2025-05-14T07:41:15-05:00 2024-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2023-07-01 470443636 ST MARY'S COMMUNITY HOSPITAL STMA 4028733321 1301 GRUNDMAN BOULEVARD NEBRASKA CITY NE 68410 NICK O'TOOL MARKET CFO 4028733321 2025-05-14 1 0 HEATHER ADKINS P01725376 3032989100 2023 2025-03-06 01:10:19Z CHI HEALTH ST MARY'S TIM BRICKER 12809 WEST DODGE ROAD OMAHA NE 68154 41731173 0 0928 X WWW.CHIHEALTH.COM X 1927 NE ST. MARY'S IS A NOT FOR PROFIT CRITICAL ACCESS HOSPITAL THAT PROVIDES ACUTE CARE FOR THE BENEFIT OF ALL REGARDLESS OF ABILITY TO PAY AND PROMOTES HEALTH THROUGH COMMUNITY OUTREACH INITIATIVES AND PARTNERSHIPS. 15 10 250 10 0 0 1069483 752174 40959270 40470201 70051 138488 401340 356239 42500144 41717102 3230 18272 0 0 19099667 19796383 0 0 0 19053068 18492387 38155965 38307042 4344179 3410060 59866550 67767575 809914 5091106 59056636 62676469 AS AN AFFILIATE OF COMMONSPIRIT HEALTH, WE MAKE THE HEALING PRESENCE OF GOD KNOWN IN OUR WORLD BY IMPROVING THE HEALTH OF THE PEOPLE WE SERVE, ESPECIALLY THOSE WHO ARE VULNERABLE, WHILE WE ADVANCE SOCIAL JUSTICE FOR ALL. 0 0 6137628 1606 3556803 ST. MARY'S COMMUNITY HOSPITAL SPECIALIZES IN RURAL MEDICAL CARE FOR YOUR ENTIRE FAMILY, INCLUDING OBSTETRIC, PEDIATRIC AND PREVENTATIVE SERVICES. THE PROVIDERS AND STAFF STRIVE TO PROVIDE THE CARE YOU EXPECT AND DESERVE. 4339401 2253 4989960 ST. MARY'S COMMUNITY HOSPITAL PROVIDES SEVERAL SPECIALTY CLINICS IN THE FOLLOWING AREAS: AUDIOLOGY, EAR, NOSE AND THROAT, CARDIOVASCULAR SERVICES, DERMATOLOGY, GASTROENTEROLOGY, GENERAL SURGERY/WOUND CARE, GYNECOLOGY/OBSTETRICS, ONCOLOGY, OPTHALMOLOGY, ORTHOPEDIC SURGERY, PODIATRY, UROLOGY, SPEECH AND OCCUPATIONAL THERAPY AND PSYCHIATRY. 3817336 7345 16268530 ST. MARY'S COMMUNITY HOSPITAL HAS STRIVED TO IMPROVE THE HEALTH STATUS OF CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS IN THIS RURAL COMMUNITY. ST. MARY'S COMMUNITY HOSPITAL IS PROUD TO OFFER HEALTHCARE SERVICES CLOSE TO HOME WITHIN THE COMMUNITY. ST. MARY'S COMMUNITY HOSPITAL PROVIDES A VARIETY OF DIAGNOSTIC SERVICES TO THE COMMUNITY, SUCH AS CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND. 17356631 7068 15654908 17356631 7068 15654908 31650996 1 1 0 1 0 0 0 0 0 1 1 1 0 1 1 1 0 1 0 0 0 0 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 1 0 0 1 X 0 0 250 1 0 0 0 0 0 0 0 0 0 0 0 0 X 15 10 1 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X TIM SCHNACK 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 JOHN PETERSDORF BOARD MEMBER 1.00 49.00 X 0 2089747 992820 EVERT KUIPER FORMER PRESIDENT & CEO CHI HEALTH 0.00 0.00 X 0 2787233 48534 TIM BRICKER EX-OFFICIO BM/ PRESIDENT & CEO CHI HEALTH 1.00 49.00 X X 0 2499192 116526 JEANETTE WOJTALEWICZ FORMER CFO, CHI HEALTH 0.00 0.00 X 0 1344835 12367 JEFFREY STEARNES MD FORMER HCE/PHYSICIAN 0.00 45.00 X 0 786288 60929 STACY BLUM MD PHYSICIAN-FAMILY MEDICINE 40.00 5.00 X 396948 113182 58507 BRETT MEYER MD PHYSICIAN-FAMILY MEDICINE 40.00 5.00 X 387605 115157 20732 BRADLEY VASA MD MEDICAL DIRECTOR 45.00 0.00 X 458438 0 58145 DAVID JONES MARKET PRESIDENT, REGIONAL HOSPITALS 5.00 45.00 X 0 460692 53617 SAMANTHA BOYER MD PHYSICIAN-FAMILY MEDICINE 35.00 10.00 X 343205 108510 19907 DANIEL DEFREECE MD PRESIDENT 49.00 1.00 X 397399 0 72195 TIM SCHNACK MARKET CFO (BEG 05/24) 1.00 49.00 X 0 369715 48053 NICK O'TOOL END 0524 INTERIM CFO (THRU 05/24) 1.00 49.00 X 0 349020 50949 KIRTIBALA GUPTA MD BOARD MEMBER/PHYSICIAN 1.00 59.00 X 0 346502 47524 COLE MAROLF PHYSICIAN-FAMILY MEDICINE 45.00 0.00 X 300388 27936 44249 HEATHER MORGAN MD BOARD MEMBER/PHYSICIAN 1.00 59.00 X 0 320425 58377 SISTER NADINE HEIMANN OSF BOARD MEMBER 1.00 11.00 X 0 0 0 SISTER MAURITA SOUKUP BOARD CHAIR 1.00 40.00 X X 0 0 0 BILL YATES VICE CHAIR 1.00 11.00 X X 0 0 0 KENT BARNEY TREASURER 1.00 11.00 X X 0 0 0 MARDELL WILSON BOARD MEMBER 1.00 11.00 X 0 0 0 KELLY BACON BOARD MEMBER 1.00 11.00 X 0 0 0 KEVIN FITZGERALD SECRETARY 1.00 11.00 X X 0 0 0 LG SEARCEY BOARD MEMBER 1.00 11.00 X 0 0 0 DAVE TAYLOR BOARD MEMBER 1.00 11.00 X 0 0 0 CYNTHIA ALLOWAY BOARD MEMBER 1.00 11.00 X 0 0 0 KATE CUTLER BOARD MEMBER 1.00 11.00 X 0 0 0 2283983 11718434 1763431 35 1 1 0 GENERAL SURGERY ASSOCIATES 1101 S 70TH ST 100 LINCOLN NE 68510 SURGICAL SERVICES 102000 1 705274 46900 752174 NET PATIENT SERVICES 900099 39151003 39151003 0 0 PHARMACY SERVICES 446110 1319198 1319198 0 0 40470201 46113 46113 1741 0 1741 1741 1741 92375 0 92375 92375 92375 8063 14071 -6008 -6008 INSURANCE RECOVERIES 900099 165152 0 0 165152 MEDICAL SERVICES 621300 83127 0 0 83127 CAFETERIA 722100 77035 0 0 77035 35192 35192 360506 41717102 40470201 0 494727 X 17122 17122 1150 1150 481576 385261 96315 15274746 12219797 3054949 770514 616411 154103 2244297 1795438 448859 1025250 820200 205050 34008 27206 6802 1845 1845 7119762 6762751 357011 29561 23649 5912 819241 666650 152591 655053 524042 131011 526624 421299 105325 44278 35422 8856 34257 27406 6851 496826 496826 1916890 1916890 178806 178806 MEDICAL SUPPLIES 3980356 3980356 0 0 INRACOMPANY ALLOCATIONS 1704244 0 1704244 0 REPAIRS AND MAINTENANCE 656207 623397 32810 0 DUES & SUBSCRIPTIONS 37584 35705 1879 0 256845 254018 2827 38307042 31650996 6656046 0 551 550 18073811 22147177 0 2535540 2216276 0 0 0 563955 562879 0 56201970 23440308 33737164 32761662 0 3287002 3630424 0 0 1668527 6448607 59866550 67767575 706780 4993303 0 24152 24152 0 0 0 0 0 78982 73651 809914 5091106 X 59053374 62673207 3262 3262 59056636 62676469 59866550 67767575 3410060 209773 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1845 0 0 0 1845 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCATION - $495 CATHOLIC HEALTH ASSOCIATION - $213 340B HEALTH - $67 NEBRASKA HOSPITAL ASSOCIATION - $1,070 726350 177504 679 355155 549378 1038606 156968 312 469536 726350 996551 109964 125 68034 1038606 974561 149428 124 127562 996551 788177 233882 293 47791 974561 1.00000 0.00000 0.00000 0 1 1 779571 779571 41794485 12133989 29660496 2177 2177 0 13051370 11290398 1760972 574367 13744 560623 32761662 CSH OPERATING INVESTMENT POOL 3630424 F 3630424 INTERCOMPANY RECEIVABLES 6375886 ROU OPERATING ASSET 72721 6448607 CURRENT PORTION OF LEASE LIABILITIES 45621 LONG TERM PORTION OF OPERATING LEASE LIABILITY 26992 SERVICE FEE LIABILITIES 1038 73651 X PART V, LINE 4: THE ENDOWMENT FUND WILL BE USED FOR BUILDING PROJECTS AT CHI HEALTH ST. MARY'S. PART X, LINE 2: ST. MARY'S COMMUNITY HOSPITAL'S FINANCIAL INFORMATION IS INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS, WHICH INCLUDES THE FOLLOWING DISCLOSURE: COMMONSPIRIT REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 1 1 X 1 X 1 X 1 1 1 0 1 1 1026 348700 348700 0.00910 5577 3600595 4003900 0 0.00000 6603 3949295 4003900 348700 0.00910 12 722 151613 397 151216 0.00390 2 63 139194 139194 0.00360 2 4988287 4166743 821544 0.02140 1 1 1 0.00000 10 8108 63302 24380 38922 0.00100 27 8893 5342397 4191520 1150877 0.02990 27 15496 9291692 8195420 1499577 0.03900 1 607 607 0.00000 1 179 1859 1859 0.00000 1 40 409 409 0.00000 3 219 2875 2875 0.00000 1 1537166 0 8755476 10648354 -1892878 X 1 1 1 1 ST MARY'S COMMUNITY HOSPITAL 1301 GRUNDMAN BLVD NEBRASKA CITY NE 68410 WWW.CHIHEALTHSTMARYS.COM H000128 X X X X ST MARY'S COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X WWW.CHIHEALTH.COM/CHNA X X 1 22 1 WWW.CHIHEALTH.COM/CHNA 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X HTTPS://WWW.CHIHEALTH.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.CHIHEALTH.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X HTTPS://WWW.CHIHEALTH.COM/PATIENTS-VISITORS/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA, CHI HEALTH ST. MARY'S TOOK 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. THE PROCESS OF IDENTIFYING THE SIGNIFICANT COMMUNITY HEALTH NEEDS IN OTOE COUNTY WAS ACCOMPLISHED BY TWO PRIMARY ACTIONS:1. ENGAGE IN THE CHNA PROCESS LED BY SOUTHEAST DISTRICT HEALTH DEPARTMENT (SEDHD), THE LOCAL PUBLIC HEALTH DEPARTMENT, TO INCLUDE PRIMARY AND SECONDARY DATA COLLECTION, AS WELL AS A STAKEHOLDER FOCUS GROUP TO REVIEW DATA AND PRIORITIZE NEEDS. 2. VALIDATION OF THE SEDHD PRIORITIZED NEEDS THROUGH ENGAGEMENT OF THE HOSPITAL'S INTERNAL COMMUNITY BENEFIT ACTION TEAM (CBAT) AND THE HOSPITAL'S COMMUNITY AND FOUNDATION BOARDSSEDHD COVERS FIVE COUNTIES: JOHNSON, NEMAHA, OTOE, PAWNEE AND RICHARDSON. IN ORDER TO ASSESS THE HEALTH NEEDS ACROSS THE FIVE-COUNTY AREA, SEDHD CONVENED THE HOSPITAL LEADERSHIP FROM HOSPITALS IN THE REGION TO SUPPORT PLANNING EFFORTS. THE GROUP PLANNED AND IMPLEMENTED A COMMUNITY SURVEY ACROSS ALL FIVE COUNTIES AND HELD FIVE STAKEHOLDER FOCUS GROUPS TO REVIEW COMMUNITY SURVEY DATA AS WELL AS SECONDARY DATA. SECONDARY DATA INCLUDED A RANGE OF COMMUNITY HEALTH INDICATORS, INCLUDING, BUT NOT LIMITED TO: POPULATION DEMOGRAPHICS, SOCIOECONOMIC FACTORS, HEALTH STATUS (INCLUDING CHRONIC DISEASE AND POOR MENTAL HEALTH PREVALENCE) AND HEALTH OUTCOMES (MORTALITY). AS PART OF THE CHNA PROCESS, SEDHD CONDUCTED A COMMUNITY SURVEY OF THE FIVE-COUNTY AREA TO GAIN INPUT ON THE HEALTH STATUS AND NEEDS OF THE COMMUNITY. SURVEYS WERE AVAILABLE FROM JULY - SEPTEMBER 2021 AND WERE EMAILED TO COMMUNITY STAKEHOLDER LISTSERVS BY EACH OF THE HOSPITALS PARTICIPATING IN THE CHNA PLANNING WITH SEDHD, PROMOTED ON SOCIAL MEDIA THROUGH SEDHD AND HOSPITAL CHANNELS, AS WELL AS PAPER COPIES MADE AVAILABLE AT HOSPITAL AND CLINIC LOCATIONS THROUGHOUT THE SEDHD REGION. 590 PARTICIPANTS COMPLETED THE COMMUNITY SURVEY INCLUDING 219 FROM OTOE COUNTY. UPON COMPLETION OF THE SURVEY, SEDHD HELD A SERIES OF FOCUS GROUP MEETINGS TO PRESENT SURVEY FINDINGS, REVIEW SECONDARY DATA, AND ENGAGE KEY COMMUNITY MEMBERS IN DETERMINING TOP NEEDS IN THE COMMUNITY. CHI HEALTH ST. MARY'S CO-HOSTED ONE OF THE FIVE FOCUS GROUP MEETINGS IN OTOE COUNTY ON NOVEMBER 30, 2021. UPON REVIEW OF THE PRIMARY AND SECONDARY DATA, STAKEHOLDERS ENGAGED IN A FACILITATED CONVERSATION TO DETERMINE DRIVERS OF POOR HEALTH OUTCOMES AND PRIORITIZE HEALTH NEEDS FOR SPECIFIC COUNTIES. CHI HEALTH ST. MARY'S CO-HOSTED A FOCUS GROUP WITH THE SEDHD TO PRESENT SURVEY FINDINGS, REVIEW SECONDARY DATA, AND ENGAGE KEY COMMUNITY MEMBERS IN DETERMINING TOP NEEDS IN THE COMMUNITY FOR OTOE COUNTY. A FACILITATED DISCUSSION WAS IMPLEMENTED TO ANALYZE WHAT STAKEHOLDERS IDENTIFIED AS AREAS OF CONCERN/IMPROVEMENT, STRENGTHS, AND OPPORTUNITIES.STAKEHOLDERS ATTENDING THE FOCUS GROUP MEETING AT CHI HEALTH ST. MARY'S REPRESENTED THOSE WHO SERVE MINORITY, AT-RISK, UNINSURED, AND AGING POPULATIONS, AS WELL AS THOSE AFFECTED BY VIOLENCE. A TOTAL OF 21 STAKEHOLDERS PARTICIPATED IN THE CHI HEALTH ST. MARY'S FOCUS GROUP INCLUDING: SOUTH EAST DISTRICT HEALTH DEPARTMENT (SEDHD); INSPRO, INC.; NEBRASKA CITY AREA ECONOMIC DEVELOPMENT; NEBRASKA CITY HOUSING; ARBOR PSYCHIATRIC AND WELLNESS CENTER; ARBOR BANKING; ARBOR DAY FARM; LIED LODGE; AND KEEP NEBRASKA CITY BEAUTIFUL.FOLLOWING THE FOCUS GROUPS, CHI HEALTH ST. MARY'S CBAT THEN REVIEWED COMMUNITY HEALTH DATA GATHERED THROUGH THE SEDHD CHNA PROCESS, AND VALIDATED WITH CHI HEALTH ST. MARY'S HOSPITAL COMMUNITY BOARD THAT THE DATA REVIEWED AND SIGNIFICANT HEALTH NEEDS IDENTIFIED, WERE ACCURATE REFLECTIONS OF THE MOST PRESSING NEEDS OF THE COMMUNITY. ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 6A: JOHNSON COUNTY HOSPITALNEMAHA COUNTY HOSPITALSYRACUSE AREA HEALTHPAWNEE COUNTY MEMORIAL HOSPITALCOMMUNITY MEDICAL CENTER ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: SOUTHEAST DISTRICT HEALTH DEPARTMENT (SEDHD) ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: THIS CHNA WAS COMPLETED IN PARTNERSHIP WITH THE SOUTHEAST DISTRICT HEALTH DEPARTMENT (SEDHD), IN ADDITION A PRESENTATION WAS MADE TO THE COMMUNITY BOARD ON MARCH 25TH, 2022 AND MAY 12TH, 2022. ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 11: THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON WWW.CHIHEALTH.COM/CHNA. THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH COMMUNITY SURVEY AND FOCUS GROUP. TOP HEALTH NEEDS (FROM 2022 CHNA): 1. ACCESS TO HEALTHCARE SERVICES2. AGING3. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH, SUICIDE, & SUBSTANCE ABUSE)4. CANCER5. CARDIOVASCULAR DISEASE6. MATERNAL & CHILD HEALTH7. NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT STATUS8. VIOLENCEFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: BEHAVIORAL HEALTHTO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES:1.1 EXPAND ACCESS TO MENTAL HEALTH SERVICES FOR YOUTH 1.1.1 PROVIDE MENTAL HEALTH SERVICES FOR AN INTEGRATED SCHOOL- BASED MENTAL HEALTH PROGRAM THAT INCLUDES THERAPY SERVICES FOR STUDENTS, FACILITATION OF PEER GROUPS AND TRAINING FOR PARENTS AND TEACHERS FY24 ACTIONS AND IMPACT: NO UPDATES TO REPORT. MEASURES: NO MEASURES TO REPORT. 1.2 PARTNER WITH THE REGION TO PROMOTE ADULT/ YOUTH MENTAL HEALTH FIRST AID TRAINING 1.2.1 PROMOTE REGION 5'S MENTAL HEALTH FIRST AID TRAININGS IN THE COMMUNITY FY24 ACTIONS AND IMPACT: PROMOTED REGION V SYSTEMS'S MENTAL HEALTH FIRST AID AND QUESTION, PERSUADE, AND REFER (QPR) TRAININGS. MEASURES: NO MEASURES TO REPORT. 1.3 PROVIDE MEDICATION ASSISTED TREATMENT (MAT) 1.3.1 IMPLEMENT A MEDICATION ASSISTED TREATMENT (MAT) PROGRAM AS PART OF HRSA OPIOID GRANT FY24 ACTIONS AND IMPACT: ALL ST. MARY'S PROVIDERS HAVE COMPLETED TRAINING AND ARE PREPARED TO PROVIDE MAT TO PATIENTS WHO PRESENT AT AN EMERGENCY DEPARTMENT OR RURAL CLINIC. MEASURES: ST. MARY'S SERVED AS ONE OF SEVEN SERVICE DELIVERY SITES FOR THE HRSA GRANT. FOR THESE SEVEN SITES, BETWEEN MARCH 2024 AND AUGUST 2024: PATIENTS WHO RECEIVED MAT: 88 PROVIDERS WHO PROVIDED MAT: 104 MEDICAL PROVIDERS: 18 NON-MEDICAL COUNSELING STAFF: 54 PEER RECOVERY SUPPORT SPECIALISTS: 18 AFTER CARE COORDINATOR: 1 COMMUNITY SUPPORT WORKS: 131.4 EXPAND ACCESS TO BEHAVIORAL HEALTH SERVICES 1.4.1 IMPLEMENT AND SUSTAIN AN INTEGRATED BH PRIMARY CARE FY24 ACTIONS AND IMPACT: CONTINUED TO COLLABORATE WITH LUTHERAN FAMILY SERVICES AND THE CHI HEALTH BEHAVIORAL HEALTH SERVICE LINE TO IDENTIFY PARTNERSHIPS FOR ACCESS TO PRESCRIBING PROVIDERS AND MENTAL HEALTH COUNSELORS. MEASURES: NO MEASURES TO REPORT. 1.5 PROVIDE CRISIS PREVENTION INTERVENTION (CPI) TRAINING FOR STAFF 1.5.1 EXPAND CRISIS PREVENTION INTERVENTION (CPI) TRAINING FOR STAFF AND SUPPORT CPI TRAININGS IN NE CITY COMMUNITY SCHOOLS FY24 ACTIONS AND IMPACT: ST. MARY'S STAFF COMPLETE TEAM (TECHNIQUES FOR EFFECTIVE AGGRESSION MANAGEMENT) TRAINING ANNUALLY. MEASURES: NO MEASURES TO REPORT. PRIORITY HEALTH NEED #2: HEALTH RELATED SOCIAL NEEDSTO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES:2.1 CONNECTION TO COMMUNITY-BASED SERVICES FOR UNMET HEALTH NEEDS 2.1.1 SUPPORT PARTNERS FOR OTOE COUNTY'S EFFORTS TO PROVIDE CENTRAL NAVIGATION SERVICES TO FAMILIES IN CRISIS AND AVOID SYSTEM INVOLVEMENT FY24 ACTIONS AND IMPACT: NO UPDATES TO REPORT. MEASURES: NO MEASURES TO REPORT. 2.1.2 INVEST IN COMMUNITY ORGANIZATIONS FOCUSED ON HEALTH RELATED SOCIAL NEEDS THROUGH THE IMPLEMENTATION OF THE COMMUNITY HEALTH IMPROVEMENT GRANT (CHIG) PROGRAM. FY24 ACTIONS AND IMPACT: AWARDED A CHIG TO BUILDING, REACHING, ACHIEVING, NEBRASKA CITY HOUSING (BRANCH). BRANCH FACILITATES PROGRAMS THAT EDUCATE AND EMPOWER PARTICIPANTS TO FIND SAFE AND AFFORDABLE HOUSING AND TO DEVELOP EMPLOYMENT SKILLS. BRANCH ALSO PROVIDES TRANSPORTATION TO MEDICAL APPOINTMENTS. MEASURES: CHIG FUNDS AWARDED (1/1/24-12/31/24): $15,0002.2 PROMOTE FINANCIAL LITERACY 2.2.1 PROVIDE FINANCIAL AND IN-KIND SUPPORT FOR THE BRIDGES OUT OF POVERTY' GETTING AHEAD FINANCIAL LITERACY PROGRAM FY24 ACTIONS AND IMPACT: SUPPORTED BRIDGES OUT OF POVERTY'S GETTING AHEAD FINANCIAL LITERACY PROGRAM THROUGH IN-KIND STAFF TIME. MEASURES: PARTICIPANTS: 15 GRADUATES: 4 IN-KIND STAFF HOURS: 40-502.3 PROMOTE EARLY DETECTION OF DEVELOPMENTAL DELAYS AND INTERVENTION FOR YOUNG CHILDREN AT GREATEST RISK DUE TO LOW SE 2.3.1 PROVIDE FINANCIAL SUPPORT FOR SOUTHEAST DISTRICT HEALTH DEPARTMENT TO DELIVER THE GROWING GREAT KIDS HOME VISITING PROGRAM SERVING FAMILIES WITH CHILDREN 0-3 AND AT RISK FOR POOR MATERNAL/ CHILD HEALTH OUTCOMES FY24 ACTIONS AND IMPACT: CONTINUED TO SUPPORT THE PROGRAM. MEASURES: CHI HEALTH ST. MARY'S FINANCIAL SUPPORT OF GROWING GREAT KIDS: $22,0002.4 SUPPORT COMMUNITY EFFORTS TO INCREASE AFFORDABLE HOUSING 2.4.1 PROVIDE LEADERSHIP AND IN-KIND SUPPORT FOR COMMUNITY EFFORTS TO IMPROVE HOUSING ACCESS AND AFFORDABILITY LED BY THE NEBRASKA CITY AREA ECONOMIC DEVELOPMENT CORPORATION (NECAEDC) FY24 ACTIONS AND IMPACT: CONTINUED TO ENGAGE WITH NECAEDC. MEASURES: NO MEASURES TO REPORT. 2.5 ENGAGE IN COMMUNITY EFFORTS TO ADDRESS THE LACK OF EARLY CHILDHOOD EDUCATION 2.5.1 EXPLORE THE OPPORTUNITY TO LAUNCH AN EARLY CHILDHOOD EDUCATION (ECE) CENTER ONSITE/ NEARSITE TO CHI HEALTH ST. MARY'S HOSPITAL FY24 ACTIONS AND IMPACT: NO UPDATES TO REPORT. MEASURES: NO MEASURES TO REPORT. 2.6 HEALTH EQUITY TRANSFORMATION ASSESSMENT (HETA) 2.6.1 COMPLETE THE AMERICAN HOSPITAL ASSOCIATION'S HETA AND UTILIZE RESULTS TO DEVELOP AN ACTION PLAN. FY24 ACTIONS AND IMPACT: COMPLETED THE HETA ASSESSMENT. CREATED A HEALTH EQUITY ACTION PLAN AND FORMED A COMMITTEE TO ADVANCE THE WORK. MEASURES: NO MEASURES TO REPORT. THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS: ACCESS TO HEALTHCARE SERVICES. IN ADDITION TO THE RATIONALE STATED ABOVE, ACCESS TO CARE IS A FUNDAMENTAL COMPONENT OF CHI HEALTH'S MISSION AND STRATEGY. CHI HEALTH AND CHI HEALTH CLINIC ARE CURRENTLY WORKING TO EXPAND THE PORTFOLIO OF PRIMARY CARE ACCESS POINTS INCLUDING EXTENDED CLINIC HOURS AND VIRTUAL CARE TO ENSURE ACCESS TO SPECIALTY CARE. IN ADDITION, CHI HEALTH INCREASES ACCESS TO CARE THROUGH THEIR FINANCIAL ASSISTANCE POLICY. AGING. BEYOND THE RATIONALE STATED ABOVE, THERE IS NOT ADDITIONAL WORK PRIORITIZED IN THIS HEALTH NEED AREA. HOWEVER, BLUE RIVERS AREA AGENCY ON AGING IS LEADING EFFORTS IN OTOE COUNTY TO ADDRESS THE NEEDS OF THE AGING POPULATION.CANCER. CHI HEALTH ST. MARY'S CONTINUES ITS EFFORTS AROUND IMPROVING SCREENING RATES FOR CANCER THROUGH CONSISTENT QUALITY IMPROVEMENT EFFORTS. THEY RECENTLY IMPLEMENTED PRACTICES TO SCREEN 80% OR MORE OF THE ELIGIBLE PATIENTS FOR COLON CANCER, AND PARTICIPATE IN THE EVERY WOMAN MATTERS CAMPAIGN TO IMPROVE BREAST CANCER SCREENING RATES. CHI HEALTH ST. MARY'S ALSO PROVIDES SPECIALTY CANCER CARE CLINICS ON-SITE IN THE RURAL LOCATION REGULARLY.CARDIOVASCULAR DISEASE. BEYOND THE RATIONALE STATED ABOVE, THERE IS NOT ADDITIONAL WORK PRIORITIZED IN THIS HEALTH NEED AREA. HOWEVER, AS A CRITICAL ACCESS HOSPITAL, CHI HEALTH ST. MARY'S RECOGNIZES THE NEED TO INCREASE ACCESS TO SPECIALTY CARE AND HOLDS A PARTNERSHIP WITH THE NEBRASKA HEART INSTITUTE TO PROVIDE SUPERIOR HEART AND VASCULAR CARE TO THE REGION. MATERNAL & CHILD HEALTH. IN ADDITION TO THE RATIONALE STATED ABOVE, CHI HEALTH ST. MARY'S HAS LONG SUPPORTED, AND WILL CONTINUE TO SUPPORT THE GROWING GREAT KIDS PROGRAM LED BY SOUTHEAST DISTRICT HEALTH DEPARTMENT, WHICH IS A HOME VISITING PROGRAM TO SUPPORT HEALTHY DEVELOPMENT FOR PREGNANT MOTHERS AND BABIES AGE ZERO TO THREE YEARS OF AGE, IN THE HOME. THE HOSPITAL PROVIDES FINANCIAL SUPPORT AND ADMINISTRATIVE GUIDANCE TO THE PROGRAM THAT SERVES OTOE COUNTY AND FOUR OTHER SURROUNDING COUNTIES. CHI HEALTH ST. MARY'S ALSO PROVIDED LEADERSHIP AND FUNDING SUPPORT TO P4OC WHICH SUPPORTED THE NEBRASKA CITY ECONOMIC DEVELOPMENT CORPORATION IN HIRING A PART-TIME EARLY CHILDHOOD DEVELOPMENT COORDINATOR. NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT STATUS. THIS NEED WILL BE ADDRESSED IN PART THROUGH OUR HEALTH-RELATED SOCIAL NEEDS STRATEGIES AND GOALS. IN ADDITION, CHI HEALTH ST. MARY'S ALSO OPERATES THE NEBRASKA CITY COMMUNITY GARDEN, OFFERING PLOTS TO THOSE IN NEED, AS WELL AS BUILDING CAPACITY OF COMMUNITY OWNERSHIP AND EDUCATIONAL ACTIVITIES RELATED TO FOOD PRODUCTION, HARVESTING, PREPARATION, AND SUSTAINABILITY. ADDITIONALLY, CHI HEALTH ST. MARY'S OFFERS THE HEALTHY FAMILIES PROGRAM, AN EVIDENCE-BASED LIFESTYLE MANAGEMENT PROGRAM FOR FAMILIES OF CHILDREN 8- 18 YEARS OF AGE WITH A HIGH BODY MASS INDEX (BMI), REFERRED BY A DOCTOR, TO RECEIVE A FREE EIGHT-WEEK COURSE ON HEALTHY EATING, ACTIVE LIVING, AND SETTING HEALTHY GOALS AS A FAMILY. THE TEAM WILL MONITOR PROGRESS AND ENROLLMENT OF THIS PROGRAM TO EVALUATE CONTINUED OFFERING. ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION. PATIENT COOPERATION STANDARDS - A PATIENT MUST COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. A PATIENT MUST EXHAUST ALL OTHER PAYMENT OPTIONS, INCLUDING PRIVATE COVERAGE, FEDERAL, STATE AND LOCAL MEDICAL ASSISTANCE PROGRAMS, AND OTHER FORMS OF ASSISTANCE PROVIDED BY THIRD PARTIES PRIOR TO BEING APPROVED. AN APPLICANT FOR FINANCIAL ASSISTANCE IS RESPONSIBLE FOR APPLYING TO PUBLIC PROGRAMS FOR AVAILABLE COVERAGE. HE OR SHE IS ALSO EXPECTED TO PURSUE PUBLIC OR PRIVATE HEALTH INSURANCE PAYMENT OPTIONS FOR CARE PROVIDED BY A COMMONSPIRIT HOSPITAL ORGANIZATION WITHIN A HOSPITAL FACILITY. A PATIENT'S AND, IF APPLICABLE, ANY GUARANTOR'S COOPERATION IN APPLYING FOR APPLICABLE PROGRAMS AND IDENTIFIABLE FUNDING SOURCES, INCLUDING COBRA COVERAGE (A FEDERAL LAW ALLOWING FOR A TIME-LIMITED EXTENSION OF EMPLOYEE HEALTHCARE BENEFITS), SHALL BE REQUIRED. IF A HOSPITAL FACILITY DETERMINES THAT COBRA COVERAGE IS POTENTIALLY AVAILABLE, AND THAT A PATIENT IS NOT A MEDICARE OR MEDICAID BENEFICIARY, THE PATIENT OR GUARANTOR SHALL PROVIDE THE HOSPITAL FACILITY WITH INFORMATION NECESSARY TO DETERMINE THE MONTHLY COBRA PREMIUM FOR SUCH PATIENT, AND SHALL COOPERATE WITH HOSPITAL FACILITY STAFF TO DETERMINE WHETHER HE OR SHE QUALIFIES FOR HOSPITAL FACILITY COBRA PREMIUM ASSISTANCE, WHICH MAY BE OFFERED FOR A LIMITED TIME TO ASSIST IN SECURING INSURANCE COVERAGE. A HOSPITAL FACILITY SHALL MAKE AFFIRMATIVE EFFORTS TO HELP A PATIENT OR PATIENT'S GUARANTOR APPLY FOR PUBLIC AND PRIVATE PROGRAMS. PART V, SECTION B, LINE 3E THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. SCHEDULE H, PART V, LINE 11 CONTINUED VIOLENCE. CHI HEALTH ST. MARY'S HAS LONG SUPPORTED VIOLENCE PREVENTION EFFORTS IN OTOE COUNTY BY LEADING A UNITED AGAINST VIOLENCE COALITION THAT BRINGS TOGETHER A MULTI-DISCIPLINARY COMMUNITY STAKEHOLDER GROUP TO IMPLEMENT SOCIAL EMOTIONAL LEARNING CURRICULUM IN THE SCHOOLS, SUPPORT THE IMPLEMENTATION OF POLICIES THAT PREVENT VIOLENCE IN THE WORKPLACE AND COMMUNITY, AND GENERALLY PROMOTE AWARENESS AROUND THE NEED TO REDUCE VIOLENT BEHAVIORS. THE HOSPITAL WILL WORK TO SUSTAIN THIS WORK THROUGH THE CONTINUATION OF THE COALITION AS PART OF THE BROADER WORK LED BY THE COMMUNITY. PART I, LINE 3C: UNLESS ELIGIBLE FOR PRESUMPTIVE FINANCIAL ASSISTANCE, THE FOLLOWING ELIGIBILITY CRITERIA MUST BE MET IN ORDER FOR A PATIENT TO QUALIFY FOR FINANCIAL ASSISTANCE: - THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS. - THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS. - THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA). FOR PATIENTS AND GUARANTORS WHO ARE UNABLE TO PROVIDE REQUIRED DOCUMENTATION, A HOSPITAL FACILITY MAY GRANT PRESUMPTIVE FINANCIAL ASSISTANCE BASED ON INFORMATION OBTAINED FROM OTHER RESOURCES. IN PARTICULAR, PRESUMPTIVE ELIGIBILITY MAY BE DETERMINED ON THE BASIS OF INDIVIDUAL LIFE CIRCUMSTANCES THAT MAY INCLUDE: - RECIPIENT OF STATE-FUNDED PRESCRIPTION PROGRAMS; - HOMELESS OR ONE WHO RECEIVED CARE FROM A HOMELESS CLINIC; - PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC); - FOOD STAMP ELIGIBILITY; - ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID); - LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR - PATIENT IS DECEASED WITH NO KNOWN ESTATE. PART I, LINE 6A: ALEGENT CREIGHTON HEALTH, DBA CHI HEALTH (A RELATED ORGANIZATION) PRODUCES AN ANNUAL PUBLIC COMMUNITY BENEFIT REPORT THAT IS MAILED TO A CORE CONSTITUENCY, PLACED IN KEY PLACES THROUGHOUT THE ORGANIZATION AND DISTRIBUTED IN COMMUNITY MEETINGS. IT IS ALSO AVAILABLE ON THE COMPANY'S INTRANET SITE AND ON ITS PUBLIC WEBSITE AT HTTPS://WWW.CHIHEALTH.COM/ABOUT-US/MISSION-VALUES/COMMUNITY-BENEFIT. THE COMMUNITY BENEFIT REPORT CONTAINS INFORMATION FOR SEVERAL RELATED ORGANIZATIONS IN IOWA AND NEBRASKA. PART I, LINE 7: COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY ("CBISA") SOFTWARE ARE USED TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS. PART I, LINE 7G: INCLUDED IN SUBSIDIZED HEALTH SERVICES IS THE FOLLOWING PHYSICIAN CLINIC:CHI HEALTH NEBRASKA CITY RURAL HEALTH CLINICTHE TOTAL EXPENSES ASSOCIATED WITH OPERATING THIS CLINIC WERE $6,137,628. REVENUE OFFSETS WERE $3,556,803. ACCORDINGLY, THE TOTAL SUBSIDIZED COST OF THESE NECESSARY SERVICES WAS $2,580,825. THE CLINIC MEETS A COMMUNITY NEED FOR PRIMARY CARE SERVICES OUTSIDE OF THE EMERGENCY ROOM SETTING. PART II, COMMUNITY BUILDING ACTIVITIES: CHI HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT INVESTMENTS, AS WELL AS HOSPITAL SPECIFIC INVESTMENTS THAT ADDRESS COMMUNITY HEALTH NEEDS WHICH INCLUDE SUPPORT OF LOCAL HEALTH COALITIONS, INVESTMENTS IN PARTNERSHIPS AND PROGRAMS THAT ADDRESS TOP COMMUNITY HEALTH NEEDS, PARTICIPATION IN LOCAL COMMITTEES AND BOARDS TIED TO TOP HEALTH NEEDS, AND INVESTMENTS IN MANY OTHER WAYS AS DESCRIBED IN OTHER AREAS OF THE SCHEDULE H NARRATIVE.BELOW ARE SPECIFIC EXAMPLES OF WORK THAT FALLS WITHIN THE DEFINITION OF COMMUNITY BUILDING ACTIVITIES. THESE ACTIVITIES ARE CRITICAL IN HELPING BUILD SOCIAL, HEALTH, AND ECONOMIC OPPORTUNITIES IN OUR COMMUNITY THAT ULTIMATELY DRIVE HEALTH STATUS AND QUALITY OF LIFE FOR OUR RESIDENTS: WORKFORCE DEVELOPMENT-ACTIVITIES TO STRENGTHEN THE COMMUNITY'S CAPACITY TO PROMOTE THE HEALTH AND WELL-BEING OF OUR RESIDENTS BY DRIVING ENTRY INTO HEALTHCARE CAREERS. COMMUNITY WASTE REDUCTION AND SHARPS DISPOSAL - PROVIDE FREE OF CHARGE TO ANY PERSONS IN THE COMMUNITY TO PROVIDE SAFE DISPOSAL OF CONTAMINATED NEEDLES AND PROPERLY DISPOSE OF UNUSED PRESCRIPTION DRUGS. HOST STUDENTS ACCELERATING IN LEADERSHIP CONFERENCE PART III, LINE 2: THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR ADDITIONAL DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: ST. MARY'S COMMUNITY HOPISTAL MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. ST. MARY'S COMMUNITY HOPISTAL'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. ST. MARY'S COMMUNITY HOPISTAL ALSO UTILIZES A WAYSTAR SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. WAYSTAR USES A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, ST. MARY'S COMMUNITY HOPISTAL DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. PART III, LINE 4: ST. MARY'S COMMUNITY HOSPITAL DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2024, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 11-12."PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES." PART III, LINE 8: COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. SAINT MARY'S COMMUNITY HOSPITAL'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $1,892,878 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS. PART III, LINE 9B: COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. PART VI, LINE 3: INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT HOSPITAL ORGANIZATION NON-MEDICAL OR MEDICAL STAFF, INCLUDING PHYSICIANS, NURSES, FINANCIAL COUNSELORS, SOCIAL WORKERS, CASE MANAGERS, CHAPLAINS, AND RELIGIOUS SPONSORS. A REQUEST FOR ASSISTANCE MAY BE MADE BY THE PATIENT OR A FAMILY MEMBER, CLOSE FRIEND OR ASSOCIATE OF THE PATIENT, SUBJECT TO APPLICABLE PRIVACY LAWS. PART VI, LINE 4: OTOE COUNTY IS CONSIDERED THE PRIMARY SERVICE AREA OF CHI HEALTH ST. MARY'S, AS A CRITICAL ACCESS HOSPITAL, CHI HEALTH ST. MARY'S SERVES A LARGELY RURAL POPULATION OVER 616 SQUARE MILES IN OTOE COUNTY, NEBRASKA. OTOE COUNTY IS HOME TO TEN COMMUNITIES WITH FIVE SCHOOL DISTRICTS. THE POPULATION OF THESE COMMUNITIES RANGE IN POPULATION FROM 57 IN BURR, TO 1,942 IN SYRACUSE AND 7,289 IN NEBRASKA CITY. CHI HEALTH ST. MARY'S IS LOCATED IN NEBRASKA CITY, WHICH ALSO SERVES AS THE COUNTY SEAT FOR OTOE COUNTY AND IS APPROXIMATELY 50 MILES FROM THE OMAHA METROPOLITAN AREA AND 50 MILES FROM THE NORTHERN KANSAS BORDER. FOR THE PURPOSES OF THE CHNA, OTOE COUNTY IS CONSIDERED THE PRIMARY SERVICE AREA OF CHI HEALTH ST. MARY'S AND IS THEREFORE THE IDENTIFIED COMMUNITY, WHICH INCLUDE THE FOLLOWING ZIP CODES: 68410, 68305, 51652. OVERALL, OTOE COUNTY IS SLIGHTLY OLDER, AND IS LESS DIVERSE (PREDOMINANTLY NON-HISPANIC WHITE), COMPARED TO THE STATE OF NEBRASKA. THE PROPORTION OF NEBRASKA CITY'S HISPANIC POPULATION INCREASED FROM 6.8% IN 2014 TO 15.1% IN 2021. OTOE COUNTY POPULATION EXPERIENCES LOWER INCOME, AND LOWER BACHELOR DEGREE ATTAINMENT THAN THE STATE AND U.S. OF THE 20% OF CHILDREN LIVING IN POVERTY IN OTOE COUNTY, 48.46% ARE HISPANIC OR LATINO. OTOE COUNTY HAS A SLIGHTLY LOWER PERCENTAGE OF PERSONS WITHOUT HEALTH INSURANCE (9.5%) WHEN COMPARED TO NEBRASKA (9.8%). OTOE COUNTY HAS SEVEN DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREAS (HPSA) INCLUDING PRIMARY CARE, DENTAL HEALTH AND MENTAL HEALTH DISCIPLINES. THE HPSA SCORES FOR THE SEVEN DESIGNATED HPSAS RANGE FROM 5- 17 FROM A SCORE RANGE OF 0- 26, IN WHICH THE HIGHER THE SCORE, THE GREATER THE PRIORITY. THERE ARE CURRENTLY NO MEDICALLY UNDERSERVED AREAS/POPULATIONS (MUA) IN OTOE COUNTY. PART VI, LINE 5: FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE. USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE. OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS. ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE.. HOSPITAL COMMUNITY BOARDS (ORG THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AN PROGRESS TOWARD IDENTIFIED GOALS. PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 24 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS. COMMONSPIRIT HEALTH AND SUBSTANTIALLY ALL OF ITS DIRECT AFFILIATES AND SUBSIDIARIES HAVE BEEN GRANTED EXEMPTIONS FROM FEDERAL INCOME TAX AS CHARITABLE ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF SEPTEMBER 25, 2024, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,300 CARE SITES, CONSISTING OF 137 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. AN ADDITIONAL 21 HOSPITALS ARE OPERATED THROUGH UNCONSOLIDATED JOINT VENTURES. IN FISCAL YEAR 2024, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.574 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.22 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $37.5 BILLION IN FISCAL YEAR 2024, HAS TOTAL ASSETS OF APPROXIMATELY $54.73 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. 1 BRANCH FOR FAMILIES INC 200 N 3RD ST NEBRASKA CITY NE 68410 611871814 501(C)(3) 15000 0 PROGRAM SUPPORT 1 0 EMPLOYEE FINANCIAL ASSISTANCE 2 1150 PART III EXPLANATION FINANCIAL ASSISTANCE WAS PROVIDED TO TWO EMPLOYEES EXPERIENCING FINANCIAL HARDSHIP TO HELP PREVENT EVICTION AND ENSURE HOUSING STABILITY. 1 1 0 0 0 0 0 0 0 JOHN PETERSDORF BOARD MEMBER 0 645040 0 716812 0 727895 0 923913 0 68907 0 3082567 0 713173 EVERT KUIPER FORMER PRESIDENT & CEO CHI HEALTH 0 749566 0 0 0 2037667 0 20045 0 28489 0 2835767 0 0 TIM BRICKER EX-OFFICIO BM/ PRESIDENT & CEO CHI H 0 876719 0 1582430 0 40043 0 82634 0 33892 0 2615718 0 0 JEANETTE WOJTALEWICZ FORMER CFO, CHI HEALTH 0 128679 0 132479 0 1083677 0 9698 0 2669 0 1357202 0 0 JEFFREY STEARNES MD FORMER HCE/PHYSICIAN 0 784356 0 0 0 1932 0 21584 0 39345 0 847217 0 0 STACY BLUM MD PHYSICIAN-FAMILY MEDICINE 395688 113182 0 0 1260 0 19175 0 36998 2334 453121 115516 0 0 BRETT MEYER MD PHYSICIAN-FAMILY MEDICINE 386590 115157 0 0 1015 0 19000 0 1732 0 408337 115157 0 0 BRADLEY VASA MD MEDICAL DIRECTOR 454826 0 0 0 3612 0 19350 0 38795 0 516583 0 0 0 DAVID JONES MARKET PRESIDENT, REGIONAL HOSPITALS 0 303052 0 156175 0 1465 0 19175 0 34442 0 514309 0 0 SAMANTHA BOYER MD PHYSICIAN-FAMILY MEDICINE 321487 108510 14818 0 6900 0 18175 0 1732 0 363112 108510 0 0 DANIEL DEFREECE MD PRESIDENT 252743 0 132482 0 12174 0 32409 0 39786 0 469594 0 9979 0 TIM SCHNACK MARKET CFO (BEG 05/24) 0 290959 0 74901 0 3855 0 19529 0 28524 0 417768 0 0 NICK O'TOOL END 0524 INTERIM CFO (THRU 05/24) 0 252554 0 96047 0 419 0 16660 0 34289 0 399969 0 0 KIRTIBALA GUPTA MD BOARD MEMBER/PHYSICIAN 0 342890 0 0 0 3612 0 18825 0 28699 0 394026 0 0 COLE MAROLF PHYSICIAN-FAMILY MEDICINE 299852 27936 0 0 536 0 16678 0 26776 795 343842 28731 0 0 HEATHER MORGAN MD BOARD MEMBER/PHYSICIAN 0 319514 0 0 0 911 0 18500 0 39877 0 378802 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2023, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH, USED ONE OR MORE OF THE METHODS DESCRIBED IN SCHEDULE J, PART I, LINE 3 TO ESTABLISH THE TOP MANAGEMENT OFFICIAL'S COMPENSATION: (1) COMPENSATION COMMITTEE; (2) INDEPENDENT COMPENSATION CONSULTANT; (3) COMPENSATION SURVEY OR STUDY; (4) APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15 FOR ADDITIONAL INFORMATION. PART 1, LINE 4A: CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY AN EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 52 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION AND TENURE, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS DURING THE 2023 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUALS' W-2 INCOME AND REPORTABLE COMPENSATION ON PART VII AND SCHEDULE J, PART II, COLUMN (B)(III): EVERT KUIPER, $2,025,542; JEANETTE WOJTALEWICZ, $1,083,464. PART 1, LINE 4B: DURING THE 2023 CALENDAR YEAR, COMMONSPIRIT HEALTH ("COMMONSPIRIT") MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DURING 2023 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: DANIEL DEFREECE, $9,979. DUE TO THE "SUPER" VESTING RULES UNDER COMMONSPIRIT'S DEFERRED COMPENSATION PLAN, PARTICIPANTS WHO HAVE MET CERTAIN REQUIREMENTS SUCH AS INVOLUNTARY TERMINATION WITHOUT CAUSE, AGE, AGE AND YEARS OF SERVICE, OR MORE THAN 5 YEARS OF PLAN PARTICIPATION ARE ELIGIBLE TO RECEIVE THEIR 2023 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN LIMITED TO PARTICIPANTS IN THE DIGNITY HEALTH RETIREMENT PLAN WHOSE BENEFITS ARE AFFECTED BY THE LIMITATIONS IMPOSED BY SECTIONS 401(A)(17) AND 415 OF THE INTERNAL REVENUE CODE. BENEFIT SERVICE UNDER THIS PLAN WAS FROZEN AS OF JANUARY 1, 2008. CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH ARE ELIGIBLE TO PARTICIPATE IN NON-QUALIFIED 457(F) PLANS THAT ARE SUBJECT TO SUBSTANTIAL RISK OF FORFEITURE, AS REQUIRED BY THE IRS. THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR EXECUTIVES HIRED PRIOR TO JUNE 30, 2006. THE BENEFIT IS INTENDED TO BRIDGE THE DIFFERENCE, IF ANY, BETWEEN THE BENEFIT PROVIDED UNDER THE DIGNITY HEALTH EXCESS BENEFIT PLAN HAD BENEFIT SERVICE NOT BEEN FROZEN AT JANUARY 1, 2008, AND THE BENEFITS PROVIDED FROM ALL OTHER QUALIFIED AND NON-QUALIFIED PLANS. BENEFITS VEST UNDER THIS 457(F) PLAN AT THE LATER OF THE DATE THE PARTICIPANT ATTAINS AGE 62 OR IS CREDITED WITH 15 YEARS OF SERVICE. THE 2010 EXECUTIVE DEFERRED COMPENSATION PLAN IS FOR CERTAIN OFFICERS AND KEY EMPLOYEES, PRIMARILY THOSE WHO ARE NOT ELIGIBLE TO PARTICIPATE IN THE DIGNITY HEALTH EXCESS BENEFIT PLAN OR THE 2007 EXECUTIVE DEFERRED COMPENSATION PLAN DESCRIBED ABOVE. THIS BENEFIT PROVIDES AN ANNUAL ACCRUAL OF 10% OF TOTAL COMPENSATION AND IS PAYABLE ANNUALLY ON JULY 1 ONCE VESTED, WHICH IS AGE 62 WITH 5 YEARS OF SERVICE. THE PLAN ALSO ALLOWS FOR SPECIAL AWARDS. PAYMENTS PURSUANT TO THE PLAN ARRANGEMENTS FOR ONE BOARD MEMBERS/OFFICER OCCURRED DURING 2023: JOHN PETERSDORF, $713,173. CERTAIN LISTED PERSONS EMPLOYED BY DIGNITY HEALTH PARTICIPATE IN THE DIGNITY HEALTH SUPPLEMENTAL EXECUTIVE RETENTION/RETIREMENT PLAN, A NONQUALIFIED SUPPLEMENTAL BENEFIT PLAN WHICH IN 2002 WAS OFFERED TO MEMBERS OF THE EXECUTIVE MANAGEMENT TEAM BY THE DIGNITY HEALTH BOARD OF DIRECTORS AND WOULD BE PAID ONLY IF THE EXECUTIVES STAYED WITH THE ORGANIZATION FOR A SPECIFIED NUMBER OF YEARS AS THE PRIMARY PURPOSE OF THIS PLAN IS TO PROVIDE FOR THE RETENTION AND RETIREMENT OF THE PARTICIPANTS. THE EXECUTIVE MANAGEMENT TEAM IS RECRUITED FROM STABLE CAREERS IN ORGANIZATIONS FROM ACROSS THE COUNTRY AND FROM VARIOUS INDUSTRIES. DUTIES ARE BOTH EXTENSIVE AND COMPLEX AND REQUIRE SUBSTANTIAL AND DIVERSE EXPERIENCE AND SKILL SETS TO EXECUTE THEIR ROLES SUCCESSFULLY. THE CALCULATION FOR THE PAYMENTS TO EACH EXECUTIVE ARE BASED ON THE VALUE OF A FINAL AVERAGE PAY ANNUITY BENEFIT BASED ON RETIREMENT AGE AND SERVICE YEARS TO THE ORGANIZATION. DISTRIBUTION OCCURS EACH JULY 1 IF THE PLAN FORMULA WARRANTS A PAYMENT. NO PAYMENTS PURSUANT TO THE PLAN ARRANGEMENT OCCURRED DURING 2023. PART II ST. MARY'S COMMUNITY HOSPITAL FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST COMMONSPIRIT IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE COMMONSPIRIT TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES COMMONSPIRIT SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND COMMONSPIRIT'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL, AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2023. PART V, LINE 1C PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF COMMONSPIRIT HEALTH ARE MADE BY COMMONSPIRIT HEALTH. THEREFORE NO FORM 1099S ARE ISSUED BY ST. MARY'S COMMUNITY HOSPITAL. COMMONSPIRIT HEALTH FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY COMMONSPIRIT HEALTH ON BEHALF OF ST. MARY'S COMMUNITY HOSPITAL ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 1A PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 2 MARDELL WILSON AND KEVIN FITZGERALD - BUSINESS RELATIONSHIP FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS CHI NEBRASKA, A NEBRASKA NON-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS CHI NEBRASKA. PURSUANT TO SECTION 5.4.1 OF THE ORGANIZATION'S BYLAWS, BOTH CHI NEBRASKA AND COMMONSPIRIT HEALTH (CHI NEBRASKA'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE COMMONSPIRIT HEALTH GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE CHI NEBRASKA'S BOARD: * APPROVE MEMBERS OF THE ST. MARY'S COMMUNITY HOSPITAL. * AMENDMENT OF THE CORPORATE DOCUMENTS OF THE ST. MARY'S COMMUNITY HOSPITAL. * APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ST. MARY'S COMMUNITY HOSPITAL. * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE ST. MARY'S COMMUNITY HOSPITAL. THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE ST. MARY'S COMMUNITY HOSPITAL. * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ST. MARY'S COMMUNITY HOSPITAL. * APPROVAL OF ISSUANCE OF DEBT BY ST. MARY'S COMMUNITY HOSPITAL. * APPROVAL OF PARTICIPATION OF ST. MARY'S COMMUNITY HOSPITAL IN A JOINT VENTURE. * APPROVAL OF FORMATION OF A NEW CORPORATION BY ST. MARY'S COMMUNITY HOSPITAL. * APPROVAL OF A MERGER INVOLVING THE ST. MARY'S COMMUNITY HOSPITAL. * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ST. MARY'S COMMUNITY HOSPITAL. * TO REQUIRE THE TRANSFER OF ASSETS BY ST. MARY'S COMMUNITY HOSPITAL TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS. PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, CHI NEBRASKA OR COMMONSPIRIT HEALTH MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 11B FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE COMMONSPIRIT HEALTH TAX DIRECTOR AND THE LOCAL CHIEF FINANCIAL OFFICER. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW AND ARE ABLE TO ASK THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR QUESTIONS PRIOR TO FILING WITH THE IRS. UPON CHIEF FINANCIAL OFFICER APPROVAL AND SIGNATURE, THE TAX ANALYST FILES THE FINAL FORM 990 AS PRESENTED TO THE BOARD AND FINANCE COMMITTEE, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO PROTECT THE INTERESTS OF COMMONSPIRIT HEALTH ("COMMONSPIRIT") IN CIRCUMSTANCES THAT MAY RESULT IN A CONFLICT BETWEEN PERSONAL INTERESTS OF A PERSON AND THE INTERESTS OF THE ORGANIZATION AND THOSE IT SERVES. COMMONSPIRIT'S COI POLICY APPLIES TO COMMONSPIRIT, ITS DIRECT AFFILIATES AND SUBSIDIARIES AND ANY RELATED ENTITY THE GOVERNING DOCUMENTS OF WHICH REQUIRE THE ENTITY TO COMPLY WITH COMMONSPIRIT POLICY (COLLECTIVELY THE "SYSTEM ENTITIES"). THE FOLLOWING PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY (VIA A FORMAL SYSTEM-ADMINISTERED SURVEY) IF THE PERSON'S AFFILIATION WITH COMMONSPIRIT CONTINUES: - MEMBERS OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF COMMITTEES OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM ("ELT") OF COMMONSPIRIT - CORPORATE OFFICERS OF SYSTEM ENTITIES - EMPLOYED PHYSICIANS AND ADVANCED PRACTICE PROVIDERS - KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES AS SPECIFIED BY THE INTERNAL REVENUE SERVICE FOR FORM 990 PURPOSES WHO ARE NOT OTHERWISE INCLUDED IN THE CATEGORIES ABOVE - EMPLOYEES OF SYSTEM ENTITIES AT THE VICE PRESIDENT LEVEL AND ABOVE - ALL INDIVIDUALS ENGAGED IN RESEARCH AT INSTITUTIONS OWNED OR OPERATED BY A SYSTEM ENTITY - SELECT EMPLOYEES AS DETERMINED FROM TIME TO TIME BY LEADERSHIP DISCLOSURE, REVIEW, AND MANAGEMENT OF PERCEIVED, POTENTIAL, OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. EACH PERSON IS REQUIRED TO PROMPTLY AND FULLY DISCLOSE ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST AS SOON AS SHE/HE BECOMES AWARE OF IT. IN ADDITION, AT THE INCEPTION OF AN INDIVIDUAL'S RELATIONSHIP WITH COMMONSPIRIT (E.G. HIRING, BOARD APPOINTMENT), AND FOR CERTAIN POSITIONS, ANNUALLY THEREAFTER, WRITTEN CONFLICT OF INTEREST DISCLOSURE FORMS MUST BE COMPLETED. A FAILURE TO DISCLOSE MAY RESULT IN DISCIPLINARY OR CORRECTIVE ACTIONS. REPORTED POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE INITIALLY REVIEWED BY LEGAL, CORPORATE RESPONSIBILITY OR RESEARCH INTEGRITY STAFF. IF NECESSARY, A CONFLICT OF INTEREST MANAGEMENT PLAN IS DEVELOPED, WHICH PLAN SHALL BE SUBJECT TO ACCEPTANCE BY THE APPROPRIATE DIRECT MANAGER, SUPERVISOR, MEDICAL STAFF OFFICE, BOARD OR BOARD COMMITTEE (FOR BOARD, BOARD COMMITTEE, ELT OR CORPORATE OFFICER CONFLICTS), OR OTHER APPROPRIATE INDIVIDUAL OR BODY. ONCE ACCEPTED, THE CONFLICT OF INTEREST MANAGEMENT PLAN IS COMMUNICATED TO THE PERSON WITH THE ACTUAL OR POTENTIAL CONFLICT AND THE INDIVIDUAL MUST CONDUCT THEMSELVES IN CONFORMITY WITH THE PLAN. IN THE EVENT THAT A TRANSACTIONAL CONFLICT INTEREST ARISES IN CONNECTION WITH A SYSTEM ENTITY BOARD MEETING, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THAT CONFLICT PRIOR TO OR AT THE BEGINNING OF THE MEETING IN WHICH THE MATTER IS TO BE CONSIDERED. THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE TRANSACTION AND IS PROHIBITED FROM USING PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, BUT IS NOT PROHIBITED FROM PROVIDING INPUT IF REQUESTED TO DO SO. FORM 990, PART VI, SECTION B, LINE 15B COMMONSPIRIT'S BOARD OF STEWARDSHIP TRUSTEES APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED EXCLUSIVELY OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR SETTING REASONABLE COMPENSATION PRACTICES FOR CERTAIN EXECUTIVES WITHIN ORGANIZATION. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE IN DETERMINING VARIABLE COMPENSATION. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES AN INDEPENDENT CONSULTANT AND FINANCIAL LEGAL COUNSEL TO VALIDATE THE ORGANIZATION'S BENCHMARKING APPROACH AND REASONABLENESS OF THE TOTAL COMPENSATION AND BENEFITS PACKAGES FOR CERTAIN EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED BY THE COMMONSPIRIT HEALTH COMPENSATION DEPARTMENT FROM INDEPENDENT THIRD-PARTY SALARY SURVEYS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES) FOR ALL OTHER STAFF AND LEADERSHIP ROLES. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 2,772,771. MANAGEMENT AND GENERAL EXPENSES 144,090. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,916,861. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 3,006,227. MANAGEMENT AND GENERAL EXPENSES 158,222. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,164,449. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 49,979. MANAGEMENT AND GENERAL EXPENSES 5,553. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 55,532. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 933,774. MANAGEMENT AND GENERAL EXPENSES 49,146. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 982,920. 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