2024-05-13T17:00:52-05:00 2023-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2022-07-01 450226711 ST ALEXIUS MEDICAL CENTER STAL 7015307000 900 EAST BROADWAY AVENUE BISMARCK ND 58501 NICK O'TOOL DIVISION VP FINANCE 7015307000 2024-05-13 1 NICK OTOOL 0 MARK STOCKI P00642127 3032989100 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z CHI ST ALEXIUS HEALTH REED REYMAN 900 EAST BROADWAY AVENUE BISMARCK ND 585014520 255946071 0 0928 X HTTP://WWW.CHISTALEXIUSHEALTH.ORG X 1905 ND ST. ALEXUS IS PROUD OF ITS STELLAR REPUTATION AS A CARING, HIGH QUALITY MEDICAL CENTER AND OF ITS AWARDS FOR CLINICAL EXCELLENCE, CUSTOMER SATISFACTION AND COMMUNITY SERVICE. 11 6 1735 75 6193794 1473131 3925994 2164604 255616036 233743066 375068 301310 14600503 19736777 274517601 255945757 602183 633262 0 0 137439010 140588463 0 0 1412216 182324869 188757821 320366062 329979546 -45848461 -74033789 233655230 248052281 336434262 422087591 -102779032 -174035310 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 288829357 633262 233743066 CHI ST. ALEXIUS HEALTH BISMARCK IS AN ACUTE CARE MEDICAL CENTER OFFERING A FULL LINE OF INPATIENT AND OUTPATIENT MEDICAL SERVICES, INCLUDING PRIMARY AND SPECIALTY PHYSICIAN CLINICS, HOME HEALTH AND HOSPICE SERVICES, DURABLE MEDICAL EQUIPMENT SERVICES, AND A FITNESS AND HUMAN PERFORMANCE CENTER.SINCE OUR FOUNDING IN 1885, CHI ST. ALEXIUS HEALTH BISMARCK HAS BEEN DEDICATED TO SERVING THE RESIDENTS OF CENTRAL AND WESTERN NORTH DAKOTA, NORTHERN SOUTH DAKOTA AND EASTERN MONTANA. WE ARE A ROMAN CATHOLIC ORGANIZATION WHOSE SPONSORS ARE THE SISTERS OF ST. BENEDICT OF THE ANNUNCIATION MONASTERY, BISMARCK, ND AND AS AN ORGANIZATION WE FOLLOW THE ETHICAL AND RELIGIOUS DIRECTIVES FOR CATHOLIC HEALTH CARE SERVICES AS PROMULGATED BY THE UNITED STATES CONFERENCE OF CATHOLIC BISHOPS.WE ARE COMPRISED OF AN INTERVENTIONAL RADIOLOGIST, CARDIOLOGISTS, HEART AND VASCULAR SURGEONS AS WELL AS OTHER HIGHLY TRAINED SUPPORT PERSONNEL.SPECIALTY CLINICS: OUR SPECIALTY CLINICS ARE A UNIQUE MULTI-SPECIALTY GROUP PRACTICE LOCATED MAINLY INSIDE ST. ALEXIUS MEDICAL CENTER. PROVIDERS IN DIFFERENT SPECIALTIES WORK TOGETHER TO CARE FOR PATIENTS. SPECIALISTS MUST COMPLETE SEVEN OR MORE YEARS OF MEDICAL SCHOOL AND POST-GRADUATE TRAINING AND THEN COMPLETE FELLOWSHIPS IN THEIR CHOSEN SPECIALTIES. ALL PHYSICIANS ARE BOARD ELIGIBLE OR BOARD CERTIFIED IN ONE OR MORE SPECIALTIES. WE PROVIDE CLINIC SERVICES IN MANY OFF SITE SATELLITE CLINICS AND BRING SPECIALTY SERVICES TO THE REGION. ST. ALEXIUS OPERATES AN OUTPATIENT FAMILY SERVICE PROGRAM CALLED ARCHWAY MENTAL HEALTH SERVICES. THIS PROGRAM OFFERS SENSITIVE AND RESPONSIVE SERVICES FOR INDIVIDUAL, MARITAL AND FAMILY PROBLEMS. THIS PROGRAM IS KEEPING WITH ST. ALEXIUS MEDICAL CENTER'S PHILOSOPHY OF BEING A LEADER IN PROGRESSIVE AND QUALITY SERVICES TO THE PEOPLE OF NORTH DAKOTA. ARCHWAY SERVICES ARE ALSO PROVIDED IN HAZEN, GARRISON, AND LINTON, ND. GREAT PLAINS REHABILITATION SERVICES IS A DIVISION OF ST. ALEXIUS MEDICAL CENTER THAT PROVIDES HOME MEDICAL EQUIPMENT, ORTHOTIC & PROSTHETIC, HOME RESPIRATORY CARE, ADA ENVIRONMENTAL AND REHABILITATION TECHNOLOGY SERVICES.GREAT PLAINS PROVIDES NEEDED MEDICAL EQUIPMENT AND SUPPLIES TO HELP INDIVIDUAL LEAD ACTIVE AND INDEPENDENT LIVES. GREAT PLAINS SERVICES ALL OF NORTH DAKOTA, CENTER AND EASTERN MONTANA, AND NORTHERN SOUTH DAKOTA. OTHER:ST. ALEXIUS MEDICAL CENTER PROVIDED COMMUNITY ACTIVITIES AND SERVICES AT REDUCED OR NO COST. THOSE INCLUDED:1. EMPLOYEE ASSISTANCE PROGRAM (EAP)- ST. ALEXIUS SERVICES EMPLOYER CONTRACTS THROUGH ITS EAP WITH EMPLOYEES BY PROVIDING PROBLEM ASSESSMENT, SHORT TERM COUNSELING AND REFERRAL TO APPROPRIATE RESOURCES FOR FOLLOW-UP CARE. EAP SERVICES ARE ONLY OPEN TO EMPLOYEES OF A PARTICIPATING COMPANY. THE SERVICE IS FREE IF YOUR EMPLOYER PAYS TO PARTICIPATE.2. EMPLOYEE ACTIVITIES - IN KEEPING WITH THE MEDICAL CENTER COMMITMENT TO ITS EMPLOYEES:A. ACTIVELY PARTICIPATED IN THE UNITED WAY FUND CAMPAIGN.B. JOURNEY BEYOND EXCELLENCE PROGRAM - WE HAVE SEVERAL TEAMS THAT ASSIST WITH OUR JOURNEY-REWARDS AND RECOGNITION, PATIENT SATISFACTION, PHYSICIAN SATISFACTION.THESE TEAMS WORK TOGETHER WITH OUR LEADERSHIP TO RESOLVE CHALLENGES AND ENGAGE ALL IN OUR MISSION.C. THE VACATION DONATION PROGRAM ASSISTED EMPLOYEES WHO HAVE AN ILLNESS OR AN ILLNESS IN THE FAMILY ALLOWING OTHER EMPLOYEES TO DONATE VACATION HOURS TO ALLOW THE AFFECTED EMPLOYEE TIME TO HEAL OR TIME WITH A FAMILY MEMBER DURING THEIR HEALING PROCESS.D. THE EMPLOYEE EMERGENCY FUND IS FOR ANY ST. ALEXIUS EMPLOYEE WHO EXPERIENCES A CRISIS OR IS DIRECTLY AFFECTED BY A CRISIS INVOLVING A FAMILY MEMBER. THE FUNDS ARE AVAILABLE TO EMPLOYEES WHO ARE FACING PERSONAL TRAGEDIES OR HARDSHIPS FOR REASON SUCH AS A LOSS OF A SPOUSE OR CHILD, CATASTROPHIC ILLNESS, LOSS OF HOME BY FIRE OR FLOOD, OR OTHER CALAMITIES.3. ACUTE CARE FACILITY - ST. ALEXIUS IS A PARTNER WITH ANOTHER ACUTE CARE FACILITY IN BISMARCK FOR THE OPERATION OF A RADIATION THERAPY FACILITY KNOWN AS THE BISMARCK CANCER CENTER. THE BISMARCK CANCER CENTER HELPS TO ENSURE THAT PATIENTS WITH CANCER RECEIVE QUALITY CARE AND MANAGEMENT OF THEIR DISEASE WITHOUT HAVING TO DRIVE A LONG DISTANCE TO RECEIVE NECESSARY CARE.CHI ST. ALEXIUS HEALTH TURTLE LAKE IS A 25 BED CRITICAL ACCESS HOSPITAL (CAH) WITH A LEVEL V EMERGENCY DEPARTMENT THAT IS AVAILABLE 24 HOURS A DAY. THE HOSPITAL HAS BEEN COMMITTED TO PROVIDING PATIENTS QUALITY MEDICAL TREATMENT IN THE TURTLE LAKE AREA AND SURROUNDING COMMUNITIES SINCE 1952. THROUGH THE YEARS, THE HOSPITAL HAS SOUGHT TO CONTINUALLY UPGRADE THE QUALITY AND NUMBERS OF SERVICES IT PROVIDES. THE HOSPITAL'S AFFILIATION WITH MAJOR MEDICAL CENTERS AND HEALTHCARE AGENCIES HAS ALLOWED IT TO EXPAND ITS HEALTHCARE SERVICES THROUGH A NETWORK THAT BEGINS AT THE LOCAL LEVEL. CHI ST. ALEXIUS HEALTH TURTLE LAKE IS EQUIPPED WITH 2 EMERGENCY ROOMS, ON-SITE LAB, RADIOLOGY, CT, AND PHYSICAL THERAPY SERVICES. PATIENTS HAVE ACCESS TO 24/7 EMERGENCY CARE, SWING-BED PROGRAM, AND ACUTE CARE SERVICES.CHI ST ALEXIUS HEALTH-TURTLE LAKE HOSTED A VARIETY OF COVID VACCINE CLINICS THROUGHOUT SURROUNDING COMMUNITIES AND BUSINESSES. OUR DON AND ADDITIONAL RN STAFF HELD THESE SERVICES THROUGHOUT THE YEAR. CLINIC RN STAFF CONTINUE TO HOLD ANNUAL FLU VACCINE CLINICS AS WELL AS BLOOD PRESSURE SCREENINGS. CLINIC STAFF IS ALSO RESPONSIBLE FOR OUR ADULT PREVENTATIVE PROGRAMS (DIABETES, WOMEN'S AND MEN'S HEALTH) BY TRACKING THESE PROGRAM SERVICES AND SENDING REMINDERS TO PATIENTS TO SCHEDULE FOLLOW-UP VISITS. CHI ST ALEXIUS HEALTH-TURTLE LAKE CONTINUES TO PARTICIPATE IN THE DAKOTA NURSING PROGRAM OFFERED THROUGH BISMARCK STATE COLLEGE. A NURSING INSTRUCTOR IS SHARED BETWEEN CHI ST ALEXIUS HEALTH TURTLE LAKE AND GARRISON. THERE IS AN 11-MONTH LPN PROGRAM AND IF STUDENTS WANT THEY CONTINUE INTO THE ASSOCIATE DEGREE RN PROGRAM, WHICH IS 9 MONTHS. THIS PROGRAM ALLOWS INDIVIDUALS IN OUR SMALLER COMMUNITIES TO EARN THEIR NURSING DEGREES THROUGH A NON-TRADITIONAL MEANS WITHOUT TRAVELING. NURSING POSITIONS ARE HARD TO FILL ESPECIALLY IN RURAL AREAS. BY OFFERING THIS PROGRAM IT'S A GREAT WAY TO RECRUIT AND RETAIN THESE INDIVIDUALS. 288829357 1 1 0 1 0 0 0 0 0 1 1 0 0 1 1 1 0 1 0 0 1 1 0 0 0 0 1 1 1 1 1 0 0 0 0 0 0 1 0 0 0 0 0 0 1 1 1 0 0 1 173 0 1 1735 1 1 1 0 0 0 0 1 1 0 0 0 0 0 0 X 11 6 0 0 0 0 1 1 1 1 1 0 0 1 1 1 1 1 1 1 1 1 1 X STEPHANIE KAUL 7015308899 900 EAST BROADWAY AVE BISMARCK ND 58501 JOHN HOYT PHYSICIAN 40.00 0.00 X 1019331 0 65683 CAMERON CHARCHENKO MD - UROLOGY 40.00 0.00 X 989033 0 38682 KURT SCHLEY FORMER DIRECTOR & CEO 0.00 0.00 X 0 971230 19769 PATRICK GRACE PHYSICIAN 40.00 0.00 X 922658 0 24244 NICHOLAS BRADBURY MD - INTERVENTIONAL RADIOLOGY 40.00 0.00 X 774163 0 28050 MICHAEL FLISAK PHYSICIAN 40.00 0.00 X 747473 0 34542 KEVIN DAHMEN MD VICE CHAIR/SECRETARY/TREASURER (THROUGH 8/2/22)/PS 40.00 5.00 X X 589888 0 58589 TODD PRESZLER MD DIRECTOR/ANESTHESIOLOGIST 40.00 1.00 X 584132 0 45128 J'PATRICK FAHN CHIEF MEDICAL OFFICER 40.00 0.00 X 425583 0 40244 SHIRAZ HYDER DIRECTOR/NEUROLOGIST 40.00 1.00 X 373445 0 54211 JULIE GOEBEL DIRECTOR/DIVISION SVP CHIEF OPERATING OFFICER 1.00 49.00 X 0 365482 21111 TIM PLANTE PRESIDENT/CEO (INTERIM THROUGH 12/18/22) 40.00 10.00 X X 0 300407 40666 DEBRA MOHESKY MARKET PRESIDENT/CEO (THROUGH 10/4/22) 40.00 5.00 X X 321199 0 1966 NICK O'TOOL DIVISION VP FINANCE 1.00 59.00 X 0 257678 47032 KEITH HORNER FORMER DIRECTOR OF PHARMACY & CLINICAL INFORMATICS 40.00 0.00 X 250302 0 40454 JAMES SMITH VICE PRESIDENT OF OPERATIONAL FINANCE (THROUGH 4/1 40.00 5.00 X 228539 0 11768 RAUMI KUDRNA VP PATIENT CARE SERVICES 40.00 0.00 X 164243 0 11920 TIMOTHY BOPP MD DIRECTOR 1.00 1.00 X 0 0 0 JOHN GIESE CHAIR 1.00 1.00 X X 0 0 0 SR NICOLE KUNZE SECRETARY/TREASURER (STARTING 8/3/22) 1.00 1.00 X X 0 0 0 SR NANCY MILLER OSB VICE CHAIR (THROUGH 8/2/22) 1.00 1.00 X X 0 0 0 JOHN MONGEON DIRECTOR 1.00 1.00 X 0 0 0 MIKE WEISBECK DIRECTOR 1.00 1.00 X 0 0 0 SR ROSANNE ZASTOUPIL DIRECTOR 1.00 1.00 X 0 0 0 REED REYMAN PRESIDENT/CEO 40.00 5.00 X X 0 0 0 7389989 1894797 584059 222 1 1 0 MEDEFIS CONSOLIDATED PO BOX 5068 NEW YORK NY 10087 TRAVELING NURSE SERVICE 15185450 NORTHERN PLAINS LAB PO BOX 2036 BISMARCK ND 58502 CONTRACTED LAB FEES 5266258 BISMARCK RADIOLOGY ASSOCIATES 1310 EAST MAIN AVE BISMARCK ND 58501 RADIOLOGY SERVICES 3971871 WEATHERBY LOCUM INC PO BOX 972633 DALLAS TX 75397 LOCUM SERVICES 3603646 COMPHEALTH PO BOX 972651 DALLAS TX 75397 LOCUM SERVICES 3087708 43 1806371 358233 2164604 NET PATIENT SERVICES 900099 232965195 232965195 CAFETERIA 722514 473623 473623 TUITION 611600 304248 304248 233743066 127800 127800 602149 0 602149 602149 602149 61666 111844 0 0 61666 111844 173510 173510 3301 314 2987 2987 PHARMACY SERVICES 456110 4506637 4506637 LABORATORY SERVICES 621500 3140163 3140163 REHAB SERVICES REVENUE 621400 3053631 3053631 8431210 8431210 19131641 255945757 233743066 6193794 13844293 X 565964 565964 56577 56577 10721 10721 2869422 1047848 1821574 110933626 104728256 5068463 1136907 3509836 3158853 315885 35098 16220597 14165907 1891360 163330 7054982 6702233 352749 546545 546545 19565 19565 71955045 48981207 22973838 41521 20761 20760 6182750 4327926 1792997 61827 6697172 3348586 3348586 6945267 6111835 833432 1505503 1309701 180748 15054 16361572 16361572 7826148 7826148 8060000 7979400 80600 1283137 1270306 12831 MEDICAL SUPPLIES 53614809 53614809 REPAIRS & MAINTENANCE 4733266 4733266 DUES & SUBSCRIPTIONS 1028405 1028405 UNRELATED BUSINESS TAXE 478040 478040 1479076 1479076 329979546 288829357 39737973 1412216 13424 5809 13063602 17539236 32047857 31686669 1247243 1499624 11971985 11462070 1495068 939898 123670315 97086524 30696478 26583791 1277963 1347638 5173186 5166776 136668424 151820770 233655230 248052281 231564333 316643325 274594 92395 154249 0 104441086 105351871 336434262 422087591 X -109230181 -180549724 6451149 6514414 -102779032 -174035310 233655230 248052281 X -74033789 63599 1263 2712649 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 19565 0 0 0 19565 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $5,183 CATHOLIC HEALTH ASSOCIATION - $2,782 NORTH DAKOTA HOSPITAL ASSOCIATION - $11,522 340B HEALTH - $78 5168186 5310 194043 191116 9646 5166777 5502345 15000 -199233 146201 3725 5168186 4512979 5000 1142302 147527 10409 5502345 4455209 15000 134210 3000 76009 12431 4512979 4175493 35000 264476 19760 4455209 0.82000 0.18000 0 1 1 7511629 7511629 12626179 10803612 1822567 100449313 84868380 15580933 3083194 1414532 1668662 26583791 INTERCOMPANY RECEIVABLES 117169960 RENTAL PROPERTY LAND 929181 RIGHT OF USE ASSETS 2681593 DEPOSITS 79139 INVESTMENTS IN UNCONSOLIDATED ORGS 30960897 151820770 INTERCOMPANY PAYABLE 81371083 LEASE LIABILITY 23015765 OTHER LIABILITIES 965023 105351871 X PART V, LINE 4: THE ENDOWMENT IS UTILIZED TO PROVIDE FUNDING TO CONTINUE TO ADVANCE MEDICAL SERVICES AND PROGRAMS FOR THE REGION AT ST. ALEXIUS MEDICAL CENTER SET FORTH IN OUR MISSION, "LET ALL BE RECEIVED AS CHRIST". PART X, LINE 2: ST. ALEXIUS MEDICAL CENTER'S FINANCIAL INFORMATION IS INCLUDED IN COMMONSPIRIT HEALTH'S CONSOLIDATED AUDITED FINANCIAL STATEMENTS, WHICH INCLUDES THE FOLLOWING DISCLOSURE: COMMONSPIRIT REVIEWS ITS TAX POSITIONS QUARTERLY AND HAS DETERMINED THAT THERE ARE NO MATERIAL UNCERTAIN TAX POSITIONS THAT REQUIRE RECOGNITION IN THE ACCOMPANYING CONSOLIDATED FINANCIAL STATEMENTS. 1 EAST ASIA AND THE PACIFIC 0 0 GRANTMAKING 10721 0 0 0 0 0 0 10721 0 10721 EAST ASIA AND THE PACIFIC PROGRAM SUPPORT 10721 CHECK 0 1 0 0 0 0 0 0 0 PART I, LINE 2: ONE GRANT WAS GIVEN TO A U.S. 501(C)(3) ORGANIZATION. THAT 501(C)(3) ORGANIZATION WILL USE THE FUNDS IN ACCORDANCE WITH THEIR CHARITABLE PURPOSE WHICH INCLUDES DISTRIBUTING MEDICAL SUPPLIES AND EQUIPMENT TO HEALTHCARE FACILITIES AROUND THE WORLD. PART III ACCOUNTING METHOD: 1 1 X 1 X 1 X 1 1 0 1 1 196294 196294 0.00060 32677671 25927566 6750105 0.02050 32873965 25927566 6946399 0.02110 9 2323 102176 102176 0.00030 3 4 185644 185644 0.00060 2 2139 2139 0.00000 14 2327 289959 289959 0.00090 14 2327 33163924 25927566 7236358 0.02200 1 9171973 65095860 78825236 -13729376 X 1 1 1 NORTHERN PLAINS LAB LABORATORY SERVICES 0.50000 0.50000 2 1 ST ALEXIUS MEDICAL CENTER 900 EAST BROADWAY BISMARCK ND 58506 WWW.CHISTALEXIUSHEALTH.ORG 5004 X X X X 2 TURTLE LAKE COMMUNITY MEMORIAL HOSPITAL 220 5TH AVE TURTLE LAKE ND 58575 SEE SCH H, PART VI, PAGE 10 5059 X X X X ST ALEXIUS MEDICAL CENTER 1 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE SCH H, PART V, PAGE 8 X 1 22 1 HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/ABOUT-US/CHNA 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE SCH H, PART V, PAGE 8 X SEE SCH H, PART V, PAGE 8 X SEE SCH H, PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 TURTLE LAKE COMMUNITY MEMORIAL HOSPITAL 2 0 0 1 X X X X X X X X X 21 1 0 1 1 X SEE SCH H, PART V, PAGE 8 X 1 21 1 HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/ABOUT-US/CHNA 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE SCH H, PART V, PAGE 8 X SEE SCH H, PART V, PAGE 8 X SEE SCH H, PART V, PAGE 8 X X X X X X 1 X 0 X X X X 1 X 0 0 ST. ALEXIUS MEDICAL CENTER PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA, THE CHI ST. ALEXIUS HEALTH BISMARCK TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH.CHI ST. ALEXIUS HEALTH COLLABORATED WITH BISMARCK-BURLEIGH PUBLIC HEALTH, CUSTER HEALTH AND SANFORD HEALTH TO COMPLETE A COMMUNITY HEALTH NEEDS ASSESSMENT IN 2021 FOR THE BURLEIGH-MORTON COUNTY AREA. WITH ASSISTANCE FROM NDSU CENTER FOR SOCIAL RESEARCH, A COMMUNITY SURVEY WAS DISTRIBUTED TO BURLEIGH AND MORTON COUNTY. THE SURVEY STRUCTURE ALIGNED WITH THE SOCIAL DETERMINANTS OF HEALTH AND CONTAINED A COMBINATION OF SCORED RESPONSES AND OPEN-ENDED QUESTIONS. SURVEY RESPONSES WERE COLLECTED BETWEEN DECEMBER 2020 AND FEBRUARY 2021. A TOTAL OF 933 OF RESPONDENTS COMPLETED THE SURVEY.MEMBERS OF THE COMMUNITY WERE ASKED A SERIES OF QUESTIONS THROUGH AN ONLINE SURVEY DESIGNED IN PARTNERSHIP WITH HEALTH EXPERTS AND PUBLIC HEALTH OFFICIALS TO UNDERSTAND THE NEEDS OF THE COMMUNITY. RESPONDENTS WERE ASKED A SERIES OF QUESTIONS SPECIFIC TO THEIR HEALTH CARE ACCESS, HEALTH CARE QUALITY, BARRIERS TO CARE, TRAVEL TO CARE, AND INSURANCE. THE SURVEY WAS SENT TO A SAMPLE OF BURLEIGH AND MORTON COUNTY POPULATIONS SECURED THROUGH QUALTRICS, A QUALIFIED VENDOR.TO FURTHER PROMOTE COMMUNITY INVOLVEMENT THE SURVEY WAS ALSO SENT TO COMMUNITY STAKEHOLDERS AND ELECTED OFFICIALS WITH KNOWLEDGE AND CONNECTIONS AMONGST MEDICALLY UNDERSERVED, LOW INCOME, OR MINORITY POPULATIONS.COMMUNITY STAKEHOLDERS WERE INVITED TO ATTEND A PRESENTATION OF THE FINDINGS OF THE CHNA. ON WEDNESDAY, MAY 26, 2021 COMMUNITY HEALTH STAKEHOLDERS MET VIRTUALLY TO VIEW SURVEY FINDINGS. FACILITATED DISCUSSION TOOK PLACE IN SMALL GROUPS. TOPICS DISCUSSED WERE THE SURVEY RESULTS AND FEEDBACK ON PRIORITIZATION OF NEEDS. TURTLE LAKE COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 5: IN CONDUCTING ITS MOST RECENT CHNA, THE CHI ST. ALEXIUS HEALTH TURTLE LAKE TOOK INTO ACCOUNT INPUT FROM PERSONS WHO REPRESENT THE BROAD INTERESTS OF THE COMMUNITY SERVED BY THE HOSPITAL FACILITY, INCLUDING THOSE WITH SPECIAL KNOWLEDGE OF OR EXPERTISE IN PUBLIC HEALTH.THIS ASSESSMENT EXAMINES HEALTH NEEDS AND CONCERNS IN MCLEAN COUNTY, SHERIDAN COUNTY, AND OLIVER COUNTY WHICH ARE ALL INCLUDED IN THE CHI ST. ALEXIUS HEALTH TURTLE LAKE SERVICE AREA. IN ADDITION TO TURTLE LAKE, LOCATED IN THE SERVICE AREA ARE THE COMMUNITIES OF MERCER, MCCLUSKY, GOODRICH, UNDERWOOD, WASHBURN, WILTON, AND CENTER. CENTER FOR RURAL HEALTH (CRH), IN PARTNERSHIP WITH CHI ST. ALEXIUS HEALTH TURTLE LAKE AND FIRST DISTRICT PUBLIC HEALTH, FACILITATED THE CHNA PROCESS. COMMUNITY REPRESENTATIVES MET REGULARLY IN-PERSON, BY TELEPHONE CONFERENCE, AND EMAIL. A CHNA LIAISON WAS SELECTED LOCALLY, WHO SERVED AS THE MAIN POINT OF CONTACT BETWEEN CRH AND CHI ST. ALEXIUS HEALTH TURTLE LAKE. A SMALL STEERING COMMITTEE WAS FORMED THAT WAS RESPONSIBLE FOR PLANNING AND IMPLEMENTING THE PROCESS LOCALLY. REPRESENTATIVES FROM CRH MET AND CORRESPONDED REGULARLY BY VIDEOCONFERENCE AND/OR VIA THE ETOOLKIT WITH THE CHNA LIAISON. THE COMMUNITY GROUP (DESCRIBED IN MORE DETAIL BELOW) PROVIDED IN-DEPTH INFORMATION AND INFORMED THE ASSESSMENT PROCESS IN TERMS OF COMMUNITY PERCEPTIONS, COMMUNITY RESOURCES, COMMUNITY NEEDS, AND IDEAS FOR IMPROVING THE HEALTH OF THE POPULATION AND HEALTHCARE SERVICES. THIRTEEN PEOPLE, REPRESENTING A CROSS SECTION DEMOGRAPHICALLY, ATTENDED THE FOCUS GROUP MEETING. THE MEETING WAS HIGHLY INTERACTIVE WITH GOOD PARTICIPATION. CHI ST. ALEXIUS HEALTH TURTLE LAKE STAFF AND BOARD MEMBERS WERE IN ATTENDANCE, AS WELL, BUT LARGELY PLAYED A ROLE OF LISTENING AND LEARNING.THE ORIGINAL SURVEY TOOL WAS DEVELOPED AND USED BY CRH. IN ORDER TO REVISE THE ORIGINAL SURVEY TOOL TO ENSURE THE DATA GATHERED MET THE NEEDS OF HOSPITALS AND PUBLIC HEALTH, CRH WORKED WITH THE NORTH DAKOTA DEPARTMENT OF HEALTH'S PUBLIC HEALTH LIAISON. CRH REPRESENTATIVES ALSO PARTICIPATED IN A SERIES OF MEETINGS THAT GARNERED INPUT FROM THE STATE'S HEALTH OFFICER, LOCAL NORTH DAKOTA PUBLIC HEALTH UNIT PROFESSIONALS, AND REPRESENTATIVES FROM NORTH DAKOTA STATE UNIVERSITY.AS PART OF THE ASSESSMENT'S OVERALL COLLABORATIVE PROCESS, CRH SPEARHEADED EFFORTS TO COLLECT DATA FOR THE ASSESSMENT IN A VARIETY OF WAYS: 1. A SURVEY SOLICITED FEEDBACK FROM AREA RESIDENTS; 2. COMMUNITY LEADERS REPRESENTING THE BROAD INTERESTS OF THE COMMUNITY TOOK PART IN ONE-ON-ONE KEY INFORMANT INTERVIEWS; 3. THE COMMUNITY GROUP, COMPRISED OF COMMUNITY LEADERS AND AREA RESIDENTS, CONVENED TO DISCUSS AREA HEALTH NEEDS AND INFORM THE ASSESSMENT PROCESS; AND 4. A WIDE RANGE OF SECONDARY SOURCES OF DATA WERE EXAMINED, PROVIDING INFORMATION ON A MULTITUDE OF MEASURES, INCLUDING DEMOGRAPHICS, HEALTH CONDITIONS, INDICATORS, OUTCOMES, RATES OF PREVENTIVE MEASURES; RATES OF DISEASE; AND AT-RISK BEHAVIOR. MEMBERS OF THE COMMUNITY GROUP AND KEY INFORMANTS REPRESENTED THE BROAD INTERESTS OF THE COMMUNITY SERVED BY CHI ST. ALEXIUS HEALTH TURTLE LAKE AND FDHU. THEY INCLUDED REPRESENTATIVES OF THE HEALTH COMMUNITY, BUSINESS COMMUNITY, POLITICAL BODIES, AND LAW ENFORCEMENT. NOT ALL MEMBERS OF THE GROUP WERE PRESENT AT BOTH MEETINGS. ST. ALEXIUS MEDICAL CENTER PART V, SECTION B, LINE 6A: SANFORD HEALTH ST. ALEXIUS MEDICAL CENTER PART V, SECTION B, LINE 6B: BISMARCK-BURLEIGH PUBLIC HEALTHCUSTER HEALTHCENTER FOR SOCIAL RESEARCH - NDSUQUALTRICS TURTLE LAKE COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 6B: CENTER FOR RURAL HEALTH UNIVERSITY OF NORTH DAKOTA SCHOOL OF MEDICINE & HEALTH SCIENCESTURTLE LAKE HOSPITAL ASSOCIATIONFIRST DISTRICT HEALTH UNIT- MCLEAN COUNTY ST. ALEXIUS MEDICAL CENTER PART V, SECTION B, LINE 11: THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/ABOUT-US/CHNA.THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY AND SECONDARY DATA FROM KEY INFORMANT INTERVIEWSTOP HEALTH NEEDS (FROM 2022 CHNA): - HEALTHY LIVING - ACCESS TO AFFORDABLE HEALTH CARE - ACCESS TO HEALTH CARE PROVIDERS - MENTAL HEALTH - LONG-TERM CARE - PUBLIC TRANSPORTATION - AFFORDABLE HOUSINGFOR THIS PLAN, THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS AS OUTLINED IN OUR CURRENT IMPLEMENTATION PLAN:PRIORITY HEALTH NEED #1: ACCESS TO AFFORDABLE HEALTH CARETO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2023- 2025:STRATEGY 1.1. RESEARCH AND DETERMINE FEASIBILITY OF COOPERATING IN THE DEVELOPMENT OF A MEDICAL RESPITE CARE FACILITYSTRATEGY 1.2 DEVELOP A PROGRAM THAT WILL ENABLE A SAFE DISCHARGE FOR THOSE WHO ARE IN PRECARIOUS LIVING CONDITIONS.FY2023 ACTIONS AND IMPACT:1. A PARTNERSHIP BETWEEN STEPPING STONE MINISTRIES AND THE HOSPITAL HAS BEEN DEVELOPED. AN INITIAL BUSINESS PLAN HAS BEEN PUT IN PLACE UNDER THE GUIDANCE OF THE NATIONAL INSTITUTE FOR MEDICAL RESPITE CARE. THE MISSION LEADER FROM THE HOSPITAL SERVES ON THE BOARD OF DIRECTORS. WE CONTINUE TO WORK ON FINALIZING A LEASE AGREEMENT FOR THE BUILDING THAT WILL BE USED FOR THIS PURPOSE.MEASURES: 1. $100,000 GRANT HAS BEEN AWARDED BY THE NATIONAL INSTITUTE FOR MEDICAL RESPITE CARE AND NATIONAL HEALTHCARE FOR THE HOMELESS COUNCIL.2. $100,000 GRANT AWARDED FOR NEXT FISCAL YEAR BY THE HOSPITAL THROUGH THE COMMONSPIRIT HEALTH COMMUNITY HEALTH IMPROVEMENT GRANTS PROGRAM. 3. PRIVATE MONETARY DONATIONS AND DONATIONS OF MEDICAL SUPPLIES, DME, EXAM TABLES AND HOSPITAL BEDS, PLANNING HAVE BEEN RECEIVED. 4. THE HOSPITAL WILL LEASE THE BUILDING TO STEPPING STONES MINISTRIES FOR $1.00/YR.5. DEVELOPMENT OF THE PROGRAM THAT WILL ENABLE SAFE DISCHARGE IS PLANNED FOR THE COMING FISCAL YEAR.PRIORITY HEALTH NEED #2: ACCESS TO HEALTH CARE PROVIDERSTO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2023- 2025:STRATEGY 2.1. PROVIDE SUPPORT GROUPS THAT ARE OPEN TO THE CIVIC COMMUNITY.STRATEGY 2.2. INCREASE EFFORTS IN PREVENTIVE SCREENINGS.FY2023 ACTIONS AND IMPACT: 1. PRIMARY CARE HAS WORKED WITH MARKETING TO SEND MEDIA FOR MEDICARE WELLNESS SCREENINGS, CLINICS ARE LOOKING AT WELL CHILD OPPORTUNITIES AND SENDING LETTERS TO APPLICABLE PATIENTS. WORK GROUP WAS ESTABLISHED TO PUT IN BENCHMARKS BY MONTH TO REVIEW PATIENT CARE OPPORTUNITIES SUCH AS OVERDUE MAMMOS, COLORECTAL SCREENING, IMMUNIZATIONS TO REVIEW WITH PROVIDERS AND SEND APPLICABLE PATIENTS REMINDERS.2. HOST SUPPORT GROUPS IN THE CLINIC/ HOSPITAL (CANCER, STROKE, PARKINSONS, BARIATRIC AND COVID)MEASURES:1. THE AVERAGE PERCENTILE RANKING FOR: DIABETES CONTROL (PERCENT OF PATIENTS WHOSE HGBA1C WAS POORLY CONTROLLED (>9%) DURING THE MEASUREMENT PERIOD) AND HYPERTENSION MANAGEMENT (PERCENT OF PATIENTS WITH AN ACTIVE PROBLEM OF ESSENTIAL HTN WHOSE BP WAS IN GOOD CONTROL (<140/<90 MMHG))2. BARIATRIC SUPPORT MEETS MONTHLY WITH 2-6 PEOPLE.3. CANCER SUPPORT MET MONTHLY WITH 2-6 PEOPLE.4. STROKE SUPPORT MET MONTHLY WITH 2-6 PEOPLE5. EACH SUPPORT GROUP MEETS FOR 1 HOUR.PRIORITY HEALTH NEED #3: HEALTHY LIVING/HEALTH-RELATED SOCIAL NEEDSTO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2023- 2025:STRATEGY 3.1. WORK TO DEVELOP AN EFFECTIVE WAY TO PROVIDE FOOD AND PERSONAL CARE ITEMS FOR THE HOMELESS PEOPLE OF THIS AREA.FY2023 ACTIONS AND IMPACT: 1. PROVIDE THE MEAL AND SERVE THE BANQUET AT THE DREAM CENTER AT LEAST 2 TIMES EACH YEAR WHILE PLANNING TO INCREASE FREQUENCY BASED ON AVAILABLE FUNDING.2. COLLECT FOOD AND PERSONAL ITEMS AND STOCK TWO LITTLE FREE PANTRIES. THE HOSPITAL MATCHES FUNDS THAT ARE RAISED.3. CULTIVATED RELATIONSHIPS WITH AGENCIES IN THE COMMUNITY TO PARTNER IN PROVIDING SERVICES TO THE NEEDY.4. IMPROVE PATIENT HEALTH BY ADDRESSING SOCIAL RISK FACTORS BY SCREENING FOR HEALTH-RELATED SOCIAL NEEDS AND LEVERAGE CHW TO CONNECT PATIENTS WITH UNMET NEEDS TO COMMUNITY RESOURCES.5. PARTICIPATE IN THE TOTAL HEALTH ROADMAP, A FRAMEWORK FOR IDENTIFYING/ADDRESSING HEALTH-RELATED SOCIAL NEEDS AND CATALYZING COLLECTIVE ACTION TO INVENT IN COMMUNITY RESOURCE GAPS. APPLY FOR A GRANT TO FUND A CHW.MEASURES:1. PROVIDED AND SERVED THE BANQUET IN JULY;A. SERVED 175 PERSONS. COST - $1,318. NUMBER OF VOLUNTEERS: 22.2. PROVIDED AND SERVED THE BANQUET IN FEBRUARY; A. SERVED 185 PERSONS. COST - $1,950. NUMBER OF VOLUNTEERS: 20.3. HOSPITAL MATCHING DONATED FUNDS IN STOCKING THE FOOD PANTRY - $693.004. PARTNERED WITH COMMUNITY ACTION - FILLED 1,500 BAGS FOR SCHOOL CHILDREN; 10 VOLUNTEERS.5. A COMMUNITY HEALTHCARE WORKER WILL BE HIRED IN FY 2024 TO ASSIST IN SCREENING AND CONNECTING PATIENTS TO COMMUNITY RESOURCES.PRIORITY HEALTH NEED #4: MENTAL HEALTHTO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2023- 2025:STRATEGY 4.1. ADDRESS THE ISSUE OF INFANTS BORN EXPOSED TO SUBSTANCE ABUSE/ADDICTION.STRATEGY 4.2 STRENGTHEN RELATIONSHIPS WITH VIOLENCE PREVENTION EFFORTS IN THE COMMUNITY.FY2023 ACTIONS AND IMPACT:1. THE PROGRAM EAT, SLEEP AND CONSOLE WILL BE IMPLEMENTED IN FY2024 TO ADDRESS THE ISSUE OF INFANTS BORN EXPOSED TO SUBSTANCE ABUSE/ADDICTION.2. CREATING A TARGETED HRSN PLAN TO TIE TOGETHER BEHAVIORAL HEALTH PRIORITY OF EAT SLEEP CONSOLE WITH TJC SENTINEL EVENT ALERT 66. TARGETED POPULATION IDENTIFIED AS: HIGH RISK PREGNANCIES EXPOSED TO SUBSTANCE ABUSE/ADDICTION AND MATERNAL POSTPARTUM DEPRESSION. 3. JOINED THE NORTH AND SOUTH DAKOTA PERINATAL QUALITY COLLABORATIVE. THE FOCUS IS MATERNAL SUBSTANCE USE DISORDER. 4. ATTENDED EDUCATION SESSION ON SEEING THE SIGNS OF HUMAN TRAFFICKING.5. ATTENDED THE BAKKEN HUMAN TRAFFICKING SUMMIT. 6. REPRESENTATION ON THE NORTH DAKOTA HUMAN TRAFFICKING TASKFORCE COMMUNITY MULTI-DISCIPLINARY TEAM WHICH MEETS QUARTERLY AT A MINIMUM.7. IDENTIFIED NEED FOR STAFF EDUCATION AND RESPONSE PROTOCOL FOR POTENTIALLY TRAFFICKED INDIVIDUALS.MEASURES: DUE TO AVAILABLE RESOURCES AND STAFF, PROGRAMMING DID NOT OCCUR IN FY23 BUT WILL RESUME IN FY24.SIGNIFICANT NEEDS THE HOSPITAL DOES NOT INTEND TO ADDRESS- AFFORDABLE HOUSING - THE ESSENTIAL NEED FOR AFFORDABLE HOUSING INVOLVES A MORE COMMUNITY WIDE EFFORT. WE WILL COLLABORATE WITH OTHER AGENCIES AS REQUESTED AND ABLE.- PUBLIC TRANSPORTATION - THIS IMPORTANT NEED IS BEING ADDRESSED BY OTHER ORGANIZATIONS IN THE COMMUNITY. - LONG-TERM CARE - OUR FOCUS WILL BE ON SHORT-TERM CARE, ESPECIALLY FOR OUR HOMELESS POPULATION THAT NEED MINIMUM CARE AND OBSERVATION UNTIL STABLE ENOUGH TO BE ON THEIR OWN. TURTLE LAKE COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 11: THE FOLLOWING OUTLINES THE CURRENT IMPLEMENTATION PLAN PRIORITIES AND STRATEGIES. THIS PLAN WAS POSTED PUBLICLY ON HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/ABOUT-US/CHNA.THE COMMUNITY IDENTIFIED THE FOLLOWING PRIORITIES AS TOP HEALTH NEEDS THROUGH PRIMARY AND SECONDARY DATA FROM KEY INFORMANT INTERVIEWS:TOP HEALTH NEEDS (FROM 2022 CHNA): 1. ABILITY TO RETAIN PRIMARY CARE PROVIDERS AND NURSES IN THE COMMUNITY2. ALCOHOL USE AND ABUSE3. ATTRACTING AND RETAINING YOUNG FAMILIES4. AVAILABILITY OF RESOURCES TO HELP THE ELDERLY STAY IN THEIR HOMES5. DEPRESSION/ANXIETY6. HAVING ENOUGH CHILD DAYCARE SERVICESFOR THIS PLAN THE HOSPITAL PRIORITIZED THE FOLLOWING HEALTH NEEDS AS OUTLINED IN THE CURRENT FY23-25 IMPLEMENTATION PLAN:PRIORITY HEALTH NEED #1: RESOURCES TO HELP ELDERLY STAY IN THEIR HOME.TO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2023- 2025:STRATEGY 1.1. INVESTIGATE EXISTING RESOURCES AVAILABLE WITHIN THE COUNTY THAT PROVIDE ASSISTANCE TO THE ELDERLY POPULATION.STRATEGY 1.2. BECOME AN ADVOCATE TO OUR ELDERLY POPULATION BY MAKING INFORMATION ABOUT AVAILABILITY OF RESOURCES EITHER WITHIN THE COUNTY OR OUR OWN HOSPITAL SERVICES. STRATEGY 1.3. INVESTIGATING QSP SERVICES AND COMPILE A LIST OF QSP PROVIDERS WITHIN OUR REGION TO OFFER RESPITE AND ADULT CAREGIVER SERVICES.FY2023 ACTIONS AND IMPACT: 1. WORK IN PARTNERSHIP WITH CHI ST. ALEXIUS HEALTH AT HOME FOR PATIENTS NEEDING MEDICAL ASSISTANCE AT HOME. PROVIDERS HAVE BEEN EDUCATED ON THE AVAILABILITY OF HEALTH AT HOME. 2. HOLD A FALL PREVENTION PROGRAM ON A YEARLY BASIS FOR THE PUBLIC. OUR PHYSICAL THERAPY ASSISTANT HELD AN EDUCATION AND EXERCISE SESSION AT ONE OF THE LOCAL CHURCHES TWICE A WEEK FOR 2 MONTHS TEACHING BALANCE AND STRENGTHENING EXERCISES. 3. PROVIDE INFORMATION REGARDING MEALS ON WHEELS, MEDICALERT SYSTEMS, VETERAN SERVICES AND MCLEAN OR SHERIDAN COUNTY PROVIDED PROGRAMS TO ELDERLY POPULATION. A SOCIAL WORKER DESIGNEE WAS RECENTLY HIRED WHO WILL BE INVOLVED IN MAKING OUR PATIENTS AS WELL AS THE PUBLIC AWARE OF SERVICES AVAILABLE. THE POSITION HAD BEEN EMPTY FOR FIVE MONTHS. 4. MARKET THE AVAILABILITY OF DAY CARE AND RESPITE SERVICES AVAILABLE AT CHI ST. ALEXIUS HEALTH TURTLE LAKE FOR CAREGIVERS NEEDING TIME AWAY FROM ELDERLY FAMILY. ACTIVITY DID NOT OCCUR DUE TO STAFFING AND RESOURCE CONSTRAINTS. WE INTEND TO RESUME THIS PROGRAM IN FY24. WE HAVE RECENTLY HIRED A SOCIAL WORKER DESIGNEE WHO WILL BE INVOLVED IN MAKING OUR PATIENTS AS WELL AS THE PUBLIC AWARE OF SERVICES AVAILABLE. THE POSITION HAD BEEN EMPTY FOR 5 MONTHS. 5. PARTICIPATE WITH HOSPITAL AUXILIARY DURING THEIR PUBLIC PROGRAMS WITH GUEST SPEAKERS ON ISSUES INVOLVING THE ELDERLY. OUR AUXILIARY DID NOT HOLD ANY MEETINGS FOR THE ELDERLY THIS PAST YEAR. THE LOCAL SENIOR CENTER WAS DEMOLISHED AND THEY ARE LOOKING FOR A PLACE TO GATHER. THE AUXILIARY WILL RESUME MEETINGS AFTER A SITE HAS BEEN SECURED.MEASURES:1. NUMBER OF PATIENTS ADDED SINCE THE EDUCATION OF OUR PROVIDERS AND NURSING STAFF TO HOME HEALTH: 52. INDIVIDUALS REACHED/TRAINED FOR BALANCE AND STRENGTHENING EXERCISES: 253. NO MEASURES TO REPORT DURING THIS PERIOD.4. THE EXPECTATION IS THAT WE WILL BE MARKETING OUR ADULT DAY CARE SERVICES AND RESPITE SERVICES THIS COMING YEAR AND HAVE MEASURES TO REPORT IN FY24.5. NUMBER OF AUXILIARY MEETINGS FOR THE ELDERLY HELD DURING THIS PERIOD: 0PRIORITY HEALTH NEED #2: NOT HAVING ENOUGH PLACES FOR EXERCISE AND WELLNESS ACTIVITIES.TO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2023- 2025:STRATEGY 2.1. WORK WITH SUPPORTING HOSPITAL BOARDS TO PROVIDE ACTIVITIES THAT ENCOURAGE WELLNESS AND EXERCISE OPPORTUNITIES. STRATEGY 2.2. WORK WITH THE TURTLE LAKE AMBULANCE. THE AMBULANCE IS PUTTING IN AN EXERCISE FACILITY WITHIN THEIR BUILDING. WE WILL DISCUSS THE OPTIONS OF OPENING IT TO THE PUBLIC FOR EXERCISE AND WELLNESS ACTIVITIES.FY2023 ACTIONS AND IMPACT: 1. MAKE HEALTH FAIRS AN ANNUAL EVENT IN CONJUNCTION WITH THE DAKOTA FEEDER CALF SHOW. THE HEALTH FAIR WAS HELD OCTOBER 2022 AND INCLUDED CHECKING BLOOD PRESSURE BLOOD SUGARS AND HEMOGLOBINS. THIS WILL BE AN ANNUAL EVENT. 2. OFFER YEARLY WELLNESS CHALLENGES FOR THE GENERAL PUBLIC TO PARTICIPATE IN AND PROVIDE EDUCATIONAL OPPORTUNITIES IN AREAS OF NUTRITION, EXERCISE, ETC., DURING THE CHALLENGE. COMPLETED A 6 WEEK WELLNESS CHALLENGE 3/23 WITH PLANS TO CONTINUE THIS OFFERING. 3. OFFER AN ADULT FITNESS PROGRAM AND MAKE AVAILABLE EXERCISE EQUIPMENT TO THE GENERAL PUBLIC FOR USE. ON-GOING WORK IN CONJUNCTION WITH THE COMMUNITY IN OPENING A WELLNESS CENTER AT THE COMMUNITY CENTER THAT WILL BE OPEN TO THE PUBLIC. YOGA CLASSES ARE BEING OFFERED AT THE COMMUNITY CENTER.MEASURES: 1. NUMBER OF COMMUNITY MEMBERS ATTENDED THE HEALTH FAIR: 25 2. NUMBER OF COMMUNITY MEMBERS PARTICIPATED IN THE YEARLY WELLNESS CHALLENGE: 25 3. WILL TRACK USAGE AND NUMBER OF PARTICIPANTS FOR NEXT FISCAL YEARS AS THIS FACILITY ONLY RECENTLY OPENED.PRIORITY HEALTH NEED #3: NOT HAVING ENOUGH CHILD DAYCARE SERVICES.TO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2023- 2025:STRATEGY 3.1. INCREASE AVAILABLE DAYCARE SERVICES FOR WORKING FAMILIES. STRATEGY 3.2. WORK WITH THE PUBLIC HEALTH, CITY BOARD, ECONOMIC DEVELOPMENT, TO LOOK INTO OPTIONS FOR A COMMUNITY DAYCARE.FY2023 ACTIONS AND IMPACT: 1. WORK WITH SUPPORTING HOSPITAL BOARDS TO SUPPORT ANY LOCAL EFFORT TO OPEN A COMMUNITY DAYCARE CENTER. TURTLE LAKE AREA CHAMBER OF COMMERCE IS LEADING THIS EFFORT. MINIMAL PROGRESS HAS BEEN MADE DUE TO THE CONDITION OF THE PROPERTY IDENTIFIED AS A SITE. 2. WORK WITH THE PUBLIC HEALTH UNIT TO OFFER SAFE SITTER CLASSES TO STUDENTS IN THE COMMUNITY TO INCREASE AVAILABLE TRAINED BABYSITTERS.MEASURES: 1. PROJECT IS ONGOING WITH PLANNING. THERE ARE NO MEASURES TO REPORT AT THIS TIME.2. PROJECT IS ONGOING WITH PLANNING FOR NEXT FISCAL YEAR. THERE ARE NO MEASURES TO REPORT AT THIS TIME.PRIORITY HEALTH NEED #4: HEALTH-RELATED SOCIAL NEEDS (HRSN) WITH THE GOAL OF IMPROVING PATIENT HEALTHTO ADDRESS THIS NEED THE HOSPITAL IMPLEMENTED THE FOLLOWING STRATEGIES IN 2023- 2025:STRATEGY 4.1. IDENTIFY PATIENTS' HRSN THROUGH SCREENING AND REFERRALS TO COMMUNITY-BASED ORGANIZATIONS.FY2023 ACTIONS AND IMPACT: 1. HIRE A COMMUNITY HEALTHCARE WORKER (CHW). 2. WE WILL BEGIN SCREENING PATIENTS FOR HRSN IN FY24 AND CONNECTING THEM TO COMMUNITY RESOURCES (E.G. FOOD, TRANSPORTATION, ETC.).MEASURES: REPORTING WILL BEGIN FY24 WHEN THE CHW IS HIRED (FY24:Q2).SIGNIFICANT NEEDS THE HOSPITAL DOES NOT INTEND TO ADDRESS:THE HOSPITAL WILL NOT ADDRESS THE FOLLOWING AS A PART OF THE IMPLEMENTATION PLAN DUE TO FACTORS OUT OF OUR CONTROL AND THE NEED TO ALLOCATE SIGNIFICANT RESOURCES TO THE FOUR PRIORITY HEALTH NEEDS IDENTIFIED ABOVE:1. ABILITY TO RETAIN PRIMARY CARE PROVIDERS AND NURSES IN THE COMMUNITY2. ALCOHOL USE AND ABUSE3. ATTRACTING AND RETAINING YOUNG FAMILIES4. DEPRESSION/ANXIETY. ST. ALEXIUS MEDICAL CENTER PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) 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 COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. 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 COMMONSPIRIT 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. TURTLE LAKE COMMUNITY MEMORIAL HOSPITAL PART V, SECTION B, LINE 13H: THE PATIENT MUST HAVE A MINIMUM ACCOUNT BALANCE OF TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) 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 COOPERATE WITH THE HOSPITAL FACILITY IN PROVIDING THE INFORMATION AND DOCUMENTATION NECESSARY TO DETERMINE ELIGIBILITY. SUCH COOPERATION INCLUDES COMPLETING ANY REQUIRED APPLICATIONS OR FORMS. THE PATIENT IS RESPONSIBLE FOR NOTIFYING THE HOSPITAL FACILITY OF ANY CHANGE IN FINANCIAL SITUATION THAT WOULD IMPACT THE ASSESSMENT OF ELIGIBILITY. 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 COMMONSPIRIT 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. SCHEDULE H, PART V, SECTION B, LINE 3E THE SIGNIFICANT HEALTH NEEDS ARE A PRIORITIZED DESCRIPTION OF THE SIGNIFICANT HEALTH NEEDS OF THE COMMUNITY AND IDENTIFIED THROUGH THE CHNA. SCHEDULE H, PART V, SECTION B, LINE 7A CHNA REPORTS FOR BOTH FACILITIES CAN BE FOUND HERE:HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/ABOUT-US/CHNA SCHEDULE H, PART V, SECTION B, LINE 16A HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16B HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE SCHEDULE H, PART V, SECTION B, LINE 16C HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/PATIENTS-AND-VISITORS/FINANCIAL-ASSISTANCE 21 1 - ST ALEXIUS HEART & LUNG CLINIC 310 NORTH 10TH STREET BISMARCK ND 58501 HEART, LUNG & PERIPHERAL VASCULAR DISEASE CLINIC 2 - GREAT PLAINS REHABILITATION SERVICES 1212 EAST MAIN BISMARCK ND 58501 HOME MEDICAL PRODUCTS 3 - ST ALEXIUS MINOT CLINIC 2111 LANDMARK CIRCLE MINOT ND 58703 FAMILY MEDICINE CLINIC 4 - THE PAIN CLINIC AT CHI ST ALEXIUS HEALT 810 E ROSSER AVE BISMARCK ND 58501 PAIN MANAGEMENT CLINIC 5 - NEUROSURGERY CLINIC AT CHI ST ALEXIUS 810 E ROSSER AVE BISMARCK ND 58501 BRAIN, NERVE, AND SPINAL CORD DISEASE CLINIC 6 - THE INFUSION CLINIC AT CHI ST ALEXIUS 310 NORTH 9TH STREET BISMARCK ND 58501 INFUSION CLINIC 7 - ARCHWAY MENTAL HEALTH SERVICES 310 NORTH 10TH STREET BISMARCK ND 58501 MENTAL HEALTH SERVICES 8 - URGENT CARE ON MAIN 807 E MAIN SUITE A BISMARCK ND 58501 URGENT CARE 9 - URGENT CARE ON 43RD 4315 OTTAWA STREET BISMARCK ND 58503 URGENT CARE 10 - THE NEUROLOGY CLINIC AT CHI ST ALEXIUS 810 E ROSSER AVE BISMARCK ND 58501 NERVOUS SYSTEM, NEUROMUSCULAR JUNCTION AND MUSCLE DISORDERS CLINIC 11 - ST ALEXIUS MANDAN CLINIC NORTH 2500 SUNSET DR NW MANDAN ND 58554 FAMILY MEDICINE CLINIC 12 - THE ARTHRITIS CLINIC AT CHI ST ALEXIUS 310 NORTH 10TH STREET BISMARCK ND 58501 JOINT, MUSCLE AND IMMUNE RHEUMATIC DISEASE CLINIC 13 - THE NEPHROLOGY CLINIC AT CHI ST ALEXIUS 310 NORTH 10TH STREET BISMARCK ND 58501 KIDNEY DISEASE CLINIC 14 - PINEHURST FAMILY MEDICAL CLINIC 921 W INTERSTATE AVE BISMARCK ND 58503 FAMILY MEDICINE CLINIC 15 - CENTURY FAMILY CLINIC 300 W CENTURY AVE BISMARCK ND 58503 FAMILY MEDICINE CLINIC 16 - OCCUPATIONAL MEDICINE CLINIC - BISMARCK 310 NORTH 9TH STREET BISMARCK ND 58501 OCCUPATIONAL MEDICINE CLINIC 17 - WASHBURN FAMILY CLINIC 1177 BORDER LANE WASHBURN ND 58577 FAMILY MEDICINE CLINIC 18 - SUPPORTIVEPALLIATIVE CARE CLINIC 810 E ROSSER AVE BISMARCK ND 58501 PALLIATIVE MEDICINE CLINIC 19 - CHI ST ALEXIUS HEALTH HEMATOLOGY & ONCOL 810 E ROSSER AVE BISMARCK ND 58501 ONCOLOGY CLINIC 20 - CHI ST ALEXIUS HEALTH TURTLE LAKE CLINIC 220 5TH AVE WEST PO BOX 280 TURTLE LAKE ND 58575 RURAL HEALTH CLINIC 21 - UNIVERSITY OF MARY CLINIC 7500 UNIVERSITY DR BISMARCK ND 58504 UNIVERSITY OF MARY HEALTH SERVICES 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 TEN DOLLARS ($10.00) WITH THE COMMONSPIRIT HOSPITAL ORGANIZATION. MULTIPLE ACCOUNT BALANCES MAY BE COMBINED TO REACH THIS AMOUNT. PATIENTS/GUARANTORS WITH BALANCES BELOW TEN DOLLARS ($10.00) MAY CONTACT A FINANCIAL COUNSELOR TO MAKE MONTHLY INSTALLMENT PAYMENT ARRANGEMENTS.- THE PATIENT MUST COMPLY WITH PATIENT COOPERATION STANDARDS.- THE PATIENT MUST SUBMIT A COMPLETED FINANCIAL ASSISTANCE APPLICATION (FAA).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 OR FREE CARE CLINIC;- PARTICIPATION IN WOMEN, INFANTS AND CHILDREN PROGRAMS (WIC);- FOOD STAMP ELIGIBILITY;- ELIGIBILITY OR REFERRALS FOR OTHER STATE OR LOCAL ASSISTANCE PROGRAMS (E.G., MEDICAID);- LOW INCOME/SUBSIDIZED HOUSING IS PROVIDED AS A VALID ADDRESS; OR- PATIENT IS DECEASED WITH NO KNOWN SPOUSE OR KNOWN ESTATE. PART I, LINE 7: COMMONSPIRIT HEALTH HOSPITALS USE A COST ACCOUNTING SYSTEM OR AN ADJUSTED COST TO CHARGE RATIO CALCULATED IN A MANNER CONSISTENT WITH WORKSHEET 2 FOR EACH REPORTING FACILITY, TO DERIVE THE REPORTED COSTS OF FINANCIAL ASSISTANCE, MEDICAID AND OTHER MEANS-TESTED PROGRAMS. WORKSHEET 3 OR THE EQUIVALENT IN THE COMMUNITY BENEFIT INVENTORY FOR SOCIAL ACCOUNTABILITY ("CBISA") SOFTWARE ARE USED TO CALCULATE EXPENSE AND REVENUE, INCLUDING WHERE APPLICABLE MEDICAID PROVIDER FEES AND PAYMENTS FROM UNCOMPENSATED CARE PROGRAMS. ACTUAL OR ESTIMATED COST AND ANY DIRECT OFFSETTING REVENUE IS REPORTED, AND SCHEDULE H WORKSHEETS OR THEIR EQUIVALENTS ARE USED, FOR OTHER COMMUNITY BENEFIT ACTIVITIES SUCH AS COMMUNITY HEALTH IMPROVEMENT SERVICES, COMMUNITY BENEFIT OPERATIONS, HEALTH PROFESSIONS EDUCATION, SUBSIDIZED HEALTH SERVICES, RESEARCH, AND CASH AND IN-KIND DONATIONS. PART III, LINE 2: THE AMOUNT OF THE ORGANIZATION'S BAD DEBT AT COST IS DETERMINED BY APPLYING THE COST TO CHARGE RATIO TO PATIENT CHARGES THAT ARE DEEMED TO BE UNCOLLECTIBLE. THIS AMOUNT REPRESENTS THE COST OF SERVICES PROVIDED TO PATIENTS WHO ARE UNABLE OR REFUSE TO PAY THEIR BILLS AND DO NOT QUALIFY FOR FREE OR DISCOUNTED CARE, GOVERNMENT SPONSORED PROGRAMS OR OTHER PAYMENT ASSISTANCE, AND ARE OTHERWISE UNINSURED.THE FILING ORGANIZATION PROVIDES FREE CARE TO ANY PATIENT WHOSE FAMILY INCOME IS AT OR BELOW 200% OF THE FEDERAL POVERTY LEVEL, OR DISCOUNTED CARE TO UNINSURED OR UNDER-INSURED INDIVIDUALS WHOSE FAMILY INCOME IS ABOVE 201% BUT LOWER THAN 400% OF THE FEDERAL POVERTY LEVEL. THE FILING ORGANIZATION ALSO PROVIDES OPTIONS FOR INTEREST-FREE EXTENDED PAYMENT PLANS FOR PATIENTS WHO HAVE DEMONSTRATED GOOD FAITH AND ARE COOPERATING IN RESOLVING THEIR HOSPITAL BILLS. ALL ACCOUNTS FOR ELIGIBLE UNINSURED PATIENTS AT ALL FACILITIES RECEIVE AN AUTOMATIC UNINSURED DISCOUNT. THE EXPECTED PATIENT PAYMENT AMOUNT ON THE PATIENT'S BILL REFLECTS THIS DISCOUNT. DISCOUNTS ARE ACCOUNTED FOR AS DEDUCTIONS FROM REVENUE, NOT AS BAD DEBT EXPENSE. PART III, LINE 3: ST. ALEXIUS MEDICAL CENTER MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. ST. ALEXIUS MEDICAL CENTER'S FINANCIAL ASSISTANCE POLICY IS COMMUNICATED TO PATIENTS UPON ADMISSION AND IS AVAILABLE IN THE LANGUAGES PRIMARILY SPOKEN IN THE COMMUNITY. IT IS ALSO POSTED IN VARIOUS COMMON AREAS OF THE HOSPITAL, SUCH AS EMERGENCY ROOMS, URGENT CARE CENTERS, ADMITTING AND REGISTRATION DEPARTMENTS, HOSPITAL BUSINESS OFFICES LOCATED ON FACILITY CAMPUSES, AND OTHER PUBLIC PLACES, AND IS PROVIDED UPON BILLING IF ELIGIBILITY IS NOT PREVIOUSLY DETERMINED. ELIGIBILITY IS REEVALUATED AS NEEDED AND AMOUNTS ARE CLASSIFIED AS CHARITY AS SOON AS ELIGIBILITY IS KNOWN. ST. ALEXIUS MEDICAL CENTER ALSO UTILIZES A PAYMENT ASSISTANCE RANK ORDERING (PARO) SCORING SYSTEM TO ASSIST IN DETERMINING IF A PATIENT MAY QUALIFY FOR PAYMENT ASSISTANCE EVEN THOUGH THEY HAVE NOT APPLIED FOR IT. PARO IS A METHODOLOGY THAT APPLIES CONSISTENT SCREENING AND APPLICATION STANDARDS TO ALL PATIENTS UTILIZING HISTORICAL DATA TO DEVELOP A PREDICTIVE MODEL FOR HEALTHCARE PAYMENT ASSISTANCE. IN ITS DEVELOPMENT, SPECIAL ATTENTION WAS PAID TO THOSE SOCIOECONOMIC FACTORS THAT MIGHT ADVERSELY AFFECT THOSE PATIENTS DESERVING THE MOST ATTENTION. OTHER CRITERIA ARE ALSO UTILIZED TO ENSURE THAT SERVICES THAT HAVE QUALIFIED AS FINANCIAL ASSISTANCE ARE NOT REPORTED AS BAD DEBT. AS SUCH, ST. ALEXIUS MEDICAL CENTER DOES NOT BELIEVE THAT ANY AMOUNTS INCLUDED IN PART III, LINE 2, ARE ATTRIBUTABLE TO PATIENTS ELIGIBLE UNDER THE ORGANIZATION'S PAYMENT ASSISTANCE POLICY, AND THEREFORE, NO PORTION OF BAD DEBT EXPENSE IS INCLUDED AS COMMUNITY BENEFIT EXPENSE. PART III, LINE 4: ST. ALEXIUS MEDICAL CENTER DOES NOT ISSUE SEPARATE COMPANY AUDITED FINANCIAL STATEMENTS. HOWEVER, THE ORGANIZATION IS INCLUDED IN THE CONSOLIDATED FINANCIAL STATEMENTS OF COMMONSPIRIT HEALTH. THE FOLLOWING IS AN EXCERPT FROM COMMONSPIRIT'S CONSOLIDATED ANNUAL AUDITED FINANCIAL STATEMENTS FOR THE YEAR ENDED JUNE 30, 2023, RELATED TO PATIENT ACCOUNTS RECEIVABLE AND NET PATIENT REVENUE. THE ENTIRE FOOTNOTE CAN BE VIEWED IN THE ATTACHED COMMONSPIRIT CONSOLIDATED FINANCIAL STATEMENTS ON PAGES 11-12."PATIENT SERVICE REVENUE IS REPORTED AT THE AMOUNTS THAT REFLECT THE CONSIDERATION COMMONSPIRIT EXPECTS TO BE PAID IN EXCHANGE FOR PROVIDING PATIENT CARE. THESE AMOUNTS ARE DUE FROM PATIENTS, THIRD-PARTY PAYORS (INCLUDING HEALTH INSURERS AND GOVERNMENT PROGRAMS), AND OTHERS, AND INCLUDE CONSIDERATION FOR RETROACTIVE REVENUE ADJUSTMENTS DUE TO SETTLEMENT OF AUDITS AND REVIEWS. GENERALLY, PERFORMANCE OBLIGATIONS FOR PATIENTS RECEIVING INPATIENT ACUTE CARE SERVICES AND OUTPATIENT SERVICES ARE RECOGNIZED OVER TIME AS SERVICES ARE PROVIDED. NET PATIENT REVENUE IS PRIMARILY COMPRISED OF HOSPITAL AND PHYSICIAN SERVICES." PART III, LINE 8: COMMONSPIRIT HEALTH HOSPITALS PREPARE MEDICARE COST REPORTS IN A MANNER THAT COMPORTS WITH PROVIDER REIMBURSEMENT MANUAL (PRM) 15-1 AND PRM 15-2 CHAPTER 40 (TRANSMITTAL 13). AS SUCH, THE FOLLOWING LANGUAGE PER PRM 15-1 DESCRIBES THE COMPUTATION OF COSTS PER THE MEDICARE COST REPORT: TOTAL ALLOWABLE COSTS OF A PROVIDER ARE APPORTIONED BETWEEN PROGRAM BENEFICIARIES AND OTHER PATIENTS SO THAT THE SHARE BORNE BY THE PROGRAM IS BASED UPON ACTUAL SERVICES RECEIVED BY PROGRAM BENEFICIARIES. THE RATIO OF COVERED BENEFICIARY CHARGES TO TOTAL PATIENT CHARGES FOR THE SERVICES OF EACH ANCILLARY DEPARTMENT IS APPLIED TO THE COST OF THE DEPARTMENT. ADDED TO THIS AMOUNT IS THE COST OF ROUTINE SERVICES FOR PROGRAM BENEFICIARIES, DETERMINED ON THE BASIS OF A SEPARATE AVERAGE COST PER DIEM FOR ALL PATIENTS FOR GENERAL ROUTINE PATIENT CARE AREAS. ANOTHER FACTOR CONSIDERED IS A SEPARATE AVERAGE COST PER DIEM FOR EACH INTENSIVE CARE UNIT, CORONARY CARE UNIT, AND OTHER SPECIAL CARE INPATIENT HOSPITAL UNITS. COMMONSPIRIT HEALTH AND ITS SUBORDINATE CORPORATIONS BELIEVE THAT THE ENTIRE MEDICARE SHORTFALL FOR THE CONSOLIDATED ENTITIES CONSTITUTES COMMUNITY BENEFIT. THE IRS COMMUNITY BENEFIT STANDARD INCLUDES THE PROVISION OF CARE TO THE ELDERLY AND MEDICARE PATIENTS. MEDICARE SHORTFALLS MUST BE ABSORBED BY COMMONSPIRIT HEALTH HOSPITALS IN ORDER TO CONTINUE TREATING THE ELDERLY IN OUR COMMUNITIES. THE HOSPITALS PROVIDE CARE REGARDLESS OF THIS SHORTFALL AND THEREBY RELIEVE THE FEDERAL GOVERNMENT OF THE BURDEN OF PAYING THE FULL COST FOR MEDICARE BENEFICIARIES. ST. ALEXIUS MEDICAL CENTER'S SHORTFALL, AS REPORTED ON PART III, SECTION B, LINE 7, OF $13,729,376 REPRESENTS THE FILING ORGANIZATION'S MEDICARE COST REPORTS. PART III, LINE 9B: COMMONSPIRIT HEALTH ENSURES THAT PATIENT ACCOUNTS ARE PROCESSED FAIRLY AND CONSISTENTLY. COMMONSPIRIT HEALTH'S BILLING AND COLLECTION POLICY CONTAINS PROVISIONS THAT PROHIBIT THE COLLECTION OF AMOUNTS DUE FROM PATIENTS WHO THE ORGANIZATION KNOWS QUALIFY FOR FINANCIAL ASSISTANCE. ACCOUNTS WITH INCORRECT OR INCOMPLETE DEMOGRAPHIC INFORMATION ARE ASSIGNED TO A COLLECTION AGENCY IF THE COMMONSPIRIT HEALTH FACILITY, OR BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH, IS UNABLE TO OBTAIN AN UPDATED ADDRESS THROUGH SKIP TRACING OR OTHER MEANS. FOR PATIENTS WHO HAVE AN APPLICATION PENDING FOR EITHER GOVERNMENT-SPONSORED ASSISTANCE OR FOR ASSISTANCE UNDER COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE POLICY, OR WHERE THE PATIENT IS ATTEMPTING IN GOOD FAITH TO SETTLE AN OUTSTANDING BILL WITH THE FACILITY VIA PAYMENT PLANS, COMMONSPIRIT HEALTH WILL NOT KNOWINGLY SEND THAT PATIENT'S BILL TO AN OUTSIDE COLLECTION AGENCY. LEGAL ACTION WILL NOT BE PURSUED TO COLLECT DEBTS FROM PATIENTS WHO HAVE QUALIFIED FOR CHARITY OR ARE COOPERATING IN GOOD FAITH TO RESOLVE THEIR DEBT. ON SELF-PAY ACCOUNTS THAT DO NOT MEET THE CRITERIA NOTED ABOVE, THE INITIAL DETERMINATION OF ASSIGNMENT TO A COLLECTION AGENCY WILL VARY DEPENDING ON THE NATURE OF THE ACCOUNT WITH THE FINAL DECISION BEING AT THE DISCRETION OF THE BILLING COMPANY RETAINED BY COMMONSPIRIT HEALTH. UPON ASSIGNMENT OF SUCH A PATIENT ACCOUNT TO A COLLECTION AGENCY, COMMONSPIRIT HEALTH REQUIRES THE AGENCY TO COMPLY WITH THE FAIR DEBT COLLECTION PRACTICES ACT. SCHEDULE H, PART V, SECTION A HTTPS://WWW.CHISTALEXIUSHEALTH.ORG/LOCATIONS/TURTLE-LAKE PART VI, LINE 2: FACILITY: ST ALEXIUS MEDICAL CENTERWE WORK IN COLLABORATION WITH SEVERAL COMMUNITY PARTNERS. HOMELESSNESS: CHI ST. ALEXIUS HEALTH WORKS COLLABORATIVELY WITH INSTITUTIONS WHO ARE PROVIDING HOUSING AND FOOD FOR HOMELESS INDIVIDUALS AND FAMILIES AS WELL AS INDIVIDUALS THAT ARE IMPAIRED. VIOLENCE PREVENTION: CHI ST. ALEXIUS HEALTH BISMARCK PARTICIPATES IN THE ND VIOLENCE PREVENTION PROGRAM. WE WORK CLOSELY WITH THIS PROGRAM AS IT IS A PART OF CHI. WE ARE INVOLVED IN SEVERAL CIVIC ORGANIZATIONS.FACILITY: TURTLE LAKE COMMUNITY MEMORIAL HOSPITALWE WORK IN COLLABORATION WITH SEVERAL COMMUNITY PARTNERS. THEY INCLUDE: NATIONAL HEALTH SERVICE CORPS; CHI ST. ALEXIUS HEALTH AT HOME; MEALS ON WHEELS; MEDICALERT SYSTEMS; VETERAN SERVICES; HOSPITAL AUXILIARY; TURTLE LAKE CHAMBER OF PROGRESS; HOSPITAL ASSOCIATION BOARD; AND TURTLE LAKE AMBULANCE SERVICES. PART VI, LINE 3: INFORMATION ABOUT COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM AND A CONTACT NUMBER ARE MADE AVAILABLE TO PATIENTS AND THE PUBLIC. PATIENTS ARE INFORMED OF COMMONSPIRIT HEALTH'S FINANCIAL ASSISTANCE PROGRAM VIA SIGNAGE IN ALL ADMITTING AREAS AND IN VARIOUS COMMON AREAS OF THE HOSPITAL. FINANCIAL ASSISTANCE PROGRAM INFORMATION NOTICES ARE POSTED IN THE EMERGENCY AND ADMITTING DEPARTMENTS AND AT OTHER PUBLIC PLACES AS EACH FACILITY MAY ELECT. SUCH INFORMATION IS PROVIDED IN THE PRIMARY LANGUAGES SPOKEN IN THE COMMUNITIES COMMONSPIRIT HEALTH SERVES. THE SIGNAGE INCLUDES NOTIFICATION THAT FURTHER DISCOUNTS MAY BE PROVIDED UPON THE COMPLETION AND SUBMISSION OF A FINANCIAL ASSISTANCE APPLICATION AND HOW TO REACH STAFF THAT CAN ASSIST WITH ANSWERING QUESTIONS AND GUIDE PATIENTS THROUGH THE APPLICATION PROCESS. INFORMATION CAN ALSO BE FOUND ON THE FACILITY WEBSITES. IF FINANCIAL ASSISTANCE ELIGIBILITY IS NOT DETERMINED PRIOR TO BILLING, INITIAL BILLING STATEMENTS TO PATIENTS INCLUDE A REQUEST TO THE PATIENT TO PROVIDE ANY INSURANCE INFORMATION THAT WAS VALID FOR THE DATES OF SERVICE BILLED AND A STATEMENT INFORMING PATIENTS HOW TO CONTACT US REGARDING FINANCIAL ASSISTANCE. ADDITIONALLY, CONTRACT TERMS WITH COLLECTION VENDORS WORKING ON BEHALF OF COMMONSPIRIT HEALTH REQUIRE THEY FOLLOW COMMONSPIRIT HEALTH FINANCIAL ASSISTANCE POLICY. ALSO, REFERRAL OF PATIENTS FOR FINANCIAL ASSISTANCE MAY BE MADE BY ANY MEMBER OF THE COMMONSPIRIT 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. PART VI, LINE 4: FACILITY: ST ALEXIUS MEDICAL CENTERTHE RESIDENTS OF THE CITIES OF BISMARCK AND MANDAN AND THEIR SURROUNDING AREAS ARE THE PRIMARY SOURCES OF PATIENTS SERVED BY CHI ST. ALEXIUS HEALTH BISMARCK. BISMARCK IS THE CAPITAL OF NORTH DAKOTA AND THE COUNTY SEAT OF BURLEIGH COUNTY. THE U.S. CENSUS POPULATION ESTIMATE FOR BISMARCK IN 2020 WAS 73,622 PEOPLE AND 98,458 FOR BURLEIGH COUNTY. BISMARCK IS THE SECOND MOST POPULOUS CITY IN THE STATE OF NORTH DAKOTA. THE CITY OF MANDAN IS DIRECTLY ACROSS THE MISSOURI RIVER FROM BISMARCK. THE U.S. CENSUS POPULATION ESTIMATE FOR MANDAN IN 2020 WAS 24,206 PEOPLE. MORTON COUNTY HAS A POPULATION ESTIMATE OF 33,291 PEOPLE. BISMARCK AND MANDAN MAKE UP THE CORE OF THE BISMARCK-MANDAN STATISTICAL AREA.POPULATION PER SQUARE MILEBISMARCK 1,986.5 BURLEIGH COUNTY 49.8 MORTON COUNTY 14.3 NORTH DAKOTA 9.7PERSONS 65 YEARS OR OLDERBISMARCK 17.3% BURLEIGH COUNTY 16.6% MORTON COUNTY 17.0% NORTH DAKOTA 15.7%PERSONS UNDER 18 YEARSBISMARCK 22.2% BURLEIGH COUNTY 23.3% MORTON COUNTY 23.1% NORTH DAKOTA 23.6%GENDER (% FEMALE)BISMARCK 50.8% BURLEIGH COUNTY 49.9% MORTON COUNTY 49.5% NORTH DAKOTA 48.8%RACE (%)WHITE ALONEBISMARCK 87.9% BURLEIGH COUNTY 90.4% MORTON COUNTY 92.2% NORTH DAKOTA 86.9%BLACK OR AFRICAN AMERICAN ALONEBISMARCK 2.8% BURLEIGH COUNTY 2.4% MORTON COUNTY 1.3% NORTH DAKOTA 3.4%AMERICAN INDIAN OR ALASKAN NATIVE ALONEBISMARCK 4.4% BURLEIGH COUNTY 4.3% MORTON COUNTY 3.8% NORTH DAKOTA 5.6%HISPANIC OR LATINOBISMARCK 2.4% BURLEIGH COUNTY 2.8% MORTON COUNTY 4.1% NORTH DAKOTA 4.1%MEDIAN HOUSEHOLD INCOMEBISMARCK $67,629 BURLEIGH COUNTY $72,974 MORTON COUNTY $72,778 NORTH DAKOTA $65,315PERSONS IN POVERTYBISMARCK 8.4% BURLEIGH COUNTY 8.6% MORTON COUNTY 8.3% NORTH DAKOTA 10.2%CHILDREN IN POVERTYBURLEIGH COUNTY 6.76% MORTON COUNTY 6.66% NORTH DAKOTA 11.12%UNEMPLOYMENT RATEBURLEIGH COUNTY 2.8% MORTON COUNTY 3.7% NORTH DAKOTA 3.3%% OF PERSON WITHOUT HEALTH INSURANCE (UNDER 65)BISMARCK 6.5% BURLEIGH COUNTY 5.6% MORTON COUNTY 6.3% NORTH DAKOTA 8.1%% OF UNINSURED CHILDREN (UNDER 18)BURLEIGH COUNTY 5.0% MORTON COUNTY 3.2% NORTH DAKOTA 7.3%HIGH SCHOOL GRADUATION RATEBURLEIGH COUNTY 90.7% MORTON COUNTY 84.6% NORTH DAKOTA 86.3%% OF POPULATION AGE 25+ WITH BACHELOR'S DEGREE OR HIGHERBISMARCK 36.9% BURLEIGH COUNTY 36.5% MORTON COUNTY 27.3% NORTH DAKOTA 30.7%FACILITY: TURTLE LAKE COMMUNITY MEMORIAL HOSPITALWITH REGARD TO DEMOGRAPHICS, MCLEAN COUNTY'S POPULATION FROM 2010 TO 2019 INCREASED BY 5.4%. THE AVERAGE NUMBER OF RESIDENTS UNDER AGE 18 (22%) FOR MCLEAN COUNTY COMES IN 1.6 PERCENTAGE POINTS LOWER THAN THE NORTH DAKOTA AVERAGE (23.6%). THE PERCENTAGE OF RESIDENTS AGES 65 AND OLDER, IS 8.5% HIGHER FOR MCLEAN COUNTY (24.2%) THAN THE NORTH DAKOTA AVERAGE (15.7%), AND THE RATE OF EDUCATION FOR MCLEAN COUNTY (92.4%) IS REFLECTIVE TO THE NORTH DAKOTA AVERAGE (92.6%). THE MEDIAN HOUSEHOLD INCOME IN MCLEAN COUNTY ($68,529) IS HIGHER THAN THE STATE AVERAGE FOR NORTH DAKOTA ($64,894). POPULATION PER SQUARE MILEMCLEAN COUNTY 4.2 NORTH DAKOTA 9.7PERSONS 65 YEARS OR OLDERMCLEAN COUNTY 24.2% NORTH DAKOTA 15.7%PERSONS UNDER 18 YEARSMCLEAN COUNTY 22% NORTH DAKOTA 23.6%GENDER (% FEMALE)MCLEAN COUNTY 51.7% NORTH DAKOTA 48.8%RACE (%)WHITE ALONEMCLEAN COUNTY 89.6% NORTH DAKOTA 86.9%MEDIAN HOUSEHOLD INCOMEMCLEAN COUNTY $68,529 NORTH DAKOTA $65,315PERSONS IN POVERTYMCLEAN COUNTY 9.4% NORTH DAKOTA 10.2%% OF PERSON WITHOUT HEALTH INSURANCE (UNDER 65)MCLEAN COUNTY 9.1% NORTH DAKOTA 8.1%HIGH SCHOOL GRADUATION RATEMCLEAN COUNTY 92.4% NORTH DAKOTA 86.3%% OF POPULATION AGE 25+ WITH BACHELOR'S DEGREE OR HIGHERMCLEAN COUNTY 20.8% NORTH DAKOTA 30.7% PART VI, LINE 5: FINANCIAL ASSISTANCE: IT IS THE POLICY OF COMMONSPIRIT HEALTH TO PROVIDE, WITHOUT DISCRIMINATION, EMERGENCY MEDICAL CARE AND MEDICALLY NECESSARY CARE IN COMMONSPIRIT HOSPITAL FACILITIES TO ALL PATIENTS, WITHOUT REGARD TO A PATIENT'S FINANCIAL ABILITY TO PAY. THIS HOSPITAL HAS A FINANCIAL ASSISTANCE POLICY THAT DESCRIBES THE ASSISTANCE PROVIDED TO PATIENTS FOR WHOM IT WOULD BE A FINANCIAL HARDSHIP TO FULLY PAY THE EXPECTED OUT-OF-POCKET EXPENSES FOR SUCH CARE, AND WHO MEET THE ELIGIBILITY CRITERIA FOR SUCH ASSISTANCE. THE FINANCIAL ASSISTANCE POLICY, A PLAIN LANGUAGE SUMMARY AND RELATED MATERIALS ARE AVAILABLE IN MULTIPLE LANGUAGES ON THE HOSPITAL'S WEBSITE.USE OF SURPLUS FUNDS: AS A NOT-FOR-PROFIT HOSPITAL ORGANIZATION DEDICATED TO IMPROVING THE QUALITY OF LIFE, THE HOSPITAL REINVESTS ALL OF ITS SURPLUS FUNDS FROM OPERATING AND INVESTMENT ACTIVITIES TO IMPROVE THE QUALITY OF PATIENT CARE, EXPAND AND REPLACE EXISTING FACILITIES AND EQUIPMENT, INVEST IN TECHNOLOGICAL ADVANCEMENTS, SUPPORT COMMUNITY HEALTH PROGRAMS, AND ADVANCE MEDICAL TRAINING, EDUCATION, AND RESEARCH. THIS ACTIVE REINVESTMENT OF FUNDS MAKES IT POSSIBLE FOR THE HOSPITAL TO DELIVER ON ITS MISSION, INCLUDING HELPING TO ENSURE THAT EVERYONE IN THE COMMUNITIES SERVED HAS ACCESS TO HEALTH CARE.OPEN MEDICAL STAFF: MEDICAL STAFF PRIVILEGES ARE OPEN TO PHYSICIANS WHOSE EXPERIENCE AND TRAINING ARE VERIFIED THROUGH A CREDENTIALING PROCESS. THE PROCESS INCLUDES GATHERING AND VERIFYING CREDENTIALS, ALLOWING THE MEDICAL STAFF TO EVALUATE AN APPLICANT'S QUALIFICATIONS, PREVIOUS EXPERIENCE, AND COMPETENCE, AND ULTIMATELY MAKING A DECISION TO GRANT OR DENY MEDICAL STAFF MEMBERSHIP AND CLINICAL PRIVILEGES ON THE BASIS OF AUTHENTIC AND VALID CREDENTIALS.ROLE OF THE BOARD: THE COMMONSPIRIT HEALTH BOARD AND SPECIFIC COMMITTEES HAVE ORGANIZATIONAL, POLICY-BASED ROLES TO OVERSEE COMMUNITY BENEFIT AND COMMUNITY HEALTH PROGRAMS, AND THEY RECEIVE REGULAR REPORTS ON ACTIVITIES AND PERFORMANCE. HOSPITAL COMMUNITY BOARDS (OR THEIR DESIGNATED COMMUNITY HEALTH OR COMMUNITY BENEFIT COMMITTEES) ARE RESPONSIBLE FOR ENSURING THAT THE HOSPITALS CONDUCT AND ADOPT COMMUNITY HEALTH NEEDS ASSESSMENTS AND IMPLEMENTATION STRATEGIES, TAKE ACTIONS TO HELP ADDRESS IDENTIFIED SIGNIFICANT HEALTH NEEDS WITH AN EMPHASIS ON POOR AND VULNERABLE POPULATIONS AND HEALTH EQUITY, AND MONITORING ACTIONS AND PROGRESS TOWARD IDENTIFIED GOALS. PART VI, LINE 6: THE ORGANIZATION IS AFFILIATED WITH COMMONSPIRIT HEALTH. COMMONSPIRIT HEALTH WAS CREATED BY THE ALIGNMENT OF CATHOLIC HEALTH INITIATIVES AND DIGNITY HEALTH IN EARLY 2019. COMMONSPIRIT HEALTH, A NONPROFIT, FAITH-BASED HEALTH SYSTEM IS COMMITTED TO BUILDING HEALTHIER COMMUNITIES, ADVOCATING FOR THOSE WHO ARE POOR AND VULNERABLE, AND INNOVATING HOW AND WHERE HEALING CAN HAPPEN BOTH INSIDE ITS HOSPITALS AND OUT IN THE COMMUNITY. COMMONSPIRIT HEALTH OWNS AND OPERATES HEALTH CARE FACILITIES IN 24 STATES AND IS THE SOLE CORPORATE MEMBER (PARENT CORPORATION) OF OTHER PRIMARILY NONPROFIT CORPORATIONS. COMMONSPIRIT HEALTH AND SUBSTANTIALLY ALL OF ITS DIRECT AFFILIATES AND SUBSIDIARIES HAVE BEEN GRANTED EXEMPTIONS FROM FEDERAL INCOME TAX AS CHARITABLE ORGANIZATIONS UNDER SECTION 501(C)(3) OF THE INTERNAL REVENUE CODE. AS OF JUNE 30, 2023, COMMONSPIRIT HEALTH IS COMPRISED OF APPROXIMATELY 2,200 CARE SITES, CONSISTING OF 142 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 2023, COMMONSPIRIT HEALTH PROVIDED MORE THAN $2.937 BILLION IN FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT FOR PROGRAMS AND SERVICES FOR THE POOR, FREE CLINICS, EDUCATION AND RESEARCH. FINANCIAL ASSISTANCE AND COMMUNITY BENEFIT TOTALED MORE THAN $5.02 BILLION WITH THE INCLUSION OF THE UNPAID COSTS OF MEDICARE. THE HEALTH SYSTEM, WHICH GENERATED OPERATING REVENUES OF $34.5 BILLION IN FISCAL YEAR 2023, HAS TOTAL ASSETS OF APPROXIMATELY $51.87 BILLION.COMMONSPIRIT HEALTH PROVIDES STRATEGIC PLANNING AND MANAGEMENT SERVICES AS WELL AS CENTRALIZED SERVICES FOR ITS DIVISIONS. THE PROVISION OF CENTRALIZED MANAGEMENT AND SHARED SERVICES INCLUDING AREAS SUCH AS ACCOUNTING, HUMAN RESOURCES, PAYROLL AND SUPPLY CHAIN PROVIDES ECONOMIES OF SCALE AND PURCHASING POWER TO THE DIVISIONS. THE COST SAVINGS ACHIEVED THROUGH COMMONSPIRIT HEALTH'S CENTRALIZATION ENABLE DIVISIONS TO DEDICATE ADDITIONAL RESOURCES TO HIGH-QUALITY HEALTH CARE AND COMMUNITY OUTREACH SERVICES TO THE MOST VULNERABLE MEMBERS OF OUR SOCIETY. 1 BENEDICTINE SISTERS OF THE ANNUNCIATION 7520 UNIVERSITY DR BISMARCK ND 58504 450261530 501(C)(3) 530450 0 PROGRAM SUPPORT 1 0 GAY WALLENTINE MEMORIAL SCHOLARSHIP 1 1500 BRITA ERIKSEN MEMORIAL SCHOLARSHIP 1 1500 ASSOCIATE EMERGENCY FUND 8 12000 NATIONAL BOARD OF RESPIRATORY CARE 1 435 TUITION REIMBURSEMENT 9 41142 PART I, LINE 2: ST. ALEXIUS MEDICAL CENTER MAKES DONATIONS TO ENTITIES WITH CHARITABLE MISSIONS TO ENSURE THAT OUR DONATIONS ARE USED FOR THE PURPOSES INTENDED. ASSISTANCE IS REQUESTED VIA AN APPLICATION FORM, IN ALL CASES, THE NEED FOR FUNDS WILL BE VERIFIED. A COMMITTEE MEETS TO REVIEW APPLICATIONS TO DETERMINE THE NEED AND MAKE SURE ALL GUIDELINES ARE FOLLOWED. X X X X 1 1 0 0 0 0 0 0 0 JOHN HOYT PHYSICIAN 630900 0 355167 0 33264 0 30750 0 34933 0 1085014 0 0 0 CAMERON CHARCHENKO MD - UROLOGY 685772 0 285775 0 17486 0 25575 0 13107 0 1027715 0 0 0 KURT SCHLEY FORMER DIRECTOR & CEO 0 152022 0 0 0 819208 0 14513 0 5256 0 990999 0 44930 PATRICK GRACE PHYSICIAN 530537 0 360907 0 31214 0 10675 0 13569 0 946902 0 0 0 NICHOLAS BRADBURY MD - INTERVENTIONAL RADIOLOGY 607200 0 166963 0 0 0 28050 0 0 0 802213 0 0 0 MICHAEL FLISAK PHYSICIAN 629059 0 95995 0 22419 0 4783 0 29759 0 782015 0 0 0 KEVIN DAHMEN MD VICE CHAIR/SECRETARY/TREASURER (THRO 313376 0 274580 0 1932 0 26275 0 32314 0 648477 0 0 0 TODD PRESZLER MD DIRECTOR/ANESTHESIOLOGIST 517840 0 62680 0 3612 0 12814 0 32314 0 629260 0 0 0 J'PATRICK FAHN CHIEF MEDICAL OFFICER 363600 0 60768 0 1215 0 10250 0 29994 0 465827 0 0 0 SHIRAZ HYDER DIRECTOR/NEUROLOGIST 348427 0 14350 0 10668 0 21898 0 32314 0 427657 0 0 0 JULIE GOEBEL DIRECTOR/DIVISION SVP CHIEF OPERATIN 0 290611 0 45000 0 29871 0 810 0 20301 0 386593 0 0 TIM PLANTE PRESIDENT/CEO (INTERIM THROUGH 12/18 0 252505 0 46846 0 1056 0 7229 0 33437 0 341073 0 0 DEBRA MOHESKY MARKET PRESIDENT/CEO (THROUGH 10/4/2 276110 0 45089 0 0 0 0 0 1966 0 323165 0 0 0 NICK O'TOOL DIVISION VP FINANCE 0 207354 0 49872 0 452 0 16380 0 30652 0 304710 0 0 KEITH HORNER FORMER DIRECTOR OF PHARMACY & CLINIC 208128 0 41109 0 1065 0 9058 0 31396 0 290756 0 0 0 JAMES SMITH VICE PRESIDENT OF OPERATIONAL FINANC 198197 0 0 0 30342 0 0 0 11768 0 240307 0 0 0 RAUMI KUDRNA VP PATIENT CARE SERVICES 146200 0 17743 0 300 0 5873 0 6047 0 176163 0 0 0 PART I, LINE 3 DURING A PORTION OF CALENDAR YEAR 2022, COMPENSATION FOR THE TOP MANAGEMENT OFFICIAL WAS ESTABLISHED AND PAID BY ALEGENT CREIGHTON HEALTH, A RELATED ORGANIZATION. ALEGENT CREIGHTON 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. SCHEDULE J, PART I, LINE 4A CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY AN EXECUTIVE 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. CERTAIN REPORTABLE INDIVIDUALS ARE COVERED BY A NON-EXECUTIVE SEVERANCE POLICY THAT PROVIDES MARKET-STANDARD COMPENSATION, RANGING FROM PAYMENTS OF 2 WEEKS TO 52 WEEKS OF BASE COMPENSATION, DEPENDING ON THE EMPLOYEE'S POSITION AND TENURE, 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 DURING THE 2022 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): KURT SCHLEY, $771,398. SCHEDULE J, PART I, LINE 4B DURING THE 2022 CALENDAR YEAR, COMMONSPIRIT HEALTH ("COMMONSPIRIT") MAINTAINED A SUPPLEMENTAL NON-QUALIFIED DEFERRED COMPENSATION PLAN FOR DIVISION CEOS/PRESIDENTS AND OTHER DESIGNATED COMMONSPIRIT EXECUTIVES AT THE LEVEL OF SENIOR VICE PRESIDENT AND ABOVE. DURING 2022 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: KURT SCHLEY, $43,231. 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 2022 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 2022, THE FOLLOWING PAYMENTS WERE MADE PURSUANT TO THE SUPER VESTING RULES: KURT SCHLEY, $4,024. SCHEDULE J, PART II ST ALEXIUS MEDICAL CENTER FOLLOWS COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY. COMMONSPIRIT'S EXECUTIVE COMPENSATION PHILOSOPHY IS DESIGNED TO ASSIST COMMONSPIRIT IN ATTRACTING AND RETAINING THE CALIBER OF EXECUTIVES REQUIRED TO ENABLE COMMONSPIRIT TO FULFILL ITS MISSION OF PROVIDING HIGH QUALITY HEALTHCARE FOR ALL PERSONS REGARDLESS OF THEIR ABILITY TO PAY FOR SERVICES, IMPROVING THE QUALITY OF LIFE IN THE COMMUNITIES COMMONSPIRIT SERVES, PROMOTING PATIENT AND EMPLOYEE SATISFACTION, AND ENSURING FINANCIAL STABILITY. A SUBSTANTIAL PORTION OF EXECUTIVE COMPENSATION IS PERFORMANCE BASED AND IS LINKED TO ORGANIZATIONAL GOALS APPROVED IN ADVANCE BY THE HUMAN RESOURCES AND COMPENSATION COMMITTEE. THESE GOALS INCLUDE ATTAINMENT OF ANNUAL AND LONG-TERM FINANCIAL PERFORMANCE, CERTAIN HEALTHCARE QUALITY STANDARDS AND COMMONSPIRIT'S COMMITMENT TO SERVING THE POOR AND DISENFRANCHISED IN THE COMMUNITIES IT SERVES. TOTAL COMPENSATION, WHICH INCLUDES BASE SALARY, ANNUAL, AND LONG-TERM INCENTIVE COMPENSATION, IS ESTABLISHED TO APPROXIMATE THE PREVAILING MARKET CONDITIONS FOR EXECUTIVES OF COMPANIES OF SIMILAR SIZE, REVENUES AND COMPLEXITY. PAYMENTS PURSUANT TO A LONG-TERM FINANCIAL PERFORMANCE GOAL WERE PAID IN CALENDAR YEAR 2022. KARI EMERY FAMILY MEMBER OF A BOARD MEMBER 330488 EMPLOYEE PAYROLL WAGES 0 HOLLI SCHOCK FAMILY MEMBER OF A KEY EMPLOYEE 68545 EMPLOYEE PAYROLL WAGES 0 AUSTIN SCHOCK FAMILY MEMBER OF A KEY EMPLOYEE 83369 EMPLOYEE PAYROLL WAGES 0 KRISTEN FAHN FAMILY MEMBER OF A KEY EMPLOYEE 45978 EMPLOYEE PAYROLL WAGES 0 FORM 990, PART VI, SECTION A, LINE 1A PURSUANT TO SECTION 8.6 OF THE BYLAWS OF ST. ALEXIUS MEDICAL CENTER, THE EXECUTIVE COMMITTEE IS COMPOSED OF ONLY DIRECTORS OF THE CORPORATION AND SHALL BE COMPOSED OF THE CHAIRPERSON OF THE BOARD, THE VICE CHAIRPERSON OF THE BOARD, AND THE PRESIDENT, EACH OF WHOM SHALL SERVE AS AN EX OFFICIO VOTING MEMBER OF THE EXECUTIVE COMMITTEE. EACH INDIVIDUAL APPOINTED TO THE EXECUTIVE COMMITTEE SHALL SERVE FOR A TERM OF ONE (1) YEAR OR UNTIL HIS OR HER SUCCESSOR IS DULY APPOINTED BY THE BOARD OF DIRECTORS. 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 ACCORDING TO THE BYLAWS OF ST. ALEXIUS MEDICAL CENTER, THE ENTITY'S SOLE MEMBER IS COMMONSPIRIT HEALTH, A COLORADO NONPROFIT ORGANIZATION. 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. (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 A, LINE 7B THE ORGANIZATION'S CORPORATE MEMBER IS COMMONSPIRIT HEALTH. PURSUANT TO SECTION 5.4 OF THE ORGANIZATION'S BYLAWS, COMMONSPIRIT HEALTH SHALL HAVE THE SPECIFIC RIGHTS SET FORTH IN THE GOVERNANCE MATRIX. PURSUANT TO THE GOVERNANCE MATRIX THE FOLLOWING RIGHTS ARE RESERVED TO THE COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: * APPROVE MEMBERS OF THE ORGANIZATION'S BOARD * AMENDMENT OF THE CORPORATE DOCUMENTS OF THE ORGANIZATION * ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE ORGANIZATION * SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE ORGANIZATION * REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ORGANIZATION * APPROVAL OF ISSUANCE OF DEBT BY ORGANIZATION * APPROVAL OF PARTICIPATION OF ORGANIZATION IN A JOINT VENTURE * APPROVAL OF FORMATION OF A NEW CORPORATION BY ORGANIZATION * APPROVAL OF A MERGER INVOLVING THE ORGANIZATION * APPROVAL OF THE SALE OF ALL OR SUBSTANTIALLY ALL OF THE ASSETS OF THE ORGANIZATION * TO REQUIRE THE TRANSFER OF ASSETS BY THE ORGANIZATION TO COMMONSPIRIT HEALTH TO ACCOMPLISH COMMONSPIRIT HEALTH'S GOALS AND OBJECTIVES, AND TO SATISFY COMMONSPIRIT HEALTH DEBTS. PURSUANT TO SECTION 5.5 OF THE ORGANIZATION'S BYLAWS, COMMONSPIRIT HEALTH MAY, IN EXERCISE OF THEIR APPROVAL POWERS, GRANT OR WITHHOLD APPROVAL IN WHOLE OR IN PART, OR MAY, IN ITS COMPLETE DISCRETION, AFTER CONSULTATION WITH THE BOARD AND ITS PRESIDENT AND THE CHIEF EXECUTIVE OFFICER OF THE ORGANIZATION, RECOMMEND SUCH OTHER OR DIFFERENT ACTIONS AS IT DEEMS APPROPRIATE. (CHCF RESERVED RIGHTS) EXCEPT AS OTHERWISE PROVIDED IN THE CORPORATION'S ARTICLES OF INCORPORATION OR THE LAWS OF THE STATE OF ORGANIZATION, CATHOLIC HEALTH CARE FEDERATION ("CHCF") SHALL HAVE SUCH RIGHTS AS ARE RESERVED TO THE CORPORATE MEMBER, ACTING IN ITS CAPACITY AS THE MEMBERSHIP BODY OF CHCF, UNDER THE GOVERNANCE MATRIX. FORM 990, PART VI, SECTION B, LINE 11B ONCE THE RETURN IS PREPARED, THE FORM 990 AND ACCOMPANYING SCHEDULES WERE MADE AVAILABLE TO ALL TRUSTEES EITHER ELECTRONICALLY OR BY HARD COPY, DEPENDING UPON THE TRUSTEES PREFERENCE, BEFORE THE COMPANY FINALIZED AND SENT THE DOCUMENTS TO THE IRS. THIS DRAFT WAS ALSO AVAILABLE AT THE ADMINISTRATIVE OFFICES OF THE REPORTING ENTITY FOR TRUSTEES' REVIEW BEFORE THE FINAL FORM 990 AND ACCOMPANYING SCHEDULES WERE FINALIZED AND SENT TO THE IRS. THE REVIEW WAS UNDER THE DIRECTION OF THE CFO AND/OR THE TAX DEPARTMENT IF REQUESTED BY THE TRUSTEES. SUBSEQUENT TO THE RETURN BEING PROVIDED TO THE BOARD, THE TAX DEPARTMENT FILES THE RETURN WITH THE APPROPRIATE FEDERAL AND STATE AGENCIES, MAKING ANY NON-SUBSTANTIVE CHANGES NECESSARY TO EFFECT E-FILING. ANY SUCH CHANGES ARE NOT RE-SUBMITTED TO THE BOARD. FORM 990, PART VI, SECTION B, LINE 12C THE ORGANIZATION HAS A CONFLICTS OF INTEREST ("COI") POLICY (THE "POLICY") IN PLACE TO PROTECT THE INTERESTS OF COMMONSPIRIT HEALTH ("COMMONSPIRIT") IN CIRCUMSTANCES THAT MAY RESULT IN A CONFLICT BETWEEN PERSONAL INTERESTS OF A PERSON AND THE INTERESTS OF THE ORGANIZATION AND THOSE IT SERVES. COMMONSPIRIT'S COI POLICY APPLIES TO COMMONSPIRIT, ITS DIRECT AFFILIATES AND SUBSIDIARIES AND ANY RELATED ENTITY THE GOVERNING DOCUMENTS OF WHICH REQUIRE THE ENTITY TO COMPLY WITH COMMONSPIRIT POLICY (COLLECTIVELY THE "SYSTEM ENTITIES"). THE FOLLOWING PERSONS ARE REQUIRED TO DISCLOSE ACTUAL OR POTENTIAL CONFLICTS OF INTEREST AT LEAST ANNUALLY (VIA A FORMAL SYSTEM-ADMINISTERED SURVEY) IF THE PERSON'S AFFILIATION WITH COMMONSPIRIT CONTINUES: - MEMBERS OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF COMMITTEES OF CORPORATE AND COMMUNITY BOARDS OF SYSTEM ENTITIES - MEMBERS OF THE EXECUTIVE LEADERSHIP TEAM ("ELT") OF COMMONSPIRIT - CORPORATE OFFICERS OF SYSTEM ENTITIES - KEY EMPLOYEES AND HIGHEST COMPENSATED EMPLOYEES AS SPECIFIED BY THE INTERNAL REVENUE SERVICE FOR FORM 990 PURPOSES WHO ARE NOT OTHERWISE INCLUDED IN THE CATEGORIES ABOVE - EMPLOYEES OF SYSTEM ENTITIES AT THE VICE PRESIDENT LEVEL AND ABOVE - ALL INDIVIDUALS ENGAGED IN RESEARCH AT INSTITUTIONS OWNED OR OPERATED BY A SYSTEM ENTITY - SELECT EMPLOYEES AS DETERMINED FROM TIME TO TIME BY LEADERSHIP DISCLOSURE, REVIEW, AND MANAGEMENT OF PERCEIVED, POTENTIAL, OR ACTUAL CONFLICTS OF INTEREST ARE ACCOMPLISHED THROUGH A DEFINED COI DISCLOSURE REVIEW PROCESS. EACH PERSON IS REQUIRED TO PROMPTLY AND FULLY DISCLOSE ANY SITUATION OR CIRCUMSTANCE THAT MAY CREATE A CONFLICT OF INTEREST AS SOON AS SHE/HE BECOMES AWARE OF IT. IN ADDITION, AT THE INCEPTION OF AN INDIVIDUAL'S RELATIONSHIP WITH COMMONSPIRIT (E.G. HIRING, BOARD APPOINTMENT), AND FOR CERTAIN POSITIONS, ANNUALLY THEREAFTER, WRITTEN CONFLICT OF INTEREST DISCLOSURE FORMS MUST BE COMPLETED. A FAILURE TO DISCLOSE MAY RESULT IN DISCIPLINARY OR CORRECTIVE ACTIONS. REPORTED POTENTIAL OR ACTUAL CONFLICTS OF INTEREST ARE INITIALLY REVIEWED BY LEGAL, CORPORATE RESPONSIBILITY OR RESEARCH INTEGRITY STAFF. IF NECESSARY, A CONFLICT OF INTEREST MANAGEMENT PLAN IS DEVELOPED, WHICH PLAN SHALL BE SUBJECT TO ACCEPTANCE BY THE APPROPRIATE DIRECT MANAGER, SUPERVISOR, MEDICAL STAFF OFFICE, BOARD OR BOARD COMMITTEE (FOR BOARD, BOARD COMMITTEE, ELT OR CORPORATE OFFICER CONFLICTS), OR OTHER APPROPRIATE INDIVIDUAL OR BODY. ONCE ACCEPTED, THE CONFLICT OF INTEREST MANAGEMENT PLAN IS COMMUNICATED TO THE PERSON WITH THE ACTUAL OR POTENTIAL CONFLICT AND THE INDIVIDUAL MUST CONDUCT THEMSELVES IN CONFORMITY WITH THE PLAN. IN THE EVENT THAT A TRANSACTIONAL CONFLICT INTEREST ARISES IN CONNECTION WITH A SYSTEM ENTITY BOARD MEETING, THE CONFLICTED INDIVIDUAL MUST DISCLOSE THAT CONFLICT PRIOR TO OR AT THE BEGINNING OF THE MEETING IN WHICH THE MATTER IS TO BE CONSIDERED. THE CONFLICTED INDIVIDUAL IS EXCLUDED FROM VOTING ON THE TRANSACTION AND IS PROHIBITED FROM USING PERSONAL INFLUENCE WITH RESPECT TO THE MATTER, BUT IS NOT PROHIBITED FROM PROVIDING INPUT IF REQUESTED TO DO SO. FORM 990, PART VI, SECTION B, LINE 15 LINE 15A FOR LEADERSHIP POSITIONS WITH SUBSTANTIAL INFLUENCE (INCLUDING THE PRESIDENT/CEO), COMPENSATION IS REVIEWED BY AN INDEPENDENT GROUP USING COMPARABILITY DATA AND RECOMMENDATIONS ARE PRESENTED TO THE ORGANIZATION'S EXECUTIVE COMMITTEE FOR APPROVAL OF BASE PAY INCREASES AND INCENTIVE ACHIEVEMENT. 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 OTHER OFFICERS AND KEY EMPLOYEES OF THE ORGANIZATION IS ESTABLISHED BY COMMONSPIRIT HEALTH COMPENSATION USING EXTERNAL COMPENSATION SURVEYS OR STUDIES CONTAINING COMPARABLE DATA FOR SIMILARLY SITUATED ORGANIZATIONS, BOTH TAXABLE AND TAX EXEMPT FOR SIMILAR JOB RESPONSIBILITIES. LINE 15B COMMONSPIRIT'S PHYSICIAN COMPENSATION SERVICES GROUP (PCSG) IS RESPONSIBLE FOR DEVELOPING COMMONSPIRIT'S PHYSICIAN COMPENSATION GUIDELINES (GUIDELINES). THE GUIDELINES INCLUDE: - GENERAL PROVIDER COMPENSATION CONSIDERATIONS - RECOMMENDED PRACTICES IN PROVIDER COMPENSATION - DOCUMENTING FAIR MARKET VALUE AND WHEN AN EXTERNAL FAIR MARKET VALUE OPINION IS REQUIRED - DOCUMENTING WHEN A COMPLIANCE REVIEW OR OTHER REVIEWS ARE NECESSARY - PROVIDER WORK PRODUCTIVITY PARAMETERS AND EXPECTATIONS IN ADDITION, THE GUIDELINES INCLUDE STANDARD PHYSICIAN TRANSACTION PARAMETERS (PARAMETERS) THAT DEFINE CRITERIA FOR STANDARD PHYSICIAN TRANSACTIONS. THE APPROVAL PROCESS REQUIRED FOR A PHYSICIAN TRANSACTION WILL DEPEND ON WHETHER THE PHYSICIAN TRANSACTION FITS WITHIN THESE PARAMETERS. A CORPORATE RESPONSIBILITY PROGRAM CONTRACTS ADMINISTRATION TEAM MEMBER (CRP CAT) WILL CONDUCT THE INITIAL REVIEW OF A PHYSICIAN TRANSACTION. THE CRP CAT REVIEW INCLUDES, BUT IS NOT LIMITED TO, THE NEED FOR THE ARRANGEMENT, ALL REMUNERATION INVOLVED, THE COMPENSATION STRUCTURE OF THE ARRANGEMENT, AND ANY DOCUMENTATION OF FAIR MARKET VALUE AND COMMERCIAL REASONABLENESS (WHEN REQUIRED UNDER THE GUIDELINES). THE CRP CAT SHALL ALSO DETERMINE IF THE PHYSICIAN TRANSACTION IS A STANDARD TRANSACTION (FITS ENTIRELY WITHIN THE PARAMETERS) OR A NON-STANDARD TRANSACTION REQUIRING REVIEW BY THE PHYSICIAN TRANSACTION ADVISORY GROUP (PTAG). IF REQUIRED, THE PURPOSE OF PTAG REVIEW SHALL BE TO EVALUATE WHETHER COMPENSATION TO BE PAID BY THE COMMONSPIRIT ENTITY TO THE PHYSICIAN UNDER THE TRANSACTION IS SUPPORTED BY DOCUMENTATION OF FAIR MARKET VALUE AND COMMERCIAL REASONABLENESS THAT SATISFIES THE REQUIREMENTS OF APPLICABLE COMMONSPIRIT POLICIES AND TO IDENTIFY WHETHER FURTHER COMPLIANCE REVIEW IS REQUIRED. ACQUIRING FAIR MARKET VALUE AND COMMERCIAL REASONABLENESS OPINIONS FROM EXTERNAL, THIRD-PARTY VALUATION FIRMS IS ENCOURAGED IN APPROPRIATE SITUATIONS. IN SOME SITUATIONS, PTAG REQUIRES EXTERNAL OPINIONS. THE VALUE OF THE CONTRACT GOVERNS APPROVAL AUTHORITY LEVEL. APPROVAL BY THE SVP OF OPERATIONS AND THE COMMONSPIRIT HEALTH CHIEF OPERATING OFFICER, FOR EXAMPLE, MAY BE REQUIRED WHEN APPROPRIATE. ALL PHYSICIAN CONTRACTS, WHETHER STANDARD PHYSICIAN TRANSACTIONS OR NON-STANDARD PHYSICIAN TRANSACTIONS, MUST BE REVIEWED BY THE CRP CAT UPON RENEWAL AND AT LEAST EVERY THREE YEARS, UNLESS AN EARLIER REVIEW IS SPECIFIED BY THE PTAG WHEN THE PHYSICIAN TRANSACTION IS INITIALLY ENTERED. 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 CONTRACT SERVICES: PROGRAM SERVICE EXPENSES 19,282,309. MANAGEMENT AND GENERAL EXPENSES 9,074,029. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 28,356,338. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 13,200,059. MANAGEMENT AND GENERAL EXPENSES 6,211,792. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 19,411,851. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 9,453,676. MANAGEMENT AND GENERAL EXPENSES 4,372,646. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 13,826,322. OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 6,983,593. MANAGEMENT AND GENERAL EXPENSES 3,286,397. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 10,269,990. CONSULTING FEES: PROGRAM SERVICE EXPENSES 61,570. MANAGEMENT AND GENERAL EXPENSES 28,974. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 90,544. FORM 990, PART XI, LINE 9: ANNUAL GIFT ANNUITY -1,500. EQUITY CHANGES IN UNCONSOLIDATED ORGS 1,314,149. AFFILIATE TRANSFERS 1,400,000. 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 - COMM MEM HOSPITAL OF 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 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