2021-05-07T02:02:41-05:00 2020-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2019-07-01 770447575 PACIFIC CENTRAL COAST HEALTH CENTERS PACI 8057393688 185 BERRY STREET NO 200 SAN FRANCISCO CA 941071777 MATT RICHARDSON CFO 8057393688 2021-05-07 1 ANGELA NOEL P01051055 3032989100 2021-05-06 2019 2022-09-23 18:48:47Z MATT RICHARDSON 1400 E CHURCH STREET SANTA MARIA CA 93454 120252435 0 X WWW.DIGNITYHEALTH.ORG X 1997 CA TO PROVIDE ACCESS TO COST EFFECTIVE, QUALITY MEDICAL SERVICES IN THE NORTHERN SANTA BARBARA COUNTY, SAN LUIS OBISPO COUNTY, KERN COUNTY AND VENTURA COUNTY COMMUNITIES. 10 8 606 10 0 0 31806868 36343471 65318375 83802750 45348 96045 57370 10169 97227961 120252435 7983154 4739931 0 0 57387118 70378266 0 0 0 26297692 35330156 91667964 110448353 5559997 9804082 29722909 61080413 5889642 26354770 23833267 34725643 X SEE SCHEDULE O 0 0 93004918 4739931 83802750 THE HEALTH CENTERS PROVIDE COST EFFECTIVE MEDICAL SERVICES TO MANY PATIENTS IN THE COMMUNITY WHO OTHERWISE COULD NOT AFFORD TREATMENT OR COULD NOT FIND PHYSICIANS TO SEE THEM. IN ADDITION TO PROVIDING PRIMARY CARE SERVICES, THE CLINIC ALSO PROVIDES ORTHOPEDIC, SURGICAL AND OBSTETRICS SERVICES. WE ALSO SERVE THE NEED OF BRINGING MORE PRIMARY CARE PHYSICIANS INTO THE SAN LUIS OBISPO, SANTA MARIA, KERN COUNTY AND VENTURA COMMUNITIES BY OPENING NEW CLINICS FOR THEM TO PRACTICE IN. 93004918 1 1 0 1 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 1 0 1 0 0 0 0 0 1 1 0 0 0 0 0 0 1 0 0 0 1 59 0 1 606 1 0 0 0 0 0 0 0 0 0 0 0 0 X 10 8 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 0 0 CA X MARY JOHNSON 6022944117 3033 NORTH 3RD AVENUE PHOENIX AZ 85013 X CHARLES COVA EX-OFFICIO MEMBER/ PRESIDENT 2.00 50.00 X X 0 2041185 183144 CAROL MCCLOSKEY MD PHYSICIAN 50.00 0.00 X 921292 0 101822 NICHOLAS SLIMACK MD PHYSICIAN 50.00 0.00 X 853618 0 102321 MATTHEW SCHRECKINGER MD PHYSICIAN 50.00 0.00 X 769615 0 96899 SUE ANDERSEN FORMER OFFICER 0.00 50.00 X 0 740471 120733 JASON CHOI MD PHYSICIAN 50.00 0.00 X 729783 0 100999 NICHOLAS KING MD PHYSICIAN 50.00 0.00 X 706028 0 83489 STEVEN GOODMAN MD VP CLINICAL SERVICES 50.00 0.00 X 663526 0 86586 SCOTT ROBERTSON MD PRESIDENT & CEO 50.00 0.00 X 0 646172 91194 MATTHEW D RICHARDSON CFO 15.00 35.00 X 0 400813 66825 ELIZABETH SNYDER FORMER OFFICER 0.00 50.00 X 0 280619 50633 APOORVE JAIN DIRECTOR OF FINANCE 50.00 0.00 X 240066 0 37102 TRACY E BELSAN CHIEF OPERATION OFFICER 50.00 0.00 X 238009 0 31147 GIGI NICKAS MD CHIEF MEDICAL OFFICER 50.00 0.00 X 166486 0 17586 KEVIN FERGUSON MD BOARD MEMBER 0.50 10.00 X 141600 0 0 MICHAEL CLAYTON BOARD MEMBER (THRU 10/3/19) 0.50 0.00 X 0 0 0 JIM COPELAND BOARD MEMBER 0.50 0.00 X 0 0 0 PATRICIA GOMEZ BOARD MEMBER (THRU 6/30/20) 0.50 0.00 X 0 0 0 TOM MARTINEZ BOARD MEMBER 0.50 0.00 X 0 0 0 PETER OPPENHEIMER BOARD MEMBER 0.50 0.00 X 0 0 0 SISTER JEAN ROLLINS OSF BOARD MEMBER 0.50 0.00 X 0 0 0 ROBERT FREEMAN SECRETARY 1.00 0.00 X X 0 0 0 JUDY FROST VICE - CHAIR 0.50 0.00 X X 0 0 0 DAVID MERLO CHAIR 1.00 0.00 X X 0 0 0 5430023 4109260 1170480 137 1 1 0 OPTUM AMBULATORY SERVICES 909 HIDDEN RIDGE IRVING TX 75038 CONSULTANT 2722152 ALAN ROINESTAD CONSTRUCTION 2646 INDUSTRIAL PKWY 100 SANTA MARIA CA 93455 CONTRACTOR 1592841 CENTRAL COAST MEDICAL ONCOLOGY 1325 E CHURCH ST SANTA MARIA CA 93454 MEDICAL/PHYSICIAN SERVICES 853750 AUGMEDIX INC 1161 MISSIONS ST SAN FRANCISCO CA 94103 MEDICAL SCRIBES 528983 ALL WAYS CLEAN PO BOX 462 MORRO BAY CA 93442 CLEANING SERVICES 521451 11 35352899 990572 36343471 PATIENT NET OF CHARITY & PRICE CO 621400 35575864 35575864 MEDICARE / MEDICAID PAYMENTS 621400 20456198 20456198 PHYSICIAN PROFESSIONAL FEES REV 621400 17418515 17418515 SHARED PHYSICIAN SERVICES 621400 8871196 8871196 HOSPITALIST 621400 1018700 1018700 462277 462277 83802750 96045 96045 A/R FINANCE CHARGES 900099 6959 6959 RECEIPT WRITE-OFFS 900099 3210 3210 10169 120252435 83802750 0 106214 X 4739931 4739931 1534841 1441573 93268 379470 379470 60222250 56302203 3920047 636597 53096 583501 4234418 3566082 668336 3370690 406597 2964093 284750 397 284353 16266 16266 4264 4264 14414017 9583633 4830384 399856 36796 363060 2291332 1178625 1112707 2315141 150726 2164415 5183240 4874357 308883 267204 218187 49017 84757 80162 4595 69913 69913 4597451 4572438 25013 1139301 1139301 MEDICAL SUPPLIES 3853397 3853397 DUES AND SUBSCRIPTIONS 149259 143577 5682 LICENSES AND TAXES 135902 130081 5821 RECRUITING 34063 0 34063 90043 84376 5667 110448353 93004918 17443435 0 9335 3244 8109404 16838797 75251 25201 6191832 8852087 342628 584955 276639 1550013 1432152 13618510 4967326 9394164 8651184 4050282 24416154 29722909 61080413 5812209 10586329 33680 29287 714909 43753 15024245 5889642 26354770 X 23833267 34725643 23833267 34725643 29722909 61080413 X 9804082 1780 1086514 X X 0 1 X 1 0 X SCHEDULE A, PART I, LINE 3 THE ORGANIZATION IS NOT LICENSED AS A HOSPITAL. IT IS LICENSED AS A HEALTH CARE CLINIC AND PROVIDES MEDICAL SERVICES TO THE COMMUNITY IT SERVES. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 0 0 0 1 4264 4264 0 PART II-B, LINE 1: LOBBYING EXPENDITURES PAID DIRECTLY BY THE FILING ORGANIZATION FOR ANNUAL MEMBERSHIP DUES: AMERICAN ACADEMY OF FAMILY PHYSICIANS $965 AMERICAN ACADEMY OF NEUROLOGY $118 AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS $51 AMERICAN ASSOCIATION OF NURSE PRACTITIONERS $14 AMERICAN ACADEMY OF PHYSICAL MED AND REHAB $24 AMERICAN ACADEMY OF PHYSICIAN ASSISTANTS $15 AMERICAN ASSOC OF NEUROMUSCULAR & ELECTRODIAGNOS $46 AMERICAN COLLEGE OF EMERGENCY PHYSICIANS $301 AMERICAN COLLEGE OF OSTETRICIANS AND GYNECOLOGISTS $1,212 AMERICAN COLLEGE OF OSTEOPATHIC FAMILY PHYSICIANGS $53 AMERICAN COLLEGE OF PHYSICIANS 95 AMERICAN COLLEGE OF SURGEONS $38 AMERICAN INSITITUE OF CERTIFIED PUBLIC ACCOUNTANTS $17 AMERICAN MEDICAL ASSOCIATION $1,044 AMERICAN OSTEOPATHIC ASSOCIATION $80 CALIFORNIA ACADEMY FOR PHYSICIAN ASSISTANTS $10 CONGRESS OF NEUROLOGICAL SURGEONS $45 NORTH AMERICAN SPINE SOCIETY $68 SOCIETY OF TEACHERS OF FAMILY MEDICINE $68 TOTAL: $4,264 9753994 3901282 5852712 3657449 1064155 2593294 207067 1889 205178 8651184 DUE FROM RELATED PARTIES 6813821 RIGHT OF USE ASSET 17535313 OTHER LONG-TERM ASSETS 67020 24416154 RIGHT OF USE - LEASE LIABILITY LT 14914750 DUE TO RELATED PARTIES 109495 15024245 X PART X, LINE 2: THE ORGANIZATION 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 DIGNITY HEALTH DBA MARIAN REGIONAL MEDICAL CENTER 1400 E CHURCH ST SANTA MARIA CA 93454 941196203 501(C)(3) 4739931 0 N/A N/A HOSPITAL SUPPORT 1 0 PART I, LINE 2: GRANTS ARE PROVIDED BY PACIFIC CENTRAL COAST HEALTH CENTERS TO CARRY OUT THE PURPOSES OF THE GRANTEE LISTED IN PART II, ITEM 1 (DIGNITY HEALTH DBA MARIAN REGIONAL MEDICAL CENTER), WHICH INCLUDE MAKING PAYMENTS DIRECTLY TO THE BENEFICIARY ORGANIZATION, TRANSFERRING AND MONITORING THAT RESTRICTIONS ARE MET BEFORE RELEASE OF FUNDS AND EXPENDITURE OF SUCH FUNDS. X 1 0 0 1 0 0 0 0 0 0 0 CHARLES COVA EX-OFFICIO MEMBER/ PRESIDENT 0 623038 0 846816 0 571331 0 138431 0 44713 0 2224329 0 534953 CAROL MCCLOSKEY MD PHYSICIAN 422950 0 497892 0 450 0 81660 0 20162 0 1023114 0 0 0 NICHOLAS SLIMACK MD PHYSICIAN 852218 0 1100 0 300 0 76115 0 26206 0 955939 0 0 0 MATTHEW SCHRECKINGER MD PHYSICIAN 683172 0 86173 0 270 0 76701 0 20198 0 866514 0 0 0 SUE ANDERSEN FORMER OFFICER 0 419806 0 287754 0 32911 0 71056 0 49677 0 861204 0 0 JASON CHOI MD PHYSICIAN 596626 0 132887 0 270 0 73716 0 27283 0 830782 0 0 0 NICHOLAS KING MD PHYSICIAN 595565 0 109173 0 1290 0 62759 0 20729 0 789516 0 0 0 STEVEN GOODMAN MD VP CLINICAL SERVICES 368898 0 292648 0 1980 0 67142 0 19444 0 750112 0 0 0 SCOTT ROBERTSON MD PRESIDENT & CEO 0 450514 0 190357 0 5301 0 65263 0 25931 0 737366 0 0 MATTHEW D RICHARDSON CFO 0 299689 0 100823 0 301 0 43837 0 22988 0 467638 0 0 ELIZABETH SNYDER FORMER OFFICER 0 219546 0 60196 0 877 0 33466 0 17167 0 331252 0 0 APOORVE JAIN DIRECTOR OF FINANCE 199674 0 40028 0 364 0 28267 0 8835 0 277168 0 0 0 TRACY E BELSAN CHIEF OPERATION OFFICER 189162 0 25000 0 23847 0 19174 0 11973 0 269156 0 0 0 GIGI NICKAS MD CHIEF MEDICAL OFFICER 166160 0 0 0 326 0 16523 0 1063 0 184072 0 0 0 PART I, LINE 1A HOUSING ALLOWANCE WAS PROVIDED TO ONE OFFICER. THIS PAYMENT WAS INCLUDED AS TAXABLE COMPENSATION TO THE LISTED PERSON. PART I, LINE 3 PACIFIC CENTRAL COAST HEALTH CENTERS RELIED ON A RELATED ORGANIZATION, DIGNITY HEALTH THAT USED A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY, AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE TO ESTABLISH THE CLINIC'S TOP MANAGEMENT OFFICIAL'S COMPENSATION. SEE SCHEDULE O DISCLOSURE FOR FORM 990, PART VI, SECTION B, LINE 15 FOR ADDITIONAL INFORMATION. PART I, LINE 4A: THE ORGANIZATION'S KEY EMPLOYEES AND CERTAIN OFFICERS AND HIGHLY COMPENSATED EMPLOYEES PARTICIPATE IN A SEVERANCE PLAN THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 1 WEEK 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 PLAN. NO PAYMENTS WERE MADE TO ANY LISTED PERSONS DURING 2019 PURSUANT TO THIS PLAN. PART I, LINE 4B CERTAIN LISTED PERSONS 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. NO PAYMENTS WERE MADE TO ANY LISTED PERSONS DURING 2019 PURSUANT TO THIS PLAN. CERTAIN LISTED PERSONS 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. A PAYMENT WAS MADE DURING 2019 PURSUANT TO THIS PLAN TO C. COVA, $534,953. COMPENSATION AMOUNTS FOR THE SUPPLEMENTAL NONQUALIFIED RETIREMENT PLANS DISCUSSED ABOVE ARE REPORTED AS DEFERRED COMPENSATION IN THE YEAR ACCRUED (SCHEDULE J, PART II, COLUMN C) AND ARE REFLECTED AGAIN AS REPORTABLE COMPENSATION IN THE YEAR PAID (SCHEDULE J, PART II, COLUMN B(III)). SCHEDULE J, PART II SUPPLEMENTAL DISCLOSURES THE ORGANIZATION FOLLOWS DIGNITY HEALTH'S EXECUTIVE COMPENSATION PHILOSOPHY, WHICH IS DESIGNED TO ASSIST THE ORGANIZATION IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE THE ORGANIZATION TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTH CARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES THE ORGANIZATION SERVES, PROMOTING 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 DIGNITY HEALTH'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 2019. JUSTIN GOODMAN FAMILY MEMBER OF S. GOODMAN, MD, KE 33299 EMPLOYMENT 0 STEVEN GOODMAN SELF, KEY EMPLOYEE 379470 LEASE PAYMENT 0 FORM 990, PART III, LINE 1 PACIFIC CENTRAL COAST HEALTH CENTERS', SPONSORED BY DIGNITY HEALTH AND DIGNITY COMMUNITY CARE, MISSION IS TO PROVIDE ACCESS TO COST EFFECTIVE, QUALITY MEDICAL SERVICES IN THE NORTHERN SANTA BARBARA COUNTY, SAN LUIS OBISPO COUNTY, KERN COUNTY AND VENTURA COUNTY COMMUNITIES REGARDLESS OF THE PATIENTS ABILITY TO PAY FOR THE SERVICES. FORM 990, PART VI, SECTION A, LINE 6 EFFECTIVE FEBRUARY 1, 2019, THE ORGANIZATION'S SOLE CORPORATE MEMBER IS DIGNITY COMMUNITY CARE, A 501(C)(3) EXEMPT ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7A EFFECTIVE FEBRUARY 1, 2019, DIGNITY COMMUNITY CARE, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY COMMUNITY CARE BOARD APPROVES NEW BOARD MEMBERS OF THE ORGANIZATION. PRIOR TO FEBRUARY 1, 2019, DIGNITY HEALTH, AS THE SOLE CORPORATE MEMBER, RATIFIES THE SELECTION OF MEMBERS AND THE DIGNITY HEALTH BOARD APPROVES NEW BOARD MEMBERS OF THE ORGANIZATION. FORM 990, PART VI, SECTION A, LINE 7B RESERVED RIGHTS OF THE CORPORATE MEMBER INCLUDE ADOPTION OF MISSION AND PHILOSOPHY STATEMENTS, AMENDMENT OR RESTATEMENT OF ARTICLES OF INCORPORATION AND BYLAWS, DISSOLUTION OF THE CORPORATION, ACQUISITION OF ANOTHER CORPORATION, CREATION OF A NEW SUBSIDIARY, MERGER OR CONSOLIDATION WITH ANOTHER CORPORATION, PARTICIPATION AS A GENERAL OR LIMITED PARTNER IN ANY VENTURE, INCURRING LONG-TERM INDEBTEDNESS IN EXCESS OF NORMAL OPERATING REQUIREMENTS, RATIFICATION OF BOARD MEMBER APPOINTMENTS AND DISMISSALS, SELECTION AND REMOVAL OF INDEPENDENT AUDITORS, AND TRANSACTIONS OUTSIDE THE ORDINARY COURSE OF BUSINESS. FORM 990, PART VI, SECTION B, LINE 11B THE ORGANIZATION'S CFO AND DIRECTOR OF FINANCE WORKED CLOSELY WITH THE RELATED ORGANIZATION'S TAX DEPARTMENT TO REVIEW THE RETURN. THE FORM 990, EXCLUDING COMPENSATION INFORMATION, WAS PROVIDED TO THE ORGANIZATION'S BOARD OF DIRECTORS SUBSEQUENT TO FILING WITH THE INTERNAL REVENUE SERVICE. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS ADOPTED DIGNITY HEALTH'S CONFLICTS OF INTEREST POLICY. DURING THE PERIOD JULY 1, 2019 THROUGH JUNE 30, 2020, DIGNITY HEALTH WAS SUBJECT TO WRITTEN CONFLICT OF INTEREST POLICIES (THE "COI POLICIES."). THESE POLICIES, PROVIDE FOR THE DISCLOSURE AND SUBSEQUENT REVIEW AND MANAGEMENT OF CONFLICTS OF INTEREST THAT MAY EXIST FOR MEMBERS OF DIGNITY HEALTH'S GOVERNING BODIES, INCLUDING ITS BOARD OF DIRECTORS AND BOARD COMMITTEES, AS WELL AS DIGNITY HEALTH'S OFFICERS AND EXECUTIVE LEADERS, KEY EMPLOYEES, MANAGEMENT PERSONNEL AT THE VICE PRESIDENT LEVEL AND ABOVE, AND ANY OTHER DESIGNATED PERSONNEL ("COVERED PERSONS"). ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS ARISING FROM THE BUSINESS, OWNERSHIP, FINANCIAL AND PERSONAL INTERESTS HELD BY SUCH COVERED PERSONS OR THEIR FAMILY MEMBERS. COVERED PERSONS ARE REQUIRED TO DISCLOSE TO THEIR SUPERVISORS OR RELEVANT DECISION MAKERS ANY INTEREST THAT MAY PRESENT A CONFLICT OF INTEREST, OR THE APPEARANCE OF A CONFLICT OF INTEREST. SUCH DISCLOSURE IS REQUIRED ON A TRANSACTIONAL BASIS AT THE TIME SUCH CONFLICTS ARISE, WHEN AN INDIVIDUAL BECOMES A COVERED PERSON (E.G. UPON HIRING OR UPON PROMOTION), AND ANNUALLY THEREAFTER. AS PART OF THE ANNUAL DISCLOSURE SURVEY CONDUCTED PURSUANT TO THE COI POLICIES, EACH COVERED PERSON IS REQUIRED TO CERTIFY THAT HE/SHE: (1) HAS RECEIVED A COPY OF THE COI POLICY OR COI POLICIES APPLICABLE TO HIS/HER POSITION; (2) HAS READ THE COI POLICY AND UNDERSTANDS SAID POLICY; AND (3) AGREES TO COMPLY WITH ALL REQUIREMENTS OF THE COI POLICY, INCLUDING COMPLETING THE CONFLICTS OF INTEREST DISCLOSURE SURVEY AS REQUIRED BY THE COI POLICIES. THE INFORMATION FROM THE ANNUAL DISCLOSURE SURVEY IS USED TO MONITOR AND MANAGE DISCLOSED CONFLICTS OF INTEREST AND ASSURE DECISIONS ARE MADE IN THE ORGANIZATION'S BEST INTERESTS. THE PROCEDURES FOR ADDRESSING A CONFLICT OF INTEREST RELATED TO A PROPOSED TRANSACTION IN THE CASE OF GOVERNING BODIES REQUIRE THAT THE BOARD SHALL CAREFULLY SCRUTINIZE AND MUST IN GOOD FAITH EITHER APPROVE OR DISAPPROVE ANY TRANSACTION IN WHICH DIGNITY HEALTH OR A DIGNITY HEALTH ENTITY IS A PARTY AND IN WHICH THE DIRECTOR EITHER: HAS A MATERIAL FINANCIAL INTEREST OR IS A DIRECTOR OR CORPORATE OFFICER OF THE OTHER PARTY (OTHER THAN A DIGNITY HEALTH-AFFILIATED ORGANIZATION). THE BOARD MUST APPROVE THE TRANSACTION BY MAJORITY OF THE DIRECTORS ON THE BOARD, WITHOUT COUNTING THE VOTE OF ANY INDIVIDUAL WHO HAS AN INTEREST IN THE TRANSACTION. IN REVIEWING SUCH TRANSACTIONS BETWEEN DIGNITY HEALTH OR DIGNITY HEALTH ENTITIES AND VENDORS OR OTHER CONTRACTORS WHO ARE, OR ARE AFFILIATED WITH, DIRECTORS, THE BOARD SHALL ACT NO MORE OR LESS FAVORABLY THAN IT WOULD IN REVIEWING TRANSACTIONS WITH UNRELATED THIRD PARTIES. THE TRANSACTION WILL NOT BE APPROVED UNLESS THE BOARD DETERMINES THAT THE TRANSACTION IS FAIR TO DIGNITY HEALTH OR THE DIGNITY HEALTH ENTITY. FORM 990, PART VI, SECTION B, LINE 15 FOR 2019 COMPENSATION, THE RELATED ORGANIZATION'S HUMAN RESOURCES DEPARTMENT CONDUCTED AN ANNUAL REVIEW AND ANALYSIS TO PROVIDE BENCHMARKING DATA FOR THE TOTAL COMPENSATION AND BENEFITS PACKAGE OF THE TOP MANAGEMENT OFFICIAL, OTHER OFFICERS, AND KEY EMPLOYEES. 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 DIRECTORS. 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. FORM 990, PART VI, SECTION C, LINE 19 FEDERAL TAX LAWS DO NOT MANDATE THAT THE ORGANIZATION'S GOVERNING DOCUMENTS, CONFLICT OF INTEREST POLICY AND FINANCIAL STATEMENTS BE MADE AVAILABLE FOR PUBLIC INSPECTION. THE ORGANIZATION IS INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED FINANCIAL STATEMENTS WHICH ARE AVAILABLE ON BOTH COMMONSPIRIT HEALTH'S AND DIGNITY HEALTH'S WEBSITES AND UPON REQUEST. FORM 990, PART VII, SECTION A ONE OR MORE OF THE INDIVIDUALS WHO PROVIDE SERVICES TO THE ORGANIZATION AS OFFICERS OR DIRECTORS ARE MEMBERS OF A RELIGIOUS CONGREGATION. SINCE ALL SUCH SISTERS ARE SUBJECT TO VOWS OF POVERTY, FAIR MARKET VALUE COMPENSATION FOR THEIR SERVICE IS PAID DIRECTLY OR INDIRECTLY TO THE RELIGIOUS CONGREGATION OF WHICH THEY ARE A MEMBER. THE NON-TAXABLE BENEFITS ARE PAID ON BEHALF OF THE ORDER. FORM 990, PART IX, LINE 11G MEDICAL SERVICES: PROGRAM SERVICE EXPENSES 3,714,252. MANAGEMENT AND GENERAL EXPENSES 1,872,073. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 5,586,325. PS COLLECTION AGENCY: PROGRAM SERVICE EXPENSES 1,614,714. MANAGEMENT AND GENERAL EXPENSES 813,855. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,428,569. ADMINISTRATIVE SERVICES: PROGRAM SERVICE EXPENSES 2,732,067. MANAGEMENT AND GENERAL EXPENSES 1,377,028. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 4,109,095. PROFESSIONAL FEES: PROGRAM SERVICE EXPENSES 388,866. MANAGEMENT AND GENERAL EXPENSES 195,998. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 584,864. REPAIRS/MAINTENANCE: PROGRAM SERVICE EXPENSES 445,963. MANAGEMENT AND GENERAL EXPENSES 224,776. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 670,739. JANITORIAL SVCS/LANDSCAPE/PEST CONTROL: PROGRAM SERVICE EXPENSES 388,037. MANAGEMENT AND GENERAL EXPENSES 195,580. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 583,617. STORAGE/SHREDDING SERVICES: PROGRAM SERVICE EXPENSES 86,384. MANAGEMENT AND GENERAL EXPENSES 43,540. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 129,924. OTHER PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 213,350. MANAGEMENT AND GENERAL EXPENSES 107,534. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 320,884. FORM 990, PART XI, LINE 9: ADJ OF EXPENSE & REVENUE INCURRED, BUT BOOKED AT RELATED ORG 1,073,459. TRUE UP OF FY19 ADJUST OF ASSETS & LIABILITIES, NET, TO FV PURSUANT TO AC 115,905. CURRENT YEAR CHANGE IN ACCOUNTING - ASC 842 ADJUSTMENT -102,850. FORM 990, PART XII, LINE 2C THE ORGANIZATION DID NOT CHANGE ITS OVERSIGHT OR SELECTION PROCESS DURING THE TAX 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 ALEGENT HEALTH-COMMUNITY MEMORIAL HOSP OF MISSOURI VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 501(C)(3) LINE 3 CHI NEBRASKA 0 ALVERNA APARTMENTS 300 SE 8TH AVE LITTLE FALLS MN 56345 411351177 LONG-TERM 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 DIGNITY HEALTH 0 BAKERSFIELD MEMORIAL HOSPITAL 420 34TH STREET BAKERSFIELD CA 93301 951802779 HOSPITAL CA 501(C)(3) LINE 3 DIGNITY COMMUNITY CARE 0 BARROW FOUNDATION UK 13 CHURCH STREET NUNNEY ENGLAND UK BA11 4LW 311724184 FUNDRAISING FOUNDATION UK 501(C)(3) LINE 12D, III-O N/A 0 BARROW NEUROLOGICAL FOUNDATION 350 WEST THOMAS ROAD PHOENIX AZ 85013 860174371 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 7 DIGNITY HEALTH 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 SLCHS 0 BAYLOR ST LUKE'S MEDICAL GROUP 6624 FANNIN ST STE 1100 HOUSTON TX 77030 760458535 PHYSICIANS TX 501(C)(3) LINE 3 SLHS 0 BORNEMANN HEALTHCARE CORPORATION 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 232187242 HEALTHCARE 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 BRHS 0 BRAZOSPORT REGIONAL PHYSICIAN SERVICES 100 MEDICAL DRIVE LAKE JACKSON TX 77566 800240261 PHYSICIANS TX 501(C)(3) LINE 3 BRHS 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 HEALTHCARE 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 DIGNITY COMMUNITY CARE 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 1150 KELLY JOHNSON BLVD 204 COLORADO SPRINGS CO 80920 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 HEALTHCARE CO 501(C)(3) LINE 12A, I CSH 0 CATHOLIC HEALTH INITIATIVES VIRTUAL HEALTH SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 460992796 PHYSICIANS CO 501(C)(3) LINE 12A, I CHINS 0 CENTENNIAL MEDICAL GROUP INC 2700 STEWART PKWY ROSEBURG OR 97471 263946191 SURGERY CENTER OR 501(C)(3) LINE 10 MMC 0 CENTRAL CALIFORNIA HEALTH CENTERS 300 OLD RIVER ROAD STE 200 BAKERSFIELD CA 93311 844171789 CLINIC CA 501(C)(3) LINE 3 DIGNITY COMMUNITY CARE 0 CENTRAL KANSAS MEDICAL CENTER 3515 BROADWAY GREAT BEND KS 67530 480543724 HOSPITAL KS 501(C)(3) LINE 3 CSH 0 CHI HEALTH CONNECT AT HOME - FARGO 4816 AMBER VALLEY PKWY S FARGO ND 58104 271966847 HOME HEALTH 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 SFH 0 CHI MEMORIAL HOSPITAL - GEORGIA 100 GROSS CRESCENT CIRCLE FORT OGLETHORPE GA 30742 822748395 HOSPITAL GA 501(C)(3) LINE 3 MHCS 0 CHI NATIONAL HOME CARE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 451261716 HEALTHCARE CO 501(C)(3) LINE 10 CHI NS 0 CHI NATIONAL SERVICES 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 452532084 HEALTHCARE CO 501(C)(3) LINE 12A, I CSH 0 CHI NEBRASKA 12809 WEST DODGE ROAD OMAHA NE 68510 363233121 HEALTHCARE NE 501(C)(3) LINE 12A, I CSH 0 CHI ST JOSEPH CHILDREN'S HEALTH 1929 LINCOLN HWY E STE 150 LANCASTER PA 17602 232342997 HEALTHCARE PA 501(C)(3) LINE 12A, I CSH 0 CHI ST JOSEPH'S CHILDREN 1516 5TH ST NW ALBUQUERQUE NM 87102 710897107 COMMUNITY NM 501(C)(3) LINE 12A, I CSH 0 CHI ST VINCENT HOSPITAL HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 710236913 HOSPITAL AR 501(C)(3) LINE 3 CHISVHS 0 CHI ST VINCENT HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125064 HOLDING CO AR 501(C)(3) LINE 12B, II SVIMC 0 CHI ST VINCENT MEDICAL GROUP HOT SPRINGS 300 WERNER ST HOT SPRINGS AR 71913 261125131 PHYSICIANS AR 501(C)(3) LINE 3 CHISVHS 0 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 470617373 HEALTHCARE CO 501(C)(3) LINE 12A, I N/A 0 COMMONSPIRIT HEALTH OPERATING INVESTMENT POOL LLC 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 850919176 INVESTMENTS CA 501(C)(3) LINE 12A, I CSH 0 COMMONSPIRIT HEALTH RESEARCH INSTITUTE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(C)(3) LINE 12A, I CSH 0 COMMUNITY HOSPITAL OF SAN BERNARDINO 1805 MEDICAL CENTER DRIVE SAN BERNARDINO CA 92411 951643373 HOSPITAL CA 501(C)(3) LINE 3 DIGNITY COMMUNITY CARE 0 COMMUNITY 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237440086 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 DIGNITY HEALTH FOUNDATION EAST VALLEY 475 SOUTH DOBSON ROAD CHANDLER AZ 85224 742418514 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 DIGNITY HEALTH HPL SELF-INSURANCE TRUST 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 943006034 SELF INSURANCE CA 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 DIGNITY HEALTH INSURANCE NEVADA LTD 185 BERRY STREET STE 200 SAN FRANCISCO NV 94107 813800752 SELF INSURANCE NV 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 DIGNITY HEALTH MEDICAL FOUNDATION 3400 DATA DRIVE RANCHO CORDOVA CA 95670 680220314 MULTI-SPECIALTY OUTPATIENT MEDICAL CLINIC CA 501(C)(3) LINE 12A, I DIGNITY COMMUNITY CARE 0 DIGNITY HEALTH WORKERS COMP SELF-INSURANCE TRUST 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 946612446 SELF INSURANCE CA 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 DOMINICAN HEALTH SERVICES 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 770056778 COMMUNITY HEALTH SYSTEM CA 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 DOMINICAN HOSPITAL FOUNDATION 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 942450442 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DIGNITY HEALTH 0 DOMINICAN OAKS CORPORATION 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 770127719 OPERATION AND MANAGEMENT OF HOUSING COMPLEX TO ELDERLY PERSONS CA 501(C)(3) LINE 10 DHS 0 EAST TEXAS CLINICAL SERVICES 2801 VIA FORTUNA SUITE 500 AUSTIN TX 78746 454736213 HEALTHCARE TX 501(C)(3) LINE 12A, I SLHS 0 ENUMCLAW REGIONAL HOSPITAL ASSOCIATION 1455 BATTERSBY AVE ENUMCLAW WA 98022 910715805 HOSPITAL WA 501(C)(3) LINE 3 FHS 0 FLAGET HEALTHCARE INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 611345363 HOSPITAL KY 501(C)(3) LINE 3 KOH 0 FLAGET MEMORIAL HOSPITAL FOUNDATION INC 4305 NEW SHEPHERDSVILLE RD BARDSTOWN KY 40004 562351341 FUNDRAISING FOUNDATION KY 501(C)(3) LINE 12A, I FH 0 FRANCISCAN CARE CENTER 4111 N HOLLAND-SYLVANIA RD TOLEDO OH 43623 341931806 HEALTHCARE OH 501(C)(3) LINE 10 CHILC 0 FRANCISCAN FOUNDATION 1717 SOUTH J ST TACOMA WA 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