2021-05-17T18:15:56-05:00 2020-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2019-07-01 911939739 FRANCISCAN MEDICAL GROUP FRAN 2536804000 1717 S J STREET TACOMA WA 98405 MICHAEL FITZGERALD INTERIM-CFO 2536804000 2021-05-17 1 PAMELA KROHN P01210500 3032989100 2019 2022-09-23 18:48:47Z JANE ROOT COO 1717 S J STREET TACOMA WA 98405 382374037 0 X WWW.CHIFRANCISCAN.ORG/ X 1999 WA FMG WAS FOUNDED ON THE PRINCIPLE TO PROVIDE COMPASSIONATE CARE TO EVERYONE REGARDLESS OF ABILITY TO PAY OR SOCIAL STATUS. FMG INCLUDES AN EXPANDING NETWORK OF CLINICS. 11 11 3182 11 0 0 172675089 9547927 374291364 371474152 102902 12097 2105746 1227623 549175101 382261799 0 0 0 0 413685332 444725818 0 0 0 137170956 138918835 550856288 583644653 -1681187 -201382854 134272107 309464643 82646877 285377083 51625230 24087560 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 544077907 0 371474152 SEE SCHEDULE O 544077907 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 1 0 0 0 0 0 0 1 0 0 0 1 0 0 3182 1 0 0 0 0 0 0 0 0 0 0 0 0 X 11 11 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 0 1 1 0 X DAVID BUTCHERITE 2536804105 1145 BROADWAY PLAZA STE 1200 TACOMA WA 98402 HOAN TRAN NEUROSURGEON 40.00 0.00 X 1533042 0 25292 SATYAVARDHAN PULUKURTHY PHYSICIAN 40.00 0.00 X 1412235 0 22962 EATHAR RAZAK ELECTRO PHYSIOLOGIST 40.00 0.00 X 1268743 0 25459 NATHAN SEGERSON PHYSICIAN 40.00 0.00 X 1194348 0 22962 TODD WILLCOX PLASTIC-RECONSTRUCTION SURGEON 40.00 0.00 X 1163330 0 25459 MIKE FITZGERALD TREASURER / FHS CFO 2.00 58.00 X 0 1021098 37301 MICHAEL MARSHALL FORMER PRESIDENT & CMO 0.00 0.00 X 514780 0 17640 THERESA RAMBOSEK CORPORATE SECRETARY 2.00 58.00 X 0 363125 17347 JANE ROOT CHIEF OPERATING OFFICER FMG 40.00 0.00 X 315193 0 35629 PETER O'CONNOR FORMER CHIEF OPERATING OFFICER 40.00 0.00 X 183525 0 13687 LARRY BJORK MEMBER 2.00 5.00 X 0 0 0 LINDA BURKHARDT MEMBER 2.00 4.00 X 0 0 0 ULI CHI PHD CHAIRMAN 2.00 8.00 X X 0 0 0 JAMES CIVILLA MEMBER 2.00 6.00 X 0 0 0 SISTER JUDE CONNELLY MEMBER 2.00 4.00 X 0 0 0 SISTER RUTH GOODWIN OSF MEMBER 2.00 4.00 X 0 0 0 MIKE HOFFMAN MEMBER 2.00 6.00 X 0 0 0 DENNY HUNTHAUSEN MEMBER 2.00 6.00 X 0 0 0 SR ANNE MCNAMARA VICE CHAIR 2.00 4.00 X X 0 0 0 DIANN PULS MEMBER 2.00 4.00 X 0 0 0 JAMES SMALLEY MEMBER 2.00 6.00 X 0 0 0 7585196 1384223 243738 682 1 1 0 DOCTORS CLINIC 9621 RIDGETOP BLVD NW SILVERDALE WA 98383 MEDICAL SERVICE 44078422 PULMONARY CONSULTANTS 10604 SW HWY SUITE 107 CHICAGO RIDGE IL 60415 CONSULTING SERVICES 9134772 WELLTOWER INC 4500 DORR STREET TOLEDO OH 43615 REAL ESTATE INVESTMENT SERVICES 4676988 AMN HEALTHCARE 12400 HIGH BLUFF DRIVE SAN DIEGO CA 92130 HEALTHCARE CONSULTING 1677372 GIG HARBOR PHYSICIANS LLC 251 LITTLE FALLS DRIVE WILMINGTON DE 19808 MEDICAL SERVICES 1583724 53 273874 9008464 265589 9547927 NET PATIENT SERVICES 900099 370740940 370740940 0 0 MEDICARE/MEDICAID 900099 552500 552500 0 0 RENTAL INCOME 900099 180712 180712 0 0 371474152 124335 124335 112238 -112238 -112238 -112238 ADMINISTRATIVE SERVICE 561000 1059202 0 0 1059202 PRODUCT SALES 446199 150974 0 0 150974 CAFETERIA 722100 10467 0 0 10467 6980 6980 1227623 382261799 371474152 0 1239720 382508 382508 81409 81409 377510990 358959157 18551833 13935895 13255777 680118 32196385 30605484 1590901 20618631 19587699 1030932 270209 270209 2660 2660 34362816 24053971 10308845 161658 153575 8083 4131324 3924758 206566 12442898 11820753 622145 33810028 32119526 1690502 940451 893429 47022 49949 47452 2497 157513 157513 4935000 4935000 16513537 15687860 825677 7610953 7610953 MEDICAL SUPPLIES 16362831 16362831 0 0 OTHER TAXES 3308394 1654197 1654197 0 DUES & SUBSCRIPTIONS 955350 477675 477675 0 MISCELLANEOUS EXPENSES 787378 657825 129553 0 2115886 1188576 927310 583644653 544077907 39566746 0 31812 33056 182529 701855 0 43709702 34478933 0 0 0 0 304706 4331651 2254289 2290876 2425804 2520211 176828157 114005623 68834673 62822534 0 0 0 0 0 16168266 15676714 360326 186608813 134272107 309464643 36215419 42773994 0 0 0 45579 0 0 0 0 0 7810344 3348558 0 38621114 239208952 82646877 285377083 X 51625230 24087560 0 0 51625230 24087560 134272107 309464643 X -201382854 173845184 X 0 1 X 1 1 1 X 97165933 156467091 157567145 172675089 9547927 593423185 233074729 305715372 375404850 374291364 371474152 1659960467 7727594 10375576 2437583 2105746 1227623 23874122 337968256 472558039 535409578 549072199 382249702 2277257774 0 0 0 2277257774 3119 11115 36064 89714 124335 264347 3119 11115 36064 89714 124335 264347 337971375 472569154 535445642 549161913 382374037 2277522121 0.99990 0.99990 0.00010 0.00010 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 1 2660 2660 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELTATED TO LOBBYING ARE AS FOLLOWS: AMERICAN MEDICAL GROUP ASSOCIATION - $2,660 3108338 690594 2417744 62653236 35725761 26927475 106826222 77589268 29236954 4240361 4240361 62822534 ROU OPERATING 184595321 ROU FINANCE, NET 1615946 DEPOSITS 87172 OTHER ASSETS 310374 186608813 ACCRUED CONTINGENT LIABILITIES 3662594 CURRENT PORTION - FINANCE LEASE 1368399 CURRENT PORTION - OPERATING LEASE 23344635 INTERCOMPANY PAYABLES 18221146 LT PORTION - FINANCE LEASE 733425 LT PORTION - OPERATING LEASE 190581219 OTHER LIABILITIES 2810 COMPENSATION ACCRUAL 1294724 239208952 X PART X, LINE 2: FRANCISCAN 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. X X 1 1 0 0 0 1 0 0 0 HOAN TRAN NEUROSURGEON 1531782 0 0 0 1260 0 16675 0 8617 0 1558334 0 0 0 SATYAVARDHAN PULUKURTHY PHYSICIAN 1281922 0 129053 0 1260 0 16675 0 6287 0 1435197 0 0 0 EATHAR RAZAK ELECTRO PHYSIOLOGIST 1140051 0 127432 0 1260 0 16675 0 8784 0 1294202 0 0 0 NATHAN SEGERSON PHYSICIAN 1011720 0 181368 0 1260 0 16675 0 6287 0 1217310 0 0 0 TODD WILLCOX PLASTIC-RECONSTRUCTION SURGEON 1161398 0 0 0 1932 0 16675 0 8784 0 1188789 0 0 0 MIKE FITZGERALD TREASURER / FHS CFO 0 642225 0 296087 0 82786 0 15890 0 21411 0 1058399 0 0 MICHAEL MARSHALL FORMER PRESIDENT & CMO 288889 0 0 0 225891 0 16278 0 1362 0 532420 0 0 0 THERESA RAMBOSEK CORPORATE SECRETARY 0 321006 0 25174 0 16945 0 15751 0 1596 0 380472 0 0 JANE ROOT CHIEF OPERATING OFFICER FMG 271825 0 35014 0 8354 0 16466 0 19163 0 350822 0 0 0 PETER O'CONNOR FORMER CHIEF OPERATING OFFICER 178287 0 0 0 5238 0 13358 0 329 0 197212 0 0 0 PART I, LINES 4A-B 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 FRANCISCAN MEDICAL GROUP 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): MICHAEL MARSHALL, $218,991 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: MIKE FITZGERALD, $58,241 PART I, LINE 6 REPORTABLE PHYSICIANS RECEIVE INCENTIVE COMPENSATION BASED ON "NET PROFESSIONAL REVENUE". "NET PROFESSIONAL REVENUE" WAS NOT DETERMINED WITH REFERENCE TO ORGANIZATIONAL NET REVENUE OR ORGANIZATIONAL "NET INCOME". RATHER, AMOUNTS WERE DETERMINED BASED UPON THE PHYSICIAN'S INDIVIDUAL CONTRIBUTION COMPUTED AS: PHYSICIANS PERSONALLY PERFORMED PROFESSIONAL SERVICES (FOR SERVICES RENDERED BY THE PHYSICIAN TO PATIENTS PERSONALLY) LESS SOME SPECIFICALLY STATED PHYSICIAN REVENUE AND REFUNDS. CHARISSA CHI FAMILY MEMBER OF BOARD MEMBER 81409 COMPENSATION & BENEFITS 0 FORM 990, PART III, LINE 4A I. INTRODUCTION A. MARKET BASED ORGANIZATION MISSION AND VISION FRANCISCAN MEDICAL GROUP WAS FOUNDED IN APRIL 1999 TO PROVIDE COMMUNITY BASED HEALTH CARE SERVICES. SINCE ITS INCEPTION, FRANCISCAN MEDICAL GROUP HAS FOCUSED ON PROVIDING QUALITY HEALTH CARE TO ALL MEMBERS OF THEIR COMMUNITY REGARDLESS OF ABILITY TO PAY FOR SERVICES. COMMUNITY SERVICE HAS ALWAYS BEEN AT THE CORE OF OUR ACTIVITY. B. COMMUNITY BENEFIT APPROACH FRANCISCAN MEDICAL GROUP CLINICS PROVIDE SERVICES ACROSS A LARGE GEOGRAPHY OF SOUTH PUGET SOUND IN WASHINGTON STATE, SERVING A DIVERSE POPULATION IN OUR SERVICE AREA. FRANCISCAN MEDICAL GROUP PROVIDES SERVICES TO PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP OR ABILITY TO PAY. THE PROGRAMS AND SERVICES SERVED BY FRANCISCAN MEDICAL GROUP NOT ONLY SERVE THE COMMUNITY BUT ALSO REDUCE THE BURDEN ON GOVERNMENTAL PROGRAMS, I.E. MEDICARE AND MEDICAID. WITHOUT THE CHARITY CARE PROVIDED BY FRANCISCAN MEDICAL GROUP CLINICS, THE COMMUNITY CHARITY CARE CASES WOULD FALL UPON THE MORE EXPENSIVE EMERGENCY ROOMS IN LOCAL HOSPITALS, INCLUDING THOSE OPERATED BY LOCAL GOVERNMENT. IN ADDITION TO PROVIDING FINANCIAL ASSISTANCE, FRANCISCAN MEDICAL GROUP SUPPORTS HEALTH PROFESSIONS EDUCATION PROGRAMS AND SUBSIDIZED PROGRAMS FOR THOSE WITH DIABETES. II. QUANTITATIVE DESCRIPTION OF COMMUNITY BENEFIT: UNCOMPENSATED CARE FRANCISCAN MEDICAL GROUP PROVIDED A SIGNIFICANT LEVEL OF CHARITY CARE SERVICES TO THOSE WITH LIMITED OR AN INABILITY TO PAY. TO THE EXTENT MEDICARE AND MEDICAID REIMBURSEMENT IS BELOW COST, FRANCISCAN MEDICAL GROUP RECOGNIZES THESE AMOUNTS AS THE UNCOMPENSATED COST OF PROVIDING CARE. AS MENTIONED ABOVE, FRANCISCAN MEDICAL GROUP PROVIDES SERVICES TO PATIENTS REGARDLESS OF RACE, CREED, SEX, NATIONAL ORIGIN, HANDICAP, OR ABILITY TO PAY. MOST PHYSICIAN GROUPS IN THE STATE OF WASHINGTON HAVE EITHER PARTIALLY OR FULLY CLOSED THEIR PRACTICES TO NEW MEDICARE AND MEDICAID PATIENTS AS THE REIMBURSEMENT FOR THESE PROGRAMS HAS INCREASINGLY FALLEN SHORT OF THE COST OF PROVIDING THAT CARE. ALTHOUGH REIMBURSEMENT FOR SERVICES RENDERED IS CRITICAL TO THE OPERATION AND STABILITY OF FRANCISCAN MEDICAL GROUP, NOT ALL INDIVIDUALS POSSESS THE ABILITY TO PURCHASE ESSENTIAL MEDICAL SERVICES AND OUR MISSION IS TO SERVE THE COMMUNITY BY PROVIDING HEALTH CARE SERVICES AND HEALTH CARE EDUCATION. THEREFORE, IN KEEPING WITH FRANCISCAN MEDICAL GROUP'S COMMITMENT TO SERVE ALL MEMBERS OF ITS COMMUNITY, WE PROVIDE CARE TO PERSONS COVERED BY GOVERNMENTAL PROGRAMS ALTHOUGH THE COST OF PROVIDING THAT CARE EXCEEDS GOVERNMENTAL PROGRAM REIMBURSEMENT. FOR THE FISCAL YEAR ENDING JUNE 30, 2020, THE COST OF UNCOMPENSATED MEDICAID AMOUNTED TO $ 58.9 MILLION; FINANCIAL ASSISTANCE TOTALED $ 3.9 MILLION FOR THE YEAR. III. QUALITATIVE DESCRIPTION OF COMMUNITY BENEFIT A. COMMUNITY OUTREACH FOR THE POOR AND THE BROADER COMMUNITY FRANCISCAN MEDICAL GROUP PROVIDES CHARITY CARE TO THOSE WITH LIMITED OR AN INABILITY TO PAY FOR CARE. CHARITY CARE IS ALSO PROVIDED THROUGH MANY REDUCED PRICE SERVICES AND FREE PROGRAMS OFFERED THROUGHOUT THE YEAR BASED ON COMMUNITY HEALTH NEEDS. COMMUNITY HEALTH EDUCATION AROUND HEART DISEASE AND DIABETES, INCLUDING FREE, WEEKLY SUPPORT GROUPS FOR THOSE WITH DIABETES, ARE PROVIDED AT SEVERAL FRANCISCAN MEDICAL GROUP CLINICS. FRANCISCAN MEDICAL GROUP AND ITS MEMBERS PARTNER CLOSELY WITH PROJECT ACCESS PIERCE COUNTY AND PROJECT ACCESS NORTHWEST. MANY FMG PROVIDERS DONATE CARE AND CHI FRANCISCAN PROVIDES FINANCIAL CONTRIBUTIONS TO BOTH ORGANIZATIONS FOR THEIR PREMIUM ASSISTANCE PROGRAMS. IT IS SIGNIFICANT TO NOTE THAT ALL OF THE FRANCISCAN MEDICAL GROUP PRIMARY CARE CLINICS OPERATE IN COMMUNITIES DESIGNATED BY THE US DEPARTMENT OF HEALTH AS MEDICALLY UNDERSERVED AREAS FOR ACCESS TO PRIMARY CARE. FRANCISCAN MEDICAL GROUP SUPPORTS TRAINING FOR MEDICAL STUDENTS TO HELP FILL THIS GAP IN OUR COMMUNITIES. FORM 990, PART VI, SECTION A, LINE 1 PURSUANT TO SECTION 7.5 OF THE BYLAWS OF THE FRANCISCAN MEDICAL GROUP THE EXECUTIVE COMMITTEE SHALL CONSIST ONLY OF DIRECTORS OF THE CORPORATION AND SHALL AT ALL TIMES BE IDENTICAL TO THE EXECUTIVE COMMITTEE OF THE MEMBER BOARD. EXCEPT AS PROVIDED BY LAW OR LIMITED BY THE BOARD FROM TIME TO TIME, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS AS MAY BE DELEGATED TO IT BY THE BOARD OF DIRECTORS. ADDITIONALLY, THE EXECUTIVE COMMITTEE SHALL HAVE AND MAY EXERCISE SUCH POWERS TO TRANSACT ROUTINE BUSINESS OF THE CORPORATION IN THE INTERIM PERIOD BETWEEN REGULARLY SCHEDULED MEETINGS OF THE BOARD OF DIRECTORS, PROVIDED THAT SUCH ACTIONS TAKEN SHALL BE CONSISTENT WITH AND NOT CONFLICT WITH ANY ACTIONS OR POLICIES OF THE BOARD OF DIRECTORS, THE CORPORATE MEMBER, THE PARENT CORPORATION OR WITH THESE BYLAWS, OR WITH APPLICABLE LAW. FORM 990, PART VI, SECTION A, LINE 6 ACCORDING TO THE BYLAWS OF FRANCISCAN MEDICAL GROUP THE SOLE MEMBER IS FRANCISCAN HEALTH SYSTEM, A WASHINGTON NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A THE CORPORATE MEMBER HAS THE POWER TO APPOINT, REPLACE OR REMOVE THE MEMBERS OF THE BOARD OF DIRECTORS. FORM 990, PART VI, SECTION A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS FRANCISCAN HEALTH SYSTEM ("FHS"). PURSUANT TO SECTION 4.4 OF THE ORGANIZATION'S BYLAWS, BOTH FRANCISCAN HEALTH SYSTEM AND COMMONSPIRIT HEALTH (FHS' SOLE CORPORATE MEMBER) HAVE RESERVED POWERS AS OUTLINED IN THE COMMONSPIRIT HEALTH GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE FRANCISCAN HEALTH SYSTEM BOARD: 1. APPROVE MEMBERS OF THE FRANCISCAN MEDICAL GROUP ("FMG") BOARD 2. AMENDMENT OF THE CORPORATE DOCUMENTS OF FMG 3. APPROVE REMOVAL OF A MEMBER OF THE GOVERNING BODY OF FMG 4. ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR FMG THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: 1. SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF FMG 2. REMOVAL OF A MEMBER OF THE GOVERNING BODY OF FMG 3. APPROVAL OF ISSUANCE OF DEBT BY FMG 4. APPROVAL OF PARTICIPATION OF FMG IN A JOINT VENTURE 5. APPROVAL OF FORMATION OF A NEW CORPORATION BY FMG 6. APPROVAL OF A MERGER INVOLVING FMG 7. APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF FMG 8. TO REQUIRE THE TRANSFER OF ASSETS BY FMG TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS. IN ADDITION, PURSUANT TO SECTION 4.5.2 OF THE ORGANIZATION'S BYLAWS, FHS OR COMMONSPIRIT HEALTH MAY, IN EXERCISE OF ITS APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND THE PRESIDENT AND 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 ONCE THE RETURN IS PREPARED, THE CFO REVIEWS THE TAX RETURN AND ANY NECESSARY CHANGES ARE INCLUDED IN THE FINAL VERSION THAT IS APPROVED FOR FILING WITH THE IRS. IN ADDITION, THE RETURN IS PROVIDED TO THE BOARD PRIOR TO FILING. SUBSEQUENT TO REVIEW, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RESUBMITTED 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, LINE 14 WHILE FRANCISCAN MEDICAL GROUP HAS A WRITTEN DOCUMENT RETENTION PLAN, THE GOVERNING BOARD HAS NOT FORMALLY ADOPTED IT. FORM 990, PART VI, SECTION B, LINE 15 AN EXTERNAL COMPENSATION FIRM IS USED WHO UTILIZES ACTUAL MARKET DATA COMPENSATION FROM SIMILAR INSTITUTIONS WITH COMPARABLE POSITIONS AND COMPENSATION LEVELS AND CONSIDERING THE ORGANIZATION'S GEOGRAPHIC LOCATION. THE EXECUTIVE COMMITTEE OF THE BOARD ANNUALLY EVALUATES AND APPROVES THE EXECUTIVE COMPENSATION ARRANGEMENT FOR EACH EXECUTIVE FOR FAIR MARKET VALUE ALONG WITH OTHER APPLICABLE FACTORS RELIED ON BY THE BOARD'S DETERMINATION. THE SUPPORTING DOCUMENTATION BECOMES PART OF THE MINUTES OF THE MEETING. THIS PROCESS IS COMPLETED YEARLY. 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 XI, LINE 9: ASC 842 ADOPTION ADJUSTMENTS -6,045,984. CAPITAL TRANSFERS 179,891,168. 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 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