2021-05-13T17:07:57-05:00 2020-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2019-07-01 470443636 ST MARY'S COMMUNITY HOSPITAL STMA 4028733321 1301 GRUNDMAN BOULEVARD NEBRASKA CITY NE 68410 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 4028733321 2021-05-13 1 ANGELA NOEL P01051055 3032989100 2019 2022-09-23 18:48:47Z CHI HEALTH ST MARY'S CLIFF ROBERTSON 12809 WEST DODGE ROAD OMAHA NE 68154 36677584 0 0928 X WWW.CHIHEALTH.COM X 1927 NE ST. MARY'S IS A NOT FOR PROFIT CRITICAL ACCESS HOSPITAL THAT PROVIDES ACUTE CARE FOR THE BENEFIT OF ALL REGARDLESS OF ABILITY TO PAY AND PROMOTES HEALTH THROUGH COMMUNITY OUTREACH INITIATIVES AND PARTNERSHIPS. 14 10 215 10 573 0 1320530 2346942 30966636 34066737 1205972 72910 186099 131058 33679237 36617647 260979 5500 0 0 13789457 14254870 0 0 0 16047648 15874330 30098084 30134700 3581153 6482947 62435343 89053506 29831632 49991681 32603711 39061825 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 3313393 1670 10342811 ST. MARY'S COMMUNITY HOSPITAL OFFERS PATIENTS THE MOST COMFORTABLE AND COMPREHENSIVE OPERATING ROOM SERVICES. 4484590 491 3043282 ST. MARY'S COMMUNITY HOSPITAL HAS STRIVED TO IMPROVE THE HEALTH STATUS OF CHILDREN, TEENS, ADULTS, SENIOR CITIZENS, FRIENDS AND NEIGHBORS IN THIS RURAL COMMUNITY. ST. MARY'S COMMUNITY HOSPITAL IS PROUD TO OFFER HEALTHCARE SERVICES CLOSE TO HOME WITHIN THE COMMUNITY. ST. MARY'S COMMUNITY HOSPITAL PROVIDES A VARIETY OF DIAGNOSTIC SERVICES TO THE COMMUNITY, SUCH AS CT SCANS, MRI AND NUCLEAR MEDICINE IN ADDITION TO GENERAL RADIOLOGY, MAMMOGRAPHY, SURGICAL RADIOGRAPHY AND ULTRASOUND. 2748653 412 2549438 ST. MARY'S COMMUNITY HOSPITAL PROVIDES SEVERAL SPECIALTY CLINICS IN THE FOLLOWING AREAS: AUDIOLOGY, EAR, NOSE AND THROAT, CARDIOVASCULAR SERVICES, DERMATOLOGY, GASTROENTEROLOGY, GENERAL SURGERY/WOUND CARE, GYNECOLOGY/OBSTETRICS, ONCOLOGY, OPTHALMOLOGY, ORTHOPEDIC SURGERY, PODIATRY, UROLOGY, SPEECH AND OCCUPATIONAL THERAPY AND PSYCHIATRY. 11339242 2927 18131206 OTHER PROGRAM SERVICES 11339242 2927 18131206 21885878 1 1 0 1 0 0 0 0 0 1 1 0 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 0 215 1 0 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 4023434671 12809 WEST DODGE ROAD OMAHA NE 68154 ANTHONY JONES BOARD MEMBER 1.00 49.00 X 0 2459531 14470 CLIFF ROBERTSON MD BOARD MEMBER/CEO CHI HEALTH 1.00 49.00 X X 0 2271574 46283 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 5.00 45.00 X 0 1053501 42366 CARY WARD MD CHIEF MEDICAL OFFICER 5.00 45.00 X 0 555669 34565 BRETT MEYER MD PHYSICIAN-FAMILY MEDICINE 40.00 0.00 X 252358 297371 17616 STACY BLUM MD PHYSICIAN-FAMILY MEDICINE 40.00 0.00 X 229552 280437 44239 AMY L MCGAHA MD BOARD MEMBER 1.00 59.00 X 0 434812 26872 STEVE HOUSTON SVP -STRATEGY BUSINESS DVLP 5.00 45.00 X 0 371218 34814 JASON KRUGER MD BOARD MEMBER 1.00 59.00 X 0 338835 44134 NANCY WALLACE FORMER SVP HR CHI HEALTH 5.00 45.00 X 0 315144 25201 DEBRA GOLDSMITH PRESIDENT, REGIONAL HOSPITAL 1.00 49.00 X 0 279918 45151 DONALD DUVAL CRNA 40.00 0.00 X 261606 0 39389 DANIEL DEFREECE MD PRESIDENT 49.00 1.00 X 123570 120824 42762 MISTY HILL CRNA 40.00 0.00 X 221129 0 38315 MIKE WATTERS FORMER VP-SENIOR COUNSEL 5.00 45.00 X 0 191790 32614 MICHAEL SEBEK PA - MEDICAL 40.00 0.00 X 75820 131895 12766 DANIEL KELLY FORMER PRESIDENT 49.00 1.00 X 180373 0 0 JENNIFER BEATY MD BOARD MEMBER 1.00 11.00 X 0 0 0 LARRY BUTLER FORMER TREASURER 1.00 11.00 X X 0 0 0 FR JAMES CLIFTON SJ SECRETARY 1.00 11.00 X X 0 0 0 RICHARD HERINK BOARD CHAIR 1.00 12.00 X 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 VICE 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 1344408 9102519 541557 24 1 1 0 KETTER & ASSOCIATES 1819 F ST AUBURN NE 68305 BUSINESS CONSULTING SERVICES 483916 ALLEVANT SOLUTIONS 4714 GETTYSBURG ROAD MECHANICSBURG PA 17055 MEDICAL CONSULTING SERVICES 205000 CORAM ALTERNATE SITE SVCS INC 555 17TH STREET SUITE 1500 DENVER CO 80202 HEALTH CARE SERVICES 180531 TRAVIS TIERNEY MD PHD LLC 1301 GRUNDMAN BLVD NEBRASKA CITY NE 68410 MEDICAL SERVICES 119180 4 46042 2300900 2346942 NET PATIENT SERVICES 900099 32961650 32961650 0 0 PHARMACY SERVICES 446110 1105087 1105087 0 0 34066737 55299 573 54726 6283 0 6283 6283 6283 65784 0 48173 65784 -48173 17611 17611 17222 11764 5458 5458 CAFETERIA 722100 71994 0 0 71994 MEDICAL SERVICES 621300 20918 0 0 20918 SERVICES SOLD 900099 14524 0 0 14524 11881 11881 119317 36617647 34066737 573 203395 X 5000 5000 500 500 276598 221278 55320 10956189 8764951 2191238 532207 425766 106441 1753348 1402678 350670 736528 589222 147306 1890 1890 3625744 2902107 723637 33557 26845 6712 659330 525111 134219 27475 21980 5495 480313 384250 96063 15562 12449 3113 4724 3780 944 1916367 1916367 8906 8906 INTERCOMPANY ALLOCATION 4391078 0 4391078 0 MEDICAL SUPPLIES 3897030 3897030 0 0 REPAIRS AND MAINTENANCE 426699 405364 21335 0 UNRELATED BUSINESS TAXE 6000 6000 0 0 379655 375200 4455 30134700 21885878 8248822 0 0 0 14191620 40039847 0 5422386 7569900 0 0 0 0 0 0 606897 670846 0 0 53972948 16758432 39024290 37214516 3270 3273 2556630 2653602 0 0 0 630250 901522 62435343 89053506 2529603 11887574 0 0 0 1989341 0 0 0 0 0 0 0 0 0 27302029 36114766 29831632 49991681 X 32600449 39058563 3262 3262 32603711 39061825 62435343 89053506 X 6482947 -23436 -1397 X 0 1 X 1 0 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1890 0 0 0 1890 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCATION - $715 CATHOLIC HEALTH ASSOCIATION - $499 NEBRASKA HOSPITAL ASSOCIATION - $676 788177 233882 293 47791 974561 1741452 377375 4589 1335239 788177 1310561 411228 20943 1280 1741452 1059818 234820 15923 1310561 3479828 258791 8669 2687470 1059818 1.00000 0.00000 0.00000 0 1 1 756821 756821 41212094 6923168 34288926 11875045 9834479 2040566 128988 785 128203 37214516 INTERCOMPANY PAYABLES 35662583 LT PORTION OF LEASE LIABILITIES 50921 CURRENT PORTION OF LEASE LIABILITIES 395463 OTHER LIABILITIES 5799 36114766 X PART V, LINE 4: THE ENDOWMENT FUND WILL BE USED FOR BUILDING PROJECTS AT CHI HEALTH ST. MARY'S. PART X, LINE 2: ST. MARY'S COMMUNITY HOSPITAL'S FINANCIAL INFORMATION IS INCLUDED IN 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. 1 1 X 1 X 300.000000000000 1 X 1 1 1 0 1 1 1313 515509 0 515509 0.01730 3134 2859842 2619752 240090 0.00800 0 0 0 4447 3375351 2619752 755599 0.02530 13 1625 160156 3768 156388 0.00520 4 41 38349 0 38349 0.00130 1 0 3100009 2464359 635650 0.02130 2 0 2407 0 2407 0.00010 9 1001 43096 6197 36899 0.00120 29 2667 3344017 2474324 869693 0.02910 29 7114 6719368 5094076 1625292 0.05440 0 0 0 0 1 0 1540 0 1540 0.00010 1 0 12 0 12 0.00000 1 154 1310 0 1310 0.00000 0 0 0 0 1 0 2860 0 2860 0.00010 1 0 12 0 12 0.00000 2 0 341 0 341 0.00000 0 0 0 0 7 154 6075 6075 0.00020 1 1823316 0 11718033 11737727 -19694 X 1 1 1 1 ST MARY'S COMMUNITY HOSPITAL 1301 GRUNDMAN BLVD NEBRASKA CITY NE 68410 WWW.CHIHEALTHSTMARYS.COM H000128 X X X X ST MARY'S COMMUNITY HOSPITAL 1 0 0 1 X X X X X X X X X 18 1 0 1 1 X WWW.CHIHEALTH.COM/CHNA X X 1 19 0 1 0 1 X 300.000000000000 300.000000000000 X X X X 1 1 X X X 1 X HTTP://WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X HTTP://WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X HTTP://WWW.CHIHEALTH.COM/FINANCIAL-ASSISTANCE X X X X X X 1 X 0 X X X X 1 X 0 0 ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 5: AS PART OF THE CHNA PROCESS, SOUTHEAST DISTRICT HEALTH DEPARTMENT (SEDHD) CONDUCTED A COMMUNITY SURVEY OF THE FIVE-COUNTY AREA TO GAIN PRIMARY INPUT ON THE HEALTH STATUS AND NEEDS OF THE COMMUNITY. SURVEYS WERE AVAILABLE FROM JUNE, 2018 UP UNTIL SEPTEMBER, 2018 AND WERE EMAILED TO COMMUNITY STAKEHOLDER LISTSERVS BY EACH OF THE HOSPITALS PARTICIPATING IN THE CHNA PLANNING WITH SEDHD, PROMOTED ON SOCIAL MEDIA THROUGH SEDHD AND HOSPITAL CHANNELS, AS WELL AS PAPER COPIES MADE AVAILABLE AT HOSPITAL AND CLINIC LOCATIONS THROUGHOUT THE SEDHD REGION.SEDHD HELD A SERIES OF FOCUS GROUP MEETINGS TO PRESENT SURVEY FINDINGS, REVIEW SECONDARY DATA, AND ENGAGE KEY COMMUNITY MEMBERS IN DETERMINING TOP NEEDS IN THE COMMUNITY. STAKEHOLDERS ATTENDING THE FOCUS GROUP MEETING AT ST. MARY'S REPRESENTED THOSE WHO SERVE MINORITY, AT-RISK, UNINSURED, AND AGING POPULATIONS, AS WELL AS THOSE AFFECTIVE BY VIOLENCE.FOLLOWING COMPLETION OF THE SEDHD PROCESS AND THE CHI HEALTH ST. MARY'S INTERNAL COMMUNITY BENEFIT ACTION TEAM (CBAT) VALIDATION PROCESS DESCRIBED ABOVE, CHI HEALTH ST. MARY'S PRESENTED FINDINGS AND TOP NEEDS FOR VALIDATION AT THE CHI HEALTH ST. MARY'S COMMUNITY BOARD MEETING ON MARCH 22, 2019. PUBLIC HEALTH LEADERSHIP FROM SEDHD PARTICIPATED IN THIS REVIEW AND VALIDATION SESSION. ALL PARTIES WHO REVIEWED THE DATA AS PART OF THIS OVERALL PROCESS FOUND THE DATA TO ACCURATELY REPRESENT THE NEEDS OF THE COMMUNITY. ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 6B: YES. CHI HEALTH ST. MARY'S PARTICIPATED IN THE SEDHD PROCESS AND EXPANDED ON THIS WORK TO COMPLETE THE HOSPITAL'S CHNA. ST. MARY'S COMMUNITY HOSPITAL PART V, SECTION B, LINE 7D: SHARED WITH CHI HEALTH ST. MARY'S COMMUNITY BOARD ON MARCH 22, 2019 ST. MARY'S COMMUNITY HOSPITAL 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 PRIMARY AND SECONDARY DATA PRESENTED, VALIDATED AND PRIORITIZED BY COMMUNITY STAKEHOLDERS CONVENED THROUGH SEDHD AND CHI HEALTH ST. MARY'S. PARTICIPATING STAKEHOLDERS REPRESENTED: HEALTHCARE, PUBLIC HEALTH, THOSE WHO SERVE MINORITY, AT-RISK, UNINSURED, AND AGING POPULATIONS, AS WELL AS THOSE AFFECTED BY VIOLENCE. TOP HEALTH NEEDS (FROM 2018 CHNA):1. ACCESS TO HEALTHCARE SERVICES2. AGING3. BEHAVIORAL HEALTH (INCLUDES MENTAL HEALTH, SUICIDE AND SUBSTANCE ABUSE)4. CANCER5. CARDIOVASCULAR DISEASE6. MATERNAL AND CHILD HEALTH7. NUTRITION, PHYSICAL ACTIVITY & WEIGHT STATUS8. VIOLENCEFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS:PRIORITY HEALTH NEED #1: SOCIAL DETERMINANTS OF HEALTHTO ADDRESS THIS NEED THE HOSPITAL WILL IMPLEMENT THE FOLLOWING STRATEGIES IN 2019-2021:*1.1: PROVIDE LEADERSHIP AND FUNDING SUPPORT TO THE P4OC STEERING COMMITTEE TO BUILD CAPACITY AND SUPPORT GROWTH OF THE COALITION-TO SERVE AS THE BACKBONE AGENCY FOR LARGER, COMMUNITY-BASED, COLLECTIVE IMPACT WORK ADDRESSING HEALTH, SOCIAL, AND ECONOMIC FACTORS TO BUILD A HEALTHY COMMUNITY WHERE EVERY CHILD AND FAMILY THRIVES* 1.2: SUPPORT EVIDENCE-BASED, COMMUNITY-BASED TRAININGS OR PROGRAMMING SUCH AS BRIDGES OUT OF POVERTY OR MENTAL HEALTH FIRST AID AS SUPPORTED AND ALIGNED WITH P4OC COALITION OBJECTIVES* 1.3: SUPPORT SOUTHEAST DISTRICT HEALTH DEPARTMENT TO OFFER THE GROWING GREAT KIDS HOME VISITING PROGRAM SERVING FAMILIES WITH CHILDREN 0-3 AND AT RISK FOR SUBSTANCE ABUSE AND POOR INFANT/MATERNAL OUTCOMES* 1.4: OPERATE THE NEBRASKA CITY COMMUNITY GARDEN, OFFERING PLOTS TO THOSE IN NEED, AS WELL AS BUILDING CAPACITY OF COMMUNITY OWNERSHIP AND EDUCATIONAL ACTIVITIES RELATED TO FOOD PRODUCTION, HARVESTING, PREPARATION, AND SUSTAINABILITYTHE HOSPITAL WILL NOT ADDRESS THE FOLLOWING HEALTH NEEDS FOR THE FOLLOWING REASONS:IN ACKNOWLEDGING THE RANGE OF PRIORITY HEALTH ISSUES THAT EMERGED FROM THE CHNA PROCESS, CHI HEALTH ST. MARY'S PRIORITIZED SOCIAL DETERMINANTS OF HEALTH IN ORDER TO MOST EFFECTIVELY FOCUS RESOURCES AND MEANINGFULLY IMPACT THE SELECTED HEALTH ISSUES. AS DESCRIBED IN THE PROCESS ABOVE, THE HOSPITAL TOOK INTO CONSIDERATION EXISTING PARTNERSHIPS, AVAILABLE RESOURCES, THE HOSPITAL'S LEVEL OF EXPERTISE, EXISTING INITIATIVES (OR LACK THEREOF), POTENTIAL FOR IMPACT, AND THE COMMUNITY'S INTEREST IN THE HOSPITAL ENGAGING IN THAT AREA IN ORDER TO SELECT THE PRIORITIES. HAVING BASIC AND SOCIAL NEEDS IS A CRITICAL COMPONENT OF A PERSON'S HEALTH AND UNMET SOCIAL DETERMINANTS ARE OFTEN KEY DRIVERS OF OTHER HEALTH NEEDS. THEREFORE, THE HOSPITAL SEEKS TO INDIRECTLY ADDRESS THE FOLLOWING HEALTH NEEDS BY ADDRESSING SOCIAL NEEDS AS A ROOT CAUSES OF POOR HEALTH OUTCOMES. IN ORDER TO MAXIMIZE RESOURCES AND IMPACT ON THE PRIORITIZED HEALTH NEED AREA ABOVE, CHI HEALTH ST. MARY'S WILL NOT WRITE STRATEGIES TO DIRECTLY ADDRESS THE FOLLOWING NEEDS, ALTHOUGH RELEVANT RELATED WORK IS HIGHLIGHTED WHERE APPLICABLE BELOW.ACCESS. IN ADDITION TO THE RATIONALE STATED ABOVE, ACCESS TO CARE IS A FUNDAMENTAL COMPONENT OF CHI HEALTH'S MISSION AND STRATEGY. CHI HEALTH AND CHI HEALTH CLINIC ARE CURRENTLY WORKING TO EXPAND THE PORTFOLIO OF PRIMARY CARE ACCESS POINTS INCLUDING EXTENDED CLINIC HOURS AND VIRTUAL CARE TO ENSURE ACCESS TO SPECIALTY CARE.AGING. IN ADDITION TO THE RATIONALE STATED PREVIOUSLY, THE HOSPITAL CONSIDERS THE WORK OUTLINED ON THE PLAN ABOVE TO BE ACROSS THE LIFE SPAN, AND THE AGING POPULATION WILL BE GIVEN SPECIAL CONSIDERATION DURING PLANNING AND IMPLEMENTATION OF RELEVANT ACTIVITIES GIVEN THE PARTNERS AND EXISTING WORK HAPPENING THAT ALIGNS WITH THE OVERALL STRATEGY DESCRIBED ABOVE.BEHAVIORAL HEALTH. IN ADDITION TO THE RATIONALE STATED ABOVE, CHI HEALTH ST. MARY'S HAS BEEN LEADING AN EFFORT TO ADDRESS BEHAVIORAL HEALTH NEEDS THROUGH A LOCAL COALITION FOR THE PAST THREE YEARS. NOW COMMUNITY PARTNERS THAT HAVE BEEN PARTICIPATING IN THIS COALITION WILL BE PARTICIPATING IN THE WORK DESCRIBED ON THE PLAN ABOVE TO BUILD COMMUNITY CAPACITY TO ADDRESS IDENTIFIED HEALTH NEEDS IN THE COMMUNITY, TO INCLUDE BEHAVIORAL HEALTH.CANCER. CHI HEALTH ST. MARY'S CONTINUES ITS EFFORTS AROUND IMPROVING SCREENING RATES FOR CANCER THROUGH CONSISTENT QUALITY IMPROVEMENT EFFORTS. THE RECENTLY IMPLEMENTED PRACTICES TO SCREEN 80% OR MORE OF THE ELIGIBLE PATIENTS FOR COLON CANCER, AND PARTICIPATE IN THE EVERY WOMAN MATTERS CAMPAIGN TO IMPROVE BREAST CANCER SCREENING RATES. CHI HEALTH ST. MARY'S ALSO PROVIDES SPECIALTY CANCER CARE CLINICS ON-SITE IN THE RURAL LOCATION REGULARLY.CARDIOVASCULAR DISEASE. BEYOND THE RATIONALE STATE ABOVE, THERE IS NOT ADDITIONAL WORK PRIORITIZED IN THIS HEALTH NEED AREA. HOWEVER, AS A CRITICAL ACCESS HOSPITAL, CHI HEALTH ST. MARY'S RECOGNIZES THE NEED TO INCREASE ACCESS TO SPECIALTY CARE AND HOLDS A PARTNERSHIP WITH THE NEBRASKA HEART INSTITUTE TO PROVIDE SUPERIOR HEART AND VASCULAR CARE TO THE REGION.MATERNAL & CHILD HEALTH. IN ADDITION TO THE RATIONALE STATED ABOVE, ST. MARY'S HAS LONG SUPPORTED, AND WILL CONTINUE TO SUPPORT THE GROWING GREAT KIDS PROGRAM LED BY SOUTHEAST DISTRICT HEALTH DEPARTMENT, WHICH IS A HOME VISITING PROGRAM TO SUPPORT HEALTHY DEVELOPMENT FOR PREGNANT MOTHERS AND BABIES AGE ZERO TO THREE YEARS OF AGE, IN THE HOME. THE HOSPITAL PROVIDES FINANCIAL SUPPORT AND ADMINISTRATIVE GUIDANCE TO THE PROGRAM THAT SERVES OTOE COUNTY AND FOUR OTHER SURROUNDING COUNTIES.NUTRITION, PHYSICAL ACTIVITY, AND WEIGHT STATUS (OBESITY). THIS NEED WILL BE ADDRESSED IN PART THROUGH THE WORK OF THE TEAM TO OPERATE AND MAINTAIN THE NEBRASKA CITY COMMUNITY GARDEN, WHICH IS OUTLINED IN THE PLAN ABOVE. ADDITIONALLY, THE TEAM HAS BEGUN OFFERING AN EVIDENCE-BASED PROGRAM FOR FAMILIES OF CHILDREN 8-18 WITH A HIGH BODY MASS INDEX (BMI) AND REFERRED BY A DOCTOR, TO RECEIVE A FREE EIGHT-WEEK COURSE ON HEALTHY EATING, ACTIVE LIVING, AND SETTING HEALTHY GOALS AS A FAMILY. THE TEAM WILL MONITOR PROGRESS AND ENROLLMENT OF THIS PROGRAM TO EVALUATE CONTINUED OFFERING.VIOLENCE. ST. MARY'S HAS LONG SUPPORTED VIOLENCE PREVENTION EFFORTS IN OTOE COUNTY BY LEADING A UNITED AGAINST VIOLENCE COALITION THAT BRINGS TOGETHER A MULTI-DISCIPLINARY COMMUNITY STAKEHOLDER GROUP TO IMPLEMENT SOCIAL EMOTIONAL LEARNING CURRICULUM IN THE SCHOOLS, SUPPORT THE IMPLEMENTATION OF POLICIES THAT PREVENT VIOLENCE IN THE WORKPLACE AND COMMUNITY, AND GENERALLY PROMOTE AWARENESS AROUND THE NEED TO REDUCE VIOLENT BEHAVIORS. THE HOSPITAL WILL WORK TO SUSTAIN THIS WORK THROUGH THE CONTINUATION OF THE COALITION AS PART OF THE BROADER WORK LED BY THE COMMUNITY. ST. MARY'S COMMUNITY HOSPITAL 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. 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: ALEGENT CREIGHTON HEALTH, DBA CHI HEALTH (A RELATED ORGANIZATION) PRODUCES AN ANNUAL PUBLIC COMMUNITY BENEFIT REPORT THAT IS MAILED TO A CORE CONSTITUENCY, PLACED IN KEY PLACES THROUGHOUT THE ORGANIZATION AND DISTRIBUTED IN COMMUNITY MEETINGS. IT IS ALSO AVAILABLE ON THE COMPANY'S INTRANET SITE AND ON ITS PUBLIC WEBSITE AT HTTP://WWW.CHIHEALTH.COM/COMMUNITY-BENEFIT. THE COMMUNITY BENEFIT REPORT CONTAINS INFORMATION FOR SEVERAL RELATED ORGANIZATIONS IN IOWA AND NEBRASKA. 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 IS THE FOLLOWING PHYSICIAN CLINIC:CHI HEALTH NEBRASKA CITY RURAL HEALTH CLINICTHE TOTAL EXPENSES ASSOCIATED WITH OPERATING THIS CLINIC WERE $3,100,009. REVENUE OFFSETS WERE $2,464,359. ACCORDINGLY, THE TOTAL SUBSIDIZED COST OF THESE NECESSARY SERVICES WAS $635,650. THE CLINIC MEETS A COMMUNITY NEED FOR PRIMARY CARE SERVICES OUTSIDE OF THE EMERGENCY ROOM SETTING. PART I, LINE 7, COLUMN (F): THE BAD DEBT EXPENSE INCLUDED ON FORM 990, PART IX, LINE 25, COLUMN (A), BUT SUBTRACTED FOR PURPOSES OF CALCULATING THE PERCENTAGE IN THIS COLUMN IS $ 300,000. 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:-HEALTHCARE CAREER EXPLORATION CAMP-DAY CAMP FUNDED BY CHI HEALTH FOR STUDENTS GRADES 10-12 TO GIVE THEM THE OPPORTUNITY TO EXPLORE A VARIETY OF HEALTHCARE PROFESSIONS- PRESENTATIONS TO HIGH SCHOOL STUDENTS ABOUT HEALTHCARE CAREERS- STAFF TIME SPENT WITH HIGH SCHOOL SHADOW STUDENTS- HOSPITAL STAFF PARTICIPATED IN THE NEBRASKA WORKFORCE DEVELOPMENT BOARD MEETINGS* 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 62.13%. 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: ST. MARY'S COMMUNITY HOSPITAL 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: ST. MARY'S COMMUNITY HOSPITAL DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE 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 2020 WAS NOT SIGNIFICANT. PART III, LINE 8: ST. MARY'S COMMUNITY HOSPITAL IS DESIGNATED AS A CRITICAL ACCESS HOSPITAL (CAH). CAHS ARE RURAL COMMUNITY HOSPITALS THAT ARE CERTIFIED TO RECEIVE COST-BASED REIMBURSEMENT FROM MEDICARE. THE REIMBURSEMENT THAT CAHS RECEIVE IS INTENDED TO IMPROVE THEIR FINANCIAL PERFORMANCE AND THEREBY REDUCE HOSPITAL CLOSURES. CAHS ARE CERTIFIED UNDER A DIFFERENT SET OF MEDICARE CONDITIONS OF PARTICIPATION (COP).SHORTFALLS ARE CREATED WHEN A FACILITY RECEIVES PAYMENTS THAT ARE LESS THAN THE COSTS OF CARING FOR PROGRAM BENEFICIARIES. BECAUSE SHORTFALLS ARE BASED ON COSTS, NOT CHARGES, ST. MARY'S COMMUNITY HOSPITAL, DUE TO THEIR DESIGNATION AS A CAH, RECEIVED COST-BASED REIMBURSEMENT FOR MEDICARE PURPOSES, ST. MARY'S COMMUNITY HOSPITAL WILL NOT EXPERIENCE MEDICARE RELATED SHORTFALLS.ALTHOUGH NOT PRESENTED ON THE MEDICARE COST REPORT, IN ORDER TO FACILITATE A MORE ACCURATE UNDERSTANDING OF THE "TRUE" COST OF SERVICES (FOR "SHORTFALL" PURPOSES) THE CHI WORKBOOK ALLOWS A HEALTH CARE FACILITY NOT TO OFFSET COSTS THAT MEDICARE CONSIDERS TO BE NON-ALLOWABLE, BUT FOR WHICH THE FACILITY CAN LEGITIMATELY ARGUE ARE RELATED TO THE CARE OF THE FACILITY'S PATIENTS. IN ADDITION, ALTHOUGH NOT REPORTABLE ON THE MEDICARE COST REPORT, THE CHI WORKBOOK INCLUDES THE COST OF SERVICES THAT ARE PAID VIA A SET FEE-SCHEDULE RATHER THAN BEING REIMBURSED BASED ON COSTS (E.G. OUTPATIENT CLINICAL LABORATORY). FINALLY, THE CHI WORKBOOK ALLOWS A FACILITY TO INCLUDE OTHER HEALTH CARE SERVICES PERFORMED BY A SEPARATE FACILITY (SUCH AS A PHYSICIAN PRACTICE) THAT ARE MAINTAINED ON SEPARATE BOOKS AND RECORDS (AS OPPOSED TO THE MAIN FACILITY'S BOOKS AND RECORDS WHICH HAS ITS COSTS OF SERVICE INCLUDED WITHIN A COST REPORT). TRUE COSTS OF MEDICARE COMPUTED USING THIS METHODOLOGY:TOTAL MEDICARE REVENUE: $11,718,033TOTAL MEDICARE COSTS: $11,737,727SURPLUS OR SHORTFALL ($19,694)ST. MARY'S COMMUNITY HOSPITAL BELIEVES THAT EXCLUDING MEDICARE LOSSES FROM COMMUNITY BENEFIT MAKES THE OVERALL COMMUNITY BENEFIT REPORT MORE CREDIBLE FOR THESE REASONS: UNLIKE SUBSIDIZED AREAS SUCH AS BURN UNITS OR BEHAVIORAL-HEALTH SERVICES, MEDICARE IS NOT A DIFFERENTIATING FEATURE OF TAX-EXEMPT HEALTH CARE ORGANIZATIONS. IN FACT, FOR-PROFIT HOSPITALS FOCUS ON ATTRACTING PATIENTS WITH MEDICARE COVERAGE, ESPECIALLY IN THE CASE OF WELL-PAID SERVICES THAT INCLUDE CARDIAC AND ORTHOPEDICS. SIGNIFICANT EFFORT AND RESOURCES ARE DEVOTED TO ENSURING THAT HOSPITALS ARE REIMBURSED APPROPRIATELY BY THE MEDICARE PROGRAM. THE MEDICARE PAYMENT ADVISORY COMMISSION (MEDPAC), AN INDEPENDENT CONGRESSIONAL AGENCY, CAREFULLY STUDIES MEDICARE PAYMENTS AND THE ACCESS TO CARE THAT MEDICARE BENEFICIARIES RECEIVE. THE COMMISSION RECOMMENDS PAYMENT ADJUSTMENTS TO CONGRESS ACCORDINGLY. THOUGH MEDICARE LOSSES ARE NOT INCLUDED BY CATHOLIC HOSPITALS AS COMMUNITY BENEFIT, THE CATHOLIC HEALTH ASSOCIATION GUIDELINES ALLOW HOSPITALS TO COUNT AS COMMUNITY BENEFIT SOME PROGRAMS THAT SPECIFICALLY SERVE THE MEDICARE POPULATION. FOR INSTANCE, IF HOSPITALS OPERATE PROGRAMS FOR PATIENTS WITH MEDICARE BENEFITS THAT RESPOND TO IDENTIFIED COMMUNITY NEEDS, GENERATE LOSSES FOR THE HOSPITAL, AND MEET OTHER CRITERIA, THESE PROGRAMS CAN BE INCLUDED IN THE CHA FRAMEWORK IN CATEGORY C AS "SUBSIDIZED HEALTH SERVICES." MEDICARE LOSSES ARE DIFFERENT FROM MEDICAID LOSSES, WHICH ARE COUNTED IN THE CHA COMMUNITY BENEFIT FRAMEWORK, BECAUSE MEDICAID REIMBURSEMENTS GENERALLY DO NOT RECEIVE THE LEVEL OF ATTENTION PAID TO MEDICARE REIMBURSEMENT. MEDICAID PAYMENT IS LARGELY DRIVEN BY WHAT STATES CAN AFFORD TO PAY, AND IS TYPICALLY SUBSTANTIALLY LESS THAN WHAT MEDICARE PAYS. 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: IN ORDER TO ASSESS THE HEALTH NEEDS OF OTOE COUNTY, CHI HEALTH ST. MARY'S TOOK TWO PRIMARY ACTIONS: 1. ENGAGE IN THE CHNA PROCESS LED BY SEDHD, THE LOCAL PUBLIC HEALTH DEPARTMENT, TO INCLUDE PRIMARY AND SECONDARY DATA COLLECTION, AS WELL AS STAKEHOLDER FOCUS GROUPS TO REVIEW DATA AND PRIORITIZE NEEDS. 2. GAIN VALIDATION OF THE SEDHD PRIORITIZED NEEDS THROUGH ENGAGEMENT OF THE HOSPITAL'S INTERNAL COMMUNITY BENEFIT ACTION TEAM (CBAT) AND THE HOSPITAL'S COMMUNITY BOARD. SEDHD COVERS FIVE COUNTIES: JOHNSON, NEMAHA, OTOE, PAWNEE AND RICHARDSON. IN ORDER TO ASSESS THE HEALTH NEEDS ACROSS THE FIVE-COUNTY AREA, SEDHD CONVENED THE HOSPITAL LEADERSHIP FROM HOSPITALS IN THE REGION TO SUPPORT PLANNING EFFORTS. THE GROUP PLANNED AND IMPLEMENTED A COMMUNITY SURVEY ACROSS ALL FIVE COUNTIES AND HELD FIVE STAKEHOLDER FOCUS GROUPS TO REVIEW COMMUNITY SURVEY DATA AS WELL AS SECONDARY DATA. SEDHD SOURCED SECONDARY DATA FROM A VARIETY OF SOURCES TO INCLUDE: - STATE OF NEBRASKA DEPARTMENT OF HEALTH AND HUMAN SERVICES, CRIME COMMISSION, DEPARTMENT OF EDUCATION, AND RISK AND PROTECTIVE FACTOR SURVEILLANCE SYSTEMS - COUNTY HEALTH RANKINGS & ROADMAPS - U.S. CENSUS BUREAU AND THE AMERICAN COMMUNITY SURVEY CHI HEALTH ST. MARY'S CO-HOSTED ONE OF THE CHNA'S FIVE FOCUS GROUP MEETINGS IN DECEMBER, 2018 AND UPON REVIEW OF THE PRIMARY AND SECONDARY DATA, THE FOCUS GROUPS ENGAGED IN A FACILITATED CONVERSATION TO DETERMINE DRIVERS OF POOR HEALTH OUTCOMES AND PRIORITIZE HEALTH NEEDS FOR SPECIFIC COUNTIES.FOLLOWING THE FOCUS GROUPS, SEDHD SUPPLIED CHI HEALTH ST. MARY'S WITH A REPORT DETAILING MEETING HIGHLIGHTS AND IDENTIFIED NEEDS. CHI HEALTH ST. MARY'S CBAT THEN REVIEWED RESULTS FROM THE SEDHD CHNA PROCESS, AND VALIDATED WITH CHI HEALTH ST. MARY'S HOSPITAL COMMUNITY BOARD.SUMMARY OF ASSESSMENT FINDINGS IN ORDER TO PRIORITIZE THE TOP HEALTH NEEDS FOR OTOE COUNTY AND THIS HOSPITAL CHNA, THE CBAT REVIEWED THE SEDHD-LED PROCESS TO VALIDATE DATA AND PROCESS METHODOLOGY. PRIORITIZATION OF THE TOP HEALTH NEEDS FOR THE PURPOSES OF THIS CHNA TOOK INTO ACCOUNT THE FOLLOWING: - PREVALENCE AND SEVERITY - TREND - DISPARITIES - COMMUNITY AND STAKEHOLDER INPUT, AND - IMPACT ON OVERALL HEALTH OUTCOMES ALL PARTIES WHO REVIEWED THE DATA FOUND THE DATA TO ACCURATELY REPRESENT THE NEEDS OF THE COMMUNITY. 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: OTOE COUNTY IS CONSIDERED THE PRIMARY SERVICE AREA OF CHI HEALTH ST. MARY'S, AS A CRITICAL ACCESS HOSPITAL AND IS THEREFORE THE IDENTIFIED AS THE COMMUNITY FOR THE PURPOSES OF THIS CHNA. AS A CRITICAL ACCESS HOSPITAL, CHI HEALTH ST. MARY'S SERVES A LARGELY RURAL POPULATION OVER 616 SQUARE MILES IN OTOE COUNTY, NEBRASKA. OTOE COUNTY IS HOME TO TEN COMMUNITIES WITH FOUR SCHOOL DISTRICTS. THE POPULATION OF THESE COMMUNITIES RANGE FROM 61 IN LORTON, TO 1,600 IN SYRACUSE AND 6,547 IN NEBRASKA CITY. CHI HEALTH ST. MARY'S IS LOCATED IN NEBRASKA CITY, WHICH ALSO SERVES AS THE COUNTY SEAT FOR OTOE COUNTY AND IS APPROXIMATELY 50 MILES FROM THE OMAHA METROPOLITAN AREA AND 50 MILES FROM THE NORTHERN KANSAS BORDER.OVERALL, OTOE COUNTY IS GROWING AT A SLOWER RATE THAN THE STATE, HAS A SLIGHTLY HIGHER PERCENTAGE OF THE POPULATION OVER AGE 65, AND IS LESS DIVERSE (PREDOMINANTLY NON-HISPANIC WHITE) COMPARED TO THE STATE. THE HISPANIC POPULATION INCREASED FROM 902 TO 1,342 PEOPLE BETWEEN 2010 AND 2017, OR BY 48.8 PERCENT. NEBRASKA CITY'S POPULATION SHOWS LOWER INCOME AND LOWER EDUCATION THAN THE COUNTY AND STATE.OTOE COUNTY DEMOGRAPHICS: 16,027 TOTAL POPULATION FOR OTOE COUNTY 24.1% OF POPULATION BELOW 18 YEARS OF AGE 19.3% OF POPULATION IS AGED 65 OR OLDER 5.1% OF POPULATION IS NON-HISPANIC AFRICAN AMERICAN 0.6% OF POPULATION IS AMERICAN INDIAN OR ALASKA NATIVE 0.7% OF POPULATION IS ASIAN 0.1% OF POPULATION IS NATIVE HAWAIIAN/ PACIFIC ISLANDER 8.4% OF POPULATION IS HISPANIC 88.5% OF POPULATION IS NON-HISPANIC WHITE 9.1% OF POPULATION LIVING BELOW THE POVERTY LINE (100% FPL) 91.2% OF ELIGIBLE PERSONS HOLD HIGH SCHOOL DIPLOMA 21.4% OF ELIGIBLE PERSONS HOLD BACHELOR'S DEGREE OR HIGHER $54,605 IS THE MEDIAN HOUSEHOLD INCOME FOR OTOE COUNTY 3.4 IS THE COUNTY UNEMPLOYMENT RATE 8.7% OF POPULATION UNDER 65 IS UNINSUREDNEBRASKA CITY DEMOGRAPHICS: 7,313 TOTAL POPULATION FOR NEBRASKA CITY 25.0% OF POPULATION BELOW 18 YEARS OF AGE 19.1% OF POPULATION IS AGED 65 OR OLDER 0.4% OF POPULATION IS NON-HISPANIC AFRICAN AMERICAN 1.1% OF POPULATION IS AMERICAN INDIAN OR ALASKA NATIVE 1.1% OF POPULATION IS ASIAN 0.0% OF POPULATION IS NATIVE HAWAIIAN/ PACIFIC ISLANDER 15.3% OF POPULATION IS HISPANIC 79.9% OF POPULATION IS NON-HISPANIC WHITE 13.6% OF POPULATION LIVING BELOW THE POVERTY LINE (100% FPL) 88.6% OF ELIGIBLE PERSONS HOLD HIGH SCHOOL DIPLOMA 16.7% OF ELIGIBLE PERSONS HOLD BACHELOR'S DEGREE OR HIGHER $44,243 IS THE MEDIAN HOUSEHOLD INCOME FOR NEBRASKA CITY 11.8% OF POPULATION UNDER 65 IS UNINSURED IN NEBRASKA CITY PART VI, LINE 5: THE ORGANIZATION'S HOSPITAL FACILITY PROMOTES 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 HAS 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 TREATS 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.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 MEDICAID COMMUNITY HEALTH IMPROVEMENT SERVICES- - COMMUNITY EDUCATION, CLASSES AND PROGRAMS (COMMUNITY BEHAVIORAL HEALTH SUPPORT AND EDUCATION, DIABETES, CANCER, PHYSICAL ACTIVITY AND HEALTHY EATING AND COOKING) - SUPPORT GROUPS (CANCER, BEREAVEMENT, YOUTH, ETC.) - COMMUNITY HEALTH FAIRS 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. - UNITED AGAINST VIOLENCE-PROVIDED FUNDING AND STAFF TIME FOR THIS MULTI-YEAR PROJECT TO MOVE TOWARDS A CULTURE OF NON-VIOLENCE IN SOUTHEAST NEBRASKA. - INFANT HEARING SCREENING TESTING-NURSING STAFF PROVIDED RETESTING FOR COMMUNITY FAMILIES WHOSE INFANTS FAILED THE INITIAL HEARING TEST- PROVIDED 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.- ALZHEIMER'S ASSOCIATION-PROVIDED FUNDS TO SUPPORT THE CONTINUED OFFERING OF FREE SUPPORT SERVICES FOR FAMILIES WITH A LOVED ONE WITH DEMENTIA/ALZHEIMER'S. SUPPORTS INCLUDE ASSISTANCE IN FINDING MEMORY UNITS, APPROPRIATE LEVELS OF CARE OR SPECIALTY PROVIDERS, CAREGIVER SUPPORT GROUPS, ETC. - NEBRASKA BREASTFEEDING COALITION-PROVIDED FUNDS THAT SUPPORTS THE BUILDING OF COALITION INFRASTRUCTURE TO INCLUDE EVALUATION OF EXISTING WORK AND DEVELOPMENT OF LONG-TERM STRATEGIC PLAN TO SECURE SUSTAINABLE FUNDING. FUTURE FOCUS IS MOVING TOWARD STRATEGIES THAT CONNECT BREASTFEEDING AND BREASTFEEDING SUPPORT WITH MENTAL HEALTH. - 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 SITES.NEBRASKA CITY- PARTNERS FOR OTOE COUNTY-PROVIDED FINANCIAL SUPPORT FOR PARTNERS FOR OTOE COUNTY, A NON-PROFIT ORGANIZATION DEDICATED TO BUILDING A HEALTHY COMMUNITY WHERE EVERY CHILD AND FAMILY THRIVES. P4OC COLLABORATES WITH INDIVIDUALS, ORGANIZATIONS, LOCAL BUSINESSES, INSTITUTIONS, AND AGENCIES TO TAKE RESPONSIBILITY FOR IMPROVING THE HEALTH AND QUALITY OF LIFE IN OUR COMMUNITY.- SOUTHEAST DISTRICT HEALTH DEPARTMENT-PROVIDED SUPPORT TO THE LOCAL HEALTH DEPARTMENT TO CONVENE AND CONDUCT REGIONAL CHNA AND PLANNING PROCESS WHICH ST. MARY'S PARTICIPATED IN, ALONG WITH TWO OTHER REGIONAL HOSPITALS AND NUMEROUS COMMUNITY PARTNERS.- GROWING GREAT KIDS-PROVIDED SUPPORT FOR GROWING GREAT KIDS, WHICH IS A PROGRAM HOUSED OUT OF SOUTHEAST DISTRICT HEALTH DEPARTMENT (SEDHD). THE PROGRAM PROVIDES HOME VISITING SERVICES DELIVERED BY NURSING STAFF, FOR FAMILIES AT RISK FOR ADVERSE CHILDHOOD EXPERIENCES DURING THE PRENATAL TO AGE 3 TIMEFRAME, TO OFFER SUPPORT IN THE PRENATAL TIME PERIOD AS WELL AS PARENTING SUPPORT AND RESOURCES AS BABY GROWS. HEALTH PROFESSIONAL EDUCATION-- CLINICAL PRECEPTORSHIPS AND CLINICAL ROTATIONS FOR HEALTHCARE PROFESSIONALS- 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- SCHOLARSHIPS FOR HEALTHCARE 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 250 RESIDENTS AND FELLOWS ANNUALLY SUBSIDIZED HEALTH SERVICES - HEALTHCARE SERVICES INCLUDING CLINICAL CARE IN THE RURAL HEALTH SETTING RESEARCH- - 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-- CORPORATE SPONSORSHIPS- 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.- PARTICIPATION IN AND SPONSORSHIP OF MENTAL HEALTH COALITIONS INCLUDING VOICES FOR CHILDREN, COMMUNITY ALLIANCE FOUNDATION AND PROJECT HARMONY.- EMPLOYEE COSTS OF COORDINATING COMMUNITY EVENTS NOT SPONSORED BY CHI HEALTH (RELAY FOR LIFE, BLOOD DRIVES, ETC.)- IN-KIND STAFF TIME ORGANIZING THE DONATION OF ITEMS TO VARIOUS NON-PROFIT GROUPS AND VOLUNTEERING TIME AT FOOD BANK OF THE HEARTLAND- 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.- HOSPITAL HOSTED BLOOD DRIVES ONSITE AND EMPLOYEES DONATED BLOOD ON PAID TIME- MEALS ON WHEELS- FOOD DONATIONS, INCLUDING MEALS ON WHEELS SUBSIDIES AND DONATIONS TO FOOD SHELTERS, AND COST FOR STAFF TIME TO PREPARE AND DELIVER MEALS. 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 AS A SINGLE MINISTRY 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 OF OTHER PRIMARILY NONPROFIT CORPORATIONS THAT ARE EXEMPT FROM FEDERAL AND STATE INCOME TAXES. COMMONSPIRIT HEALTH IS COMPRISED OF 137 HOSPITALS, INCLUDING ACADEMIC HEALTH CENTERS, MAJOR TEACHING HOSPITALS, AND CRITICAL ACCESS FACILITIES, COMMUNITY HEALTH SERVICES ORGANIZATIONS, ACCREDITED NURSING COLLEGES, HOME HEALTH AGENCIES, LIVING COMMUNITIES, A MEDICAL FOUNDATION AND OTHER AFFILIATED MEDICAL GROUPS, AND OTHER FACILITIES AND SERVICES THAT SPAN THE INPATIENT AND OUTPATIENT CONTINUUM OF CARE. IN FISCAL YEAR 2020, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.2 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $4.5 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $29.57 BILLION IN FISCAL YEAR 2020, HAS TOTAL ASSETS OF APPROXIMATELY $46.77 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. PART VI, LINE 5 (CONTINUED): COMMUNITY BUILDING ACTIVITIES- - HEALTHCARE CAREER EXPLORATION CAMP-DAY CAMP FUNDED BY CHI HEALTH FOR STUDENTS GRADES 10-12 TO GIVE THEM THE OPPORTUNITY TO EXPLORE A VARIETY OF HEALTHCARE PROFESSIONS- PRESENTATIONS TO HIGH SCHOOL STUDENTS ABOUT HEALTHCARE CAREERS- STAFF TIME SPENT WITH HIGH SCHOOL SHADOW STUDENTS- HOSPITAL STAFF PARTICIPATED IN THE NEBRASKA WORKFORCE DEVELOPMENT BOARD MEETINGS- COMMUNITY AND ECONOMIC DEVELOPMENT INCLUDING SUPPORT OF LOCAL CHAMBERS OF COMMERCE - HOSPITAL PRESIDENT PARTICIPATED IN THE NEBRASKA CITY AREA ECONOMIC DEVELOPMENT MEETINGS- HOSPITAL STAFF PRESENTED TO LEADERSHIP NEBRASKA CITY TO TRAIN THEM ON LEADERSHIP DEVELOPMENT- PARTNERS FOR OTOE COUNTY-TIME SPENT WORKING WITH PARTNERS FOR OTOE COUNTY COALITION TO WORK WITH LOCAL COMMUNITY MEMBERS TO REDUCE DRUG AND ALCOHOL USE; INCREASE POSITIVE RELATIONSHIPS, PROVIDE AFTER SCHOOL CLUBS, AND TO BUILD A COMMUNITY WHERE EVERY FAMILY THRIVES.- SHARPS AND PRESCRIPTION DRUG DISPOSAL-IN AN EFFORT TO SAFELY REMOVE CONTAMINATED WASTE IN THE COMMUNITY, ST. MARY'S PROVIDED SHARPS CONTAINERS FREE OF CHARGE TO ANY PERSONS OR ORGANIZATIONS IN THE COMMUNITY. THEY ALSO MAINTAIN A MEDICATION COLLECTION BOX IN WHICH INDIVIDUALS CAN SAFELY AND APPROPRIATELY DISCARD UNUSED PRESCRIPTIONS. 1 1 0 0 0 0 0 1 0 ANTHONY JONES BOARD MEMBER 0 1193615 0 1247337 0 18579 0 0 0 14470 0 2474001 0 0 CLIFF ROBERTSON MD BOARD MEMBER/CEO CHI HEALTH 0 1062248 0 848919 0 360407 0 16675 0 29608 0 2317857 0 136676 JEANETTE WOJTALEWICZ CFO, CHI HEALTH 0 569967 0 340681 0 142853 0 15642 0 26724 0 1095867 0 48668 CARY WARD MD CHIEF MEDICAL OFFICER 0 509754 0 23303 0 22612 0 16294 0 18271 0 590234 0 0 BRETT MEYER MD PHYSICIAN-FAMILY MEDICINE 252043 296942 0 0 315 429 14017 0 2983 616 269358 297987 0 0 STACY BLUM MD PHYSICIAN-FAMILY MEDICINE 229203 279947 0 0 349 490 17243 0 23532 3464 270327 283901 0 0 AMY L MCGAHA MD BOARD MEMBER 0 433436 0 0 0 1376 0 16574 0 10298 0 461684 0 0 STEVE HOUSTON SVP -STRATEGY BUSINESS DVLP 0 333551 0 15372 0 22295 0 16675 0 18139 0 406032 0 0 JASON KRUGER MD BOARD MEMBER 0 338106 0 0 0 729 0 16505 0 27629 0 382969 0 0 NANCY WALLACE FORMER SVP HR CHI HEALTH 0 104558 0 12441 0 198145 0 11953 0 13248 0 340345 0 0 DEBRA GOLDSMITH PRESIDENT, REGIONAL HOSPITAL 0 235136 0 10584 0 34198 0 27972 0 17179 0 325069 0 17782 DONALD DUVAL CRNA 261406 0 0 0 200 0 13817 0 25572 0 300995 0 0 0 DANIEL DEFREECE MD PRESIDENT 108592 120824 8461 0 6517 0 16552 0 22940 3270 163062 124094 0 0 MISTY HILL CRNA 220887 0 0 0 242 0 12730 0 25585 0 259444 0 0 0 MIKE WATTERS FORMER VP-SENIOR COUNSEL 0 184089 0 0 0 7701 0 16525 0 16089 0 224404 0 0 MICHAEL SEBEK PA - MEDICAL 75760 131781 0 0 60 114 10528 0 1489 749 87837 132644 0 0 DANIEL KELLY FORMER PRESIDENT 0 0 0 0 180373 0 0 0 0 0 180373 0 0 0 PART I, LINE 3 DURING THE CALENDAR YEAR 2019, 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. PART 1, 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. THE FOLLOWING REPORTABLE INDIVIDUALS RECEIVED SEVERANCE PAYMENTS FROM COMMONSPIRIT HEALTH (A RELATED ORGANIZATION) DURING THE 2019 CALENDAR YEAR, AND THESE SEVERANCE PAYMENTS WERE INCLUDED IN THE INDIVIDUALS' W-2 INCOME AND REPORTABLE COMPENSATION ON PART VII AND SCHEDULE J, PART II, COLUMN (B)(III): NANCY WALLACE, $188,001; DANIEL KELLY, $180,373. PART 1, 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. DURING 2019 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: CLIFF ROBERTSON, $139,927; JEANETTE WOJTALEWICZ, $62,916; DEBRA GOLDSMITH, $17,924. 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: CLIFF ROBERTSON, $182,082; JEANETTE WOJTALEWICZ, $57,305. PART 1, LINE 7: DURING THE 2019 CALENDAR YEAR, COMMONSPIRIT MAINTAINED A VARIABLE PAY PROGRAM FOR MANAGERS AND ABOVE THAT PUTS A CERTAIN AMOUNT OF COMPENSATION AT RISK. AWARDS OF INCENTIVE COMPENSATION UNDER THE VARIABLE PAY PROGRAM ARE MADE BASED UPON ACHIEVEMENT OF ORGANIZATIONAL OBJECTIVES INCLUDING FINANCIAL OUTCOMES, QUALITY IMPROVEMENT, AND OTHER MEASURES AS DETERMINED ANNUALLY BY THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES. HOWEVER, ELIGIBLE AWARDS PAYABLE UNDER THIS PROGRAM ARE DEPENDENT ON REACHING MINIMUM LEVELS OF OPERATING MARGIN AND CHARITY CARE LEVELS, UNLESS THE HR COMMITTEE OF THE BOARD OF STEWARDSHIP TRUSTEES USES ITS DISCRETION TO APPROVE AN EXCEPTION. SUCH EXCEPTIONS ARE NOT APPLIED TO INDIVIDUALS OR CLASSES OF INDIVIDUALS, BUT RATHER TO THE PROGRAM AS A WHOLE. PART V, LINE 1C PAYMENTS TO VENDORS FOR ENTITIES THAT ARE PART OF COMMONSPIRIT HEALTH ARE MADE BY COMMONSPIRIT HEALTH. THEREFORE NO FORM 1099S ARE ISSUED BY ALEGENT CREIGHTON HEALTH. COMMONSPIRIT HEALTH FILES THE FORM 1099S AND COMPLIES WITH THE BACKUP WITHHOLDING RULES FOR REPORTABLE PAYMENTS TO VENDORS AND GAMING WINNINGS. THE 1099S ISSUED BY COMMONSPIRIT HEALTH ON BEHALF OF ALEGENT CREIGHTON HEALTH ARE REPORTED TO THE IRS. FORM 990, PART VI, SECTION A, LINE 1 PURSUANT TO SECTION 8.1 OF THE CORPORATION'S BYLAWS, COMMITTEES, SUCH AS THE EXECUTIVE COMMITTEE, THAT ARE GRANTED THE AUTHORITY TO ACT ON BEHALF OF THE BOARD OF DIRECTORS MAY INCLUDE ONLY DIRECTORS OF THE CORPORATION. FURTHER, PURSUANT TO SECTION 8.6 OF THE CORPORATION'S BYLAWS, THE EXECUTIVE COMMITTEE HAS AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. THE EXECUTIVE COMMITTEE ALSO POSSESSES THE POWER TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 6 THE SOLE MEMBER OF THE ORGANIZATION IS CHI NEBRASKA, A NEBRASKA NON-PROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS CHI NEBRASKA. PURSUANT TO SECTION 5.4.1 OF THE ORGANIZATION'S BYLAWS, BOTH CHI NEBRASKA AND COMMONSPIRIT HEALTH (CHI NEBRASKA'S SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE COMMONSPIRIT HEALTH GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE HELD BY THE CHI NEBRASKA'S BOARD: * APPROVE MEMBERS OF THE ST. MARY'S COMMUNITY HOSPITAL. * AMENDMENT OF THE CORPORATE DOCUMENTS OF THE ST. MARY'S COMMUNITY HOSPITAL. * APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ST. MARY'S COMMUNITY HOSPITAL. * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE ST. MARY'S COMMUNITY HOSPITAL. THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE ST. MARY'S COMMUNITY HOSPITAL. * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ST. MARY'S COMMUNITY HOSPITAL. * APPROVAL OF ISSUANCE OF DEBT BY ST. MARY'S COMMUNITY HOSPITAL. * APPROVAL OF PARTICIPATION OF ST. MARY'S COMMUNITY HOSPITAL IN A JOINT VENTURE. * APPROVAL OF FORMATION OF A NEW CORPORATION BY ST. MARY'S COMMUNITY HOSPITAL. * APPROVAL OF A MERGER INVOLVING THE ST. MARY'S COMMUNITY HOSPITAL. * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ST. MARY'S COMMUNITY HOSPITAL. * TO REQUIRE THE TRANSFER OF ASSETS BY ST. MARY'S COMMUNITY HOSPITAL TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS. PURSUANT TO SECTION 5.5.2 OF THE ORGANIZATION'S BYLAWS, CHI NEBRASKA OR COMMONSPIRIT HEALTH MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. FORM 990, PART VI, SECTION B, LINE 11B FOLLOWING THE PREPARATION OF THE FORM 990 BY TAX ANALYSTS OF COMMONSPIRIT HEALTH, A RELATED ORGANIZATION, THE RETURN IS REVIEWED BY THE COMMONSPIRIT HEALTH TAX DIRECTOR AND THE LOCAL CHIEF FINANCIAL OFFICER. ADDITIONALLY, THE BOARD OF DIRECTORS ARE PROVIDED THE FINAL FORM 990 AND RELATED SCHEDULES TO REVIEW AND ARE ABLE TO ASK THE CHIEF FINANCIAL OFFICER AND TAX DIRECTOR QUESTIONS PRIOR TO FILING WITH THE IRS. UPON CHIEF FINANCIAL OFFICER APPROVAL AND SIGNATURE, THE TAX ANALYST FILES THE FINAL FORM 990 AS PRESENTED TO THE BOARD AND FINANCE COMMITTEE, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY IN ORDER TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO 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 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 ST. MARY'S COMMUNITY HOSPITAL 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 FINANCIAL STATEMENTS, CONFLICT OF INTEREST POLICY AND GOVERNING DOCUMENTS ARE AVAILABLE TO THE PUBLIC UPON REQUEST. THE ORGANIZATION'S FINANCIAL STATEMENTS ARE INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS THAT ARE AVAILABLE AT WWW.COMMONSPIRIT.ORG. FORM 990, PART IX, LINE 11G PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 1,902,320. MANAGEMENT AND GENERAL EXPENSES 473,690. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,376,010. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 699,620. MANAGEMENT AND GENERAL EXPENSES 174,905. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 874,525. CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 200,193. MANAGEMENT AND GENERAL EXPENSES 50,048. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 250,241. OTHER FEES: PROGRAM SERVICE EXPENSES 99,974. MANAGEMENT AND GENERAL EXPENSES 24,994. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 124,968. FORM 990, PART XI, LINE 9: ASC 842 ADJUSTMENT -1,397. 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 - COMMUNITY MEMORIAL HOSPITAL MO VALLEY IA 631 N 8TH ST MISSOURI VALLEY IA 51555 420776568 HOSPITAL IA 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 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 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 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 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 DCC 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 FUNDRAISING FOUNDATION 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 COMMONSPIRIT HEALTH RESEARCH INSTITUTE 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 271050565 HEALTHCARE CO 501(C)(3) LINE 12A, I CSH 0 CHI KENTUCKY INC 3900 OLYMPIC BLVD STE 400 ERLANGER KY 41018 202741651 HEALTHCARE KY 501(C)(3) LINE 12A, I CSH 0 CHI LIVING COMMUNITIES 5942 RENAISSANCE PLACE STE A TOLEDO OH 43623 341892096 HEALTHCARE 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 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LINE 12A, I AH-CMHMV 0 CONTINUING CARE HOSPITAL ONE SAINT JOSEPH DRIVE LEXINGTON KY 40504 611400619 HOSPITAL KY 501(C)(3) LINE 3 SJHS 0 DIGNITY COMMUNITY CARE 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 815009488 HOSPITAL CO 501(C)(3) LINE 3 CSH 0 DIGNITY HEALTH 185 BERRY STREET STE 200 SAN FRANCISCO CA 94107 941196203 HOSPITAL CA 501(C)(3) LINE 3 CSH 0 DIGNITY HEALTH CONNECTED LIVING 200 MERCY OAKS DRIVE REDDING CA 96003 237115371 SENIOR CENTER SERVICES CA 501(C)(3) LINE 7 DH 0 DIGNITY HEALTH FOUNDATION 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 462037641 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH FOUNDATION - INLAND EMPIRE 2101 N WATERMAN AVENUE SAN BERNARDINO CA 92404 237440086 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH FOUNDATION EAST VALLEY 475 SOUTH DOBSON ROAD CHANDLER AZ 85224 742418514 FUNDRAISING FOUNDATION AZ 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH HPL SELF-INSURANCE TRUST 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 943006034 SELF INSURANCE CA 501(C)(3) LINE 12A, I DH 0 DIGNITY HEALTH INSURANCE NEVADA LTD 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 813800752 SELF INSURANCE NV 501(C)(3) LINE 12A, I DH 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 DCC 0 DIGNITY HEALTH WORKERS COMP SELF-INSURANCE TRUST 185 BERRY STREET SUITE 200 SAN FRANCISCO CA 94107 946612446 SELF INSURANCE CA 501(C)(3) LINE 12A, I DH 0 DOMINICAN HEALTH SERVICES 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 770056778 COMMUNITY HEALTH SYSTEM CA 501(C)(3) LINE 12A, I DH 0 DOMINICAN HOSPITAL FOUNDATION 1555 SOQUEL DRIVE SANTA CRUZ CA 95065 942450442 FUNDRAISING FOUNDATION CA 501(C)(3) LINE 12A, I DH 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 98405 911145592 FUNDRAISING FOUNDATION WA 501(C)(3) LINE 10 FHS 0 FRANCISCAN HEALTH SYSTEM 1717 SOUTH J ST TACOMA WA 98405 910564491 HOSPITAL WA 501(C)(3) LINE 3 CSH 0 FRANCISCAN HEALTH VENTURES FKA SJMGROUP TACOMA FNC CTR BLDG 1145 BROADWAY TACOMA WA 98402 431882377 PHYSICIANS MO 501(C)(3) LINE 10 CSH 0 FRANCISCAN MEDICAL GROUP 1313 BROADWAY STE 200 TACOMA WA 98402 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