2022-05-13T16:54:33-05:00 2021-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2020-07-01 420776568 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IOWA ALEG 4023434323 631 N 8TH ST MISSOURI VALLEY IA 515551102 JEANETTE WOJTALEWICZ CFO 4023434323 2022-05-13 1 JEANETTE WOJTALEWICZ ANGELA NOEL P01051055 3032989100 2 AAL1 IAL1 2020 2022-09-23 18:48:47Z EJ KUIPER 12809 WEST DODGE ROAD OMAHA NE 68154 28487391 0 X WWW.CHIHEALTH.COM X 1955 IA THE MISSION OF THE CORPORATION IS TO NURTURE THE HEALING MINISTRY OF THE CHURCH, SUPPORTED BY EDUCATION AND RESEARCH. 14 10 183 17 6027 5027 1588197 371411 24679354 25355876 1381404 2593702 100003 157553 27748958 28478542 14705 12805 0 0 11668661 12286700 0 0 0 10415352 12664860 22098718 24964365 5650240 3514177 62983632 71208941 10370657 9141153 52612975 62067788 X 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 5767467 1311 2596004 AH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY PROVIDES PATIENTS WITH ACCESS TO PRIMARY CARE THROUGH FAMILY MEDICINE PRACTITIONERS THAT PROVIDE CONTINUING, COMPREHENSIVE HEALTH CARE FOR INDIVIDUAL FAMILY MEMBERS OF BOTH GENDERS AND ALL AGES. BY PLACING SPECIAL ATTENTION ON THE FAMILY AS A GROUP, THE FAMILY MEDICINE PRACTITIONER PROVIDES INTEGRATED CARE TO ALL PATIENTS WITHIN A FAMILY. FAMILY PRACTITIONERS; EMPHASIZE DISEASE PREVENTION AND WELLNESS BY RECOMMENDING PREVENTITIVE TESTS, COACH PATIENTS TO CHANGE HEALTH BEHAVIORS SO THEY DO NOT DEVELOP CHRONIC CONDITIONS, MONITOR CHRONIC CONDITIONS TO PREVENT FURTHER COMPLICATIONS, COLLABORATE WITH THE SPECIALIST, COORDINATING THE PATIENT'S HEALTHCARE AND SERVING AS THE PATIENT'S ADVOCATE IN ALL CARE SETTINGS WHEN A REFERRAL TO A SPECIALIST IS NECESSARY. 2352628 4920 9743010 ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY IS PROUD TO OFFER DIAGNOSTIC IMAGING SERVICES - CLOSE TO HOME - WITHIN THE COMMUNITY. THE DIAGNOSTIC IMAGING SERVICES PROVIDED INCLUDE THE FOLLOWING: CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND. 1880915 994 1967602 AS A COMMUNITY HOSPITAL, ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY HAS STAYED COMMITTED TO KEEPING RESIDENTS OF HARRISON COUNTY IN GOOD HEALTH. THROUGH THE YEARS, ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL HAS STRIVED TO IMPROVE THE HEALTH STATUS OF SOUTHWEST IOWA RESIDENT CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS THROUGH 24-HOUR EMERGENCY CARE WITH HELIPORT ACCOMMODATIONS. 13831489 5580 11049260 OTHER PROGRAMS: 13831489 5580 11049260 23832499 1 1 0 1 0 0 0 0 0 1 1 1 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 0 0 183 1 1 1 0 0 0 0 0 0 0 0 0 0 0 X 14 10 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 1 0 X JEANETTE WOJTALEWICZ 4023434323 12809 WEST DODGE ROAD OMAHA NE 68154 ANTHONY JONES BOARD MEMBER 1.00 59.00 X 0 2948442 27283 CLIFF ROBERTSON MD BOARD MEMBER/CEO, CHI HEALTH 5.00 45.00 X X 0 2330702 46702 JOHN PETERSDORF BOARD MEMBER 1.00 49.00 X 0 1060100 793557 JEANETTE WOJTALEWICZ BOARD MEMBER/CFO/INTERIM CEO, CHI HEALTH 5.00 45.00 X X 0 986312 50266 CARY WARD MD FORMER OFFICER 6.00 44.00 X 0 642515 41571 AHMAD ALCHOMMALI MD PHYSICIAN 60.00 0.00 X 570528 0 44802 STEVE HOUSTON FORMER KEY EMPLOYEE 10.00 40.00 X 0 433805 41724 NATHANIEL ALVIS MD PHYSICIAN 60.00 0.00 X 421364 0 49122 DANIEL RICHTER MD PHYSICIAN 60.00 0.00 X 388427 0 46380 HEATHER MORGAN MD BOARD MEMBER 1.00 59.00 X 0 293208 48743 CARRIE GRADY MD PHYSICIAN 60.00 0.00 X 293052 0 41040 MATTHEW BOGARD MD PHYSICIAN 60.00 0.00 X 286399 0 39753 JONATHAN MOE FORMER PRESIDENT, COMMUNITY MEMORIAL 50.00 0.00 X 253488 0 46109 DEBRA GOLDSMITH PRESIDENT, REGIONAL HOSPITAL 1.00 49.00 X 0 234088 48985 NICK OTOOL INTERIM CFO, CHI HEALTH 5.00 45.00 X 0 212548 40111 JASON KRUGER MD BOARD MEMBER 1.00 59.00 X 0 143420 41585 JENNIFER BEATY MD BOARD MEMBER 1.00 11.00 X 0 0 0 FR JAMES CLIFTON SJ SECRETARY 1.00 11.00 X X 0 0 0 RICHARD HERINK BOARD MEMBER 1.00 11.00 X 0 0 0 SUSANNE L HRUZA MD BOARD MEMBER 1.00 11.00 X 0 0 0 ROBERT LANIK TREASURER 1.00 11.00 X X 0 0 0 THOMAS MURRAY PHD BOARD MEMBER 1.00 11.00 X 0 0 0 BARRY SANDSTROM BOARD MEMBER 1.00 11.00 X 0 0 0 SISTER MAURITA SOUKUP BOARD CHAIR 1.00 12.00 X X 0 0 0 BILL YATES BOARD MEMBER 1.00 11.00 X 0 0 0 NADINE HEIMANN OSF BOARD MEMBER 1.00 11.00 X 0 0 0 MARDELL WILSON EDD BOARD MEMBER 1.00 11.00 X 0 0 0 KENT BARNEY BOARD MEMBER 1.00 11.00 X 0 0 0 DAVID JONES PRESIDENT, COMMUNITY MEMORIAL 50.00 0.00 X 0 0 0 2213258 9285140 1447733 18 1 1 0 MCKINNIS ROOFING & SHEET METAL 164 SOUTH 1ST ST BLAIR NE 68008 ROOFING CONSTRUCTION SERVICES 306799 SNYDER CHARLESON THERAPY SVCS 8031 W CENTER RD STE 300 OMAHA NE 68124 THERAPY SERVICES 187353 THOMAS RICE CRNA 1154 S 96TH ST OMAHA NE 68124 ANESTHESIOLOGY SERVICES 156320 3 371411 371411 NET PATIENT SERVICES 900099 22328365 22328365 0 0 PHARMACY SERVICES 446110 3027511 3027511 0 0 25355876 456159 6027 450132 43298 0 43298 43298 43298 2075954 61589 0 0 2075954 61589 2137543 2137543 10108 8849 1259 1259 ADMINISTRATION 900099 41629 0 0 41629 CARE MGMT-INTERCOMPANY 900099 41555 0 0 41555 CAFETERIA 722100 25384 0 0 25384 4428 4428 112996 28478542 25355876 6027 2745228 X 7805 7805 5000 5000 245674 233391 12283 9566710 9076091 490619 490328 465811 24517 1354481 1286757 67724 629507 598032 31475 193737 184050 9687 3828 3828 63736 60549 3187 4658615 4430243 228372 13949 13251 698 470806 447266 23540 774223 735512 38711 497393 472524 24869 3169 3011 158 52 49 3 555665 527882 27783 638153 606246 31907 108688 103254 5434 MEDICAL SUPPLIES 2468328 2468328 0 0 MISCELLANEOUS EXPENSES 1938992 1841608 97384 0 REPAIRS AND MAINTENANCE 207649 197267 10382 0 UNRELATED BUSINESS TAXE 5200 5200 0 0 62677 59544 3133 24964365 23832499 1131866 0 872 206192 267286 0 30077767 31094350 0 0 0 364426 316276 7462 7462 9689944 4320477 4842697 5369467 0 26605359 33413462 0 0 879729 739766 62983632 71208941 7264956 7696922 0 2718954 1197846 0 0 0 0 0 386747 246385 10370657 9141153 X 52612975 62067788 0 52612975 62067788 62983632 71208941 X 3514177 4340014 -60029 1660651 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 3828 0 0 0 3828 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: IOWA HOSPITAL ASSOCIATION - $2,817 AMERICAN HOSPITAL ASSOCIATION - $660 CATHOLIC HEALTH ASSOCIATION - $351 560248 16360 0 4200 572408 556637 1856 10430 8675 560248 537445 178926 -3718 156016 556637 444406 101099 1596 9656 537445 307308 125355 11743 444406 0.00000 0.51000 0.49000 0 1 1 861370 861370 4641984 2001274 2640710 3529054 2173524 1355530 657536 145679 511857 5369467 CSH OPERATING INVESTMENT POOL 33413462 F 33413462 ENVIRONMENTAL REMEDIATION LIABILITY 4139 OPERATING LEASE LIABILITY 241989 ONPLAN SERVICE FEE LIABILITY 257 246385 X PART V, LINE 4: ENDOWMENT FUNDS ARE INTENDED TO HELP WITH THE ORGANIZATIONAL OPERATIONS OF COMMUNITY MEMORIAL HOSPITAL MEDICAL SERVICES FOUNDATION AND ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IA. PART X, LINE 2: ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA'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 300.000000000000 1 X 1 1 0 1 1 2102 253231 0 253231 0.01010 5074 3516509 2623180 893329 0.03580 0 0 0 7176 3769740 2623180 1146560 0.04590 6 160 44402 0 44402 0.00180 1 0 476 0 476 0.00000 2 0 3488343 2514111 974232 0.03900 1 0 1177 0 1177 0.00000 2 0 13957 0 13957 0.00060 12 160 3548355 2514111 1034244 0.04140 12 7336 7318095 5137291 2180804 0.08730 1 435190 0 8790612 8763199 27413 X 1 1 1 1 AH-COM MEM HOSPITAL OF MISSOURI VALLEY 631 N 8TH ST MISSOURI VALLEY IA 51555 WWW.CHIHEALTH.COM 430030H X X X A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 18 1 0 1 1 X WWW.CHIHEALTH.COM/CHNA X X 1 19 1 WWW.CHIHEALTH.COM/CHNA 0 1 X 300.000000000000 300.000000000000 X X X X 1 1 X X X 1 X WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: AH-COM MEM HOSPITAL OF MISSOURI VALLEY FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5: COMMUNITY INPUT WAS GATHERED THROUGH THE HEALTHY HARRISON COALITION, CO-LED BY CHI HEALTH MISSOURI VALLEY AND HARRISON COUNTY HOME AND PUBLIC HEALTH DEPARTMENT, AND CHI HEALTH MISSOURI VALLEY'S PATIENT AND FAMILY ADVISORY COUNCIL.SPECIFIC POPULATIONS AT HIGHER HEALTH RISK OR THAT HAVE POORER HEALTH OUTCOMES WERE IDENTIFIED IN THE HARRISON COUNTY COMMUNITY AS:-INDIVIDUALS 65 YEARS AND OLDER-LOW-INCOME POPULATION-PERSONS WITH DISABILITIES-INDIVIDUALS IMPACTED BY VIOLENCEON DECEMBER 18, 2018, THE HEALTHY HARRISON COALITION HOSTED A COMMUNITY HEALTH NEEDS ASSESSMENT DATA PRESENTATION FACILITATED BY CHI HEALTH. MEMBERS REPRESENTING SPECIAL POPULATIONS- AGING, DISABILITY, VIOLENCE AND LOW- INCOME- WERE INVITED TO PARTICIPATE. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B: HARRISON COUNTY HOME & PUBLIC HEALTH (HCHPH) FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 7D: SHARED WITH THE HOSPITAL'S PATIENT FAMILY ADVISORY COMMITTEE ON APRIL 4, 2019. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11: THE MOST RECENT CHNA AND CORRESPONDING IMPLEMENTATION PLAN WAS COMPLETED IN THE TAX REPORTING YEAR 2018. 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 REVIEW OF SECONDARY DATA VALIDATED AND PRIORITIZED BY COMMUNITY STAKEHOLDERS CONVENED THROUGH THE HEALTHY HARRISON COALITION. PARTICIPATING STAKEHOLDERS REPRESENTED: HEALTHCARE, PUBLIC HEALTH, EDUCATION, THE AGING POPULATION, LOW- INCOME POPULATION, PERSONS WITH DISABILITIES AND INDIVIDUALS IMPACTED BY VIOLENCE AND SUBSTANCE ABUSE.TOP HEALTH NEEDS (FROM 2018 CHNA):1. AGING2. CANCER3. CARDIOVASCULAR DISEASE4. CHILD ABUSE & NEGLECT5. CHRONIC LOWER RESPIRATORY DISEASE6. MENTAL HEALTH7. OBESITY & LIFESTYLE FACTORS FOR CHRONIC DISEASE8. SEXUALLY TRANSMITTED INFECTIONS9. SUBSTANCE ABUSE10. UNINTENTIONAL INJURIESFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: NUTRITION, PHYSICAL ACTIVITY & WEIGHTTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:- SUPPORT HARRISON COUNTY FARMER'S MARKET FRESH FRUIT & VEGETABLE VOUCHER PROGRAM (INCLUDING TRANSPORTATION, EDUCATION AND VOUCHERS)- EXPLORE THE FEASIBILITY OF A COMMUNITY GARDEN IN MISSOURI VALLEY AND SUPPORT COMMUNITY EFFORTS TO IMPLEMENT- ALIGN WITH AND PROMOTE 5-2-1-0 MESSAGING WHICH ENCOURAGES HEALTHY EATING HABITS AND APPROPRIATE LEVELS OF PHYSICAL ACTIVITYPRIORITY HEALTH NEED #2: BEHAVIORAL HEALTHTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:- SUPPORT AND PROMOTE SCHOOL- BASED MENTAL HEALTH PROGRAMMING FOCUSED ON PREVENTION OF SUICIDE, SUBSTANCE ABUSE AND BUILDING POSITIVE PARENTING SKILLS, SUCH AS: * COPING THROUGH THE TEEN YEARS (SUICIDE PREVENTION) * ME360 (SUBSTANCE ABUSE PREVENTION) * COMMON SENSE PARENTING (IMPROVING PARENT-CHILD INTERACTIONS THROUGH SKILL DEVELOPMENT) - PARTNER WITH CHI HEALTH CLINICS TO IMPROVE CONTINUUM OF CARE FOR PATIENTS WITH POSITIVE DEPRESSION SCREENING - PARTNER WITH THE REGION AND CHI HEALTH PSYCHIATRIC ASSOCIATES TO DELIVER MENTAL HEALTH FIRST AID TRAINING (MHFA).THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS: AGING. CHI HEALTH MISSOURI VALLEY RECOGNIZES THE GROWING AGING POPULATION IN HARRISON COUNTY PRESENTS CHALLENGES FOR HEALTH SERVICES INFRASTRUCTURE, HOWEVER HARRISON COUNTY HAS SEVERAL RESOURCES THAT EXIST TO OFFER RELEVANT SUPPORT TO ELDERLY POPULATIONS AND BETTER ADDRESS THE CHALLENGES THAT AGING PRESENT. THE COMMUNITY BENEFIT ACTION TEAM (CBAT) HAS EMPLOYED A LIFECOURSE APPROACH TO THE PRIORITY HEALTH NEEDS OF MENTAL HEALTH AND NUTRITION, PHYSICAL ACTIVITY AND WEIGHT STATUS, SO CONSIDERATION OF THE AGING POPULATION WILL BE ADDRESSED WITHIN THE ACTIVITIES AND STRATEGIES SELECTED. ADDITIONALLY, CHI HEALTH MISSOURI VALLEY LEADERSHIP WILL CONTINUE TO PARTICIPATE IN NURSING HOME PROVIDER MEETINGS TO BETTER INFORM CHALLENGES AND UNCOVER SOLUTIONS TO IMPROVING HEALTH AND SERVICE DELIVERY FOR THE AGING POPULATION. CANCER. CANCER WAS NOT SELECTED FOR WORK IN AN EFFORT TO MAXIMIZE EXISTING RESOURCES AND STAFF TIME TO ADDRESS NEEDS OR ROOT CAUSES WHICH HAVE THE POTENTIAL TO IMPACT OTHER IDENTIFIED HEALTH NEEDS. HOWEVER, CHI HEALTH WILL CONTINUE TO HOST A CANCER SUPPORT GROUP AND SMOKING CESSATION SERVICES. NUTRITION AND PHYSICAL ACTIVITY WAS AN IDENTIFIED HEALTH NEED WHICH WAS PRIORITIZED AND WILL INDIRECTLY ADDRESS CANCER.CARDIOVASCULAR DISEASE. THIS HEALTH NEEDS WAS NOT SELECTED FOR WORK IN AN EFFORT TO MAXIMIZE EXISTING RESOURCES AND STAFF TIME TO ADDRESS NEEDS OR ROOT CAUSES WHICH HAVE THE POTENTIAL TO IMPACT OTHER IDENTIFIED HEALTH NEEDS. NUTRITION AND PHYSICAL ACTIVITY WAS AN IDENTIFIED HEALTH NEED WHICH WAS PRIORITIZED IN AN EFFORT TO INDIRECTLY ADDRESS CARDIOVASCULAR DISEASE. CHILD ABUSE & NEGLECT. WHILE THIS HEALTH NEED WAS NOT PRIORITIZED, ACKNOWLEDGMENT WAS MADE BY THE CBAT THAT THIS NEED IS BEING ADDRESSED BY THE CHILD ABUSE PREVENTION COUNCIL, OF WHICH HARRISON COUNTY HOME AND PUBLIC HEALTH DEPARTMENT IS THE CONVENER. HCHPH WILL CONTINUE TO LEAD THESE EFFORTS AND SEEK ADDITIONAL FUNDING. IN ADDITION, CHI HEALTH MISSOURI VALLEY SPONSORS THE ANNUAL RACE TO RESILIENCY. THE ISSUE OF CHILD ABUSE AND NEGLECT MAY BE CONSIDERED THROUGH THE FOCUS ON BEHAVIORAL HEALTH. CHRONIC LOWER RESPIRATORY DISEASE. IN AN EFFORT TO MAXIMIZE STAFF TIME AND RESOURCES, AND BE MINDFUL OF THE HOSPITAL'S CAPACITY TO DO THIS WORK, CHRONIC LOWER RESPIRATORY DISEASE WAS NOT PRIORITIZED FOR WORK. AS NOTED ABOVE, CHI HEALTH MISSOURI VALLEY OFFERS SMOKING CESSATION SERVICES. SEXUALLY TRANSMITTED INFECTIONS. CHI HEALTH MISSOURI VALLEY DID NOT SELECT THIS HEALTH NEED AS IT WAS NOT PRIORITIZED BY THE HEALTHY HARRISON COALITION OR HOSPITAL LEADERSHIP. THIS HEALTH NEED IS BEING ADDRESSED THROUGH THE HARRISON COUNTY HOME AND PUBLIC HEALTH DEPARTMENT. UNINTENTIONAL INJURY. IN AN EFFORT TO MAXIMIZE STAFF TIME AND RESOURCES, AND BE MINDFUL OF THE HOSPITAL'S CAPACITY TO DO THIS WORK, UNINTENTIONAL INJURY WAS NOT PRIORITIZED FOR WORK. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) 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 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 CHI 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. 5 1 - AH LOGAN RURAL HEALTH CLINIC 122 W 8TH STREET LOGAN IA 51546 RURAL HEALTH CLINIC 2 - AH WOODBINE RURAL HEALTH CLINIC 410 ELY WOODBINE IA 51579 RURAL HEALTH CLINIC 3 - AH MISSOURI VALLEY RURAL HEALTH CLINIC 809 EAST ELM STREET MISSOURI VALLEY IA 51555 RURAL HEALTH CLINIC 4 - AH DUNLAP RURAL HEALTH CLINIC 707 IOWA AVE DUNLAP IA 51529 RURAL HEALTH CLINIC 5 - AH CMH SKILLED NURSING FACILITY 631 N 8TH STREET MISSOURI VALLEY IA 51555 SKILLED NURSING FACILITY 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 THIRTY-FIVE DOLLARS ($35.00) WITH THE CHI HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW THIRTY-FIVE DOLLARS ($35) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS.-THE PATIENT'S FAMILY INCOME MUST BE AT OR BELOW 300% OF THE FPG.-THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS AS DESCRIBED [IN THE FAP].-THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION.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;-SUBSIDIZED SCHOOL LUNCH PROGRAM ELIGIBILITY;-ELIGIBILITY FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID SPEND-DOWN);-LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR-PATIENT IS DECEASED WITH NO KNOWN ESTATE. PART I, LINE 6A: YES, THE CHI HEALTH SYSTEM 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 HTTP://WWW.CHIHEALTH.COM/COMMUNITY-BENEFIT. PART I, LINE 7: A COST ACCOUNTING SYSTEM WAS NOT USED TO COMPUTE AMOUNTS IN THE TABLE; RATHER COSTS IN THE TABLE WERE COMPUTED USING WORKSHEET 2 TO COMPUTE THE COST-TO-CHARGE RATIO. THE COST-TO-CHARGE RATIO COVERS ALL PATIENT SEGMENTS. PART I, LINE 7G: INCLUDED IN SUBSIDIZED HEALTH SERVICES ARE THE FOLLOWING PHYSICIAN CLINICS:-CHI HEALTH MISSOURI VALLEY RURAL HEALTH CLINIC-CHI HEALTH DUNLAP RURAL HEALTH CLINIC-CHI HEALTH LOGAN RURAL HEALTH CLINIC-CHI HEALTH WOODBINE RURAL HEALTH CLINICTHE TOTAL EXPENSES ASSOCIATED WITH OPERATING THESE CLINICS WERE $3,488,343. REVENUE OFFSETS WERE $2,514,111. ACCORDINGLY, THE TOTAL SUBSIDIZED COST OF THESE NECESSARY SERVICES WAS $974,232. THE CLINICS MEET 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-THE FOLLOWING ACTIVITIES WORK TO STRENGTHEN THE COMMUNITY'S CAPACITY TO PROMOTE THE HEALTH AND WELL-BEING OF OUR RESIDENTS BY DRIVING ENTRY INTO HEALTHCARE CAREERS: * PRESENTATIONS TO HIGH SCHOOL STUDENTS ABOUT HEALTHCARE CAREERS * STAFF TIME SPENT WITH HIGH SCHOOL SHADOW STUDENTS- COMMUNITY AND ECONOMIC DEVELOPMENT INCLUDING SUPPORT OF LOCAL CHAMBERS OF COMMERCE PART III, LINE 2: COSTING METHODOLOGY FOR AMOUNTS REPORTED ON LINE 2 IS DETERMINED USING THE ORGANIZATION'S COST/CHARGE RATIO OF 62.73%. WHEN DISCOUNTS ARE EXTENDED TO SELF-PAY PATIENTS, THESE PATIENT ACCOUNT DISCOUNTS ARE RECORDED AS A REDUCTION IN REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA DOES NOT BELIEVE THAT ANY PORTION OF BAD DEBT EXPENSE COULD REASONABLY BE ATTRIBUTED TO PATIENTS WHO QUALIFY FOR FINANCIAL ASSISTANCE SINCE AMOUNTS DUE FROM THOSE INDIVIDUALS' ACCOUNTS WILL BE RECLASSIFIED FROM BAD DEBT EXPENSE TO CHARITY CARE WITHIN 30 DAYS FOLLOWING THE DATE THAT THE PATIENT IS DETERMINED TO QUALIFY FOR CHARITY CARE. PART III, LINE 4: ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE CONSOLIDATED FOOTNOTE READS AS FOLLOWS:COMMONSPIRIT RELIES ON THE RESULTS OF DETAILED REVIEWS OF HISTORICAL WRITE-OFFS AND COLLECTIONS IN ESTIMATING THE COLLECTABILITY OF ACCOUNTS RECEIVABLE. UPDATES TO THE HINDSIGHT ANALYSIS IS PERFORMED AT LEAST QUARTERLY USING PRIMARILY A ROLLING EIGHTEEN-MONTH COLLECTION HISTORY AND WRITE-OFF DATA. SUBSEQUENT CHANGES TO ESTIMATES OF THE TRANSACTION PRICE ARE GENERALLY RECORDED AS ADJUSTMENTS TO NET PATIENT REVENUE IN THE PERIOD OF CHANGE. SUBSEQUENT CHANGES THAT ARE DETERMINED TO BE THE RESULT OF AN ADVERSE CHANGE IN A THIRD-PARTY PAYOR'S ABILITY TO PAY ARE RECORDED AS BAD DEBT EXPENSE IN PURCHASED SERVICES AND OTHER IN THE ACCOMPANYING CONSOLIDATED STATEMENTS OF OPERATIONS AND CHANGE IN NET ASSETS. BAD DEBT EXPENSE FOR 2021 AND 2020 WAS NOT SIGNIFICANT. 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. ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA'S SURPLUS, AS REPORTED ON PART III, SECTION B, LINE 7, OF $27,413 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS. PART III, LINE 9B: THE ORGANIZATION'S BILLING AND COLLECTIONS POLICY APPLIES TO ALL INDIVIDUALS PRESENTING FOR EMERGENCY OR OTHER MEDICALLY NECESSARY CARE. THE POLICY CONTAINS PROVISIONS FOR COLLECTING AMOUNTS DUE FROM THOSE PATIENTS WHO THE ORGANIZATION KNOWS TO QUALIFY FOR FINANCIAL ASSISTANCE EITHER THROUGH THE TRADITIONAL FINANCIAL ASSISTANCE APPLICATION PROCESS OR THROUGH PRESUMPTIVE ELIGIBILITY PROCESSES. BEFORE ENGAGING IN EXTRAORDINARY COLLECTION ACTIONS (ECAS) TO OBTAIN PAYMENT FOR EMCARE, HOSPITAL FACILITIES MUST MAKE REASONABLE EFFORTS THROUGH ITS BILLING AND COLLECTIONS PROCESSES, PURSUANT TO TREAS. REG. 1.501(R)-6(C), TO DETERMINE WHETHER AN INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. IN NO EVENT WILL AN ECA BE INITIATED PRIOR TO 120 DAYS FROM THE DATE THE FACILITY PROVIDES THE FIRST POST-DISCHARGE BILLING STATEMENT (I.E., DURING THE NOTIFICATION PERIOD) UNLESS ALL REASONABLE EFFORTS HAVE BEEN MADE.HOSPITAL FACILITIES WILL NOT REFER ACCOUNTS FOR COLLECTION WHERE THE PATIENT HAS INITIALLY APPLIED FOR FINANCIAL ASSISTANCE, AND THE HOSPITAL FACILITY HAS NOT YET MADE REASONABLE EFFORTS WITH RESPECT TO THE ACCOUNT. 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. PATIENTS WHO QUALIFY FOR MEDICAID ARE PRESUMED TO QUALIFY FOR FULL CHARITY WRITE OFF. ANY CHARGES FOR DAYS OR SERVICES WRITTEN OFF (EXCLUDING MEDICAID DENIALS RELATED TO TIMELINESS OF BILLING, INSUFFICIENT MEDICAL RECORD DOCUMENTATION, MISSING INVOICES, AUTHORIZATION, OR ELIGIBILITY ISSUES) AS A RESULT OF A MEDICAID ARE BOOKED AS CHARITY.SOME MEDICAID PLANS OFFER COVERAGE FOR A LIMITED OR RESTRICTED LIST OF SERVICES. IF A PATIENT IS ELIGIBLE FOR MEDICAID, ANY CHARGES FOR DAYS OR SERVICES NOT COVERED BY THE PATIENT'S COVERAGE MAY BE WRITTEN OFF TO CHARITY WITHOUT A COMPLETED APPLICATION. THIS DOES NOT INCLUDE ANY SHARE OF COST (SOC) OR OTHER PATIENT COST-SHARING AMOUNTS SUCH AS DEDUCTIBLES OR COPAYMENTS, AS SUCH COSTS ARE DETERMINED BY THE STATE TO BE AN AMOUNT THAT THE PATIENT MUST PAY BEFORE THE PATIENT IS ELIGIBLE FOR MEDICAID. HEALTH AND HUMAN SERVICES (HSS) USES THE TERM "SPEND DOWN" INSTEAD OF SHARE OF COST.ALL COLLECTION ACTIVITIES CONDUCTED BY THE FACILITY, A DESIGNATED SUPPLIER, OR ITS THIRD-PARTY COLLECTION AGENTS WILL BE IN CONFORMANCE WITH ALL FEDERAL AND STATE LAWS GOVERNING DEBT COLLECTION PRACTICES. ALL THIRD-PARTY AGREEMENTS GOVERNING COLLECTION AND RECOVERY ACTIVITIES MUST INCLUDE A PROVISION REQUIRING COMPLIANCE WITH THE HOSPITAL FACILITIES' FINANCIAL ASSISTANCE AND BILLING AND COLLECTIONS POLICY AND INDEMNIFICATION FOR FAILURES AS A RESULT OF ITS NONCOMPLIANCE. THIS INCLUDES, BUT IS NOT LIMITED TO, AGREEMENTS BETWEEN THIRD PARTIES WHO SUBSEQUENTLY SELL OR REFER DEBT OF THE HOSPITAL FACILITY. PART VI, LINE 2: THE PROCESS OF IDENTIFYING COMMUNITY HEALTH NEEDS IN HARRISON COUNTY WAS LED BY CHI HEALTH, IN PARTNERSHIP WITH HARRISON COUNTY HOME AND PUBLIC HEALTH DEPARTMENT (HCHPH).-HARRISON COUNTY HOME & PUBLIC HEALTH DEPARTMENT PARTNERS WITH STATE PUBLIC HEALTH, POLICYMAKERS, HEALTH CARE PROVIDERS, BUSINESS AND MANY OTHERS TO FULFILL ITS MISSION TO PROMOTE PHYSICAL AND MENTAL HEALTH AND PREVENT DISEASE, INJURY, AND DISABILITY FOR THE RESIDENTS OF HARRISON COUNTY, IA.OVERALL METHODOLOGY:A COMPREHENSIVE EXAMINATION OF EXISTING SECONDARY DATA SOURCES WAS COMPLETED BY CHI HEALTH MISSOURI VALLEY AND HCHPH IN LATE 2018 THROUGH EARLY 2019, FOCUSING PRIMARILY ON THE FOLLOWING SOURCES:-CENTER FOR APPLIED RESEARCH AND ENGAGEMENT SYSTEMS (CARES) ENGAGEMENT NETWORK 2019 HTTPS://ENGAGEMENTNETWORK.ORG-CHILD & FAMILY POLICY CENTER HTTPS://WWW.CFPCIOWA.ORG/EN/DATA/KIDS_COUNT/CHILD_ABUSE_AND_NEGLECT/-COUNTY HEALTH RANKINGS AND ROADMAPS 2018 WWW.COUNTYHEALTHRANKINGS.ORG-IOWA DEPARTMENT OF PUBLIC HEALTH TRACKING PORTAL HTTP://IDPH.IOWA.GOV/PUBLICHEALTHDATA/SEARCH-IOWA BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) - HTTPS://IDPH.IOWA.GOV/PORTALS/1/FILES/BRFSS/2016BRFSSANNUALREPORT.PDF-2016 IOWA YOUTH SURVEY - HTTP://WWW.IOWAYOUTHSURVEY.IOWA.GOV/IMAGES/2016_COUNTY_REPORTS/43.HARRISON.PDF THE STATE OF OBESITY - HTTP://STATEOFOBESITY.ORG/STATES/IA/-U.S. CENSUS BUREAU/ AMERICAN COMMUNITY SURVEY- HTTPS://WWW.CENSUS.GOV/IN ORDER TO ANALYZE DATA, BENCHMARKING IS VITAL. THIS WAS ACCOMPLISHED BY REVIEWING TREND DATA PROVIDED BY THE IOWA DEPARTMENT OF PUBLIC HEALTH, IOWA YOUTH SURVEY, BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM (BRFSS) DATA, AND HEALTHY PEOPLE 2020 (HP2020). PART VI, LINE 3: NOTIFICATION ABOUT THE AVAILABILITY OF FINANCIAL ASSISTANCE FROM CHI HOSPITAL ORGANIZATIONS SHALL BE DISSEMINATED BY VARIOUS MEANS, WHICH MAY INCLUDE, BUT NOT BE LIMITED TO:-CONSPICUOUS PUBLICATION OF NOTICES IN PATIENT BILLS;-NOTICES POSTED IN EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING/REGISTRATION DEPARTMENTS, BUSINESS OFFICES, AND AT OTHER PUBLIC PLACES AS A HOSPITAL FACILITY MAY ELECT; AND-PUBLICATION OF A SUMMARY OF THIS POLICY ON THE HOSPITAL FACILITY'S WEBSITE AND AT OTHER PLACES WITHIN THE COMMUNITIES SERVED BY THE HOSPITAL FACILITY AS IT MAY ELECT.SUCH NOTICES AND SUMMARY INFORMATION SHALL INCLUDE A CONTACT NUMBER AND SHALL BE PROVIDED IN ENGLISH, SPANISH, AND OTHER PRIMARY LANGUAGES SPOKEN BY THE POPULATION SERVED BY AN INDIVIDUAL HOSPITAL FACILITY, AS APPLICABLE. REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE CHI 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.IN ADDITION, HOSPITAL REGISTRATION CLERKS ARE TRAINED TO PROVIDE CONSULTATION TO THOSE WHO HAVE NO INSURANCE OR POTENTIALLY INADEQUATE INSURANCE CONCERNING THEIR FINANCIAL OPTIONS INCLUDING APPLICATION FOR MEDICAID AND FOR ASSISTANCE UNDER THE FINANCIAL ASSISTANCE POLICY. COUNSELORS ASSIST MEDICARE ELIGIBLE PATIENTS IN ENROLLMENT BY PROVIDING REFERRALS TO THE APPROPRIATE GOVERNMENT AGENCIES. ONCE IT IS DETERMINED THAT THE PATIENT DOES NOT QUALIFY FOR ANY THIRD PARTY FUNDING, THE PATIENT IS VERBALLY NOTIFIED ABOUT THE EXISTENCE OF FINANCIAL ASSISTANCE APPLICATION AND ADDITIONAL SCREENING TAKES PLACE BY A HOSPITAL EMPLOYEE TO DETERMINE IF THE PATIENT IS ELIGIBLE FOR CHARITY SERVICE PRIOR TO DISCHARGE. UPON REGISTRATION (AND ONCE ALL EMTALA REQUIREMENTS ARE MET), PATIENTS WHO ARE IDENTIFIED AS UNINSURED (AND NOT COVERED BY MEDICARE OR MEDICAID) ARE PROVIDED WITH A PACKET OF INFORMATION THAT ADDRESSES THE FINANCIAL ASSISTANCE POLICY, THE PLAIN LANGUAGE SUMMARY OF THAT POLICY, AND AN APPLICATION FOR ASSISTANCE. HOSPITAL REGISTRATION CLERKS READ THE ORGANIZATION'S MEDICAL ASSISTANCE POLICY TO THOSE WHO APPEAR TO BE INCAPABLE OF READING, AND PROVIDE TRANSLATORS FOR NON-ENGLISH-SPEAKING INDIVIDUALS.PATIENTS THAT HAVE BEEN DISCHARGED PRIOR TO CHARITY SCREENING, SUCH AS EMERGENCY ROOM PATIENTS, RECEIVE A WRITTEN NOTIFICATION OF POSSIBLE ELIGIBILITY FOR SERVICES. IF THE PATIENT IS DETERMINED NOT TO BE ELIGIBLE FOR GOVERNMENT ASSISTANCE, HE/SHE MAY NOTIFY THE HOSPITAL THAT THEY SEEK CHARITY ASSISTANCE. THE APPROPRIATE CHARITY FORM IS SENT TO THE PATIENT/GUARANTOR FOR COMPLETION AND THEN RETURNED TO THE HOSPITAL FOR EVALUATION AND QUALIFICATION. ONCE DETERMINATION OF ELIGIBILITY IS MADE, THE PATIENT IS SENT A NOTICE INFORMING HIM/HER IF THEY QUALIFY FOR FULL, PARTIAL, OR NO CHARITY CARE SERVICES.HOSPITAL FACILITIES MUST MAKE REASONABLE EFFORTS THROUGH ITS BILLING AND COLLECTIONS PROCESSES, PURSUANT TO TREAS. REG. 1.501(R)-6(C), TO DETERMINE WHETHER ANY INDIVIDUAL IS ELIGIBLE FOR FINANCIAL ASSISTANCE. PART VI, LINE 4: CHI HEALTH MISSOURI VALLEY'S IDENTIFIED PRIMARY SERVICE AREA IS HARRISON COUNTY WHICH IS LOCATED ON THE WESTERN BORDER OF IOWA, AND DIRECTLY NORTH OF POTTAWATTAMIE COUNTY AND THE OMAHA/COUNCIL BLUFFS METRO AREA. HARRISON COUNTY REPRESENTS BETWEEN 75%-90% OF PATIENTS SERVED BY CHI HEALTH MISSOURI VALLEY, AND THEREFORE THE HOSPITAL SELECTED THE COUNTY AS THE FOCUS FOR THEIR CHNA. IMPORTANTLY, ANOTHER CHI HEALTH ENTITY, MERCY COUNCIL BLUFFS, IS LOCATED IN NEIGHBORING POTTAWATTAMIE COUNTY, IOWA. CHI HEALTH MERCY COUNCIL BLUFFS ALSO COMPLETED A CHNA AND RELATED IMPLEMENTATION PLAN.CHI HEALTH MISSOURI VALLEY RESIDES IN MISSOURI VALLEY, IOWA. MISSOURI VALLEY IS IN THE SOUTHWEST CORNER OF HARRISON COUNTY, A NON-METROPOLITAN COUNTY LOCATED IN WEST CENTRAL IOWA. HARRISON COUNTY IS COMPOSED OF NINE SCHOOL DISTRICTS AND 10 INCORPORATED TOWNS: DUNLAP, LITTLE SIOUX, LOGAN, MAGNOLIA, MISSOURI VALLEY, MODALE, MONDAMIN, PERSIA, PISGAH AND WOODBINE. LOGAN IS THE COUNTY SEAT AND THERE ARE ALSO SIX UNINCORPORATED TOWNS, AND 20 TOWNSHIPS.POPULATION CHARACTERISTICS:POPULATION DATA SHOWS A PRIMARILY NON-HISPANIC WHITE POPULATION, AND A SLIGHTLY HIGHER PERCENTAGE OF RESIDENTS OVER 65 YEARS OF AGE (19.6%) COMPARED TO THE STATE OF IOWA (16.7%). AS A PREDOMINANTLY RURAL COUNTY, HARRISON COUNTY COVERS APPROXIMATELY 697 SQUARE MILES AND HAS A POPULATION DENSITY OF 21 PERSONS PER SQUARE MILE. LOGAN IS THE COUNTY SEAT AND IS LOCATED APPROXIMATELY 40 MINUTES FROM THE OMAHA/COUNCIL BLUFFS METRO AREA.HARRISON COUNTY:-14,134 TOTAL POPULATION-23.1% OF POPULATION IS UNDER 18 YEARS OF AGE-0.4% OF POPULATION IS NON-HISPANIC AFRICAN AMERICAN-0.4% OF POPULATION IS AMERICAN INDIAN/ALASKAN NATIVE-0.3% OF POPULATION IS ASIAN-0.0% OF POPULATION IS NATIVE HAWAIIAN-1.8% OF POPULATION IS HISPANIC-96.2% OF POPULATION IS NON-HISPANIC WHITE-$57,558 IS THE MEDIAN HOUSEHOLD INCOME-2.8% OF POPULATION IS UNEMPLOYED-10% OF POPULATION IS LIVING IN POVERTY-13.08% OF CHILDREN UNDER AGE 18 LIVE IN POVERTY IN HARRISON COUNTY (COMPARED TO 14.75% OF IOWA OVERALL)-5.4% OF POPULATION IS UNINSURED-3.1% OF CHILDREN ARE UNINSURED-92.0% OF RESIDENTS 25 YEARS OR OLDER ARE HIGH SCHOOL GRADUATES PART VI, LINE 5: CHI HEALTH HAS A HISTORY OF CENTRALIZED COMMUNITY BENEFIT AND HOSPITAL SPECIFIC COMMUNITY BENEFIT INVESTMENTS TO ADDRESS COMMUNITY HEALTH NEEDS OF THE PARTICULAR SERVICE AREA. EXAMPLES OF HOW CHI HEALTH FURTHERS ITS EXEMPT PURPOSE BY PROMOTING THE HEALTH OF THE COMMUNITY INCLUDE: FINANCIAL ASSISTANCE AND UNPAID COSTS OF MEDICAIDCOMMUNITY HEALTH IMPROVEMENT SERVICES- - COMMUNITY EDUCATION, CLASSES AND PROGRAMS (BICYCLE HELMET SAFETY, COMMUNITY BEHAVIORAL HEALTH SUPPORT AND EDUCATION, DIABETES, CANCER, PHYSICAL ACTIVITY AND HEALTHY EATING AND COOKING) - SUPPORT GROUPS (CANCER, BEREAVEMENT, YOUTH, ETC.) - COMMUNITY HEALTH EDUCATION/PROMOTION AND SCREENINGS- SCHOOL BASED HEALTHCARE SERVICES- MENTAL HEALTH HOTLINE-STAFF AND OPERATE 717-HOPE MENTAL HEALTH HOTLINE FOR ANYONE IN THE COMMUNITY TO ACCESS. THIS PROGRAM AVERAGES OVER 5,000 PHONE CALLS PER MONTH FROM COMMUNITY MEMBERS IN NEED.- PARISH NURSING PROGRAM AND FAITH COMMUNITY HEALTH NETWORK-THE CHI HEALTH FAITH COMMUNITY HEALTH NETWORK PARTNERS WITH CONGREGATIONS OF ALL FAITHS TO BUILD CAPACITY AND SUPPORT THE GROWTH OF HEALTH MINISTRIES WHICH PROMOTE HEALTH, HEALING AND WHOLENESS IN THE COMMUNITIES SERVED.- 5-4-3-2-1GO!- HEALTHY LIFESTYLE CAMPAIGN FOR KIDS; OPERATED IN SCHOOLS, OUT OF SCHOOL SETTINGS, CLINICS, COMMUNITY SETTINGS IN DOUGLAS, SARPY, CASS, AND COLFAX COUNTIES IN NE. INITIAL WORK COMPLETED BY CHI HEALTH IN FY19 AND FOLLOWING CONTRACTOR DEPARTURE, WORK WAS TRANSITIONED THROUGH A GRANT TO LIVE WELL OMAHA FOR THE BROADER OMAHA COMMUNITY STRATEGY IN DOUGLAS COUNTY AS PART OF A 2-YEAR GRANT. - COUNSELING AND ASSISTANCE IN ENROLLING INDIVIDUALS IN MEANS TESTED INSURANCE PROGRAMS TO IMPROVE ACCESS TO CARE.- SUPPORT TO HEALTH COALITIONS AND INVESTMENTS IN SOCIAL AND ENVIRONMENTAL IMPROVEMENT STRATEGIES. THESE ARE PROGRAMS, ACTIVITIES AND PARTNERSHIPS THAT IMPROVE THE HEALTH OF PERSONS IN THE COMMUNITY BY ADDRESSING THE DETERMINANTS OF HEALTH, WHICH INCLUDES THE SOCIAL, ECONOMIC AND PHYSICAL ENVIRONMENT. SEE SPECIFIC EXAMPLES BY COMMUNITY BELOW:REGIONAL- NEBRASKA APPLESEED TYPICALLY PROVIDES FUNDS TO SUPPORT HUNGER/FOOD ACCESS EFFORTS; THIS INCLUDES SUMMER MEALS PROGRAM OUTREACH, ENRICHMENT PROGRAMMING AT SUMMER MEALS SITES AND SUPPORT TO LAUNCH STATE'S FIRST SNAP EMPLOYMENT & TRAINING (E&T) THIRD PARTY PARTNERSHIP, WHICH PROVIDES JOB TRAINING FOR SNAP RECIPIENTS. IN THIS RECENT YEAR NEBRASKA APPLESEED PROVIDED SNAP OUTREACH TO NEWLY ELIGIBLE INDIVIDUALS THAT WERE EXPERIENCING ECONOMIC HARDSHIP DUE TO COVID19.- FOOD BANK FOR THE HEARTLAND DONATED FUNDS TO HELP SUPPORT THE INCREASED NEED FOR EMERGENCY FOOD BROUGHT ON BY THE PANDEMIC- NEBRASKA EXTENSION-PROVIDED FUNDS TO SUPPORT DOUBLE UP FOOD BUCKS IN OMAHA AND LINCOLN; PROGRAM FOR SNAP RECIPIENTS TO RECEIVE AN ADDITIONAL $1 FOR EVERY $1 THEY SPEND (UP TO $20/DAY) ON FRUITS AND VEGETABLES AT PARTICIPATING SITES; NUTRITION/COOKING EDUCATION IS ALSO PROVIDED AT ALL SITESMISSOURI VALLEY- HEALTHY COOKING DEMONSTRATION PROVIDED MONTHLY AT THE FARMER'S MARKET- HARRISON COUNTY HOME & PUBLIC HEALTH DEPARTMENT - PROVIDED FUNDS TO HELP SUPPORT THE RECEIPT OF A MENTAL HEALTH CERTIFICATEHEALTH PROFESSIONAL EDUCATION-- ADMINISTRATION AND STUDENT ONBOARDING COSTS FOR NURSING PRECEPTORSHIPS AND CLINICALS- STAFF TIME FACILITATING THE SMALL-GROUP ETHICS CASE DISCUSSIONS WITH MEDICAL STUDENTS- CLINICAL PASTORAL EDUCATION- ACADEMIC AFFILIATION WITH CREIGHTON UNIVERSITY AND ITS HEALTH PROFESSIONS PROGRAMS, INCLUDING THE SCHOOL OF MEDICINE, COLLEGE OF ARTS & SCIENCES, SCHOOL OF DENTISTRY, SCHOOL OF PHARMACY AND HEALTH PROFESSIONS, COLLEGE OF NURSING.- PHYSICIAN RESIDENCY AND FELLOWSHIP PROGRAMS TRAIN MORE THAN 170 RESIDENTS AND FELLOWS ANNUALLY SUBSIDIZED HEALTH SERVICES - HEALTHCARE SERVICES INCLUDING EMERGENCY CARE AND CLINICAL CARE IN THE RURAL HEALTH SETTINGRESEARCH- - UNFUNDED STAFF SUPPORT OF THE NATIONAL CANCER INSTITUTE COMMUNITY ONCOLOGY RESEARCH PROGRAM (NCORP)- TRAUMA INFORMED CARE-THIS WAS AN IDENTIFIED NEED ON THE COMMUNITY HEALTH IMPROVEMENT PLAN. CHI HEALTH IS PARTNERING TO IMPLEMENT STAFF TRAINING FOR AWARENESS OF TRAUMA AND ITS IMPACT AND COMPLETING A RESEARCH STUDY ON THE EFFECTIVENESS OF THE TRAINING TO HELP BUILD PUBLIC TRAINING AND EDUCATION RESOURCES. FINANCIAL AND IN-KIND CONTRIBUTIONS-- TANZANIA HEALTH MINISTRY-CHI HEALTH IS A MINISTRY PARTNER WITH THE MACHAME LUTHERAN HOSPITAL IN TANZANIA WHICH PROVIDES FULL SERVICE HEALTH CARE IN A DESPERATELY IMPOVERISHED AREA OF THE COUNTRY INCLUDING A FULL SERVICE HOSPITAL, PHARMACY, HOSPICE OUTREACH, CLINICS, CLINICAL OFFICER SCHOOL, AND THE RECENTLY ESTABLISHED SCHOOL OF NURSING. - STAFF SERVICE ON HEALTH RELATED BOARD AND COALITIONS- PARTICIPATION IN AND FUNDING OF MATERNAL HEALTH, SUBSTANCE ABUSE, FOOD ACCESS, VIOLENCE PREVENTION, CANCER AND OTHER COMMUNITY HEALTH COALITIONS.- IN-KIND DONATIONS OF SPACE, FOOD AND STAFF TIME PROVIDING STRATEGIC PLANNING, FACILITATION AND CONSULTING SERVICES FOR NOT-FOR-PROFIT ORGANIZATIONS AND COMMUNITY GROUPS- IN-KIND DONATIONS (STAFF TIME, SPACE, ETC.) SUPPORTING GRANTS FOR BEHAVIORAL HEALTH, VIOLENCE PREVENTION, AND COMMUNITY LINK.THE ORGANIZATION'S HOSPITAL FACILITY(IES) PROMOTE HEALTH FOR THE BENEFIT OF THE COMMUNITY. MEDICAL STAFF PRIVILEGES IN THE HOSPITAL ARE AVAILABLE TO ALL QUALIFIED PHYSICIANS IN THE AREA, CONSISTENT WITH THE SIZE AND NATURE OF ITS FACILITIES. THE ORGANIZATION'S HOSPITAL FACILITY(IES) HAVE AN OPEN MEDICAL STAFF. ITS BOARD OF TRUSTEES IS COMPOSED OF PROMINENT CITIZENS IN THE COMMUNITY. EXCESS FUNDS ARE GENERALLY APPLIED TO EXPANSION AND REPLACEMENT OF EXISTING FACILITIES AND EQUIPMENT, AMORTIZATION OF INDEBTEDNESS, IMPROVEMENT IN PATIENT CARE, AND MEDICAL TRAINING, EDUCATION, AND RESEARCH. THE FACILITY(IES) TREAT PERSONS PAYING THEIR BILLS WITH THE AID OF PUBLIC PROGRAMS LIKE MEDICARE AND MEDICAID. ALL PATIENTS PRESENTING AT THE HOSPITAL FOR EMERGENCY AND OTHER MEDICALLY NECESSARY CARE ARE TREATED REGARDLESS OF THEIR ABILITY TO PAY FOR SUCH TREATMENT. 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 21 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. COMMONSPIRIT HEALTH IS COMPRISED OF MORE THAN 1,500 CARE SITES, CONSISTING OF 140 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. IN FISCAL YEAR 2021, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.5 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 $5.1 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $33.25 BILLION IN FISCAL YEAR 2021, HAS TOTAL ASSETS OF APPROXIMATELY $54.87 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. 0 1 0 0 0 0 0 0 0 ANTHONY JONES BOARD MEMBER 0 1172323 0 1760362 0 15757 0 15734 0 11549 0 2975725 0 0 CLIFF ROBERTSON MD BOARD MEMBER/CEO, CHI HEALTH 0 1011674 0 921351 0 397677 0 16975 0 29727 0 2377404 0 157178 JOHN PETERSDORF BOARD MEMBER 0 509017 0 445500 0 105583 0 729483 0 64074 0 1853657 0 0 JEANETTE WOJTALEWICZ BOARD MEMBER/CFO/INTERIM CEO, CHI HE 0 553985 0 277663 0 154664 0 17649 0 32617 0 1036578 0 49946 CARY WARD MD FORMER OFFICER 0 497053 0 139634 0 5828 0 17150 0 24421 0 684086 0 0 AHMAD ALCHOMMALI MD PHYSICIAN 566777 0 0 0 3751 0 16844 0 27958 0 615330 0 0 0 STEVE HOUSTON FORMER KEY EMPLOYEE 0 333375 0 95069 0 5361 0 16975 0 24749 0 475529 0 0 NATHANIEL ALVIS MD PHYSICIAN 420579 0 0 0 785 0 16975 0 32147 0 470486 0 0 0 DANIEL RICHTER MD PHYSICIAN 381670 0 1000 0 5757 0 17150 0 29230 0 434807 0 0 0 HEATHER MORGAN MD BOARD MEMBER 0 292203 0 0 0 1005 0 17050 0 31693 0 341951 0 0 CARRIE GRADY MD PHYSICIAN 292494 0 0 0 558 0 12988 0 28052 0 334092 0 0 0 MATTHEW BOGARD MD PHYSICIAN 286086 0 0 0 313 0 13307 0 6574 19872 306280 19872 0 0 JONATHAN MOE FORMER PRESIDENT, COMMUNITY MEMORIAL 186606 0 64317 0 2565 0 17168 0 28941 0 299597 0 0 0 DEBRA GOLDSMITH PRESIDENT, REGIONAL HOSPITAL 0 218630 0 0 0 15458 0 29073 0 19912 0 283073 0 10500 NICK OTOOL INTERIM CFO, CHI HEALTH 0 185719 0 26478 0 351 0 11109 0 29002 0 252659 0 0 JASON KRUGER MD BOARD MEMBER 0 142625 0 0 0 795 0 13865 0 27720 0 185005 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2020, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH USED THE FOLLOWING 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. COMPENSATION FOR THE OTHER OFFICERS OF ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA WAS ESTABLISHED BY THE CHI HEALTH CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE. PART I, LINE 4B SCHEDULE J, PART I, LINE 4A - SEVERANCE OR CHANGE-OF-CONTROL PAYMENTS: FOR REPORTABLE INDIVIDUALS EMPLOYED PRIOR TO 2019, POST-TERMINATION PAYMENTS ARE ADDRESSED IN EXECUTIVE EMPLOYMENT AGREEMENTS FOR EMPLOYEES AT THE LEVEL OF VICE PRESIDENT AND ABOVE. THESE EMPLOYMENT AGREEMENTS REQUIRE THAT IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT AGREEMENT. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. OFFICERS, KEY EMPLOYEES AND CERTAIN HIGHLY COMPENSATED EMPLOYEES WHO BEGAN EMPLOYMENT AFTER NOVEMBER 1ST OF 2019 ARE COVERED BY THE COMMONSPIRIT HEALTH EXECUTIVE SEVERANCE POLICY. THIS POLICY PROVIDES FOR SEVERANCE PAY WHICH VARIES BASED UPON THE EXECUTIVE'S POSITION LEVEL, IN THE EVENT OF A POSITION ELIMINATION OR OTHER QUALIFYING EVENT, IN ACCORDANCE WITH THE GUIDELINES OF THE EXECUTIVE SEVERANCE POLICY. AN EXECUTIVE'S WRITTEN EMPLOYMENT OR SEVERANCE AGREEMENT SHALL CONTROL WHERE THE SEVERANCE PAY AMOUNTS IN THE POLICY CONFLICT WITH THE EXECUTIVE'S WRITTEN EMPLOYMENT OR SEVERANCE AGREEMENT. IN ORDER FOR THE EXECUTIVE TO RECEIVE POST-TERMINATION PAYMENTS, THESE INDIVIDUALS MUST EXECUTE A GENERAL RELEASE AND SETTLEMENT OF CLAIMS. POST-TERMINATION PAYMENT ARRANGEMENTS ARE PERIODICALLY REVIEWED FOR OVERALL REASONABLENESS IN LIGHT OF THE EXECUTIVE'S OVERALL COMPENSATION PACKAGE. SCHEDULE J, PART I, LINE 4B - SUPPLEMENTAL NONQUALIFIED RETIREMENT PLAN: DURING THE 2020 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 2020 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON, $186,901, JEANETTE WOJTALEWICZ, $71,692 AND DEBRA GOLDSMITH, $11,243. 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 2020 CONTRIBUTIONS IN CASH. THESE CASH PAYOUTS ARE INCLUDED IN THE PARTICIPANT'S REPORTABLE COMPENSATION IN COLUMN (III) OTHER REPORTABLE COMPENSATION ON SCHEDULE J PART II. DURING 2020, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: CLIFF ROBERTSON, $195,187 AND JEANETTE WOJTALEWICZ, $77,144. FORM 990, PART V, LINE 1C: PAYMENTS TO VENDORS PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF COMMONSPIRIT HEALTH (CSH) ARE MADE BY CSH, THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA. CSH FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY CSH ON BEHALF OF ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 6 CHI NEBRASKA IS THE SOLE MEMBER OF ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL MISSOURI VALLEY, IOWA. 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 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 ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL BOARD. *AMENDMENT OF THE CORPORATE DOCUMENTS OF THE ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL. *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ALEGENT HEALTH COMMUNITY MEMORIAL HOSPITAL. *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE ALEGENT HEALTH- COMMUNITY MEMORIAL 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 ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL. *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL. *APPROVAL OF ISSUANCE OF DEBT BY ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL. *APPROVAL OF PARTICIPATION OF ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL IN A JOINT VENTURE. *APPROVAL OF FORMATION OF A NEW CORPORATION BY ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL. *APPROVAL OF A MERGER INVOLVING THE ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL. *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ALEGENT HEALTH- COMMUNITY MEMORIAL HOSPITAL. *TO REQUIRE THE TRANSFER OF ASSETS BY THE SAINT ALEGENT HEALTH- COMMUNITY MEMORIAL 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 (CSH), A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE CSH 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. THE POLICY WAS LAST UPDATED DURING THE TAX YEAR ENDED 6/30/2021. 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 - 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 THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION WAS PAID BY COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. THE COMMONSPIRIT HEALTH BOARD OF STEWARDSHIP TRUSTEES APPOINTS A HUMAN RESOURCES AND COMPENSATION COMMITTEE, COMPRISED EXCLUSIVELY OF INDEPENDENT DIRECTORS, WHO ARE ACCOUNTABLE FOR APPROVING REASONABLE COMPENSATION PACKAGES FOR EACH OFFICER AND CERTAIN KEY EMPLOYEES (INCLUDING THE PRESIDENT/CEO). THE HUMAN RESOURCES AND COMPENSATION COMMITTEE APPROVES, CONSISTENT WITH THE ORGANIZATION'S PHILOSOPHY AND PRINCIPLES, THE ANNUAL PERFORMANCE GOALS AND CRITERIA TO BE USED IN DETERMINING MERIT INCREASES AND VARIABLE COMPENSATION CRITERIA FOR OFFICERS AND KEY EXECUTIVES. THE HUMAN RESOURCES AND COMPENSATION COMMITTEE ALSO ENGAGES OUTSIDE LEGAL COUNSEL AS NECESSARY AND QUALIFIED INDEPENDENT COMPENSATION AND BENEFITS SPECIALISTS (INDEPENDENT EXPERTS) TO REVIEW, ANALYZE AND PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGES OF OFFICERS AND KEY EXECUTIVES. APPROPRIATE COMPARABLE DATA IS OBTAINED FROM THE INDEPENDENT EXPERTS, (E.G., TOTAL ECONOMIC BENEFITS PAID BY SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX-EXEMPT, FOR SIMILAR JOB RESPONSIBILITIES). KEY DELIBERATIONS OF THE COMMITTEE ARE DOCUMENTED IN MEETING MINUTES WHICH ARE APPROVED AT THE NEXT COMMITTEE MEETING AND PROVIDED TO THE BOARD OF STEWARDSHIP TRUSTEES. THE DOCUMENTATION OF THE DELIBERATIONS INCLUDES (A) THE TERMS OF THE AGREEMENT APPROVED AND THE DATE APPROVED; (B) THE MEMBERS OF THE COMMITTEE WHO WERE PRESENT DURING DISCUSSION OF THE APPROVED AGREEMENT AND THOSE WHO VOTED ON IT; AND (C) THE COMPARABILITY DATA OBTAINED AND RELIED UPON BY THE COMMITTEE AND HOW THE DATA WAS OBTAINED. COMPENSATION FOR THE OTHER OFFICERS OF ALEGENT HEALTH-COMMUNITY MEMORIAL HOSPITAL OF MISSOURI VALLEY, IOWA WAS ESTABLISHED BY THE CHI HEALTH CEO AND HUMAN RESOURCES DIRECTOR USING THE FOLLOWING METHODS TO ESTABLISH THE COMPENSATION: (1) COMPENSATION SURVEYS OR STUDIES (2) INDEPENDENT COMPENSATION CONSULTANT AND (3) APPROVAL BY THE BOARD COMPENSATION COMMITTEE. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S GOVERNING DOCUMENTS AND CONFLICT OF INTEREST POLICY ARE AVAILABLE UPON REQUEST FROM THE ADMINISTRATION DEPARTMENT. IN ADDITION, THE ARTICLES OF INCORPORATION ARE AVAILABLE FROM THE IOWA SECRETARY OF STATE WEBSITE. 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 OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 180,901. MANAGEMENT AND GENERAL EXPENSES 4,723. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 185,624. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 788,685. MANAGEMENT AND GENERAL EXPENSES 41,510. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 830,195. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 1,512,996. MANAGEMENT AND GENERAL EXPENSES 79,631. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 1,592,627. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,947,661. MANAGEMENT AND GENERAL EXPENSES 102,508. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,050,169. FORM 990, PART XI, LINE 9: AUXILIARY ADJUSTMENT 312. REALLOCATION OF CARES ACT FUNDS 1,650,008. OTHER CHANGES IN NET ASSETS 10,331. FORM 990, PART XI, LINE 8 PRIOR PERIOD ADJUSTMENT: CENTRALIZED TRANSACTIONS: TRANSFERS FOR JOURNAL ENTRIES RECORDED CENTRALLY AT COMMONSPIRIT TO STANDARDIZE CONTRACTUAL ALLOWANCE METHODOLOGY ACROSS ALL COMMONSPIRIT AFFILIATES AND SUBSIDIARIES. RECORDED CENTRALLY AT YEAR END AND TRANSFERRED TO FACILITIES IN THE FOLLOWING YEAR. ALEGENT CREIGHTON CLINIC 12809 W DODGE RD OMAHA NE 68154 470765154 HOSPITAL NE 501(C)(3) LINE 3 ACH 0 ALEGENT CREIGHTON HEALTH 12809 W DODGE RD OMAHA NE 68154 470757164 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - BERGAN MERCY HEALTH SYSTEM 7500 MERCY RD OMAHA NE 68124 470484764 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - IMMANUEL MEDICAL CENTER 6901 N 72ND ST OMAHA NE 68122 470376615 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - MEMORIAL HOSPITAL SCHUYLER 104 W 17TH ST SCHUYLER NE 68661 470399853 HOSPITAL NE 501(C)(3) LINE 3 CHI NEBRASKA 0 ALEGENT HEALTH - MERCY HOSPITAL CORNING IOWA PO BOX 368 CORNING IA 50841 420782518 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LTERM CARE MN 501(C)(3) LINE 10 CSH 0 APPLETREE COURT 601 OAK ST BRECKENRIDGE MN 56520 411850500 SENIOR LIVING MN 501(C)(3) LINE 10 SFH 0 ARROYO GRANDE COMMUNITY HOSPITAL FOUNDATION 345 S HALCYON RD ARROYO GRANDE CA 93420 203256066 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 BAKERSFIELD MEMORIAL HOSPITAL 420 34TH STREET BAKERSFIELD CA 93301 951802779 HOSPITAL CA 501(C)(3) LINE 3 DCC 0 BARROW NEUROLOGICAL FOUNDATION 350 WEST THOMAS ROAD PHOENIX AZ 85013 860174371 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 7 DH 0 BAYLOR ST LUKE'S HEALTH VENTURES 17200 ST LUKES WAY STE 170 THE WOODLANDS TX 77384 274499340 PHYSICIANS TX 501(C)(3) LINE 12A, I SLHS 0 BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON TX 77030 760458535 PHYSICIANS TX 501(C)(3) LINE 3 BSLHV 0 BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232187242 INACTIVE PA 501(C)(3) LINE 12A, I CSH 0 BRAZOSPORT HEALTH FOUNDATION INC 1 WEST WAY CT LAKE JACKSON TX 77566 760080110 FUNDRAISING FOUNDATION TX 501(C)(3) LINE 12A, I TCHB 0 BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(C)(3) LINE 3 TCHB 0 BURLESON ST JOSEPH HEALTH CENTER 2801 FRANCISCAN DRIVE BRYAN TX 77802 742759890 HOSPITAL TX 501(C)(3) LINE 3 SJSC 0 BURLESON ST JOSEPH MANOR 2801 FRANCISCAN DRIVE BRYAN TX 77802 742913931 REHABILITATION TX 501(C)(3) LINE 10 SJSC 0 CALIFORNIA HOSPITAL MEDICAL CENTER FOUNDATION 1401 SOUTH GRAND AVENUE LOS ANGELES CA 90015 954000909 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DCC 0 CARRINGTON HEALTH CENTER 800 N 4TH ST CARRINGTON ND 58421 450227311 HOSPITAL ND 501(C)(3) LINE 3 CSH 0 CATHOLIC HEALTH INITIATIVES - COLORADO 9100 EAST MINERAL CIRCLE CENTENNIAL CO 80112 840405257 HOSPITAL CO 501(C)(3) LINE 3 CSH 0 CATHOLIC HEALTH INITIATIVES - IOWA CORP 1111 6TH AVE DES MOINES IA 50314 420680448 HOSPITAL IA 501(C)(3) LINE 3 CSH 0 CATHOLIC HEALTH INITIATIVES COLORADO FOUNDATION 9100 EAST MINERAL CIRCLE CENTENNIAL CO 80112 840902211 FUNDRAISING FOUNDATION CO 501(C)(3) LINE 7 CHIC 0 CATHOLIC HEALTH INITIATIVES NATIONAL FOUNDATION 1150 KELLY JOHNSON BLVD 204 COLORADO SPRINGS CO 80920 270930004 FUNDRAISING FOUNDATION CO 501(C)(3) LINE 12A, I CSH 0 CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 TELEHEALTH CO 501(C)(3) LINE 12A, I CHI NS 0 CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 SURGERY CENTER OR 501(C)(3) LINE 10 MMC - ROSEBURG 0 CENTRAL CALIFORNIA HEALTH CENTERS 300 OLD RIVER ROAD STE 200 BAKERSFIELD CA 93311 844171789 CLINIC CA 501(C)(3) LINE 3 DCC 0 CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 480543724 INACTIVE KS 501(C)(3) LINE 3 CSH 0 CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 SENIOR LIVING MN 501(C)(3) LINE 10 CSH 0 CHI HEALTH FOUNDATION 12809 W DODGE RD OMAHA NE 68154 470648586 FUNDRAISING FOUNDATION NE 501(C)(3) LINE 7 ACH 0 CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 INVESTMENTS KY 501(C)(3) LINE 12A, I CSH 0 CHI LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 SENIOR LIVING OH 501(C)(3) LINE 12A, I 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