year? .................................

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."

Dues, assessments and similar amounts from members ......................................................................

Section 162(e) nondeductible lobbying and political expenditures (do not include amounts of political expenses for which the section 527(f) tax was paid).

Current year .............................................................................................................................

Carryover from last year ............................................................................................................

Total ...........................................................................................................................................

Aggregate amount reported in section 6033(e)(1)(A) notices of nondeductible section 162(e) dues .

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? ......................................................................................................................

Taxable amount of lobbying and political expenditures (see instructions) .........................................

Part IV

Supplemental Information

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, lines 1 and 2 (see instructions), and Part ll-B, line 1. Also, complete this part for any additional information.

Return Reference	Explanation
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.
Schedule C, Part II-B, Line 1 DETAILED DESCRIPTION OF THE LOBBYING ACTIVITY	Lobbying expenses represent the portion of dues paid to national and state hospital associations that is specifically allocable to lobbying. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. does not participate in or intervene in (including the publishing or distributing of statements) any political campaign on behalf of (or in opposition to) any candidate for public office.

Schedule C (Form 990 or 990EZ) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

SCHEDULE D
(Form 990)

Department of the Treasury
Internal Revenue Service

Supplemental Financial Statements

Complete if the organization answered "Yes," on 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

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Our Lady of Lourdes Memorial Hospital Inc

Employer identification number

15-0532221

Part I

Organizations Maintaining Donor Advised Funds or Other Similar Funds or Accounts. Complete if the organization answered "Yes" on Form 990, Part IV, line 6.

		(a) Donor advised funds	(b) Funds and other accounts
1	Total number at end of year .........
2	Aggregate value of contributions to (during year)
3	Aggregate value of grants from (during year)
4	Aggregate value at end of year ........

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? ............

Yes No

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? ...................................

Yes No

Part II

Conservation Easements.
Complete if the organization answered "Yes" on Form 990, Part IV, line 7.

Purpose(s) of conservation easements held by the organization (check all that apply).

Preservation of land for public use (e.g., recreation or education) Preservation of an historically important land area

Protection of natural habitat Preservation of a certified historic structure

Preservation of open space

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.


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 7/25/06, and not on a historic structure listed in the National Register ...	2d

Number of conservation easements modified, transferred, released, extinguished, or terminated by the organization during the
tax year SchDMd Bullet

Number of states where property subject to conservation easement is located SchDMd Bullet

Does the organization have a written policy regarding the periodic monitoring, inspection, handling of violations, and enforcement of the conservation easements it holds? ............

Yes No

Staff and volunteer hours devoted to monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

Amount of expenses incurred in monitoring, inspecting, handling of violations, and enforcing conservation easements during the year
SchDMd Bullet

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)? .............................

Yes No

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" on Form 990, Part IV, line 8.

If the organization elected, as permitted under FASB 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.

If the organization elected, as permitted under FASB 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)

Revenue included on Form 990, Part VIII, line 1 ......................... SchDMd Bullet

(ii)

Assets included in Form 990, Part X ............................... SchDMd Bullet

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 FASB ASC 958 relating to these items:

Revenue included on Form 990, Part VIII, line 1 .......................... SchDMd Bullet

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) 2019

Page 2

Part III

Organizations Maintaining Collections of Art, Historical Treasures, or Other Similar Assets (continued)

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):

Public exhibition

Loan or exchange programs

Scholarly research

Other

Preservation for future generations

Provide a description of the organization’s collections and explain how they further the organization’s exempt purpose in
Part XIII.

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?...

Yes No

Part IV

Escrow and Custodial Arrangements. Complete if the organization answered "Yes" on Form 990, Part IV, line 9, or reported an amount on Form 990, Part X, line 21.

Is the organization an agent, trustee, custodian or other intermediary for contributions or other assets not
included on Form 990, Part X? ....................................

Yes No


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

Did the organization include an amount on Form 990, Part X, line 21, for escrow or custodial account liability? ...

Yes No

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" on Form 990, Part IV, line 10.

		(a) Current year	(b) Prior year	(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 ......

Provide the estimated percentage of the current year end balance (line 1g, column (a)) held as:

Board designated or quasi-endowment SchDMd Bullet

Permanent endowment SchDMd Bullet

Term endowment SchDMd Bullet

The percentages on lines 2a, 2b, and 2c should equal 100%.

Are there endowment funds not in the possession of the organization that are held and administered for the
organization by:

Yes

(i) Unrelated organizations .................

3a(i)

(ii) Related organizations .................

3a(ii)

If "Yes" on 3a(ii), are the related organizations listed as required on Schedule R? .........

Describe in Part XIII the intended uses of the organization's endowment funds.

Part VI

Land, Buildings, and Equipment.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11a. 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 .....	544,659		544,659
b	Buildings ....	139,798,535	71,931,725	67,866,810
c	Leasehold improvements	3,035,189	1,912,091	1,123,098
d	Equipment ....	59,388,853	37,896,730	21,492,123
e	Other .....	16,187,054	3,037,809	13,149,245
Total. Add lines 1a through 1e. (Column (d) must equal Form 990, Part X, column (B), line 10(c).)..				104,175,935

Schedule D (Form 990) 2019

Page 3

Part VII

InvestmentsOther Securities.
Complete if the organization answered "Yes" on Form 990, Part IV, line 11b. 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.........
(2) Closely-held equity interests........
(3)Other
(B)
(C)
(D)
(E)
(F)
(G)
(H)
(I)
Total. (Column (b) must equal Form 990, Part X, col. (B) line 12.)

Part VIII

InvestmentsProgram Related. Complete if the organization answered 'Yes' on Form 990, Part IV, line 11c. See Form 990, Part X, line 13.

(a) Description of investment	(b) Book value	(c) Method of valuation: Cost or end-of-year market value

(2)
(3)
(4)
(5)
(6)
(7)
(8)
(9)
(10)
Total. (Column (b) must equal Form 990, Part X, col.(B) line 13.)

Part IX

Other Assets.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11d. See Form 990, Part X, line 15.

(a) Description				(b) Book value
(1)Other Assets
(2)Other Current Assets				139,614
(3)Due from Affiliates				5,931,271
(4)Other Receivables				6,145,776
(5)Deferred Compensation/Retirement/Pension Asset				14,545,217
(6)Physician Guarantee Asset				492,500
(7)Security Deposit				20,450
(8)Beneficial Interest in Foundation				25,174,505
(9)Estimated 3rd Party Payor Settlements				2,472,478
(10)Interest in Investments Held by Ascension Health Alliance				178,526,598
(11)Cash Surrender Value of Life Insurance				141,433
Total. (Column (b) must equal Form 990, Part X, col.(B) line 15.)...........				233,589,842

Part X

Other Liabilities.
Complete if the organization answered 'Yes' on Form 990, Part IV, line 11e or 11f. See Form 990, Part X, line 25.

1.(a) Description of liability	(b) Book value
(1) Federal income taxes	0
Total. (Column (b) must equal Form 990, Part X, col.(B) line 25.)	117,084,289
2. Liability for uncertain tax positions. 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) 2019

Page 4

Part XI Reconciliation of Revenue per Audited Financial Statements With Revenue per Return. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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 (losses) 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. Complete if the organization answered 'Yes' on Form 990, Part IV, line 12a.
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

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.

Return Reference	Explanation
Schedule D, Part X, Line 2 FIN 48 (ASC 740) footnote	THE SYSTEM ACCOUNTS FOR UNCERTAINTY IN INCOME TAX POSITIONS BY APPLYING A RECOGNITION THRESHOLD AND MEASUREMENT ATTRIBUTE FOR FINANCIAL STATEMENT RECOGNITION AND MEASUREMENT OF A TAX POSITION TAKEN OR EXPECTED TO BE TAKEN IN A TAX RETURN. THE SYSTEM HAS DETERMINED THAT NO MATERIAL UNRECOGNIZED TAX BENEFITS OR LIABILITIES EXIST AS OF JUNE 30, 2018.

Schedule D (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

SCHEDULE H
(Form 990)

Department of the Treasury
Internal Revenue Service

Hospitals

Complete if the organization answered "Yes" on Form 990, Part IV, question 20.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990EZ for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Our Lady of Lourdes Memorial Hospital Inc

Employer identification number

15-0532221

Part I

Financial Assistance and Certain Other Community Benefits at Cost

Yes

Did the organization have a financial assistance policy during the tax year? If "No," skip to question 6a . . . .

Yes

If "Yes," was it a written policy? ......................

Yes

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.

Applied uniformly to all hospital facilities Applied uniformly to most hospital facilities Generally tailored to individual hospital facilities

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.

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:

Yes

100% 150% 200% Other 25000 %

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: . . . . . . . .

Yes

200% 250% 300% 350% 400% Other %

If the organization used factors other than FPG in determining eligibility, describe in Part VI the criteria used 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.

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"? . . . . . . . . . . . . .

Yes

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

Yes

If "Yes," did the organization's financial assistance expenses exceed the budgeted amount? . . . . . .

Yes

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? . . . . . . . . . . . . .

Did the organization prepare a community benefit report during the tax year? . . . . . . . . .

Yes

If "Yes," did the organization make it available to the public? . . . . . . . . . . . . .

Yes

Complete the following table using the worksheets provided in the Schedule H instructions. Do not submit these worksheets with the Schedule H.

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) . . .			5,070,925		5,070,925	1.38 %
b	Medicaid (from Worksheet 3, column a) . . . . .			60,388,633	34,890,844	25,497,789	6.93 %
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	0	65,459,558	34,890,844	30,568,714	8.30 %
Other Benefits
e	Community health improvement services and community benefit operations (from Worksheet 4).			2,447,397		2,447,397	0.66 %
f	Health professions education (from Worksheet 5) . . .			3,794,541		3,794,541	1.03 %
g	Subsidized health services (from Worksheet 6) . . . .			48,478,709	28,480,702	19,998,007	5.43 %
h	Research (from Worksheet 7) .					0	0 %
i	Cash and in-kind contributions for community benefit (from Worksheet 8) . . . .			875		875	0 %
j	Total. Other Benefits . .	0	0	54,721,522	28,480,702	26,240,820	7.13 %
k	Total. Add lines 7d and 7j .	0	0	120,181,080	63,371,546	56,809,534	15.43 %

For Paperwork Reduction Act Notice, see the Instructions for Form 990. Cat. No. 50192T Schedule H (Form 990) 2019

Schedule H (Form 990) 2019

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
1	Physical improvements and housing					0
2	Economic development					0
3	Community support					0
4	Environmental improvements					0
5	Leadership development and training for community members					0
6	Coalition building			1,326		1,326
7	Community health improvement advocacy					0
8	Workforce development					0
9	Other					0
10	Total	0	0	1,326	0	1,326

Part III

Bad Debt, Medicare, & Collection Practices

Section A. Bad Debt Expense

Yes

Did the organization report bad debt expense in accordance with Healthcare Financial Management Association Statement No. 15? ..........................

Enter the amount of the organization's bad debt expense. Explain in Part VI the methodology used by the organization to estimate this amount. ......

4,238,580

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. ......

907,934

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

Enter total revenue received from Medicare (including DSH and IME).....

-199,630,925

Enter Medicare allowable costs of care relating to payments on line 5.....

-179,355,123

Subtract line 6 from line 5. This is the surplus (or shortfall)........

-20,275,802

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:

Cost accounting system Cost to charge ratio Other

Section C. Collection Practices

Did the organization have a written debt collection policy during the tax year? ..........

Yes

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 .........................

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 %
1
2
3
4
5
6
7
8
9
10
11
12
13

Schedule H (Form 990) 2019

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?1Name, address, primary website address, and state license number (and if a group return, the name and EIN of the subordinate hospital organization that operates the hospital facility)
1	Our Lady of Lourdes Memorial Hospital Inc 169 Riverside Drive Binghamton,NY13905 www.lourdes.com 03011001H	X	X	X	X

Schedule H (Form 990) 2019

Page 4

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)

	Our Lady of Lourdes Memorial Hospital Inc
Name of hospital facility or letter of facility reporting group

Line number of hospital facility, or line numbers of hospital facilities in a facility
reporting group (from Part V, Section A):

Yes

Community Health Needs Assessment

Was the hospital facility first licensed, registered, or similarly recognized by a state as a hospital facility in the current tax year or the immediately preceding tax year?........................

Was the hospital facility acquired or placed into service as a tax-exempt hospital in the current tax year or the immediately preceding tax year? If “Yes,” provide details of the acquisition in Section C...............

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 12......................

Yes

If "Yes," indicate what the CHNA report describes (check all that apply):

A definition of the community served by the hospital facility

Demographics of the community

Existing health care facilities and resources within the community that are available to respond to the health needs of the community

How data was obtained

The significant health needs of the community

Primary and chronic disease needs and other health issues of uninsured persons, low-income persons, and minority groups

The process for identifying and prioritizing community health needs and services to meet the community health needs

The process for consulting with persons representing the community’s interests

The impact of any actions taken to address the significant health needs identified in the hospital facility's prior CHNA(s)

Other (describe in Section C)

Indicate the tax year the hospital facility last conducted a CHNA: 20 15

In conducting its most recent CHNA, did the hospital facility take into account input from persons who represent the broad interests of the community served by the hospital facility, including those with special knowledge of or expertise in public health? If "Yes," describe in Section C how the hospital facility took into account input from persons who represent the community, and identify the persons the hospital facility consulted .................

Yes

6 a

Was the hospital facility’s CHNA conducted with one or more other hospital facilities? If "Yes," list the other hospital facilities in Section C..................................

Yes

Was the hospital facility’s CHNA conducted with one or more organizations other than hospital facilities?” If “Yes,” list the other organizations in Section C. ............................

Yes

Did the hospital facility make its CHNA report widely available to the public?..............

Yes

If "Yes," indicate how the CHNA report was made widely available (check all that apply):

Hospital facility’s website (list url): https://www.lourdes.com/about-us/community-service-plan/

Other website (list url):

Made a paper copy available for public inspection without charge at the hospital facility

Other (describe in Section C)

Did the hospital facility adopt an implementation strategy to meet the significant community health needs
identified through its most recently conducted CHNA? If "No," skip to line 11. ..............

Yes

Indicate the tax year the hospital facility last adopted an implementation strategy: 20 15

Is the hospital facility's most recently adopted implementation strategy posted on a website?.........

Yes

If "Yes" (list url): https://www.lourdes.com/about-us/community-service-plan/

If "No," is the hospital facility’s most recently adopted implementation strategy attached to this return? ......

10b

Describe in Section C how the hospital facility is addressing the significant needs identified in its most recently conducted CHNA and any such needs that are not being addressed together with the reasons why such needs are not being addressed.

12a

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)?...............................

12a

If "Yes" on line 12a, did the organization file Form 4720 to report the section 4959 excise tax?........

12b

If "Yes" on line 12b, 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) 2019

Page 5

Part VFacility Information (continued)

Financial Assistance Policy (FAP)

	Our Lady of Lourdes Memorial Hospital Inc
Name of hospital facility or letter of facility reporting group

Yes

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 included free or discounted care?

Yes

If “Yes,” indicate the eligibility criteria explained in the FAP:

Federal poverty guidelines (FPG), with FPG family income limit for eligibility for free care of 250.0%
and FPG family income limit for eligibility for discounted care of 400.0%

Income level other than FPG (describe in Section C)

Asset level

Medical indigency

Insurance status

Underinsurance discount

Residency

Other (describe in Section C)

Explained the basis for calculating amounts charged to patients?.................

Yes

Explained the method for applying for financial assistance?...................

Yes

If “Yes,” indicate how the hospital facility’s FAP or FAP application form (including accompanying instructions) explained the method for applying for financial assistance (check all that apply):

Described the information the hospital facility may require an individual to provide as part of his or her application

Described the supporting documentation the hospital facility may require an individual to submit as part of his or
her application

Provided the contact information of hospital facility staff who can provide an individual with information about the
FAP and FAP application process

Provided the contact information of nonprofit organizations or government agencies that may be sources of
assistance with FAP applications

Other (describe in Section C)

Was widely publicized within the community served by the hospital facility?........

Yes

If "Yes," indicate how the hospital facility publicized the policy (check all that apply):

The FAP was widely available on a website (list url):

https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/

The FAP application form was widely available on a website (list url):

https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/

A plain language summary of the FAP was widely available on a website (list url):
https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/

The FAP was available upon request and without charge (in public locations in the hospital facility and by mail)

The FAP application form was available upon request and without charge (in public locations in the hospital facility
and by mail)

A plain language summary of the FAP was available upon request and without charge (in public locations in the
hospital facility and by mail)

Individuals were notified about the FAP by being offered a paper copy of the plain language summary of the FAP, by
receiving a conspicuous written notice about the FAP on their billing statements, and via conspicuous public displays or
other measures reasonably calculated to attract patients' attention

Notified members of the community who are most likely to require financial assistance about availability of the FAP

The FAP, FAP application form, and plain language summary of the FAP were translated into the primary language(s)
spoken by LEP populations

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 6

Part VFacility Information (continued)

Billing and Collections

	Our Lady of Lourdes Memorial Hospital Inc
Name of hospital facility or letter of facility reporting group

Yes

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 all of the actions the hospital facility or other authorized party may take upon nonpayment?..................................

Yes

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 individual’s eligibility under the facility’s FAP:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring, denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

None of these actions or other similar actions were permitted

Did the hospital facility or other authorized party perform any of the following actions during the tax year before making reasonable efforts to determine the individual’s eligibility under the facility’s FAP?............

If "Yes," check all actions in which the hospital facility or a third party engaged:

Reporting to credit agency(ies)

Selling an individual’s debt to another party

Deferring , denying, or requiring a payment before providing medically necessary care due to nonpayment of a previous
bill for care covered under the hospital facility's FAP

Actions that require a legal or judicial process

Other similar actions (describe in Section C)

Indicate which efforts the hospital facility or other authorized party made before initiating any of the actions listed (whether or not checked) in line 19. (check all that apply):

Provided a written notice about upcoming ECAs (Extraordinary Collection Action) and a plain language summary of the
FAP at least 30 days before initiating those ECAs (if not, describe in Section C)

Made a reasonable effort to orally notify individuals about the FAP and FAP application process (if not, describe in
Section C)

Processed incomplete and complete FAP applications (if not, describe in Section C)

Made presumptive eligibility determinations (if not, describe in Section C)

Other (describe in Section C)

None of these efforts were made

Policy Relating to Emergency Medical Care

Did the hospital facility have in place during the tax year a written policy relating to emergency medical care that required 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?..................

Yes

If "No," indicate why:

The hospital facility did not provide care for any emergency medical conditions

The hospital facility’s policy was not in writing

The hospital facility limited who was eligible to receive care for emergency medical conditions (describe in Section C)

Other (describe in Section C)

Schedule H (Form 990) 2019

Page 7

Part VFacility Information (continued)

Charges to Individuals Eligible for Assistance Under the FAP (FAP-Eligible Individuals)

	Our Lady of Lourdes Memorial Hospital Inc
Name of hospital facility or letter of facility reporting group

Yes

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.

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month period

The hospital facility used a look-back method based on claims allowed by Medicaid, either alone or in combination with
Medicare fee-for-service and all private health insurers that pay claims to the hospital facility during a prior 12-month
period

The hospital facility used a prospective Medicare or Medicaid method

During the tax year, did the hospital facility charge any FAP-eligible individual 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? ...............................

If "Yes," explain in Section C.

During the tax year, did the hospital facility charge any FAP-eligible individual an amount equal to the gross charge for any service provided to that individual? ...........................

If "Yes," explain in Section C.

Schedule H (Form 990) 2019

Page 8

Part V

Facility Information (continued)

Section C. Supplemental Information for Part V, Section B. Provide descriptions required for Part V, Section B, lines 2, 3j, 5, 6a, 6b, 7d, 11, 13b, 13h, 15e, 16j, 18e, 19e, 20a, 20b, 20c, 20d, 20e, 21c, 21d, 23, and 24. If applicable, provide separate descriptions for each hospital facility in a facility reporting group, designated by facility reporting group letter and hospital facility line number from Part V, Section A (“A, 1,” “A, 4,” “B, 2,” “B, 3,” etc.) and name of hospital facility.
Form and Line Reference	Explanation
Schedule H, Part V, Section B, Line 3E	To better target community resources on the service area's most pressing health needs, the hospital participated in a group discussion with organizational decision makers and community leaders to prioritize the significant community health needs while considering several criteria: alignment with Ascension Health strategies of healthcare that leaves no one behind; care for the poor and vulnerable; opportunities for partnership; availability of existing programs and resources; opportunities for partnership; addressing disparities of subgroups; availability of evidence-based practices; and community input. The significant health needs are a prioritized description of the significant health needs of the community as identified through the CHNA. See Schedule H, Part V, Line 7 for the link to the CHNA and Schedule H, Part V, Line 11 for how those needs are being addressed.
Schedule H, Part V, Section B, Line 5 Facility , 1	Facility , 1 - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. ELICITED INPUT OF REPRESENTATIVES WITH SPECIAL KNOWLEDGE OF PUBLIC HEALTH BY ENGAGING PERSONS WHO REPRESENT THE COMMUNITY SERVED BY LOURDES AND THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH WERE INCLUDED IN THE EVALUATION OF COMMUNITY HEALTH NEEDS, IDENTIFICATION OF HEALTH PRIORITIES AND GOALS AND OBJECTIVES OF THE IMPLEMENTATION STRATEGY. THE PUBLIC PARTICIPATED IN THE DEVELOPMENT OF THE COMMUNITY HEALTH NEEDS ASSESSMENT AND COMMUNITY HEALTH IMPROVEMENT PLAN/IMPLEMENTATION STRATEGY THROUGH INTERVIEWS, SURVEYS, INTERACTIVE PRESENTATIONS AND COMMUNITY MEETINGS. Identification of community health status themes, September 2015- May 2016. 2. Community health status prioritization, May-July 2016. 3. Development of Community Health Improvement Plan, July-August 2016; 4. Lourdes Board of Directors approval, September 2016. 5. Submission of CHNA/CHIP to the New York State Department of Health, December 30, 2016.
Schedule H, Part V, Section B, Line 6a Facility , 1	Facility , 1 - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. UHS HOSPITAL
Schedule H, Part V, Section B, Line 6b Facility , 1	Facility , 1 - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. RMS HEALTHCARE
Schedule H, Part V, Section B, Line 11 Facility , 1	Facility , 1 - Our Lady of Lourdes Memorial Hospital, INc.. Our Lady of Lourdes Memorial Hospital, Inc. (Lourdes) identified several needs needs during the Community Health Needs Assessment for the 2016-2018 period. The following is a listing of the needs that Lourdes is addressing and how they are being addressed. Behavioral Health (Mental Health & Substance Abuse): Goal: lower barriers to mental health and substance use services Ways Addressed in FY 2018: - Our Lady of Lourdes Memorial Hospital, INc. YOUTH SERVICES PROVIDED SERVICES TO AT-RISK ADOLESCENTS THROUGH TWO PROGRAMS: 1) THE LOURDES MENTAL HEALTH JUVENILE JUSTICE (MHJJ) PROJECT WORKED SUCCESSFULLY TO KEEP 100% (52 TOTAL PARTICIPANTS, AN INCREASE IN PARTICIPATION OVER FY2017) OF THE YOUTH SERVED OUT OF DETENTION AND OUT OF HOME PLACEMENT. 2) THE DETENTION ALTERNATIVE AFTER SCHOOL PROGRAM (DAASP) KEPT 100% OF THE YOUTH SERVED OUT OF PLACEMENT (32 TOTAL PARTICIPANTS). - Our Lady of Lourdes Memorial Hospital, INc. CONTINUED TO OFFER SUICIDE INTERVENTION TRAINING PROGRAMS; LEAD A Our Lady of Lourdes Memorial Hospital, INc. SPECIFIC SUBSTANCE ABUSE AND MENTAL HEALTH TASK FORCE; SERVED OVER 14,500 PEOPLE THROUGH ITS STUDENT ASSISTANCE PROGRAM (SAP) AND ALCOHOL & DRUG EDUCATION PREVENTION TEAM (ADEPT); ADMINISTERED SUICIDE PREVENTION SCREENING; PROVIDED INPATIENT AND EMERGENCY DEPARTMENT SCREENING FOR ALCOHOL AND SUBSTANCE ABUSE. Obesity Prevention, Wellness & Chronic Disease Goal: lower barriers to healthy life style choices Ways Addressed in FY 2018: - DIABETES PREVENTION AND EDUCATION: Our Lady of Lourdes Memorial Hospital, INc. IS CARRYING OUT A DIABETES PREVENTION PROJECT AND IS COLLABORATING WITH 95% OF Our Lady of Lourdes Memorial Hospital, INc. PRIMARY CARE PROVIDERS TO IDENTIFY AND INTERVENE ON INDIVIDUALS IDENTIFIED AS PRE-DIABETICS. THE PROJECT AIMS TO DELAY OR AVOID THE PROGRESSION TO TYPE 2 DIABETES IN AN AT-RISK POPULATION. AT THE CLOSE OF 2018, THERE WERE 900 INDIVIDUALS ENROLLED IN THE PROJECT. -Our Lady of Lourdes Memorial Hospital, INc. OFFERS THE CDC'S NATIONAL DIABETES PREVENTION PROGRAM ON CAMPUS. 19 INIDIVIDUALS REGULARLY ATTEND CLASSES IN THE YEAR LONG PROGRAM (AN INCREASE FROM FY2017. - Our Lady of Lourdes Memorial Hospital, INc. ASSOCIATE HEALTH OFFERS DIABETES RISK ASSESSMENTS WITH ANNUAL PHYSICALS. - FIT AND FUN MEALS WERE PROVIDED AT THE Our Lady of Lourdes Memorial Hospital, INc. ALL SPICE CAFE - SUPPORTING A HEALTHY START FOR NEWBORNS, PATIENTS ARE ENCOURAGED TO BREAST FEED Socioeconomic Poor & Vulnerable Goal: Focus on the poor and vulnerable with special attention to those enrolled in the Medicaid program. Ways Addressed in FY 2018: - Our Lady of Lourdes Memorial Hospital, INc. CONTINUES TO PARTICIPATE IN A FEDERAL DRUG DISCOUNT PROGRAM CALLED 340B, WHICH HELPS HOSPITALS TO SERVE THE MEDICATION NEEDS OF RURAL COMMUNITIES; UNDER THE PROGRAM HOSPITALS RECEIVE PHARMACEUTICALS AT DISCOUNTED PRICES FROM DRUG COMPANIES. - Our Lady of Lourdes Memorial Hospital, INc. CONTINUES TO OFFER THE PATIENT FINANCIAL ASSISTANCE PROGRAM (PFAP) TO PATIENTS WHO MEET CERTAIN INCOME GUIDELINES THAT MAY HAVE DIFFICUTLY COVERING THEIR COPAYS, DEDUCTIBILES AND/OR OTHER MEDICAL-RELATED EXPENSES. - The Mission in Motion mobile mammography van provides no charge screening to those in need Our Lady of Lourdes Memorial Hospital, INc. recognizes that no one organization can address the entire health care needs of the community. Our Lady of Lourdes Memorial Hospital, INc. is conscious of its stewardship of resources to best meet the needs of our community. As such, Our Lady of Lourdes Memorial Hospital, INc. will focus resources in those areas in which Our Lady of Lourdes Memorial Hospital, INc. can impact community health most. Our Lady of Lourdes Memorial Hospital, INc. practice is to maximize resources with existing programs, new services planned, to avoid duplication of services, and to establish metrics and tools which foster continuous improvement. For those reasons, the needs identified that will not be addressed are: - Improve Health Status and Health Disparities - Promote a Health and Safe Environment - Preventing Chronic Disease - Promoting Healthy Women, Infants, and Children
Schedule H, Part V, Section B, Line 13 Facility , 1	Facility , 1 - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.. OUR LADY OF LOURDES MEMORIAL HOSPITAL USED THE FOLLOWING ADDITIONAL CRITERIA TO DETERMINE ELIGIBILITY FOR FREE DISCOUNTED CARE: - MEDICAID/MEDICARE - STATE REGULATIONS

Schedule H (Form 990) 2019

Page 9

Part VFacility Information (continued)

Section D. 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?18
Name and address		Type of Facility (describe)
1	Center for Family Health 303 Main Street Binghamton,NY13905	Primary Care Office
2	Lourdes Pediatrics 161 Riverside Drive Suite 206 Binghamton,NY13905	Primary Care Office
3	Lourdes at Home 4102 Old Vestal Road Vestal,NY13850	Home Care
4	Internal Medicine 3101 Shippers Road Suite 202 Vestal,NY13850	Primary Care Office
5	Primary Care Associates 276-280 Robinson Street Binghamton,NY13904	Primary Care Office
6	Primary Care Associates 415 East Main Street Endicott,NY13760	Primary Care Office
7	Riverside Surgical 169 Riverside Drive Binghamton,NY13905	Primary Care Office
8	Hospice at Lourdes 4102 Old Vestal Road Vestal,NY13850	End of Life Care
9	Family Medicine 3101 Shippers Road Suite 203 Vestal,NY13850	Primary Care Office
10	Riverside Medical 161 Riverside Drive Suite 306 Binghamton,NY13905	Primary Care Office
11	Lourdes Family Practice 500 5th Avenue Owego,NY13827	Primary Care Office
12	Lourdes Gastroenterology 161 Riverside Drive Suite 210 Binghamton,NY13905	Primary Care Office
13	Lourdes Family Practice 1130 Upper Front Street Binghamton,NY13901	Primary Care Office
14	Lourdes Vascular Surgery 161 Riverside Drive Suite 105 Binghamton,NY13905	Primary Care Office
15	Lourdes Dermatology 3101 Shippers Road Suite 102 Binghamton,NY13850	Primary Care Office
16	Lourdes Family Practice 2660 Main Street Whitney Point,NY13862	Primary Care Office
17	Lourdes Family Practice 39 East Main Street Hancock,NY13783	Primary Care Office
18	North Tioga Center for Family Health 13293 Route 38 Richford,NY13835	Primary Care Office

Schedule H (Form 990) 2019

Page 10

Part VI

Supplemental Information

Provide the following information.

1	Required descriptions. Provide the descriptions required for Part I, lines 3c, 6a, and 7; Part II and Part III, lines 2, 3, 4, 8 and 9b.
2	Needs assessment. Describe how the organization assesses the health care needs of the communities it serves, in addition to any CHNAs 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.

Form and Line Reference	Explanation
Schedule H, Part I, Line 7g Subsidized Health Services	THE ORGANIZATION HAD NO COSTS ATTRIBUTABLE TO PHYSICIAN CLINICS.
Schedule H, Part I, Line 7 Costing Methodology used to calculate financial assistance	The cost of providing charity care, means-tested government programs, and other community benefit programs is estimated using internal cost data, and is calculated in compliance with Catholic Health Association ("CHA") guidelines. The organization uses a cost accounting system that addresses all patient segments (for example, inpatient, outpatient, emergency room, private insurance, Medicaid, Medicare, uninsured, or self pay). The best available data was used to calculate the amounts reported in the table. For the information in the table, a cost-to-charge ratio was calculated and applied.
Schedule H, Part II Community Building Activities	RESEARCH SHOWS THAT SOCIAL DETERMINANTS AND QUALITY OF LIFE PLAY A MAJOR ROLE IN THE HEALTH STATUS OF INDIVIDUALS AND COMMUNITIES. COMMUNITY BUILDING ACTIVITIES, WHICH FOCUS ON IMPROVING THE QUALITY OF LIFE WITHIN A COMMUNITY, ULTIMATELY INFLUENCE AND IMPROVE HEALTH STATUS.
Schedule H, Part III, Line 2 Bad debt expense - methodology used to estimate amount	After satisfaction of amounts due from insurance and reasonable efforts to collect from the patient have been exhausted, the Corporation follows established guidelines for placing certain past-due patient balances within collection agencies, subject to the terms of certain restrictions on collection efforts as determined by Ascension Health. Accounts receivable are written off after collection efforts have been followed in accordance with the Corporation's policies. After applying the cost-to-charge ratio, the share of the bad debt expense in fiscal year 2018 was $12,110,228 at charges, ($4,238,580 at cost).
Schedule H, Part III, Line 3 Bad Debt Expense Methodology	The provision for doubtful accounts is based upon management's assessment of expected net collections considering historical experience, economic conditions, trends in healthcare coverage, and other collection indicators. Periodically throughout the year, management assesses the adequacy of the allowance for doubtful accounts based upon historical write-off experience by payor category, including those amounts not covered by insurance. The results of this review are then used to make any modifications to the provision for doubtful accounts to establish an appropriate allowance for doubtful accounts.
Schedule H, Part III, Line 4 Bad debt expense - financial statement footnote	The organization is part of the Ascension Health Alliance's consolidated audit in which the footnote that discusses the bad debt expense is located on page 21.
Schedule H, Part III, Line 8 Community benefit & methodology for determining medicare costs	A cost to charge ratio is applied to the organization's Medicare Expense to determine the Medicare allowable costs reported in the organization's Medicare Cost Report. Ascension Health and its related health ministries follow the Catholic Health Association (CHA) guidelines for determining community benefit. CHA community benefit reporting guidelines suggest that Medicare shortfall is not treated as community benefit.
Schedule H, Part III, Line 9b Collection practices for patients eligible for financial assistance	OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. FOLLOWS THE ASCENSION GUIDELINES FOR COLLECTION PRACTICES RELATED TO PATIENTS QUALIFYING FOR CHARITY OR FINANCIAL ASSISTANCE. A PATIENT CAN APPLY FOR CHARITY OR FINANCIAL ASSISTANCE AT ANY TIME DURING THE COLLECTION CYCLE. ONCE QUALIFYING DOCUMENTATION IS RECEIVED THE PATIENT'S ACCOUNT IS ADJUSTED. PATIENT ACCOUNTS FOR THE QUALIFYING PATIENT IN THE PREVIOUS SIX MONTHS MAY ALSO BE CONSIDERED FOR CHARITY OR FINANCIAL ASSISTANCE. ONCE A PATIENT QUALIFIES FOR CHARITY OR FINANCIAL ASSISTANCE, ALL COLLECTION ACTIVITY IS SUSPENDED.
Schedule H, Part V, Section B, Line 16a FAP website	- Our Lady of Lourdes Memorial Hospital, Inc.: Line 16a URL: https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/;
Schedule H, Part V, Section B, Line 16b FAP Application website	- Our Lady of Lourdes Memorial Hospital, Inc.: Line 16b URL: https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/;
Schedule H, Part V, Section B, Line 16c FAP plain language summary website	- Our Lady of Lourdes Memorial Hospital, Inc.: Line 16c URL: https://www.lourdes.com/patient-guide/billing/financial-assistance/pfap/;
Schedule H, Part VI, Line 2 Needs assessment	OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. recognizes that Public Participation is an important aspect of the Community Health Needs Assessment (CHNA). The Broome County Community Health Needs Assessment is the result of collaboration and the basis for the Public Health Priorities framing OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC.'s CHNA. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. provides an update to the community on the implementation strategies in the CHNA annually in the Community Service Plan (CSP). WHILE MAINTAINING OUR PROGRESS TOWARDS ADDRESSING THE HEALTHCARE ISSUES IN OUR TARGET AREAS THAT WERE IDENTIFIED IN THE PREVIOUS COMMUNITY HEALTH NEEDS ASSESSMENT (2016-2018) AND WHOSE PROGRESS IS COMMUNICATED IN THE MOST RECENT CSP, WE UNDERSTAND THE DYNAMIC NATURE OF OUR HEALTHCARE LANDSCAPE WE OPERATE IN. IN THAT RESPECT, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. IS CURRENTLY ENGAGED IN CONDUCTING A NEW AND UPDATED COMMUNITY HEALTH NEEDS ASSESSMENT, TO DETERMINE WHETHER THE ISSUES STATED IN THE PREVIOUS CHNA REMAIN HIGH-PRIORITY NEEDS IN THE COMMUNITIES WE SERVE-OR IF NEWER, MORE CRITICAL CHALLENGES HAVE EMERGED. THIS WORK WILL RESULT IN AN UPDATED COMMUNITY HEALTH IMPROVEMENT PLAN (CHIP) THAT WILL GUIDE OUR ONGOING EFFORTS TO REMOVE BARRIERS TO CARE AND IMPROVE HEALTH OUTCOMES IN OUR POPULATION, OVER THE NEXT THREE (3) YEARS (BEGINNING IN 2019). This comprehensive plan reflects extensive communication and interaction with stakeholders from many sectors, to identify and prioritize unmet community needs and strategies for addressing them. As recommended by the New York State Department of Health, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. was involved in the Community Health Needs Assessment and planning process of the local health department (Broome County), Outreach to health and human service organizations, consumers, community groups and facility advisory boards were accomplished in collaboration with the Broome County Health Department Community Health Assessment Steering Committee. This collective collaboration enabled the community to have more public participation in identifying community need than could have been accomplished independently by OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Additionally, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. provided input to the Tioga County Health Department's Community Health Assessment through active participation on the Tioga County Community Health Needs Assessment Steering Committee. IN ADDITION TO CARRYING OUT ITS OWN CHNA, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. PARTICIPATED IN THE DEVELOPMENT OF A COMPREHENSIVE COMMUNITY HEALTH NEEDS ASSESSMENT AS PART OF THE NYS DELIVERY SYSTEM REDESIGN INCENTIVE PAYMENT PROGRAM (DSRIP) PLANNING GRANT IN 2014. This extensive CHNA was for a ten county Southern Tier Rural Integrated Performing Provider System (STRIPPS) region, which included OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Primary Service Area of Broome County, The CHNA focused on the health issues of Medicaid Beneficiaries, the uninsured (low and non-utilizers). 2,011 persons participated in this CHNA, representing providers, beneficiaries, community based organizations, and the community at large. Ninety in depth interviews were conducted and 15 focus groups with 127 Medicaid beneficiaries were held. Participants self-identified to participate in an on-going Panel which will continue to inform STRIPPS in the design of interventions (projects) to address Community Health status, This CHNA validated key health issues for the Medicaid and Uninsured population to be obesity prevention & associated cardiovascular chronic disease and mental health/substance abuse. To ensure that the CHNA is effective, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. assesses the community's health care needs annually through several venues: - Broome County Community Health Assessment Steering Committee: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. participates as a member of a multi-agency collaborative Community Health Assessment Steering Committee". This over-sight committee meets or communicates monthly to assess community health status/needs and identify and monitor interventions. The Steering Committee, under the guidance of the local Health Department and the New York State Health Department, addresses public health issues and underlying causes contributing factors to health status and chronic disease, and reviews current interventions and outcomes. Efforts to coordinate interventions and share best practices occur through these interactive meeting. Oversight and monitoring during 2014 also occurred through the design and development of the aforementioned DSRIP work: - Active participation on community committees, boards and coalitions: Key partners that OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. works with to achieve the Community Public Health Priorities include but are not limited to the American Cancer Association, American Diabetes Association, American Heart Association, Broome County Health Department Community Health Needs Assessment (CHNA), Steering Committee, Broome County Health Department, local health departments in whose county OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. provides services, Action for Older Persons, Binghamton VA Outpatient Clinic, the Dr, Garrabed A, Fattal Community Free Clinic (Broome County based), Community Alternative Systems Agency (CASA), Communities Joined in Action, Department of Social Services, Mothers & Babies Perinatal Network of SCNY, Office of Mental Health, Rural Health Network of South Central New York, United Way, Binghamton University School of Nursing, HEALTH-E-CONNECTIONS (REGIONAL HEALTH INFOMRATION ORGANIZATION, BROOME COUNTY OFFICE FOR THE AGING, AND THE AMERICAN CIVIC ASSOCIATION: - Patient and provider satisfaction surveys/feedback - OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Patient and Family Advisory Council Community Focus Groups - New York State SPARCS data - New York State registries which provide prevalence and incidence rates of disease.
Schedule H, Part VI, Line 3 Patient education of eligibility for assistance	During registration insurance coverage for each patient is verified, If the patient is registered as self-pay (uninsured) OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Financial Counseling program is designed to assess each patient's eligibility for a NY healthcare program (Child Health Plus, NY Medicaid or a Qualified Health Plan through NY state) and the OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Patient Financial Assistance Program. The process varies based on patient type and location of service, an overview of the existing process is summarized as follows: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Emergency Room: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Financial Counselors are on-site within the ER, they meet with each ER patient after treatment and prior to discharge. The Financial Counselor reviews insurance coverage with each patient. For each uninsured patient we attempt to conduct a face to face eligibility interview. The eligibility interview takes 5 minutes to determine if the patient is eligible for a NY State healthcare program and/or OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Patient Financial Assistance Program. We also help patients complete applications for OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Patient Financial Assistance Program and assist in enrolling into Medicaid or during open enrollment, a Qualified Health Plan. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Primary Care Network: Uninsured patients are called by the Financial Counselors and interviewed for eligibility. Based on results we provide assistance for NY program or OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Patient Financial Assistance Program enrollment. All Other Patient Types: The Business Office runs a monthly extract to identify account balances due from self-pay patients that are over 30 days old which indicates possible financial hardship, The Business Office Financial Counselors attempt to contact these patients by phone to determine if financial assistance is needed. Where ever possible we conduct eligibility interview over the phone. Based on results we provide assistance for NY program or OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Patient Financial Assistance Program enrollment. Appointments are made as needed for facilitated enrollment into Affordable Care Act Medicaid programs or Qualified Health Plans. Patient Education: Brochures on the OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Patient Financial Assistance Program are available at all OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. patient care sites and on the OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. internet web site.
Schedule H, Part VI, Line 4 Community information	OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is based in Binghamton, New York. For community and local health planning purposes, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Health Needs Assessment (CHNA) addresses the needs of the residents of Broome County, as over 80% of those served by OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. reside in Broome County. This primary service area definition is consistent with physician needs assessment methodologies based on qualitative standards established by the Internal Revenue Service (IRS Final Revenue Ruling on Physician Recruitment: Revenue Rule 97-21, Source: Fall 2014 AmeriMed Consulting Medical Staff Development Plan for Our Lady of Lourdes Memorial Hospital, Executive Summary, page 1). A status report to the community is provided annually through OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Community Service Plan (CSP) WITH THE MOST RECENT REPORT BEING ISSUED FOR ACTIVITIES CARRIED OUT IN CALENDAR YEAR 2018. While OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. CHNA and CSP address residents in Broome County, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. extends its services and sphere of influence to the residents of Tioga, Delaware, and Chenango, New York, and to the residents of Susquehanna, Pennsylvania. Persons are served through OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. comprehensive range of primary care OFFERED AT 11 LOCATIONS THROUGHOUT THREE COUNTIES (IN ADDITION, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. HAS INTEGRATED SOCIAL WORKERS AT ALL PRIMARY CARE SITES TO BOLSTER BEHAVIORAL HEALTH CAPACITY), five walk-in clinics, Endocrinology & Diabetes Centers of Excellence, outpatient diagnostic services, outpatient physical therapy (4 locations), mobile van services (mammography & dental care}, regional cancer center services, specialty care, acute care, home health care, durable medical equipment company, hospice care, youth behavioral health and development, oral health, occupational health services and worker's compensation preferred provider organization programs, as well as health education and outreach programs.
Schedule H, Part VI, Line 5 Promotion of community health	(1) OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. evaluates existing infrastructure and location of services to ensure the community health needs are met. Results of these evaluations have resulted in the following: - Bone density testing and podiatry services were expanded to the rural community of Hancock - Lourdes Vestal: a project begun in 2012 was designed to bring many existing services together in one physical location, with the addition of some new services, the project was completed in calendar year 2014. The building and services were designed with the current and future health care needs of our patients and the community in mind, for persons of all ages, Our goal has always been to be true to our mission to create a positive patient and family experience, in a healing environment. The Lourdes Vestal services are convenient and accessible, are on bus routes; and will continue to provide safe, high quality care, Primary Care is provided by internal medicine and family practice providers from 4 existing Lourdes primary care practices. Not all of our existing sites have the same ancillary services, such as lab, x-ray, mammography, or physical therapy; hence location of these services will improve access for patients, Women's health services include screening and diagnostic mammography. Breast ultrasound and access to a Breast Surgeon on site was a new service begun in 2014. Occupational Health services was relocated from the hospital to Vestal to increase community access: - Other new services located at Lourdes vestal were also, based on community need and include, (a) bone densitometry for the evaluation of fracture risk and osteoporosis for women and men, This service is also available at the hospital, (b) Community Room- which will offer education supportive of community health priorities identified in the CHNA; (c) A dermatology practice; (d) Walk-in services and (e) Retail Pharmacy, - Lourdes Pediatric Walk-in services were added in 2014 to increase appropriate access for pediatric patients needing evening appointments, (2)OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is considered a disproportionate share hospital for Medicaid purposes, Unique financial assistance programs that OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. offers or participates in include: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Patient Financial Assistance Program (PFAP), prompt pay program, Medicaid, Hope Dispensary, Lourdes Care Plus, Prenatal care Assistance Program, Child Health Plus, Medicaid and Medicaid Managed Care. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. increased the employment of financial counselors from 8 to 11 to assist uninsured persons in determining eligibility for health care coverage and have implemented an "out bound call" program. All financial counselors became Certified Applications Counselors. (3) OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. participates in Health Prevention Initiatives through Breast, Cervical and Colorectal Cancer screening. OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. administers over $2.1 million annually in grant programs for at risk children and youth. Also active in promoting the health and well-being of the community are nearly 500 voluntary members of the medical staff and 15 volunteer community board members (which excludes senior leadership). OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is active in medical staff development recruitment and succession planning. THIS YEAR ACCESS TO PRIMARY AND SPECIALTY CARE WAS EXPANDED THROUGH THE HIRING OF SEVERAL NEW PROVIDERS. THROUGHOUT THE YEAR WE CONTINUED TO PRESS FORWARD TO ADDRESS ACCESS NEEDS FOR CHILDREN'S ORAL HEALTH, PHARMACEUTICALS, AND BEHAVIORAL HEALTH SERVICES FOR YOUTH. THE LOURDES CENTER FOR MENTAL HEALTH (LCMH) SERVED OVER 1,350 CLIENTS, WITH OVER 16,500 TOTAL VISITS IN 2018 (A 2.3% INCREASE OVER 2017). THE OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. STUDENT ASSISTANCE PROGRAM AND ALCOHOL AND DRUG eDUCATION PREVENTION TEAM PROVIDED ALCOHOL AND DRUG ABUSE PREVENTION SERVICES TO OVER 14,750 STUDENTS AND PARENTS IN 2018 THROUGH A VARIETY OF EVIDENCED BASED PROGRAMS. NO SBIRT TRAININGS (SCREENING, BRIEF INTERVENTION AND REFERRAL TO TREATMENT) WERE PROVIDED TO OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. ASSOCIATES IN 2018, HOWEVER OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. REMAINS COMMITTED TO THE TREATMENT OF sUBSTANCE ABUSE AND CONTINUES TO LOOK FOR WAYS TO ENGAGE AT-RISK POPULATIONS FOR SUBSTANCE ABUSE-PARTICULARLY THOSE SUFFERING FROM OPIOID USE DISORDER (OUD). (4) Volunteering - As a OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Volunteer, you become an integral part of the hospital team. Volunteers' efforts benefit the hospital in continuing its commitment to excellence while providing them with the personal satisfaction of contributing to the welfare of those in need. Each year, hundreds of volunteers find fulfillment, practical work experience and companionship within OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. There are volunteer opportunities for Adults and Juniors. Volunteers provide many of the services that improve the quality of patient stays and support medical and administrative staff at OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. The following are some, but not all of the opportunities volunteers can take part in: OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Auxiliary Gift Shop & Cafe DePaul: Two to four hour assignments in the Gift Shop (gift suggestions/register) and Cafe DePaul (food preparation/serving). All proceeds from the Gift Shop & Cafe DePaul benefit OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. patients. Patient Care: Areas where volunteers provide hospitality and conversation while assisting the staff with general tasks - Emergency Room - Physical Therapy - Occupational Therapy - Speech Therapy - Ambulatory Surgery - Breast Care Center - Spiritual Care (Eucharistic Minister) - Patient Floors - Primary Care Facilities - Laser/Eye Center or Holding Area - Patient Reading Program - Diagnostic Imaging - Diabetic Education Clerical Areas: Volunteers assist the staff with clerical duties which may include photocopying, filing, faxing, telephones, collating, data entry and typing in the following departments: - Administration - Business Office - Pharmacy - Medical Staff Office - Nursing Education - Facilities Management - Public Relations - Human Resources - Purchasing Department - Volunteer Services - Physician Offices - Pre-Admission Testing - Patient Floor Clerical - Library - Diabetes Education - Information Systems - Laser/Eye Unit OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. Physician Practices: A wide variety of volunteer opportunities are available in many different departments throughout the hospital and at the Primary Care sites: - Blood Pressure Screening - Pharmacy Deliveries - Admit/Registration Escorting - Sterile Processing Department - Laboratory - Food & Nutrition (Dietary) - Information Desk - Flower Room - Laundry Services - Information Systems
Schedule H, Part VI, Line 6 Affiliated health care system	OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC, AND AFFILIATES (THE HOSPITAL) IS A MEMBER OF ASCENSION HEALTH. ASCENSION HEALTH ALLIANCE, DOING BUSINESS AS ASCENSION, IS THE SOLE CORPORATE MEMBER AND PARENT ORGANIZATION OF ASCENSION HEALTH, A CATHOLIC, NATIONAL HEALTH SYSTEM CONSISTING PRIMARILY OF NONPROFIT CORPORATIONS THAT OWN AND OPERATE MORE THAN 1,900 LOCAL HEALTH CARE FACILITIES, OR HEALTH MINISTRIES, LOCATED IN 24 OF THE UNITED STATES AND THE DISTRICT OF COLUMBIA. IN ADDITION TO SERVING AS THE SOLE CORPORATE MEMBER OF ASCENSION HEALTH. ASCENSION SERVES AS THE MEMBER OR SHAREHOLDER OF VARIOUS OTHER SUBSIDIARIES, ASCENSION, ITS SUBSIDIARIES, AND HEALTH MINISTRIES ARE REFERRED COLLECTIVELY FROM TIME TO TIME HEREAFTER AS THE SYSTEM. ASCENSION IS SPONSORED BY ASCENSION SPONSOR, A PUBLIC JURIDIC PERSON. THE PARTICIPATING ENTITIES OF ASCENSION SPONSOR ARE THE DAUGHTERS OF CHARITY OF ST. VINCENT DE PAUL IN THE UNITED STATES, ST. LOUISE PROVINCE, THE CONGREGATION OF ST. JOSEPH, THE CONGREGATION OF THE SISTERS OF ST. JOSEPH OF CARONDELET, THE CONGREGATION OF ALEXIAN BROTHERS OF THE IMMACULATE CONCEPTION PROVINCE-AMERICAN PROVINCE, AND THE SISTERS OF THE SORROWFUL MOTHER OF THE THIRD ORDER OF ST. FRANCIS OF ASSISI-US/CARIBBEAN PROVINCE. THE HOSPITAL, LOCATED IN BINGHAMTON, NEW YORK, IS A NONPROFIT ACUTE CARE HOSPITAL. THE HOSPITAL PROVIDES INPATIENT, OUTPATIENT AND EMERGENCY CARE SERVICES FOR THE RESIDENTS OF BROOME COUNTY AND THE SURROUNDING COMMUNITIES. ADMITTING PHYSICIANS ARE PRIMARILY PRACTITIONERS IN THE LOCAL AREA. ALSO INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS ARE CORBETT CORPORATION (CORBETT) , A FOR PROFIT, WHOLLY OWNED SUBSIDIARY OF THE HOSPITAL FORMED TO CONSTRUCT AND RENOVATE BUILDINGS IN THE HOSPITAL' S PROXIMITY, AND LOURDES REALTY, INC. (REALTY), A NONPROFIT REAL ESTATE COMPANY FORMED TO ACQUIRE AND RENOVATE OFFICE SPACE IN THE HOSPITAL' S PROXIMITY. THE HOSPITAL IS THE SOLE CORPORATE MEMBER OF REALTY. THE HOSPITAL IS RELATED TO ASCENSION HEALTH'S OTHER SPONSORED ORGANIZATIONS THROUGH COMMON CONTROL. SUBSTANTIALLY ALL EXPENSES OF ASCENSION HEALTH AND ITS SPONSORED ORGANIZATIONS ARE RELATED TO PROVIDING HEALTH CARE SERVICES. MISSION THE SYSTEM DIRECTS ITS GOVERNANCE AND MANAGEMENT ACTIVITIES TOWARD STRONG, VIBRANT, CATHOLIC HEALTH MINISTRIES UNITED IN SERVICE AND HEALING AND DEDICATES ITS RESOURCES TO SPIRITUALLY CENTERED CARE WHICH SUSTAINS AND IMPROVES THE HEALTH OF THE INDIVIDUALS AND COMMUNITIES IT SERVES. IN ACCORDANCE WITH THE SYSTEM'S MISSION OF SERVICE TO THOSE PERSONS LIVING IN POVERTY AND VULNERABLE PERSONS, EACH HEALTH MINISTRY ACCEPTS PATIENTS REGARDLESS OF THEIR ABILITY TO PAY. THE SYSTEM USES FOUR CATEGORIES TO IDENTIFY THE RESOURCES USED FOR THE CARE OF PERSONS LIVING IN POVERTY AND COMMUNITY BENEFIT PROGRAMS: - TRADITIONAL CHARITY CARE INCLUDES THE COST OF SERVICES PROVIDED TO PERSONS WHO CANNOT AFFORD HEALTH CARE BECAUSE OF INADEQUATE RESOURCES AND/OR WHO ARE UNINSURED OR UNDERINSURED - UNPAID COST OF PUBLIC PROGRAMS, EXCLUDING MEDICARE REPRESENTS THE UNPAID COST OF SERVICES PROVIDED TO PERSONS COVERED BY PUBLIC PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS - COST OF OTHER PROGRAMS FOR PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS INCLUDES UNREIMBURSED COSTS OF PROGRAMS INTENTIONALLY DESIGNED TO SERVE PERSONS LIVING IN POVERTY AND OTHER VULNERABLE PERSONS OF THE ACOMMUNITY, INCLUDING SUBSTANCE ABUSERS, THE HOMELESS, VICTIMS OF CHILD ABUSE, AND PERSONS WITH ACQUIRED IMMUNE DEFICIENCY SYNDROME - COMMUNITY BENEFIT CONSISTS OF THE UNREIMBURSED COSTS OF COMMUNITY BENEFIT PROGRAMS AND SERVICES FOR THE GENERAL COMMUNITY, NOT SOLELY FOR PERSONS LIVING IN POVERTY, INCLUDING HEALTH PROMOTION AND EDUCATION, HEALTH CLINICS AND SCREENINGS. DISCOUNTS ARE PROVIDED TO ALL UNINSURED PATIENTS, INCLUDING THOSE WITH THE MEANS TO PAY. " DISCOUNTS PROVIDED TO THOSE PATIENTS WHO DID NOT QUALIFY FOR ASSISTANCE UNDER CHARITY CARE GUIDELINES ARE NOT INCLUDED IN THE COST OF PROVIDING CARE TO PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS. THE COST OF PROVIDING CARE OF PERSONS LIVING IN POVERTY AND OTHER COMMUNITY BENEFIT PROGRAMS IS ESTIMATED BY REDUCING CHARGES FORGONE BY A FACTOR DERIVED FROM THE RATIO OF TOTAL OPERATING EXPENSES TO BILLED CHARGES FOR PATIENT CARE.
Schedule H, Part VI, Line 7 State filing of community benefit report	NY

Schedule H (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

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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," on Form 990, Part IV, line 21 or 22.
lBullet

Attach to Form 990.
lBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization
Our Lady of Lourdes Memorial Hospital Inc

Employer identification number
15-0532221

Part I

General Information on Grants and Assistance

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? ........................

Yes No

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 Domestic Organizations and Domestic Governments. Complete if the organization answered "Yes" on 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 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 noncash assistance	(h) Purpose of grant or assistance
(1) EVANS STREET BASEBALL PO BOX 598 BINGHAMTON,NY13902	46-2306815		10,000				OPERATING SUPPORT

Enter total number of section 501(c)(3) and government organizations listed in the line 1 table ................. Bullet Image

Enter total number of other organizations listed in the line 1 table ........................ . Bullet Image

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50055P

Schedule I (Form 990) 2019

Page 2

Part III

Grants and Other Assistance to Domestic Individuals. Complete if the organization answered "Yes" on 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 noncash assistance	(e) Method of valuation (book, FMV, appraisal, other)	(f) Description of noncash assistance

(1)
(2)
(3)
(4)
(5)
(6)
(7)

Part IV

Supplemental Information. Provide the information required in Part I, line 2; Part III, column (b); and any other additional information.

Return Reference	Explanation
Schedule I, Part I, Line 2 Procedures for monitoring use of grant funds.	DOCUMENTATION IS SUBMITTED BY THE REQUESTING ORGANIZATION BEFORE FUNDS ARE ISSUED.

Schedule I (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

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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" on Form 990, Part IV, line 23.
SchJMediumBullet

Attach to Form 990.
SchJMediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Our Lady of Lourdes Memorial Hospital Inc

Employer identification number

15-0532221

Part I

Questions Regarding Compensation

Yes

Check the appropiate box(es) if the organization provided any of the following to or for a person listed on Form
990, Part VII, Section A, line 1a. Complete Part III to provide any relevant information regarding these items.

First-class or charter travel Housing allowance or residence for personal use

Travel for companions Payments for business use of personal residence

Tax idemnification and gross-up payments Health or social club dues or initiation fees

Discretionary spending account Personal services (e.g., maid, chauffeur, chef)

If any of the boxes on 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 .........

Did the organization require substantiation prior to reimbursing or allowing expenses incurred by all
directors, trustees, officers, including the CEO/Executive Director, regarding the items checked on Line 1a? ..

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.

Compensation committee Written employment contract

Independent compensation consultant Compensation survey or study

Form 990 of other organizations Approval by the board or compensation committee

During the year, did any person listed on Form 990, Part VII, Section A, line 1a, with respect to the filing organization or a related organization:

Receive a severance payment or change-of-control payment? .............

Yes

Participate in, or receive payment from, a supplemental nonqualified retirement plan? .........

Yes

Participate in, or receive payment from, an equity-based compensation arrangement? .........

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), 501(c)(4), and 501(c)(29) organizations must complete lines 5-9.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the revenues of:

The organization? ....................

Any related organization? .......................

If "Yes," on line 5a or 5b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization pay or accrue any
compensation contingent on the net earnings of:

The organization? ..................

Any related organization? ......................

If "Yes," on line 6a or 6b, describe in Part III.

For persons listed on Form 990, Part VII, Section A, line 1a, did the organization provide any nonfixed
payments not described in lines 5 and 6? If "Yes," describe in Part III ............

Were any amounts reported on 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 ..........................

If "Yes" on line 8, did the organization also follow the rebuttable presumption procedure described in Regulations section 53.4958-6(c)? .........................

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50053T

Schedule J (Form 990) 2019

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 on 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 in column (B) reported as deferred on prior Form 990
(A) Name and Title		(i) Base compensation	(ii) Bonus & incentive compensation	(iii) Other reportable compensation	(C) Retirement and other deferred compensation	(D) Nontaxable benefits	(E) Total of columns (B)(i)-(D)
1KATHRYN CONNERTON PRESIDENT & CEO	(i) (ii)	357,232 ------------- 0	334,930 ------------- 0	61,401 ------------- 0	15,900 ------------- 0	12,389 ------------- 0	781,851 ------------- 0	0 ------------- 0
2JAMES STEINMETZ MD BOARD MEMBER/PHYSICIAN	(i) (ii)	437,581 ------------- 0	94,353 ------------- 0	5,346 ------------- 0	13,500 ------------- 0	29,603 ------------- 0	580,383 ------------- 0	0 ------------- 0
3DAVID F CLEMENTS FORMER OFFICER (END 8/2016)	(i) (ii)	190,994 ------------- 0	19,149 ------------- 0	1,564 ------------- 0	13,766 ------------- 0	3,228 ------------- 0	228,701 ------------- 0	0 ------------- 0
4LINDA A MCCORMACK-MILLER FORMER OFFICER (END 11/2016)	(i) (ii)	447 ------------- 0	0 ------------- 0	231,269 ------------- 0	0 ------------- 0	1,772 ------------- 0	233,488 ------------- 0	0 ------------- 0
5SEAN MILLS VP-FINANCE/CFO	(i) (ii)	209,471 ------------- 0	36,790 ------------- 0	13,501 ------------- 0	5,156 ------------- 0	26,125 ------------- 0	291,043 ------------- 0	0 ------------- 0
6DEBORAH S MICAN VP-NURSING (END 3/2018)	(i) (ii)	192,560 ------------- 0	37,536 ------------- 0	11,100 ------------- 0	14,138 ------------- 0	19,321 ------------- 0	274,655 ------------- 0	0 ------------- 0
7LISA YVETTE HARRIS SR VP MEDICAL AFFAIRS/CMO (END 8/2018)	(i) (ii)	170,787 ------------- 0	52,936 ------------- 0	135,135 ------------- 0	10,766 ------------- 0	20,018 ------------- 0	389,642 ------------- 0	0 ------------- 0
8CHAD A PATTON VP-PHYSICIAN NETWORK	(i) (ii)	192,345 ------------- 0	38,684 ------------- 0	8,591 ------------- 0	15,285 ------------- 0	25,537 ------------- 0	280,442 ------------- 0	0 ------------- 0
9RICHARD BLANSKY MD CHIEF MEDICAL OFFICER	(i) (ii)	571,625 ------------- 0	30,698 ------------- 0	2,908 ------------- 0	13,500 ------------- 0	6,067 ------------- 0	624,798 ------------- 0	0 ------------- 0
10ANNE E WOLANSKI FORMER KEY EMPLOYEE (END 12/2016)	(i) (ii)	13,646 ------------- 0	0 ------------- 0	173,505 ------------- 0	194 ------------- 0	5,096 ------------- 0	192,441 ------------- 0	0 ------------- 0
11DEBORAH BLAKENEY VP-CONTINUUM CARE	(i) (ii)	174,893 ------------- 0	25,160 ------------- 0	7,804 ------------- 0	0 ------------- 0	10,464 ------------- 0	218,321 ------------- 0	0 ------------- 0
12SANJIV PATEL PRESIDENT MEDICAL STAFF	(i) (ii)	220,833 ------------- 0	14,096 ------------- 0	702 ------------- 0	13,262 ------------- 0	3,140 ------------- 0	252,033 ------------- 0	0 ------------- 0
13MARY E HUGHS CHRO	(i) (ii)	0 ------------- 191,657	0 ------------- 32,100	0 ------------- 5,353	0 ------------- 13,280	0 ------------- 18,018	0 ------------- 260,408	0 ------------- 0
14RATNAKISHORE PALLAPOTHU PHYSICIAN	(i) (ii)	340,502 ------------- 0	308,325 ------------- 0	1,704 ------------- 0	14,257 ------------- 0	29,546 ------------- 0	694,334 ------------- 0	0 ------------- 0
15JOHN DIMENNA MD PHYSICIAN	(i) (ii)	475,977 ------------- 0	46,500 ------------- 0	8,791 ------------- 0	6,750 ------------- 0	23,273 ------------- 0	561,291 ------------- 0	0 ------------- 0
16JOYLEEN EARLE MD PHYSICIAN	(i) (ii)	465,042 ------------- 0	44,250 ------------- 0	8,041 ------------- 0	14,850 ------------- 0	15,468 ------------- 0	547,651 ------------- 0	0 ------------- 0
17CHARLES CAMPBELL MD PHYSICIAN	(i) (ii)	466,286 ------------- 0	42,750 ------------- 0	4,177 ------------- 0	6,750 ------------- 0	28,372 ------------- 0	548,335 ------------- 0	0 ------------- 0
18ELDAD EINVA MD PHYSICIAN	(i) (ii)	459,744 ------------- 0	41,750 ------------- 0	3,319 ------------- 0	13,696 ------------- 0	27,984 ------------- 0	546,493 ------------- 0	0 ------------- 0

Schedule J (Form 990) 2019

Page 3

Part III

Supplemental Information

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.

Return Reference	Explanation
Schedule J, Part I, Line 3 Arrangement used to establish the top management official's compensation	ASCENSION HEALTH, A RELATED ORGANIZATION OF OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC., USES THE FOLLOWING TO ESTABLISH THE COMPENSATION OF THE ORGANIZATION'S CEO/EXECUTIVE DIRECTOR: - COMPENSATION COMMITTEE - INDEPENDENT COMPENSATION CONSULTANT - COMPENSATION SURVEY OR STUDY - APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE
Schedule J, Part I, Line 4a Severance or change-of-control payment	THE FOLLOWING INDIVIDUAL(S) RECEIVED SEVERANCE PAYMENTS FROM THE ORGANIZATION OR A RELATED ORGANIZATION: LINDA MCCORMACK-MILLER - $225,061 ANNE E WOLANSKI - $161,635 LISA Y HARRIS - $107,888
Schedule J, Part I, Line 4b Supplemental nonqualified retirement plan	Eligible executives participate in a program that provides for supplemental retirement benefits. The payment of benefits under the program, if any, is entirely dependent upon the facts and circumstances under which the executive terminates employment with the organization. Benefits under the program are unfunded and non-vested. Due to the substantial risk of forfeiture provision, there is no guarantee that these executives will ever receive any benefit under the program. Any amount ultimately paid under the program to the executive is reported as compensation on Form 990, Schedule J, Part II, Column F in the year paid. NO PAYMENTS WERE MADE TO LISTED PERSONS IN PART VII UNDER THE VARIOUS NON-QUALIFIED DEFERRED COMPENSATION PLANS DURING THE YEAR.

Schedule J (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

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 990-EZ or to provide any additional information.
MediumBullet

Attach to Form 990 or 990-EZ.
MediumBullet

Go to www.irs.gov/Form990 for the latest information.

OMB No. 1545-0047

2019

Open to Public
Inspection

Name of the organization

Our Lady of Lourdes Memorial Hospital Inc

Employer identification number

15-0532221

Return Reference	Explanation
Form 990, Part IV, Line 20b AUDITED FINANCIAL STATEMENTS	The activity of OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is reported in the consolidated financial statements of Ascension Health Alliance. No individual audit of OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is completed. Therefore, the attached audited financial statements are of Ascension Health Alliance and Affiliates, which include the activity of OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC..
Form 990, Part VI, Line 15a PROCESS TO ESTABLISH COMPENSATION OF TOP MANAGEMENT OFFICIAL	IN DETERMINING THE COMPENSATION OF THE ORGANIZATION'S PRESIDENT & CEO, THE PROCESS PERFORMED BY ASCENSION HEALTH, A RELATED ORGANIZATION OF OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE PRESIDENT & CEO WAS COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE COMMITTEE MINUTES. THE INDIVIDUAL WAS NOT PRESENT WHEN HIS COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 6 Classes of members or stockholders	Our Lady of Lourdes Hospital, Inc. has a single corporate member, Ascension Health.
Form 990, Part VI, Line 7a Members or stockholders electing members of governing body	Our Lady of Lourdes Memorial Hospital, Inc. has a single corporate member, Ascension Health, who has the ability to elect members to the governing body of Our Lady of Lourdes Memorial Hospital, Inc.
Form 990, Part VI, Line 7b Decisions requiring approval by members or stockholders	All decisions that have a material impact to Our Lady of Lourdes Memorial Hospital, Inc.'s. financial information or corporation as a whole are subject to approval by its sole corporate member, Ascension Health.
Form 990, Part VI, Line 11b Review of form 990 by governing body	DURING THE RETURN PREPARATION PROCESS, THE TAX DEPARTMENT WORKS WITH OTHER FUNCTIONAL AREAS INCLUDING FINANCE, ACCOUNTING, TREASURY, LEGAL, HUMAN RESOURCES, AND CORPORATE COMPLIANCE FOR ADVICE, INFORMATION AND ASSISTANCE IN ORDER TO PREPARE A COMPLETE AND ACCURATE RETURN. UPON COMPLETION, THE FORM 990 IS REVIEWED BY THE ORGANIZATION'S INTERNAL TAX DEPARTMENT WHICH CONSISTS OF ATTORNEYS AND CPAS. A COMPLETE FINAL COPY OF THE RETURN IS PROVIDED TO THE ORGANIZATION'S PRESIDENT, FINANCIAL OFFICER, AND/OR OTHER KEY OFFICERS IN LIEU OF THE FULL BOARD.
Form 990, Part VI, Line 12c Conflict of interest policy	The organization regularly and consistently monitors and enforces compliance with the conflict of interest policy in that any director, principal officer, or member of a committee with governing board delegated powers, who has a direct or indirect financial interest, must disclose the existence of the financial interest and be given the opportunity to disclose all material facts to the directors and members of the committees with governing board delegated powers considering the proposed transaction or arrangement. The remaining individuals on the governing board or committee will decide if conflicts of interest exist. Each director, principal officer and member of a committee with governing board delegated powers annually signs a statement which affirms such person has received a copy of the conflicts of interest policy, has read and understands the policy, has agreed to comply with the policy, and understands that the organization is charitable and in order to maintain its federal tax exemption it must engage primarily in activities which accomplish its tax-exempt purpose.
Form 990, Part VI, Line 15b Process to establish compensation of other employees	IN DETERMINING COMPENSATION OF THE ORGANIZATION'S OFFICERS AND KEY EMPLOYEES, THE PROCESS PERFORMED INCLUDED A REVIEW AND APPROVAL BY INDEPENDENT PERSONS, COMPARABILITY DATA, AND CONTEMPORANEOUS SUBSTANTIATION OF THE DELIBERATION AND DECISION. THE EXECUTIVE COMPENSATION COMMITTEE REVIEWED AND APPROVED THE COMPENSATION. IN THE REVIEW OF THE COMPENSATION, THE OFFICERS' SALARIES WERE COMPARED TO INDIVIDUALS AT OTHER ORGANIZATIONS IN THE AREA WHO HOLD THE SAME TITLE. DURING THE REVIEW AND APPROVAL OF THE COMPENSATION, DOCUMENTATION OF THE DECISION WAS RECORDED IN THE MINUTES. INDIVIDUALS WERE NOT PRESENT WHEN THEIR COMPENSATION WAS DECIDED.
Form 990, Part VI, Line 19 Required documents available to the public	The Organization will provide any documents open to public inspection upon request.
Form 990, Part VIII, Line 2f Other Program Service Revenue	Services to Affiliates - Total Revenue: 83327, Related or Exempt Function Revenue: 83327, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Income from Joint Ventures - Total Revenue: -392202, Related or Exempt Function Revenue: -272503, Unrelated Business Revenue: -119699, Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Management Fees - Total Revenue: 7050, Related or Exempt Function Revenue: 7050, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Consulting Fees - Total Revenue: 59481, Related or Exempt Function Revenue: 59481, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Contracted Services Revenue - Total Revenue: 90751, Related or Exempt Function Revenue: 90751, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Billing Service Revenue - Total Revenue: 302421, Related or Exempt Function Revenue: 302421, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Occupational Health - Total Revenue: 398981, Related or Exempt Function Revenue: 398981, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ; Research - Total Revenue: 62503, Related or Exempt Function Revenue: 62503, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: ;
Form 990, Part VIII, Line 11d Other Miscellaneous Revenue	Community Services - Total Revenue: 10875, Related or Exempt Function Revenue: 10875, Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 0; Escheatment Revenue - Total Revenue: 4954, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 4954; Medical Records Fees - Total Revenue: 20040, Related or Exempt Function Revenue: , Unrelated Business Revenue: , Revenue Excluded from Tax Under Sections 512, 513, or 514: 20040; Miscellaneous Revenue - Total Revenue: 1422964, Related or Exempt Function Revenue: 462133, Unrelated Business Revenue: 249680, Revenue Excluded from Tax Under Sections 512, 513, or 514: 711151;
Form 990, Part XI, Line 9 Other changes in net assets or fund balances	Change in Beneficial Interest in Foundation - 1844564; Transfers with Alpha Fund - 77756;
Form 990, Part XII, Line 2c AUDIT COMMITTEE	OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is included in the consolidated financial statements of Ascension Health Alliance. The Finance and Audit committee of Ascension Health Alliance's Board assumes responsibility for the consolidated organization as a whole.

For Paperwork Reduction Act Notice, see the Instructions for Form 990 or 990-EZ.

Cat. No. 51056K

Schedule O (Form 990 or 990-EZ) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

- TIN:

SCHEDULE R
(Form 990)

Department of the Treasury
Internal Revenue Service

Related Organizations and Unrelated Partnerships

Complete if the organization answered "Yes" on Form 990, Part IV, line 33, 34, 35b, 36, or 37.
MediumBullet

Attach to Form 990.
MediumBullet

Go to www.irs.gov/Form990 for instructions and the latest information.

OMB No. 1545-0047

2019

Open to Public Inspection

Name of the organization

Our Lady of Lourdes Memorial Hospital Inc

Employer identification number

15-0532221

Part I

Identification of Disregarded Entities. Complete if the organization answered "Yes" on 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

Part II

Identification of Related Tax-Exempt Organizations. Complete if the organization answered "Yes" on 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?
(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	Yes	No
(1)Ascension Health Alliance PO Box 45998 St Louis,MO631455998 45-3358926	National Health System	MO	501(c)(3)	Type I	NA		No
(2)Ascension Health PO Box 45998 St Louis,MO63145 31-1662309	National Health System	MO	501(c)(3)	Type I	Ascension Health Alliance		No
(3)Lourdes Realty Corporation Inc 169 Riverside Drive Binghamton,NY13905 22-2873637	Rental of Health Care Facilities	NY	501(c)(2)		Our Lady of Lourdes Memorial Hospital Inc	Yes
(4)SOUTHERN TIER MEDICAL CARE - NY PC 169 RIVERSIDE DRIVE BINGHAMTON,NY13905 82-1103087	HEALTHCARE	NY	501(c)(3)	3	OUR LADY OF LOURDES MEMORIAL HOSPITAL INC	Yes

For Paperwork Reduction Act Notice, see the Instructions for Form 990.

Cat. No. 50135Y

Schedule R (Form 990) 2019

Page 2

Part III

Identification of Related Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on 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
(a) Name, address, and EIN of related organization	(b) Primary activity	(c) Legal domicile (state or foreign country)	(d) Direct controlling entity		(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No
(1) Lourdes Health Support LLC 333 Butternut Drive Suite 100 Dewitt,NY13214 16-1611707	Medical Equipment Provider	NY	Our Lady of Lourdes Memorial Hospital Inc	Excluded	-275,599	310,895		No	-131,384		No	60 %

Part IV

Identification of Related Organizations Taxable as a Corporation or Trust. Complete if the organization answered "Yes" on 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?
(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		Yes	No
(1) Corbett Corporation 169 Riverside Drive Binghamton,NY13905 16-1268267	Property Management	NY	Our Lady of Lourdes Memorial Hospital Inc	C Corporation	128,980	2,174,711	100 %	Yes

Schedule R (Form 990) 2019

Page 3

Part V

Transactions With Related Organizations. Complete if the organization answered "Yes" on 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

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 .....................

b Gift, grant, or capital contribution to related organization(s) ............................

c Gift, grant, or capital contribution from related organization(s) ............................

d Loans or loan guarantees to or for related organization(s) ............................

e Loans or loan guarantees by related organization(s) ............................

f Dividends from related organization(s) ............................

g Sale of assets to related organization(s) ............................

h Purchase of assets from related organization(s) ............................

i Exchange of assets with related organization(s) ............................

j Lease of facilities, equipment, or other assets to related organization(s) .......................

Yes

k Lease of facilities, equipment, or other assets from related organization(s) ......................

Yes

l Performance of services or membership or fundraising solicitations for related organization(s) .....................

Yes

m Performance of services or membership or fundraising solicitations by related organization(s) .................

Yes

n Sharing of facilities, equipment, mailing lists, or other assets with related organization(s) ...................

o Sharing of paid employees with related organization(s) ............................

Yes

p Reimbursement paid to related organization(s) for expenses ............................

Yes

q Reimbursement paid by related organization(s) for expenses ............................

Yes

r Other transfer of cash or property to related organization(s) ............................

Yes

s Other transfer of cash or property from related organization(s) ............................

Yes

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 related organization	(b) Transaction type (a-s)	(c) Amount involved	(d) Method of determining amount involved
(1) CORBETT CORPORATION	L	3,284,172	FAIR MARKET VALUE
(2) CORBETT CORPORATION	O	121,560	FAIR MARKET VALUE
(3) LOURDES REALTY COMPANY	J	680,145	FAIR MARKET VALUE
(4) LOURDES REALTY COMPANY	K	466,202	FAIR MARKET VALUE
(5) LOURDES REALTY COMPANY	L	3,514,574	FAIR MARKET VALUE
(6) LOURDES REALTY COMPANY	O	120,177	FAIR MARKET VALUE
(7) LOURDES REALTY COMPANY	Q	71,236	FAIR MARKET VALUE

Schedule R (Form 990) 2019

Page 4

Part VI

Unrelated Organizations Taxable as a Partnership. Complete if the organization answered "Yes" on 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)	(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?
(a) Name, address, and EIN of entity	(b) Primary activity	(c) Legal domicile (state or foreign country)	Yes	No	(f) Share of total income	(g) Share of end-of-year assets	Yes	No	(i) Code V-UBI amount in box 20 of Schedule K-1 (Form 1065)	Yes	No

Schedule R (Form 990) 2019

Page 5

Part VII

Supplemental Information

Provide additional information for responses to questions on Schedule R. (see instructions).

Return Reference	Explanation

Schedule R (Form 990) 2019

Additional Data

Software ID:	17005876
Software Version:	2017v2.2

1	Briefly describe the organization’s mission or most significant activities: To improve the health and well-being of all people in the communities we serve.
2	Check this box
3	Number of voting members of the governing body (Part VI, line 1a) ........	3	13
4	Number of independent voting members of the governing body (Part VI, line 1b) .....	4	11
5	Total number of individuals employed in calendar year 2019 (Part V, line 2a) ......	5	2,865
6	Total number of volunteers (estimate if necessary) .............	6	295
7a	Total unrelated business revenue from Part VIII, column (C), line 12 ........	7a	129,981
b	Net unrelated business taxable income from Form 990-T, line 39 .........	7b	-178,301

		Prior Year	Current Year
8	Contributions and grants (Part VIII, line 1h) .........	4,617,605	3,115,044
9	Program service revenue (Part VIII, line 2g) .........	318,768,665	355,707,155
10	Investment income (Part VIII, column (A), lines 3, 4, and 7d ) ....	8,994,965	5,190,466
11	Other revenue (Part VIII, column (A), lines 5, 6d, 8c, 9c, 10c, and 11e)	6,475,349	3,221,359
12	Total revenue—add lines 8 through 11 (must equal Part VIII, column (A), line 12)	338,856,584	367,234,024
13	Grants and similar amounts paid (Part IX, column (A), lines 1–3 )...	60,772	23,925
14	Benefits paid to or for members (Part IX, column (A), line 4).....		0
15	Salaries, other compensation, employee benefits (Part IX, column (A), lines 5–10)	165,163,906	181,884,422
16a	Professional fundraising fees (Part IX, column (A), line 11e) .....	0	0
b	Total fundraising expenses (Part IX, column (D), line 25) 0
17	Other expenses (Part IX, column (A), lines 11a–11d, 11f–24e)....	163,052,397	186,220,666
18	Total expenses. Add lines 13–17 (must equal Part IX, column (A), line 25)	328,277,075	368,129,013
19	Revenue less expenses. Subtract line 18 from line 12.......	10,579,509	-894,989
		Beginning of Current Year	End of Year
20	Total assets (Part X, line 16).............	406,205,422	401,851,510
21	Total liabilities (Part X, line 26).............	146,765,224	139,705,721
22	Net assets or fund balances. Subtract line 21 from line 20.....	259,440,198	262,145,789

Sign Here

	Signature of officer	Date

	Type or print name and title


4a	(Code: ) (Expenses $ 275,231,263 including grants of $ 23,925 ) (Revenue $ 356,299,862 )
	OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. is a 154-bed hospital campus providing services without regard to patient race, creed, national origin, economic status, or ability to pay. During fiscal year 2018, OUR LADY OF LOURDES MEMORIAL HOSPITAL, INC. treated 9,577 adults and children for a total of 36,554 patient days of service. The hospital also provided services for 1,394,054 outpatient visits, which included 11,273 outpatient surgeries and 45,717 Emergency Room Visits. See Schedule H for a non-exhaustive list of community benefit programs and descriptions.

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 expenses275,231,263

1b	Sub-Total................
c	Total from continuation sheets to Part VII, Section A....
d	Total (add lines 1b and 1c)...........	6,786,730	229,110	490,471

1a	Federated campaigns..		1a
b	Membership dues..		1b
c	Fundraising events..		1c
d	Related organizations		1d
e	Government grants (contributions)		1e	2,845,461

f	All other contributions, gifts, grants, and similar amounts not included above		1f	269,583

g	Noncash contributions included in lines 1a - 1f:$		1g

h Total. Add lines 1a-1f.......		3,115,044

		Business Code
2a	Net Patient Service Revenue	621990	312,256,547	312,256,547
b	Pharmacy Revenue	446110	39,018,816	39,018,816
c	DSRIP & Care Compass	621990	2,309,911	2,309,911
d	Government Incentives	900099	829,424	829,424
e	Rental Income from Affiliates	531120	680,145	680,145
f	All other program service revenue.		612,312	732,011	-119,699	0
g	Total. Add lines 2a–2f .....		355,707,155

3 Investment income (including dividends, interest, and othersimilar amounts) ......			5,248,109			5,248,109
4 Income from investment of tax-exempt bond proceeds
5 Royalties...........
		(ii) Personal	(i) Real
6a	Gross rents	40	416,006	6a
b	Less: rental expenses			6b
c	Rental income or (loss)	40	416,006	6c
d	Net rental income or (loss).......			416,046			416,046
		(ii) Other	(i) Securities
7a	Gross amount from sales of assets other than inventory			7a
b	Less: cost or other basis and sales expenses	57,643		7b
c	Gain or (loss)	-57,643	0	7c
d	Net gain or (loss).........			-57,643			-57,643
8a	Gross income from fundraising events (not including $ of contributions reported on line 1c). See Part IV, line 18 ....
			8a
b	Less: direct expenses ...		8b
c	Net income or (loss) from fundraising events..
9a	Gross income from gaming activities. See Part IV, line 19 ...
			9a
b	Less: direct expenses ...		9b
c	Net income or (loss) from gaming activities..
10a	Gross sales of inventory, less returns and allowances ..
			10a	503,544
b	Less: cost of goods sold ..		10b	97,437
c	Net income or (loss) from sales of inventory..			406,107			406,107
Business Code			Miscellaneous Revenue
11a	Cafeteria/Vending Revenue		722514	864,119			864,119
b	Fitness Club Revenue		713940	42,474			42,474
c	Medical Staff Dues		900099	33,780			33,780
d	All other revenue ....			1,458,833	473,008	249,680	736,145
e	Total. Add lines 11a–11d ......			2,399,206
12	Total revenue. See instructions.....			367,234,024	356,299,862	129,981	7,689,137

1	Grants and other assistance to domestic organizations and domestic governments. See Part IV, line 21 ....	23,925	23,925
2	Grants and other assistance to domestic individuals. See Part IV, line 22 ...........
3	Grants and other assistance to foreign organizations, foreign governments, and foreign individuals. See Part IV, lines 15 and 16. .............
4	Benefits paid to or for members .......
5	Compensation of current officers, directors, trustees, and key employees ...........	3,693,169	3,323,852	369,317
6	Compensation not included above, to disqualified persons (as defined under section 4958(f)(1)) and persons described in section 4958(c)(3)(B) .........
7	Other salaries and wages........	143,575,646	129,343,177	14,232,469
8	Pension plan accruals and contributions (include section 401(k) and 403(b) employer contributions) ....	6,295,032	5,670,972	624,060
9	Other employee benefits .......	18,576,873	16,735,122	1,841,751
10	Payroll taxes ...........	9,743,702	8,777,623	966,079
11	Fees for services (non-employees):
a	Management ......	521,934	521,675	259
b	Legal .........	36,976		36,976
c	Accounting ...........	104,995		104,995
d	Lobbying ...........	4,674		4,674
e	Professional fundraising services. See Part IV, line 17
f	Investment management fees ......
g	Other (If line 11g amount exceeds 10% of line 25, column (A) amount, list line 11g expenses on Schedule O)	15,608,148	5,289,859	10,318,289	0
12	Advertising and promotion ....	364,848	100,662	264,186
13	Office expenses .......	1,556,928	728,010	828,918
14	Information technology ......	573,831	143,804	430,027
15	Royalties ..
16	Occupancy ...........	10,152,109	7,469,621	2,682,488
17	Travel ............	888,965	780,824	108,141
18	Payments of travel or entertainment expenses for any federal, state, or local public officials .
19	Conferences, conventions, and meetings ....	585,716	407,782	177,934
20	Interest ...........	1,380,731		1,380,731
21	Payments to affiliates .......
22	Depreciation, depletion, and amortization ..	12,333,197	4,985,571	7,347,626
23	Insurance ...	2,877,261	867,006	2,010,255
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	Medical Supplies	59,989,275	59,989,275
b	Purchased Services	27,523,772	13,413,925	14,109,847
c	Management Fee to Affiliate	33,226,362		33,226,362
d	Contract Labor	8,321,922	8,076,075	245,847
e	All other expenses	10,169,022	8,582,503	1,586,519	0
25	Total functional expenses. Add lines 1 through 24e	368,129,013	275,231,263	92,897,750	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 if following SOP 98-2 (ASC 958-720).

1	Cash–non-interest-bearing ........			8,205,345	1	26,599
2	Savings and temporary cash investments .........			197,287,125	2	12,101,360
3	Pledges and grants receivable, net ......			516,023	3	793,150
4	Accounts receivable, net .............			34,519,076	4	41,561,826
5	Loans and other payables to any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .......
				0	5	0
6	Loans and other receivables from other disqualified persons (as defined under section 4958(f)(1)), and persons described in section 4958(c)(3)(B) ...
				0	6	0
7	Notes and loans receivable, net ...........				7
8	Inventories for sale or use ............			4,892,242	8	4,852,807
9	Prepaid expenses and deferred charges ......			1,822,514	9	1,798,830
10a	Land, buildings, and equipment: cost or other basis. Complete Part VI of Schedule D	10a	218,954,290
b	Less: accumulated depreciation	10b	114,778,355	105,643,797	10c	104,175,935
11	Investments—publicly traded securities .				11
12	Investments—other securities. See Part IV, line 11 .....			0	12
13	Investments—program-related. See Part IV, line 11 ..			605,733	13	204,281
14	Intangible assets ...............			3,362,509	14	2,746,880
15	Other assets. See Part IV, line 11 ...........			49,351,058	15	233,589,842
16	Total assets. Add lines 1 through 15 (must equal line 33)...			406,205,422	16	401,851,510

17	Accounts payable and accrued expenses .....	23,975,176	17	22,621,432
18	Grants payable ...		18
19	Deferred revenue .........		19
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 any current or former officer, director, trustee, key employee, creator or founder, substantial contributor, or 35% controlled entity or family member of any of these persons .........
		0	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	122,790,048	25	117,084,289
26	Total liabilities. Add lines 17 through 25..	146,765,224	26	139,705,721

	Organizations that follow FASB ASC 958, check here and complete lines 27, 28, 32, and 33.
27	Net assets without donor restrictions ..........		27
28	Net assets with donor restrictions ...........		28
	Organizations that do not follow FASB ASC 958, check here and complete lines 29 through 33.
29	Capital stock or trust principal, or current funds .....		29
30	Paid-in or capital surplus, or land, building or equipment fund ...		30
31	Retained earnings, endowment, accumulated income, or other funds		31
32	Total net assets or fund balances ...........	259,440,198	32	262,145,789
33	Total liabilities and net assets/fund balances ........	406,205,422	33	401,851,510