2024-05-14T11:19:50-05:00 2023-06-30 470617373 COMMONSPIRIT HEALTH 198 INVERNESS DRIVE WEST ENGLEWOOD CO 80112 990 2022-07-01 275401105 TRINITY HOSPITAL TWIN CITY TRIN 7409222800 819 NORTH FIRST STREET DENNISON OH 44621 DAVE WERKIN CFO 7409222800 2024-05-14 1 DAVE WERKIN XXX-XX-XXXX 0 PAMELA KROHN P01210500 3032989100 2 AAL1 IAL1 2022 2023-04-26 12:10:37Z DWAYNE RICHARDSON 819 NORTH FIRST STREET DENNISON OH 44621 25050801 0 X HTTPS://WWW.TRINITYTWINCITY.ORG/ X 1912 OH ASSURE AN EFFECTIVE HEALTH AND HUMAN SERVICES MINISTRY (CONTINUED ON SCHEDULE O) 20 16 260 27 0 0 1403519 879369 24230818 23789113 1926 -14481 859701 363544 26495964 25017545 0 0 0 0 13806442 14260797 0 0 0 12620854 13364472 26427296 27625269 68668 -2607724 20670866 19683002 12357126 13976986 8313740 5706016 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 23452498 0 23789113 SEE SCHEDULE H 23452498 1 1 0 1 0 0 0 0 0 1 1 0 0 0 1 1 0 1 0 0 0 0 0 0 0 0 1 1 0 0 1 0 0 0 0 0 0 0 0 0 0 0 0 0 1 0 0 0 1 27 0 1 260 1 0 0 0 0 0 0 0 0 0 0 0 0 X 20 16 0 0 0 0 1 1 1 1 1 0 0 0 1 1 1 1 1 0 1 0 OH X JIM DUMPMAN 7402837845 380 SUMMIT AVENUE STEUBENVILLE OH 44621 LARRY SCHUMACHER BOARD MEMBER/DIV SVP 1.00 50.00 X 0 2744155 38181 CHARN NANDRA MD BOARD MEMBER/CARDIOLOGIST 1.00 40.00 X 0 961678 24875 MATT GRIMSHAW PRESIDENT & CEO THS/BOARD MEMBER 1.00 40.00 X 0 746327 44639 MATTHEW PHILLIPS PHYSICIAN 40.00 0.00 X 384140 0 20904 TIM MCKNIGHT MD CHIEF MEDICAL OFFICER 40.00 0.00 X 349967 0 27888 SAM LICATA BOARD MEMBER 2.00 40.00 X 0 350002 27160 DAVE WERKIN CFO 2.00 40.00 X 0 303182 22253 STUART BROWN PHYSICIAN 40.00 0.00 X 278438 0 26475 DWAYNE RICHARDSON PRESIDENT, TRINITY HOSPITAL TWIN CITY & REGIONAL D 40.00 0.00 X 0 271526 25998 ANDREW NEWBURN PHYSICIAN 40.00 0.00 X 255160 0 26417 KATELYN OBERMILLER NP 40.00 0.00 X 210269 0 26127 MATTHEW COLFLESH MD BOARD MEMBER/CHIEF MEDICAL OFFICER (PARTIAL YEAR) 1.00 40.00 X 0 202671 10851 ERIC DURBIN PHARMACIST 40.00 0.00 X 173731 0 26673 MICHAEL BIASI BOARD MEMBER 1.00 4.00 X 0 0 0 DAN DAILY BOARD MEMBER 1.00 4.00 X 0 0 0 ERIC EXLEY BOARD MEMBER 1.00 4.00 X 0 0 0 SHEILA HENDRICKS BOARD MEMBER 1.00 4.00 X 0 0 0 MARK MORELLI SECRETARY 2.00 4.00 X X 0 0 0 JAMES PADDEN VICE CHAIR 2.00 4.00 X X 0 0 0 DOUGLAS SCHAEFER CHAIR 2.00 4.00 X X 0 0 0 DAVID SKIVIAT SR TREASURER 2.00 4.00 X X 0 0 0 DENNIS WOLTERS BOARD MEMBER 1.00 4.00 X 0 0 0 AARON PROVENZANO DO BOARD MEMBER 1.00 4.00 X 0 0 0 KARLA GREGORY-MARTIN BOARD MEMBER 1.00 4.00 X 0 0 0 JONATHAN BEDWAY BOARD MEMBER 2.00 4.00 X 0 0 0 CLAUDIA BRONSING SR BOARD MEMBER 2.00 4.00 X 0 0 0 THERESA GAGLIARDI BOARD MEMBER 2.00 4.00 X 0 0 0 JEFFREY GRECO BOARD MEMBER 2.00 4.00 X 0 0 0 JOSEPH LUCKINO BOARD MEMBER 2.00 4.00 X 0 0 0 1651705 5579541 348441 6 0 1 0 STEEL VALLEY EMERGENCY 2720 SUNSET BLVD STEUBENVILLE OH 43952 ER PHYSICIANS & HOSPITALISTS 1296177 TEN BROECH HEALTHCARE 603 MAIN STREET WINDEMERE FL 34786 REHAB SERVICES 346800 SIGHTPATH MEDICAL LLC PO BOX 204253 DALLAS TX 75320 OPHTHALMIC SERVICES 303004 LEYDA ANESTHESIA SERVICES 3119 CLAY ROAD NW DELLROY OH 44620 ANESTHESIA SERVICES 108162 4 826218 53151 879369 NET PATIENT SERVICES 900099 23789113 23789113 0 0 23789113 3622 3622 18103 -18103 -18103 -18103 20667 15153 5514 5514 PHARMACY SERVICES 456110 277162 0 0 277162 CAFETERIA 722100 65580 0 0 65580 OTHER MISCELLANEOUS RE 900099 15288 0 0 15288 358030 25017545 23789113 0 349063 X 730454 693931 36523 10143060 9635907 507153 2673514 2539838 133676 713769 678081 35688 35883 35883 11460 11460 1482 1482 7124130 5699303 1424827 141138 141138 977008 928158 48850 696618 661787 34831 23564 22386 1178 153766 146078 7688 692544 692544 596040 566238 29802 139805 139805 MEDICAL SUPPLIES 1559393 1543799 15594 0 STATE PROVIDER TAX 753141 0 753141 0 REPAIRS AND MAINTENANCE 271927 258331 13596 0 MISCELLANEOUS EXPENSES 118427 12022 106405 0 68146 66639 1507 27625269 23452498 4172771 0 2150 2150 5687322 5327034 0 6124633 5689296 0 0 0 412129 525291 56954 148203 13472291 6137862 7628973 7334429 0 0 0 500000 500000 258705 156599 20670866 19683002 2472066 1272609 0 732441 732441 0 0 0 0 0 9152619 11971936 12357126 13976986 X 7867947 5210223 445793 495793 8313740 5706016 20670866 19683002 -2607724 0 X 0 1 X 1 1 1 X RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED RESTRICTED 0 0 0 0 0 1 1482 0 0 0 1482 0 PART II-B, LINE 1: THE PORTION OF ORGANIZATION DUES THAT ARE RELATED TO LOBBYING ARE AS FOLLOWS: AMERICAN HOSPITAL ASSOCIATION - $303 CATHOLIC HEALTH ASSOCIATION - $162 OHIO HOSPITAL ASSOCIATION - $1,017 77089 77089 77127 38 77089 76489 52125 51487 77127 80788 30811 35110 76489 77227 158707 155146 80788 0.36000 0.00000 0.64000 0 0 156670 156670 8845300 2900535 5944765 17345 16523 822 4120829 3026197 1094632 332147 194607 137540 7334429 INTERCOMPANY PAYABLES 11892370 OPERATING LEASE LIABILITY 79566 11971936 X PART V, LINE 4: 0% OF THE CONTRIBUTIONS ARE RELATED TO THE FEDERAL GRANT THAT WAS AWARDED IN PREVIOUS FISCAL YEARS BY HRSA. THIS GRANT ENDED IN JULY '19. THE REST OF THE CONTRIBUTIONS CONSIST OF DONATIONS. $27,819 OF THE END OF YEAR BALANCE IS THE ONLY PORTION OF THIS ACCOUNT THAT APPEARS TO SOMEWHAT MEET THE DEFINITION OF 'ENDOWMENT' AS IT WAS DONATED AND RESTRICTED FOR CAPITAL USE BY OUR PREVIOUS GOVERNING BODY ALTHOUGH NONE OF THE DOLLARS IN THIS ACCOUNT ARE INVESTED, THIS IS STRICTLY A CASH ACCOUNT. PART X, LINE 2: TRINITY HOSPITAL TWIN CITY'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 1 X 1 X 1 X 1 1 0 1 1 489394 2514891 0 0.00000 14610 6787202 1865171 4922031 0.17820 14610 7276596 4380062 4922031 0.17820 1 300 250 0 250 0.00000 1 0 1000 0 1000 0.00000 2 300 1250 1250 0.00000 2 14910 7277846 4380062 4923281 0.17820 1 1992216 0 7665507 7472026 193481 X 1 1 1 1 TRINITY HOSPITAL TWIN CITY 819 NORTH FIRST STREET DENNISON OH 44621 HTTPS://WWW.TRINITYTWINCITY.ORG/ 2001194 X X X A FACILITY REPORTING GROUP - A 0 0 1 X X X X X X X X X 21 1 1 1 1 X SEE SCHEDULE H, PART V SUPPLEMENTAL INFORMATION X SEE SCHEDULE H, PART V SUPPLEMENTAL INFORMATION X 1 22 1 SEE SCHEDULE H, PART V SUPPLEMENTAL INFORMATION 0 1 X 200.000000000000 400.000000000000 X X X X X X 1 1 X X X 1 X SEE PART V, SECTION C X SEE PART V, SECTION C X SEE PART V, SECTION C X X X X X X 1 X 0 X X X X 1 X 0 0 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. PART V, SECTION B, LINE 7A HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 10A HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/COMMUNITY-HEALTH-NEEDS-ASSESSMENT PART V, SECTION B, LINE 7B: ACCESS TUSCARAWAS: WWW.ACCESSTUSC.ORGHOSPITAL COUNCIL OF NORTHWEST OHIO: HTTPS://WWW.HCNO.ORG/COMMUNITY-SERVICES/COMMUNITY-HEALTH-ASSESSMENTS/NEW PHILADELPHIA CITY HEALTH DEPARTMENT: HTTP://WWW.NEWPHILAOH.COM/HEALTH-DEPARTMENTTUSCARAWAS COUNTY HEALTH DEPARTMENT: WWW.TCHDNOW.ORG PART V, SECTION B FACILITY REPORTING GROUP A FACILITY REPORTING GROUP A CONSISTS OF: - FACILITY 1: TRINITY HOSPITAL TWIN CITY FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 5: THIS COMMUNITY HEALTH NEEDS ASSESSMENT PROCESS WAS COMMISSIONED BY HEALTHY TUSC. HEALTHY TUSC HAS BEEN IN EXISTENCE SINCE 2009 WITH APPROXIMATELY 29 MEMBER ORGANIZATIONS. MULTIPLE SECTORS, INCLUDING THE GENERAL PUBLIC, WERE ASKED THROUGH RADIO AND PRINT MEDIA, AND THROUGH OUTREACH TO EMPLOYERS TO PARTICIPATE IN THE PROCESS, INCLUDING DEFINING THE SCOPE OF THE PROJECT, CHOOSING QUESTIONS FOR THE SURVEYS, REVIEWING INITIAL DATA, PLANNING A COMMUNITY RELEASE, AND IDENTIFYING AND PRIORITIZING NEEDS. TWENTY-NINE COMMUNITY ORGANIZATIONS WORKED TOGETHER TO CREATE ONE COMPREHENSIVE ASSESSMENT AND PLAN, WITH MORE THAN 250 OF COMMUNITY MEMBERS VIEWING THE ONLINE VIDEO RELEASE AND PROVIDING QUALITATIVE FEEDBACK. PUBLIC HEALTH PARTICIPANTS INCLUDED TUSCARAWAS COUNTY HEALTH DEPARTMENT AND THE NEW PHILADELPHIA CITY HEALTH DEPARTMENT. DATA FOR THE 2021 CHNA WERE OBTAINED BY INDEPENDENT RESEARCHERS FROM THE TOLEDO-BASED HOSPITAL COUNCIL OF NORTHWEST OHIO AND THEIR PARTNERS AT THE UNIVERSITY OF TOLEDO, WHO ADMINISTERED SURVEYS TO A CROSS-SECTIONAL, RANDOMIZED SAMPLE OF TUSCARAWAS COUNTY RESIDENTS AS FOLLOWS: ADULTS AGED 19 YEARS AND OLDER. THE SURVEY INSTRUMENT CONTAINED BOTH CUSTOMIZED QUESTIONS AND A SET OF CORE QUESTIONS TAKEN FROM THE CENTER FOR DISEASE CONTROL AND PREVENTION'S BEHAVIORAL RISK FACTOR SURVEILLANCE SYSTEM. THE NUMBER OF SURVEYS COMPLETED AND ANALYZED MET THE THRESHOLD FOR STATISTICAL SIGNIFICANCE AT THE 95% CONFIDENCE LEVEL, WITH A 6% MARGIN OF ERROR. WHEREVER POSSIBLE, LOCAL FINDINGS HAVE BEEN COMPARED TO OTHER LOCAL, REGIONAL, STATE, AND NATIONAL DATA. AS WE MOVE FORWARD WITH PLANNING STRATEGIES, WE CONTINUE TO COMMIT TO SERVING THOSE IN OUR COUNTY WHO EXPERIENCE HEALTH AND BASIC NEEDS DISPARITIES. FINALLY, ADDITIONAL INFORMATION WAS COLLECTED FROM SECONDARY DATA SOURCES (I.E., VITAL STATISTICS, OHIO DISEASE REPORTING SYSTEM, ETC.) TO SUPPLEMENT FINDINGS FROM THE ADULT SURVEY. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6A: CLEVELAND CLINIC-UNION HOSPITAL FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 6B: THE CHNA WAS MADE POSSIBLE THROUGH THE WORK OF 38 PROFESSIONALS REPRESENTING THE FOLLOWING ORGANIZATIONS: ACCESS TUSC; ADAMHS BOARD; AULTMAN HEALTH FOUNDATION; CLEVELAND CLINIC FOUNDATION; CLEVELAND CLINIC UNION HOSPITAL; COMMUNITY HOSPICE; COMMUNITY VOLUNTEER; COMPASS; EAST CENTRAL OHIO EDUCATIONAL SERVICE CENTER; FRIENDS OF THE HOMELESS OF TUSCARAWAS COUNTY; NEW PHILADELPHIA CITY HEALTH DEPARTMENT; OHIO GUIDESTONE, EMPOWER TUSC; OHIO MID-EASTERN GOVERNMENT ASSOCIATION; OHIO RISE/AETNA; PROVIA; PUENTES GROUP; SPRINGVALE HEALTH CENTER; TRINITY HEALTH SYSTEM TWIN CITY MEDICAL CENTER; TWIN CITY MEDICAL CENTER VIBRANT LIVING; TUSCARAWAS CLINIC FOR THE WORKING UNINSURED; TUSCARAWAS COUNTY ADDICTION TASK FORCE; TUSCARAWAS COUNTY COMMISSIONERS; TUSCARAWAS COUNTY ECONOMIC DEVELOPMENT COUNCIL; TUSCARAWAS COUNTY EMERGENCY MANAGEMENT AGENCY; TUSCARAWAS COUNTY HEALTH DEPARTMENT; TUSCARAWAS COUNTY SENIOR CENTER; TUSCARAWAS COUNTY SENIOR CENTER MOBILITY MANAGEMENT; TUSCARAWAS COUNTY CONVENTION AND VISITORS BUREAU; TUSCARAWAS COUNTY COUNCIL FOR CHURCH & COMMUNITY; TUSCARAWAS COUNTY FAMILY & CHILDREN FIRST COUNCIL; TUSCARAWAS VALLEY FARMERS MARKET; TUSCO DISPLAY; UNITED WAY OF TUSCARAWAS COUNTY; YMCA. FACILITY REPORTING GROUP - A PART V, SECTION B, LINE 11: THE HOSPITAL IS DEDICATED TO IMPROVING COMMUNITY HEALTH AND DELIVERING COMMUNITY BENEFITS WITH THE ENGAGEMENT OF ITS MANAGEMENT TEAM, BOARD, CLINICIANS AND STAFF, AND IN COLLABORATION WITH COMMUNITY PARTNERS. HOSPITAL AND HEALTH SYSTEM PARTICIPANTS INCLUDED PRESIDENT, DWAYNE RICHARDSON; SENIOR TEAM MEMBERS, OTHER LEADERSHIP TEAM MEMBERS AND THE EXECUTIVE ASSISTANT. COMMUNITY INPUT OR CONTRIBUTIONS TO THIS IMPLEMENTATION STRATEGY INCLUDED COLLABORATION WITH THE HEALTHY TUSC COMMITTEE WHICH IS A LOCAL COLLABORATIVE AGENCY MADE UP OF OTHER HEALTHCARE FACILITIES AND NONPROFIT ORGANIZATIONS WHO WORK TOGETHER TO CREATE A HEALTHIER COMMUNITY FOR OUR CITIZENS. HEALTHY TUSC COMPRISES MORE THAN 20 LOCAL ORGANIZATIONS WITH THE SAME GOAL OF IMPROVING THE HEALTH OUTCOMES IN OUR COMMUNITY. PRIORITY #1 - HEALTH BEHAVIORS:PHYSICAL ACTIVITY/NUTRITION STRATEGIES: CREATE A COMMUNITY-WIDE PHYSICAL ACTIVITY CAMPAIGN. RECRUIT AT LEAST FIVE AGENCIES WHO ARE WORKING TO IMPROVE AND PROMOTE TUSCARAWAS COUNTY'S PHYSICAL ACTIVITY OPPORTUNITIES. DETERMINE THE GOALS AND OBJECTIVES OF THE PHYSICAL ACTIVITY CAMPAIGN. ENGAGE COMMUNITY AGENCIES THAT COORDINATE A UNIFIED MESSAGE TO INCREASE AWARENESS OF TUSCARAWAS COUNTY PHYSICAL ACTIVITY OPPORTUNITIES AND CREATE A CULTURE OF HEALTH. BRAND THE CAMPAIGN AND EXPLORE THE FEASIBILITY OF CREATING A COUNTY PHYSICAL ACTIVITY RESOURCE THAT HOUSES INFORMATION ABOUT ALL PHYSICAL ACTIVITY OPPORTUNITIES. TOBACCO STRATEGIES - SMOKE FREE ENVIRONMENTS: CONDUCT POLICY SCAN. IDENTIFY AREAS NOT 100% SMOKE FREE. WORK WITH STAKEHOLDERS TO PASS AN ORDINANCE OR CREATE A POLICY TO BE SMOKE FREE. TOBACCO STRATEGIES - ACCESS TO CESSATION: QUIT LINE REFERRALS/QUIT ATTEMPTS. HEALTH CARE PROVIDER REMINDER SYSTEMS. CONDUCT OUTREACH WITH COMMUNITY MEMBERS, AGENCIES, GROUPS, ORGANIZATIONS THIS CAN BE DONE VIA TRAININGS, PRESENTATIONS, OR COMMUNITY EVENTS. TOBACCO STRATEGIES - LICENSURE FOR RETAILERS: GROUNDWORK FOR TOBACCO RETAILER LICENSE (TRL): SWOT ANALYSIS; IDENTIFY DECISION MAKERS AND GATHER INFORMATION ON PROBABLE POSITIONS OF POTENTIAL DECISION MAKERS; CREATE IMPLEMENTATION PLAN; COMPILE LIST OF RETAILERS.PRIORITY #2 ACCESS TO CAREACCESS TO CARE - SCHOOL-BASED HEALTH CENTERS: GATHER COMMUNITY LEADERS, STAKEHOLDERS, LOCAL QUALIFIED HEALTHCARE PROVIDERS (SUCH AS NURSE PRACTITIONERS), AND MENTAL HEALTH PROVIDERS TO DISCUSS AND ASSESS THE NEED FOR A SCHOOL-BASED HEALTH CENTER AND DETERMINE THE TYPE OF SERVICES IT WILL BE PROVIDE TO THE STUDENTS THAT FOLLOW STATE STANDARDS. RESEARCH AND SECURE FUNDING THROUGH THE STATE, COUNTY HEALTH DEPARTMENT, FEDERALLY QUALIFIED HEATH CENTERS (FQHC), LOCAL BUSINESSES, COMMUNITY PROVIDERS, GRANTS, AND ANOTHER FUNDRAISING. OPEN 2 SCHOOL-BASED HEALTH CLINICS IN TUSCARAWAS COUNTY. ACCESS TO CARE - COMMUNITY RESOURCE GUIDE: REVIEW OLD COMMUNITY RESOURCE GUIDE AND UPDATE INFORMATION AS NEEDED. PROMOTE/SHARE GUIDE THROUGH VARIOUS OUTLETS (I.E., SOCIAL MEDIA, NEWSPAPER, BULLETINS, AND RADIO) AND PROVIDE PRINT COPIES THROUGHOUT THE COUNTY. ACCESS TO CARE - EXPAND BROADBAND INTERNET ACCESS TO RURAL AREAS: COLLECT BASELINE DATA ON THE NUMBER OF COMMUNITY MEMBERS WHO LACK ACCESS TO INTERNET IN RURAL AREAS. SHARE INFORMATION WITH VARIOUS COMMUNITY STAKEHOLDERS AND REVIEW CURRENT CONTRACT(S) WITH BROADBAND COMPANY(IES). WORK WITH STAKEHOLDERS AND BROADBAND COMPANY(IES) TO CREATE A PLAN FOR EXTENDING SERVICES TO RURAL AREAS. ACCESS TO CARE - COMMUNITY HEALTH WORKERS: INCREASE NUMBER OF COMMUNITY HEALTH WORKERS (CHW) AND/OR IMPROVE CHW COMMUNITY ENGAGEMENT.PRIORITY #3 MENTAL HEALTH AND ADDICTION:MENTAL HEALTH AND ADDICTION - UNIVERSAL SCHOOL-BASED SUICIDE AWARENESS AND EDUCATION PROGRAMS: INTRODUCE SCHOOL-BASED SUICIDE AWARENESS AND EDUCATION PROGRAM (I.E., SIGNS OF SUICIDE (SOS), QUESTION, PERSUADE, REFER (QPR), HOPE SQUAD PEER SUPPORT, AND MENTAL HEALTH FIRST AID) ALONG WITH SUPPORTING DATA, TO ALL SCHOOL DISTRICTS AND ENGAGE INTERESTED DISTRICTS IN A PLANNING PROCESS.MENTAL HEALTH AND ADDICTION - COLLABORATE WITH SCHOOLS TO SUPPORT THE IMPLEMENTATION OF SOCIAL EMOTIONAL LEARNING STANDARDS AND ONGOING BEHAVIORAL HEALTH SUPPORT: WORK WITH SCHOOLS TO DETERMINE AREAS OF NEED AS WELL AS OPPORTUNITIES TO PARTNER BEHAVIORAL HEALTH RESOURCES AND TRAININGS IN DISTRICTS THAT ARE WILLING. MENTAL HEALTH AND ADDICTION - MENTAL HEALTH FIRST AID: OBTAIN BASELINE DATA ON THE NUMBER OF MENTAL HEALTH FIRST AID (MHFA) TRAININGS THAT HAVE TAKEN PLACE IN THE TUSCARAWAS COUNTY. MARKET THE TRAINING TO LOCAL CHURCHES, SCHOOLS, ROTARY CLUBS, LAW ENFORCEMENT, CHAMBERS OF COMMERCE, CITY COUNCILS, COLLEGE STUDENTS, ETC. PROVIDE AT LEAST TWO MHFA TRAININGS.MENTAL HEALTH AND ADDICTION - INCREASE COUNTY AWARENESS OF SIGNS AND SYMPTOMS OF ALCOHOL ADDICTION AND LOCAL RESOURCES: REVIEW EXISTING AWARENESS CAMPAIGNS RELATED TO ALCOHOL ADDICTION AND DETERMINE WHICH WOULD HAVE THE MOST IMPACT IN THE COUNTY. ENSURE CAMPAIGN INCLUDES CONNECTION TO LOCAL RESOURCES AS WELL AS EASE OF ENGAGEMENT IN SERVICES. DEVELOP A ROLL-OUT PLAN FOR CAMPAIGN.THE HOSPITAL WILL NOT BE ADDRESSING THE FOLLOWING HEALTH NEEDS: YOUTH MENTAL HEALTH/DRUG USE AND YOUTH SMOKING. ANY NEEDS IN THIS REPORT THAT THE HOSPITAL ITSELF DOES NOT INTEND TO ADDRESS ARE DUE TO OTHER LOCAL AGENCIES COMPLETING THESE PROJECTS OR THESE PROJECTS FALLING UNDER ANOTHER AGENCY'S EXPERTISE. THE HOSPITAL COLLABORATES WITH ALL INITIATIVES IDENTIFIED IN THIS CHIP AND ADVOCATES FOR ALL INITIATIVES IDENTIFIED, EVEN IF THE HOSPITAL IS NOT NOTED AS THE RESPONSIBLE ORGANIZATION ON THE SPECIFIC STRATEGY. FACILITY REPORTING GROUP - A 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. PART V, SECTION B, LINE 16A HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/FINANCIAL-ASSISTANCE-SERVICES-2 PART V, SECTION B, LINE 16B HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/FINANCIAL-ASSISTANCE-SERVICES-2 PART V, SECTION B, LINE 16C HTTPS://WWW.TRINITYTWINCITY.ORG/HOSPITAL-INFORMATION/FINANCIAL-ASSISTANCE-SERVICES-2 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 4: TRINITY HOSPITAL TWIN CITY 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. TRINITY HOSPITAL TWIN CITY'S SURPLUS, AS REPORTED ON PART III, SECTION B, LINE 7, OF $193,481 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. PART III, LINE 3: TRINITY HOSPITAL TWIN CITY MAKES EVERY EFFORT TO DETERMINE IF A PATIENT QUALIFIES FOR FINANCIAL ASSISTANCE UPON ADMISSION. TRINITY HOSPITAL TWIN CITY'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. TRINITY HOSPITAL TWIN CITY 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 UNINSURED 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, TRINITY HOSPITAL TWIN CITY 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 VI, LINE 2: PROGRESS WILL BE MONITORED WITH MEASURABLE INDICATORS IDENTIFIED FOR EACH STRATEGY. MOST INDICATORS ALIGN DIRECTLY WITH THE SHIP. THE INDIVIDUALS OR AGENCIES THAT ARE WORKING ON STRATEGIES WILL MEET ON AN AS- NEEDED BASIS. THE HEALTHY TUSC TASK FORCE WILL MEET AT LEAST QUARTERLY TO REPORT PROGRESS AND WILL CREATE A PLAN TO DISSEMINATE THE CHIP TO THE COMMUNITY. STRATEGIES, RESPONSIBLE AGENCIES, AND TIMELINES WILL BE REVIEWED AT THE END OF EACH YEAR BY THE HEALTHY TUSC TASK FORCE. AS THIS CHIP IS A LIVING DOCUMENT, EDITS AND REVISIONS WILL BE MADE ACCORDINGLY. TUSCARAWAS COUNTY WILL CONTINUE FACILITATING CHAS EVERY THREE YEARS TO COLLECT DATA AND DETERMINE TRENDS.PRIMARY DATA WILL BE COLLECTED FOR ADULTS AND SECONDARY DATA WILL BE ANALYZED FOR YOUTH USING NATIONAL SETS OF QUESTIONS TO NOT ONLY COMPARE TRENDS IN TUSCARAWAS COUNTY, BUT ALSO BE ABLE TO COMPARE TO THE STATE AND NATION. THIS DATA WILL SERVE AS MEASURABLE OUTCOMES FOR EACH PRIORITY AREA. INDICATORS HAVE ALREADY BEEN DEFINED THROUGHOUT THIS REPORT AND ARE IDENTIFIED WITH THE ICON.IN ADDITION TO OUTCOME EVALUATION, PROCESS EVALUATION WILL ALSO BE USED ON A CONTINUOUS BASIS TO FOCUS ON THE SUCCESS OF THE STRATEGIES. AREAS OF PROCESS EVALUATION THAT THE HEALTHY TUSC TASK FORCE WILL MONITOR INCLUDE THE FOLLOWING: NUMBER OF PARTICIPANTS, LOCATION(S) WHERE SERVICES ARE PROVIDED, NUMBER OF POLICIES IMPLEMENTED, ECONOMIC STATUS AND RACIAL/ETHNIC BACKGROUND OF THOSE RECEIVING SERVICES (WHEN APPLICABLE), AND INTERVENTION DELIVERY (QUANTITY AND FIDELITY). FURTHERMORE, ALL STRATEGIES HAVE BEEN INCORPORATED INTO A "PROGRESS REPORT" TEMPLATE THAT CAN BE COMPLETED AT ALL FUTURE MEETINGS, KEEPING THE COMMITTEE ON TASK AND ACCOUNTABLE. THIS PROGRESS REPORT MAY ALSO SERVE AS MEETING MINUTES. 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: THE COMMUNITY HAS BEEN DEFINED AS TUSCARAWAS COUNTY. MOST OF CLEVELAND CLINIC UNION HOSPITAL'S AND TWIN CITY MEDICAL CENTER'S DISCHARGES WERE RESIDENTS OF TUSCARAWAS COUNTY. IN ADDITION, CLEVELAND CLINIC UNION HOSPITAL AND TWIN CITY MEDICAL CENTER COLLABORATE WITH MULTIPLE STAKEHOLDERS, MOST OF WHOM PROVIDE SERVICES AT THE COUNTY-LEVEL. IN LOOKING AT THE COMMUNITY POPULATION SERVED BY THE HOSPITAL FACILITIES, HEALTH DEPARTMENTS, AND TUSCARAWAS COUNTY AS A WHOLE, IT WAS CLEAR THAT ALL OF THE FACILITIES AND PARTNERING ORGANIZATIONS INVOLVED IN THE COLLABORATIVE ASSESSMENT, DEFINE THEIR COMMUNITY TO BE THE SAME. DEFINING THE COMMUNITY AS SUCH ALLOWS THE HOSPITAL TO READILY COLLABORATE WITH PUBLIC HEALTH PARTNERS FOR BOTH COMMUNITY HEALTH ASSESSMENTS AND HEALTH IMPROVEMENT PLANNING. TUSCARAWAS COUNTY IS AN APPALACHIAN COUNTY LOCATED IN EAST CENTRAL OHIO WITH A POPULATION OF 92,335. TUSCARAWAS COUNTY IS A FEDERALLY DESIGNATED AS A PRIMARY MEDICAL, MENTAL HEALTH CARE, AND DENTAL CARE HEALTH PROFESSIONAL SHORTAGE AREA (HPSA). REFER TO APPENDIX IV TO SEE A BREAKDOWN OF THE ZIP CODES FOR THE 2021 ADULT SURVEY SAMPLE. DATA IN THE CHNA REPORT STATE THAT THE POPULATION IS 97 PERCENT WHITE, AND THREE PERCENT OF HISPANIC ORIGIN. THE MEDIAN AGE IS 41 YEARS, AND 19 PERCENT ARE 65 YEARS AND OVER. THE HIGHEST EDUCATION LEVEL FOR 45 PERCENT IS A HIGH SCHOOL DIPLOMA, AND 14 PERCENT DO NOT HAVE A HIGH SCHOOL DIPLOMA. THIRTY-SIX PERCENT OF FAMILIES HAVE ANNUAL INCOME OF LESS THAN $50,000. NEARLY 13 PERCENT OF THE POPULATION IS BELOW THE FEDERAL POVERTY LEVEL. THE UNEMPLOYMENT RATE IS 3 PERCENT. 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. PART VI, LINE 7: OH 0 1 0 0 0 0 0 0 0 LARRY SCHUMACHER BOARD MEMBER/DIV SVP 0 1172822 0 1129494 0 441839 0 17444 0 20737 0 2782336 0 181486 CHARN NANDRA MD BOARD MEMBER/CARDIOLOGIST 0 950019 0 0 0 11659 0 0 0 24875 0 986553 0 0 MATT GRIMSHAW PRESIDENT & CEO THS/BOARD MEMBER 0 456489 0 267194 0 22644 0 17929 0 26710 0 790966 0 0 MATTHEW PHILLIPS PHYSICIAN 384140 0 0 0 0 0 0 0 20904 0 405044 0 0 0 TIM MCKNIGHT MD CHIEF MEDICAL OFFICER 171303 0 178664 0 0 0 0 0 27888 0 377855 0 0 0 SAM LICATA BOARD MEMBER 0 350002 0 0 0 0 0 0 0 27160 0 377162 0 0 DAVE WERKIN CFO 0 257682 0 45500 0 0 0 0 0 22253 0 325435 0 0 STUART BROWN PHYSICIAN 147014 0 131424 0 0 0 0 0 26475 0 304913 0 0 0 DWAYNE RICHARDSON PRESIDENT, TRINITY HOSPITAL TWIN CIT 0 241490 0 30036 0 0 0 0 0 25998 0 297524 0 0 ANDREW NEWBURN PHYSICIAN 240009 0 15151 0 0 0 0 0 26417 0 281577 0 0 0 KATELYN OBERMILLER NP 130000 0 80269 0 0 0 0 0 26127 0 236396 0 0 0 MATTHEW COLFLESH MD BOARD MEMBER/CHIEF MEDICAL OFFICER ( 0 202671 0 0 0 0 0 0 0 10851 0 213522 0 0 ERIC DURBIN PHARMACIST 165523 0 8208 0 0 0 0 0 26673 0 200404 0 0 0 PART I, LINE 3 THE CEO IS COMPENSATED BY TRINITY HEALTH SYSTEM GROUP, WHO USES A COMPENSATION COMMITTEE, COMPENSATION SURVEY OR STUDY AND APPROVAL BY THE BOARD OR COMPENSATION COMMITTEE, TO DETERMINE COMPENSATION. PART 1, 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. PART 1, 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 2 022 THE FOLLOWING DISTRIBUTIONS WERE MADE BY COMMONSPIRIT FROM THE DEFERRED COMPENSATION PLAN: LAWRENCE SCHUMACHER, $247,481. 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: MATTHEW GRIMSHAW, $22,644; LAWRENCE SCHUMACHER, $177,414. PART II: TRINITY HOSPITAL TWIN CITY 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. FORM 990, PART I, LINE 1 (CONTINUED) FAITHFUL TO THE TEACHING OF THE CATHOLIC CHURCH AND TO THE SPONSORSHIP PHILOSOPHY AND VALUES OF THE SISTERS OF ST. FRANCIS. FORM 990, PART VI, SECTION A, LINE 6 ACCORDING TO THE ARTICLES OF INCORPORATION OF TRINITY HOSPITAL TWIN CITY, THE ENTITY'S SOLE MEMBER IS TRINITY HEALTH SYSTEM, AN OHIO NONPROFIT CORPORATION. FORM 990, PART VI, SECTION A, LINE 7A ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS SHALL BE APPOINTED OR REFUSED BY THE CORPORATE MEMBER. THE CORPORATE MEMBER MAY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS, AND MAY AT ANY TIME REMOVE, WITH OR WITHOUT CAUSE, ANY MEMBER OF THE BOARD OF DIRECTORS. ACCORDING TO THE ORGANIZATION'S BYLAWS, DIRECTORS OF THE CORPORATION SHALL BE APPOINTED BY THE CORPORATE MEMBER NO LATER THAN JUNE 30 OF EACH YEAR. THE NAMES AND QUALIFICATIONS OF EACH INDIVIDUAL ACCEPTED BY THE BOARD OF DIRECTORS SHALL BE SUBMITTED TO THE CORPORATE MEMBER, WHO SHALL APPOINT OR REFUSE EACH NOMINEE IN ACCORDANCE WITH THE CORPORATE MEMBER'S BYLAWS AND WITH ENDORSEMENT OF THE SENIOR VICE PRESIDENT OF OPERATIONS. THE CORPORATE MEMBER MAY UNILATERALLY APPOINT ONE OR MORE INDIVIDUALS TO THE BOARD OF DIRECTORS SHOULD THE BOARD FAIL TO FURNISH THE CORPORATE MEMBER WITH A LIST OF INDIVIDUALS QUALIFIED TO SERVE ON THE BOARD OF DIRECTORS OF THE CORPORATION. (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 TRINITY HEALTH SYSTEM. PURSUANT TO SECTION 5.4 OF THE ORGANIZATION'S BYLAWS, BOTH TRINITY HEALTH SYSTEM AND COMMONSPIRIT HEALTH (TRINITY HEALTH SYSTEM'S 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 COMMONSPIRIT HEALTH BOARD DIRECTLY OR THROUGH POWERS DELEGATED TO THE COMMONSPIRIT HEALTH CHIEF EXECUTIVE OFFICER: *SUBSTANTIAL CHANGE IN THE MISSION OR PHILOSOPHY OF THE ORGANIZATION *AMENDMENT OF THE CORPORATE DOCUMENTS OF THE ORGANIZATION *APPROVE MEMBERS OF THE ORGANIZATION'S BOARD *REMOVAL OF A MEMBER OF THE GOVERNING BODY OF THE ORGANIZATION *APPROVAL OF ISSUANCE OF DEBT BY THE ORGANIZATION *APPROVAL OF PARTICIPATION OF THE ORGANIZATION IN A JOINT VENTURE *APPROVAL OF FORMATION OF A NEW CORPORATION BY THE 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. *ADOPTION OF LONG RANGE AND STRATEGIC PLANS FOR THE ORGANIZATION. PURSUANT TO SECTION 5.5 OF THE ORGANIZATION'S BYLAWS, TRINITY HEALTH SYSTEM 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 RETURN IS REVIEWED BY THE CHIEF FINANCIAL OFFICER. SUBSEQUENT TO THE CFO'S REVIEW, 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 CFO. 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 15B FOR LEADERSHIP POSITIONS WITH SUBSTANTIAL INFLUENCE (NOT INCLUDING THE PRESIDENT/CEO, WHO IS PAID BY A RELATED ORGANIZATION), 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 (INCLUDING THE PRESIDENT/CEO) 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. FORM 990, PART VI, SECTION C, LINE 19 AN INDIVIDUAL MAY INSPECT THE TAX RETURNS AND/OR TAX EXEMPT APPLICATIONS ALONG WITH SCHEDULES, ATTACHMENTS, AND DOCUMENTS (ARTICLES OR BYLAWS) DURING NORMAL POSTED BUSINESS HOURS WITH THE PRESENCE OF ADMINISTRATION. REQUESTS FOR COPIES CAN BE SUBMITTED IN WRITING TO: ADMINISTRATION C/O TRINITY HOSPITAL TWIN CITY, 819 N FIRST STREET, DENNISON, OHIO 44621. WRITTEN REQUESTS ARE RESPONDED TO WITHIN 30 DAYS OF RECEIPT AND IN PERSON REQUESTS ARE ATTEMPTED TO BE HONORED ON THE DAY RECEIVED. FORM 990, PART IX, LINE 11G OTHER FEES FOR SERVICES: PROGRAM SERVICE EXPENSES 1,894,294. MANAGEMENT AND GENERAL EXPENSES 473,574. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 2,367,868. CONSULTING: PROGRAM SERVICE EXPENSES 24,606. MANAGEMENT AND GENERAL EXPENSES 6,152. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 30,758. CONTRACT LABOR: PROGRAM SERVICE EXPENSES 635,252. MANAGEMENT AND GENERAL EXPENSES 158,813. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 794,065. PURCHASED SERVICES: PROGRAM SERVICE EXPENSES 3,145,151. MANAGEMENT AND GENERAL EXPENSES 786,288. FUNDRAISING EXPENSES 0. TOTAL EXPENSES 3,931,439. 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