2021-05-11T09:15:08-05:00 2020-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2019-07-01 263946191 CENTENNIAL MEDICAL GROUP INC CENT 5416773650 2700 STEWART PARKWAY ROSEBURG OR 974711281 THOMAS SAFLEY CFO 5416773650 2021-05-11 1 PAMELA KROHN P01210500 3032989100 2019 2022-09-23 18:48:47Z JASON GRAY 2700 STEWART PARKWAY ROSEBURG OR 974711281 35963294 0 X N/A X 2009 OR CENTENNIAL MEDICAL GROUP PROVIDES HOSPITAL-BASED PHYSICIAN SERVICES, AS WELL AS SPECIALTY PHYSICIAN SERVICES IN A CLINIC SETTING TO PATIENTS IN THE ROSEBURG COMMUNITY ON A CHARITABLE BASIS. 3 0 0 0 0 0 0 1364446 29722611 33708802 646 415 1160521 889631 30883778 35963294 5600 6000 0 0 33428617 38296010 0 0 0 12017974 12230151 45452191 50532161 -14568413 -14568867 7360102 17282217 85780844 110369604 -78420742 -93087387 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 47081430 6000 33708802 SEE SCHEDULE O 47081430 1 1 0 0 0 0 0 0 0 0 1 0 0 1 1 1 0 1 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 1 1 0 0 0 1 X 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 X 3 0 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 0 0 0 OR X DAVID BUTCHERITE INTERIM CFO 2536804005 1717 S J STREET TACOMA WA 98405 X CARY SANDERS ORTHOPEDIST-GENERAL 50.00 0.00 X 753291 0 45781 KELLY MORGAN BOARD MEMBER 2.00 58.00 X 0 722989 37657 CHARLES MCGLADE RADIOLOGIST 50.00 0.00 X 679376 0 40155 GARY BRONSTEIN PHYSICIAN 50.00 0.00 X 618137 0 47264 SUBHAJIT MUKHERJEE GASTROENTEROLOGIST 50.00 0.00 X 602695 0 46274 IBRAHIM OSMAN CARDIOLOGIST-INVASIVE 50.00 0.00 X 553457 0 40156 JASON GRAY SECRETARY/TREASURER 10.00 40.00 X X 0 416203 44854 ARIC GROSHONG BOARD CHAIR/PRESIDENT & CEO 40.00 0.00 X X 380774 0 17263 THOMAS SAFLEY VP OF OPERATIONAL FINANCE 10.00 41.00 X 0 215568 31326 JEAN LARSON FORMER DIRECTOR OF FINANCE 0.00 50.00 X 147347 0 22181 3735077 1354760 372911 7 1 1 0 UMPQUA HEALTH LLC 500 SE CASS AVENUE SUITE 101 ROSEBURG OR 97470 PROFESSIONAL SERVICES 776536 CHAMBERS CONSTRUCTION 3028 JUDKINS RD 1 EUGENE OR 97403 CONSTRUCTION SERVICES 658656 DOUGLAS COUNTRY IPA INC 1813 W HARVARD SUITE 432 ROSEBURG OR 97471 CODING AND BILLING 362017 QUATRIS HEALTHCO LLC 3301 AIRPORT FREEWAY SUITE 350 BEDFORD TX 76021 INFORMATION SYSTEMS 234227 UMPQUA VALLEY MEDICAL ARTS LLC 1624 WEST HARVARD AVENUE ROSEBURG OR 97471 PROFESSIONAL SERVICES 120094 5 1364446 1364446 NET PATIENT SERVICES 900099 33313798 33313798 INTERCOMPANY TRANSACTI 900099 395004 395004 33708802 415 415 LABORATORY SERVICES 621500 489277 489277 LEASED EMPLOYEES 561300 291889 291889 MEDICAL SERVICES 621300 76750 76750 31715 31715 889631 35963294 33708802 0 890046 6000 6000 382841 382841 31530328 30301240 1229088 633227 617015 16212 3883076 3689743 193333 1866538 1773212 93326 4724702 3543526 1181176 98490 98490 1231064 1169511 61553 10494 9969 525 2891453 2746880 144573 110375 104856 5519 4606 4606 307262 307262 541372 514304 27068 MEDICAL SUPPLIES 1624226 1543015 81211 EDUCATION 230275 218761 11514 REPAIRS AND MAINTENANCE 224783 213544 11239 MISCELLANEOUS EXPENSES 129555 123077 6478 101494 96419 5075 50532161 47081430 3450731 0 0 90162 842135 280124 5926720 2867061 133760 289963 5637930 2061716 457487 3576214 0 10178693 7360102 17282217 2458203 4727941 0 372045 83322641 105269618 85780844 110369604 X -78420742 -93087387 -78420742 -93087387 7360102 17282217 X -14568867 -97778 X 0 1 X 1 0 X 9132 235047 1364446 1608625 21235860 25016041 28607681 29482783 33708802 138051167 712774 755585 757936 705187 489277 3420759 21957766 25771626 29600664 30187970 35562525 143080551 0 0 0 143080551 217 25754 26535 646 415 53567 217 25754 26535 646 415 53567 383925 511875 341806 455334 400354 2093294 22341908 26309255 29969005 30643950 35963294 145227412 0.98520 0.98500 0.00040 0.00040 X SCHEDULE A, PART III, LINE 12, EXPLANATION OF OTHER INCOME: OTHER EXCLUDED REVENUE - 2015 AMOUNT: $ 383,925. 2016 AMOUNT: $ 511,875. 2017 AMOUNT: $ 341,806. 2018 AMOUNT: $ 455,334. 2019 AMOUNT: $ 400,354. RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 2255902 1344243 911659 1182028 717473 464555 2200000 2200000 3576214 ROU OPERATING 10178693 10178693 INTERCOMPANY PAYABLES 94301337 LEASE LIABILITIES 10968281 105269618 X PART X, LINE 2: CENTENNIAL MEDICAL GROUP'S FINANCIAL INFORMATION IS INCLUDED IN THE CONSOLIDATED AUDITED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION. COMMONSPIRIT HEALTH'S ASC 740 FOOTNOTE FOR THE YEAR ENDED JUNE 30, 2020, READS AS FOLLOWS: COMMONSPIRIT HAS ESTABLISHED ITS STATUS AS AN ORGANIZATION EXEMPT FROM INCOME TAXES UNDER INTERNAL REVENUE CODE SECTION 501(C)(3) AND THE LAWS OF THE STATES IN WHICH IT OPERATES, AND AS SUCH, IS GENERALLY NOT SUBJECT TO FEDERAL OR STATE INCOME TAXES. HOWEVER, COMMONSPIRIT'S EXEMPT ORGANIZATIONS ARE SUBJECT TO INCOME TAXES ON NET INCOME DERIVED FROM A TRADE OR BUSINESS, REGULARLY CARRIED ON, WHICH DOES NOT FURTHER THE ORGANIZATIONS' EXEMPT PURPOSES. NO SIGNIFICANT INCOME TAX PROVISION HAS BEEN RECORDED IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS FOR NET INCOME DERIVED FROM UNRELATED TRADE OR BUSINESS. COMMONSPIRIT'S FOR-PROFIT SUBSIDIARIES ACCOUNT FOR INCOME TAXES RELATED TO THEIR OPERATIONS. THE FOR-PROFIT SUBSIDIARIES RECOGNIZE DEFERRED TAX ASSETS AND LIABILITIES FOR TEMPORARY DIFFERENCES BETWEEN THE FINANCIAL REPORTING BASIS AND THE TAX BASIS OF THEIR ASSETS AND LIABILITIES, ALONG WITH NET OPERATING LOSS AND TAX CREDIT CARRYOVERS, FOR TAX POSITIONS THAT MEET THE MORE-LIKELY-THAN-NOT RECOGNITION CRITERIA. CHANGES IN RECOGNITION OR MEASUREMENT ARE REFLECTED IN THE PERIOD IN WHICH THE CHANGE IN JUDGMENT OCCURS. INCOME TAX INTEREST AND PENALTIES ARE RECORDED AS INCOME TAX EXPENSE. FOR THE YEARS ENDED JUNE 30, 2020 AND 2019, COMMONSPIRIT'S TAXABLE ENTITIES RECORDED AN IMMATERIAL AMOUNT OF INTEREST AND PENALTIES AS PART OF THE PROVISION FOR INCOME TAXES. COMMONSPIRIT'S TAXABLE ENTITIES DID NOT HAVE ANY MATERIAL UNRECOGNIZED INCOME TAX EXPENSE AS OF JUNE 30, 2020 AND 2019. 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. 0 1 0 0 0 0 0 1 0 CARY SANDERS ORTHOPEDIST-GENERAL 751671 0 0 0 1620 0 16675 0 29106 0 799072 0 0 0 KELLY MORGAN BOARD MEMBER 0 562310 0 112525 0 48154 0 16675 0 20982 0 760646 0 0 CHARLES MCGLADE RADIOLOGIST 445493 0 228583 0 5300 0 9800 0 30355 0 719531 0 0 0 GARY BRONSTEIN PHYSICIAN 615425 0 0 0 2712 0 16483 0 30781 0 665401 0 0 0 SUBHAJIT MUKHERJEE GASTROENTEROLOGIST 566742 0 0 0 35953 0 15493 0 30781 0 648969 0 0 0 IBRAHIM OSMAN CARDIOLOGIST-INVASIVE 526125 0 0 0 27332 0 9375 0 30781 0 593613 0 0 0 JASON GRAY SECRETARY/TREASURER 0 376308 0 37859 0 2036 0 14240 0 30614 0 461057 0 0 ARIC GROSHONG BOARD CHAIR/PRESIDENT & CEO 353533 0 25740 0 1501 0 16675 0 588 0 398037 0 0 0 THOMAS SAFLEY VP OF OPERATIONAL FINANCE 0 184836 0 25650 0 5082 0 12667 0 18659 0 246894 0 0 JEAN LARSON FORMER DIRECTOR OF FINANCE 84950 0 17965 0 44432 0 7626 0 14555 0 169528 0 0 0 PART I, LINE 3: DURING THE CALENDAR YEAR 2019, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY CHI FRANCISCAN HEALTH, A RELATED ORGANIZATION AND PAID BY MERCY MEDICAL CENTER. FHS 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; (5) WRITTEN EMPLOYMENT CONTRACT. PART I, LINE 4A: 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 A SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 9 MONTHS TO 2 YEARS OF BASE COMPENSATION, DEPENDING ON THE EXECUTIVE'S POSITION, IN THE EVENT OF A POSITION ELIMINATION OR OTHER INVOLUNTARY TERMINATION, IN ACCORDANCE WITH THE GUIDELINES OF THE POLICY. PART I, LINE 4B: DURING THE 2019 CALENDAR YEAR, COMMONSPIRIT MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/HOSPITAL PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. 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 2019 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 2019, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: KELLY C. MORGAN - $27,831 PART I, LINE 7: CERTAIN PHYSICIANS ARE ELIGIBLE FOR SIGNING AND RETENTION BONUSES. SECURING THE SERVICES OF SUCH PROFESSIONALS IS AN INDISPENSABLE PART OF CENTENNIAL MEDICAL GROUP, INC.'S (CMG) OPERATIONS. WITHOUT THE SERVICES OF THESE INDIVIDUALS, CMG WOULD BE SEVERELY LIMITED IN ITS ABILITY TO PROVIDE CARE TO MEMBERS OF OUR COMMUNITY. THEREFORE, IN CONJUNCTION WITH THE RECRUITMENT OF PHYSICIANS, CMG PROVIDES BONUSES TO CERTAIN PHYSICIANS. IN ADDITION, SEVERAL PHYSICIANS ARE ENTITLED TO INCENTIVE COMPENSATION BASED ON RVUS WORKED IN EXCESS OF A THRESHOLD AS STATED IN THEIR INDIVIDUAL EMPLOYMENT CONTRACTS. TOTAL PHYSICIAN COMPENSATION IS SET IN ADVANCE BY A COMMITTEE OF THE BOARD OF MERCY MEDICAL CENTER (MMC) USING IRC SECTION 4958 REBUTTABLE PRESUMPTION OF REASONABLENESS PROCEDURES. PHYSICIAN TOTAL COMPENSATION IS SUBJECT TO A CAP THAT ENSURES PHYSICIAN COMPENSATION REMAINS WITHIN FAIR MARKET VALUE. FORM 990, PART III, LINE 4A: CENTENNIAL MEDICAL GROUP (CMG) IS AN OREGON NON-PROFIT CORPORATION FORMED ON JANUARY 1, 2009, TO INCREASE ACCESS TO QUALITY CLINICAL PHYSICIAN SERVICES FOR THE RESIDENTS OF DOUGLAS COUNTY, OREGON, THE SERVICE AREA OF ITS SOLE MEMBER, MERCY MEDICAL CENTER. DOUGLAS COUNTY, OREGON IS A DESIGNATED HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). MERCY MEDICAL CENTER (MMC) IS THE APPLICANT'S SOLE CORPORATE MEMBER AND AN OREGON NON-PROFIT HOSPITAL EXEMPT FROM FEDERAL INCOME TAX AS AN ORGANIZATION DESCRIBED UNDER 501(C)(3) AND 170(B)(1)(A)(III) OF THE INTERNAL REVENUE CODE (IRC) PURSUANT TO THE GROUP RULING ISSUED TO THE UNITED STATES CATHOLIC CONFERENCE OF BISHOPS. FOUNDED IN 1909, MMC IS A 174-BED FACILITY WITH A LEVEL III TRAUMA DESIGNATION WITH AN ADULT AND ADOLESCENT INTENSIVE CARE. MMC OPERATES A 24-HOUR EMERGENCY ROOM 365 DAYS PER YEAR. THE EMERGENCY ROOM IS OPEN TO ALL INDIVIDUALS REGARDLESS OF ABILITY TO PAY. MMC PARTICIPATES IN MEDICARE AND MEDICAID, AND HAS AN ACTIVE CHARITY CARE PROGRAM. MMC SERVES ALL PERSONS IN DOUGLAS COUNTY, OREGON (POP. 107,000) ON A NONDISCRIMINATORY BASIS REGARDLESS OF ABILITY TO PAY. MMC HAS A BOARD OF DIRECTORS THAT IS COMPRISED OF INDEPENDENT COMMUNITY REPRESENTATIVES. CMG IS EXEMPT FROM TAX AS AN IRC 501(C)(3) CHARITABLE ORGANIZATION WITH NON-PRIVATE FOUNDATION STATUS AS A PUBLICLY SUPPORTED ORGANIZATION PURSUANT TO IRC 509(A)(2). CMG IS A MULTI-SPECIALTY PHYSICIAN CLINIC SERVING THE RESIDENTS OF DOUGLAS COUNTY, OREGON. THE FORMATION OF CMG PROVIDES AN INTEGRATED PLATFORM FOR THE DELIVERY OF HEALTH CARE BY CMG'S EMPLOYED HOSPITALISTS, PRIMARY CARE PHYSICIANS AND SPECIALISTS. BECAUSE THE PHYSICIANS WILL BE INTEGRATED INTO ONE MULTI-SPECIALTY PRACTICE, IT IS ANTICIPATED THAT PHYSICIANS WILL BETTER COORDINATE TRAINING AND EDUCATION ACTIVITIES AMONG THE SPECIALTIES. FURTHER, AS A RESULT OF THE INTEGRATION, PATIENTS WILL BENEFIT FROM ACCESS TO A BROAD RANGE OF PRIMARY AND SPECIALTY PHYSICIANS CAPABLE OF PROVIDING WELL COORDINATED CARE. MMC WILL PROVIDE CMG WITH BACK OFFICE SUPPORT INCLUDING BUT NOT LIMITED TO ACCOUNTING, PROVIDER CONTRACTING, INVESTMENT SUPPORT, HUMAN RESOURCES, AND PRACTICE MANAGEMENT, AS WELL AS ACCESS TO PATIENT ELECTRONIC MEDICAL RECORDS. MMC'S SUPPORT WILL FREE CMG'S PHYSICIANS TO FOCUS ON WHAT THEY DO BEST - DELIVERY OF HIGH QUALITY PATIENT CARE. FURTHER, AS MENTIONED PREVIOUSLY, CMG IS LOCATED IN A DESIGNATED HEALTH CARE SHORTAGE AREA. MMC WORKS WITH A LOCAL TEAM OF COMMUNITY HEALTH REPRESENTATIVES TO ASCERTAIN THE NEED FOR OTHER PHYSICIAN SPECIALTIES IN THE COMMUNITY. THE TEAM'S MOST RECENTLY CONDUCTED NEEDS ASSESSMENT INDICATED A SHORTAGE OF PHYSICIANS IN DOUGLAS COUNTY FOR SPECIALTIES INCLUDING HOSPITALIST, PHYSICAL MEDICINE, NEUROLOGY, ORTHOPEDICS, GASTROENTEROLOGY, UROLOGY, RADIATION/ONCOLOGY, AND PSYCHIATRY. THE EXISTENCE OF CMG AS AN EFFICIENT, WELL-INTEGRATED PRIMARY AND SPECIALTY CLINIC IS EXPECTED TO HAVE A POSITIVE IMPACT ON MMC'S ABILITY TO RECRUIT ADDITIONAL SPECIALTY PHYSICIANS TO THE COMMUNITY. CMG MEETS THE FOLLOWING CRITERIA, QUALIFYING IT AS AN IRC SEC. 501(C)(3) HEALTH CARE ORGANIZATION. COMMUNITY BOARD - MMC'S BOARD OF DIRECTORS IS COMPRISED OF 25% PHYSICIANS, 65% COMMUNITY MEMBERS AND 10% MANAGEMENT. CMG HAS A THREE PERSON BOARD, ALL OF WHOM ARE APPOINTED BY THE CORPORATE MEMBER, ONE OF WHOM IS A PHYSICIAN. ACCORDINGLY, BECAUSE THE CMG MANAGEMENT MUST ACT UNDER THE DIRECTION OF THE MMC COMMUNITY BOARD, CMG IS ULTIMATELY CONTROLLED BY AN INDEPENDENT COMMUNITY BOARD. OPEN MEDICAL STAFF - CMG WAS FORMED TO CONSOLIDATE THE PATIENT CARE OF CMG'S SPECIALISTS IN THE AREAS OF PATHOLOGY, CARDIOLOGY, SURGERY, HOSPITALIST, ORTHOPEDICS, PULMONOLOGY, AND GASTROENTEROLOGY. WHETHER MMC'S MEDICAL STAFF PRIVILEGES ARE OPEN FOR A PARTICULAR SPECIALTY HAS BEEN DETERMINED ON A SERVICE BY SERVICE BASIS. OF THE CMG SPECIALTY AREAS, ONLY THE HOSPITALISTS AND PATHOLOGISTS ARE CLOSED SPECIALTIES. HOSPITAL CARE - CONSISTENT WITH THE POLICY OF MMC AND CMG, CMG ACCEPTS MEDICARE AND MEDICAID PATIENTS. EMERGENCY ROOM / CHARITY CARE AND OTHER COMMUNITY BENEFIT - THE PHYSICIANEMPLOYEES OF CMG PARTICIPATE IN THE OPERATION OF THE MMC EMERGENCY ROOM WHICH IS OPEN TO ALL REGARDLESS OF ABILITY TO PAY AND WITHOUT DISCRIMINATION. MMC'S EMERGENCY ROOM PROVIDES TREATMENT TO INDIVIDUALS IN NEED OF IMMEDIATE MEDICAL TREATMENT, WITH CONTINUING CARE PROVIDED BY MMC OR CMG, OR OTHER PROVIDERS AS APPROPRIATE. WHILE CMG DOES NOT ITSELF OPERATE AN EMERGENCY ROOM, CMG HAS ADOPTED A CHARITY CARE POLICY MODELED ON THE MMC CHARITY CARE AND DISCOUNT POLICY AND RENDERS CHARITY CARE TO PATIENTS OF MMC AND CMG IN A MANNER SIMILAR TO THE FINANCIAL ASSISTANCE LEVELS RENDERED BY THE HOSPITAL. ELIGIBILITY FOR CHARITY CARE DISCOUNTS IS DETERMINED BASED ON INCOME LEVELS AT OR BELOW 400% OF THE FEDERAL POVERTY GUIDELINES AND ANY EXTENUATING CIRCUMSTANCES. FOR THE FISCAL YEAR ENDED JUNE 30, 2020, CMG PROVIDED $8,262,306 IN UNCOMPENSATED CARE. IN ADDITION, CMG PARTICIPATES OR HAS PARTICIPATED IN MMC'S COMMUNITY EDUCATION ACTIVITIES BY PROVIDING EMPLOYED PHYSICIANS TO LECTURE TO THE PUBLIC, PROVIDE GUIDANCE REGARDING ADVANCE DIRECTIVES, AND PROVIDE PREVENTATIVE HEALTH SCREENINGS. APPLICATION OF SURPLUS - TO THE EXTENT THAT CMG'S ACTIVITIES RESULT IN A SURPLUS, ANY SUCH SURPLUS WILL BE REINVESTED INTO PROGRAMS THAT ENHANCE PATIENT CARE. FORM 990, PART V, LINE 2A: CENTENNIAL MEDICAL GROUP (CMG) CONTRACTS PHYSICIANS FROM MERCY MEDICAL CENTER, INC. (MMC), A RELATED ORGANIZATION. THESE PHYSICIANS ARE CONTRACTUALLY EMPLOYED BY CMG, AND ARE REPORTED ON PART VII AS REQUIRED. HOWEVER, SINCE THESE EMPLOYEES ARE PAID BY MMC, CMG DID NOT REPORT ANY EMPLOYEES ON FORM W-3. ACCORDINGLY, THE ORGANIZATION HAS REPORTED ZERO ON FORM 990, PART V, LINE 2A AND FORM 990, PART VII, SECTION A, LINE 2. FORM 990, PART VI, SECTION A, LINE 1 PURSUANT TO SECTION 8.1 OF THE BYLAWS OF CENTENNIAL MEDICAL GROUP, INC., THE BOARD OF DIRECTORS MAY, BY RESOLUTION ADOPTED BY A MAJORITY OF THE VOTING DIRECTORS THEN IN OFFICE, ESTABLISH ONE OR MORE COMMITTEES, AS NEEDED OR REQUIRED TO CONDUCT AND TRANSACT THE BUSINESS OF THE CORPORATION. EXCEPT AS OTHERWISE PROVIDED IN THESE BYLAWS, THE BOARD OF DIRECTORS MAY SET THE QUALIFICATIONS FOR MEMBERSHIP ON ANY COMMITTEE IT MAY ESTABLISH; PROVIDED THAT EACH COMMITTEE OTHER THAN THE NOMINATING ADVISORY COMMITTEE SHALL CONSIST OF AT LEAST TWO DIRECTORS OF THE CORPORATION. COMMITTEES MAY INCLUDE PERSONS OTHER THAN DIRECTORS, EXCEPT THAT A COMMITTEE THAT HAS THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MUST INCLUDE ONLY DIRECTORS OF THE CORPORATION. MINUTES OF ALL COMMITTEE MEETINGS SHALL BE RECORDED AND COPIES OF SUCH MINUTES SHALL BE PROVIDED TO THE BOARD OF DIRECTORS. ACTIONS OF COMMITTEES SHALL BE SUBJECT TO RATIFICATION BY THE FULL BOARD OF DIRECTORS. THE PROVISIONS OF ARTICLE VI OF THESE BYLAWS WITH RESPECT TO REGULAR AND SPECIAL MEETINGS, QUORUM, MANNER OF ACTING, ACTION WITHOUT A MEETING, NOTICE, AND WAIVER OF NOTICE SHALL ALSO APPLY TO ALL COMMITTEES ESTABLISHED BY THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 ACCORDING TO THE BYLAWS OF CENTENNIAL MEDICAL GROUP, INC., THE ENTITY'S SOLE MEMBER IS MERCY MEDICAL CENTER, INC., AN OREGON NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A PURSUANT TO SECTION 6.5 OF CENTENNIAL MEDICAL GROUP, INC.'S BYLAWS, DIRECTORS SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30TH OF EACH YEAR, AS NEEDED TO FILL ANY EXPIRED TERMS OR VACANCIES AMONG THE DIRECTORS FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS MERCY MEDICAL CENTER, INC.. PURSUANT TO SECTION 5.4 OF THE ORGANIZATION'S BYLAWS, BOTH MERCY MEDICAL CENTER, INC. AND COMMONSPIRIT HEALTH (MERCY MEDICAL CENTER, INC.'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE COMMONSPIRIT HEALTH GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE MERCY MEDICAL CENTER, INC. BOARD: *APPROVE MEMBERS OF THE CENTENNIAL MEDICAL GROUP, INC. BOARD *AMENDMENT OF THE CORPORATE DOCUMENTS OF THE CENTENNIAL MEDICAL GROUP, INC. *APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE CENTENNIAL MEDICAL GROUP, INC. *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE CENTENNIAL MEDICAL GROUP, INC. 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 CENTENNIAL MEDICAL GROUP, INC. *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE CENTENNIAL MEDICAL GROUP, INC. *APPROVAL OF ISSUANCE OF DEBT BY CENTENNIAL MEDICAL GROUP, INC. *APPROVAL OF PARTICIPATION OF CENTENNIAL MEDICAL GROUP, INC. IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY CENTENNIAL MEDICAL GROUP, INC. *APPROVAL OF A MERGER INVOLVING THE CENTENNIAL MEDICAL GROUP, INC. *APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE CENTENNIAL MEDICAL GROUP, INC. *TO REQUIRE THE TRANSFER OF ASSETS BY THE CENTENNIAL MEDICAL GROUP, INC. 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, MERCY MEDICAL CENTER, INC. 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. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION B, LINE 11B THE RETURN IS REVIEWED BY THE FINANCE DIRECTOR. ONCE THE FORM 990 HAS BEEN APPROVED BY THE FINANCE DIRECTOR A COPY OF THE RETURN IS PROVIDED TO THE BOARD MEMBERS PRIOR TO BEING FILED WITH THE IRS. SUBSEQUENT TO PROVIDING A COPY OF THE RETURN TO THE BOARD MEMBERS, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE FINANCE DIRECTOR. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO MAINTAIN THE INTEGRITY OF ITS ACTIVITIES. THE POLICY APPLIES TO THE FOLLOWING PERSONS ("COVERED PERSONS"): MEMBERS OF THE COMMONSPIRIT HEALTH ("COMMONSPIRIT") BOARD OF STEWARDSHIP TRUSTEES AND ITS COMMITTEES; COMMONSPIRIT HEALTH CORPORATE OFFICERS; MEMBERS OF THE DIGNITY HEALTH BOARD OF STEWARDSHIP TRUSTEES AND ITS COMMITTEES. IN ADDITION, THE POLICY APPLIES TO ORGANIZATIONS THAT WERE AFFILIATES AND SUBSIDIARIES OF COMMONSPIRIT HEALTH PRIOR TO ITS AFFILIATION WITH DIGNITY HEALTH ("CHI ENTITIES"). COVERED PERSONS OF CHI ENTITIES INCLUDE: MEMBERS OF ANY CHI ENTITY DIRECT AFFILIATE OR SUBSIDIARY BOARD AND THEIR COMMITTEES; EMPLOYEES OF CHI ENTITIES; AND CHI ENTITY RESEARCHERS (AS DEFINED BY THE POLICY). DISCLOSURE, REVIEW AND MANAGEMENT OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. ALL COVERED PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS AND MUST DISCLOSE THAT CONFLICT TO HIS/HER DIRECT MANAGER (OR OTHER PERSON AS IS APPROPRIATE PER POLICY). 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 BOARD APPOINTMENT), AND ANNUALLY THEREAFTER. DISCLOSURES OF PERCEIVED, POTENTIAL OR ACTUAL CONFLICTS ARE INITIALLY REVIEWED BY NATIONAL OR REGIONAL LEGAL OR CORPORATE RESPONSIBILITY TEAM MEMBERS TO DETERMINE WHETHER AN ACTUAL OR POTENTIAL CONFLICT MAY EXIST. IF IT IS DETERMINED THAT A POTENTIAL OR ACTUAL CONFLICT EXISTS, ISSUES ARE ELEVATED TO THE BOARD EXECUTIVE COMMITTEE OR BOARD CHAIR (FOR BOARD OR OFFICER CONFLICTS), OR THE CONFLICTS OF INTEREST REVIEW COMMITTEE (FOR ANY OTHER CONFLICT). THE PROCEDURES FOR ADDRESSING A CONFLICT RELATED TO A PROPOSED TRANSACTION IN THE CASE OF GOVERNING BODIES OR A CORPORATE OFFICER INCLUDE, BUT ARE NOT LIMITED TO 1) DISCLOSURE TO THE BOARD, 2) THE TRUSTEE OR CORPORATE OFFICER BEING EXCUSED FROM THE MEETING DURING DISCUSSION AND VOTE ON THE CONFLICT OF INTEREST (ALTHOUGH HE OR SHE MAY RESPOND TO PERTINENT QUESTIONS IF THE KNOWLEDGE IS RELEVANT), AND 3) BOARD APPROVAL OF THE TRANSACTION BY A MAJORITY OF DISINTERESTED MEMBERS. IN ADDITION, BOARDS CAREFULLY REVIEW AND SCRUTINIZE ANY NON-TRANSACTIONAL CONFLICTS OF INTEREST. IN SUCH CIRCUMSTANCES, BY A MAJORITY VOTE OF THE DISINTERESTED TRUSTEES, THE BOARD TAKES WHATEVER ACTION IS DEEMED APPROPRIATE. FOR CONFLICTS NOT INVOLVING A BOARD MEMBER OR OFFICER, THE CONFLICTS OF INTEREST REVIEW COMMITTEE ("C-CIRC") WILL FACILITATE A COI MANAGEMENT PLAN TO MITIGATE THE CONFLICT IF ADEQUATE CONTROLS AREN'T ALREADY IN PLACE. NOTWITHSTANDING THE FOREGOING, AT ITS SOLE DISCRETION, AN ENTITY MAY REJECT A PERSON'S REQUEST TO ENTER INTO THE RELATIONSHIP IN QUESTION, OR REQUIRE THE RELATIONSHIP BE SUFFICIENTLY ALTERED TO AVOID A POTENTIAL CONFLICT OF INTEREST. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A: THE ORGANIZATION'S TOP MANAGEMENT OFFICIAL'S COMPENSATION IS ESTABLISHED BY CHI FRANCISCAN HEALTH, A RELATED ORGANIZATION, AND PAID BY MERCY MEDICAL CENTER. ALL EXECUTIVE COMPENSATION ARRANGEMENTS WITH ANY PERSON OF SUBSTANTIAL INFLUENCE ARE SUBJECT TO REVIEW AND APPROVAL BY THE CHI FRANCISCAN HEALTH BOARD OF DIRECTORS, OR AN AUTHORIZED COMMITTEE OF THE BOARD, IN ACCORDANCE WITH THE EXECUTIVE COMPENSATION REVIEW POLICY. EXECUTIVE COMPENSATION ARRANGEMENTS WITH ANY PHYSICIAN WHO IS A PERSON OF SUBSTANTIAL INFLUENCE MERCY MEDICAL CENTER, INC. 93-0386868 ARE NOT SUBJECT TO THIS POLICY, BUT SHALL BE REVIEWED AND APPROVED IN ACCORDANCE WITH THE SYSTEM'S PHYSICIAN TRANSACTION REVIEW POLICY. LINE 15B: CENTENNIAL MEDICAL GROUP (CMG) CONTRACTS EMPLOYEES FROM MERCY MEDICAL CENTER, INC. ALL OFFICERS, DIRECTORS AND KEY EMPLOYEES THAT ARE CONTRACTUALLY EMPLOYED BY CMG ARE SUBJECT TO THE COMPENSATION REVIEW POLICY OF MERCY MEDICAL CENTER. MERCY MEDICAL CENTER, INC ANNUALLY SEEKS COMPARABLE MARKET DATA FOR THEIR VPS FROM AN INDEPENDENT SOURCE. THE DATA IS PRESENTED TO A SUBCOMMITTE OF THE BOARD WHO APPROVES ANY INCREASES FROM A MARKET PERSPECTIVE. INCREASES ARE RECOMMENDED DEPENDING ON THE DATA AND FINANCES. FOR KEY PERSONNEL THAT HAVE EMPLOYMENT CONTRACTS IN PLACE, THE CONTRACT IS FOLLOWED FOR ANY INCREASES (MOST CONTRACTS ARE FOR 3 YRS). CONTRACT RENEWALS ARE APPROVED BY A PHYSICIAN TRANSACTION COMMITTEE. EMPLOYEES THAT HAVE EMPLOYMENT CONTRACTS AREN'T PART OF THE MERIT OR MARKET REVIEW PROCESS. PERSONS ELIGIBLE FOR MERIT INCREASES HAVE AN ANNUAL EVALUATION THAT IS APPROVED BY THE HIGHEST LEVEL OF SENIOR MANAGEMENT. FORM 990, PART VI, SECTION C, LINE 19 THE ORGANIZATION'S FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG. FORM 990, PART VII, SECTION A, LINE 2: CENTENNIAL MEDICAL GROUP (CMG) CONTRACTS PHYSICIANS FROM MERCY MEDICAL CENTER, INC. (MMC), A RELATED ORGANIZATION. THESE PHYSICIANS ARE CONTRACTUALLY EMPLOYED BY CMG, AND ARE REPORTED ON PART VII AS REQUIRED. HOWEVER, SINCE THESE EMPLOYEES ARE PAID BY MMC, CMG DID NOT REPORT ANY EMPLOYEES ON FORM W-3. ACCORDINGLY, THE ORGANIZATION HAS REPORTED ZERO ON FORM 990, PART V, LINE 2A AND FORM 990, PART VII, SECTION A, LINE 2. FORM 990, PART XI, LINE 9: ASC 842 ADJUSTMENT -97,778. 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